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Found 206 results
  1. Content Article
    Key findings Providing safe and high-quality care for acutely ill medical patients has always been challenging but has become more so as the volume and complexity of work has increased. Most of these patients are old and frail with complex physical and mental health needs that may be difficult to diagnose and treat. Many clinicians are involved in their care and this requires a high degree of collaboration and co-ordination to deliver the best possible outcomes. Clinical teams experience frustrations in providing care including the intensity of work, lack of contact with GPs, difficulties in communication within hospitals and ineffective information systems. Despite the best efforts of staff, patients may sometimes be harmed by weaknesses in communication and information systems, staff shortages and lack of continuity of care. Frontline teams, who often know what needs to be done to improve care, need to be supported by trust leaders who have a key role in signalling, through their words and actions, that the needs of patients come first. More could be done to draw on the experience of junior doctors who are able to compare and contrast practices in different hospitals through the rotations they undertake during training. This requires trust leaders to genuinely value junior doctors’ insights and to challenge the hierarchies and tribal divisions that are longstanding barriers to teamworking. A continuing effort must be made to avoid the desensitisation of staff that can harm patients, however inadvertently, and to develop cultures in which the needs of patients always come first. Trust leaders can nurture these cultures by actively demonstrating their commitment to developing patient-centred care. Some trusts have found solutions to some of these frontline challenges, but solutions to others – such as the need for care environments that provide space for staff to work or patients to be treated with dignity, and for information systems that provide rapid access to patients’ records and test results – require action across the NHS.
  2. News Article
    Pradeep Gill can see very little of the intense activity around him. He is leaning back in a reclining chair inside one of Heatherwood Hospital's operating theatres. Buzzing around him is the operating team, led by consultant orthopaedic surgeon Jeremy Granville-Chapman. For the surgeon and his team, this procedure is the very definition of routine. They have carried out more than 1,000 joint operations in the past 10 months. Heatherwood Hospital, part of the Frimley Health NHS Foundation Trust, is a specialist elective hub where patients can come in for routine but life-changing surgery at a super-charged pace with theatres working at full tilt, six days a week. It is busy. But it is a good-busy, not the bad-busy we have come to associate with the NHS during this winter crisis. The site opened in March last year and Frimley's hospital executives are keen to stress the impact it has made. "As a specialist planned care facility, Heatherwood has been able to perform surgery six days a week with four out of its six state-of-the-art theatres dedicated to orthopaedic procedures," it said in a press release. "The hospital has also successfully reduced the length of time patients stay in hospital, with 40% of patients safely discharged within 24 hours." This is the practice the NHS wants to adopt as it battles a record seven-million-strong waiting list. Heatherwood can do that because the hospital is ring-fenced from acute pressures that affect other hospitals, as one its most senior orthopaedic surgeons, Mr Rakesh Kucheira, explained. "We have now realised that winter pressures are 12 months not just three months, which means the acute sites are not going to be able to do planned activity that they planned for, so we've got to create more space," he said. Read full story Source: Sky News, 9 March 2023
  3. News Article
    The CEO of a troubled trust has said evidence is emerging of ‘massively reduced’ length of stay in a new hospital criticised for being too small. Emergency staff have raised concerns about a lack of space and bed capacity at the new Royal Liverpool Hospital, which opened in October, as services have come under severe pressure this winter. The new building, on a next-door site to the old hospital, has fewer beds, although more have opened elsewhere in the city. In an interview with HSJ, Liverpool University Hospitals Foundation Trust chief executive officer James Sumner acknowledged aspects of the new building have created difficulties, including in relation to accident and emergency configuration and capacity, but added the move’s benefits are beginning to be seen. He said a new care model and single rooms throughout the whole hospital are helping to reduce length of stay, as well as eliminating bed closures due to infection outbreaks. He said: “We’ve got really good evidence of massively reduced length of stay in this new building, [with] about 70 fewer people every day waiting over seven, 14 and 21 days in hospital. Read full story (paywalled) Source: HSJ, 1 February 2023
  4. News Article
    NHS England has effectively admitted the backlog of cancer long-waiters will still be higher in March 2024 than before covid hit, in a document seen by HSJ. The consultation document, detailing trajectories for reducing numbers waiting 62 days or more from referral, shows the expected national total in March 2024 is 18,755. NHS England previously committed to reducing this to pre-pandemic levels (14,226) by March 2022, then delayed the target until March this year. There are now significant backlogs in diagnostics, with particular challenges in endoscopy and breast screening. NHS Providers director of policy and strategy Miriam Deakin said: “Cancer is a key priority for trusts. They understand the risk to patients who have to wait. “The pandemic left people waiting longer than NHS trusts wanted for diagnosis or to start treatment, with some people not coming forward, but now urgent referrals for suspected cancer are far higher than pre-pandemic. Read full story (paywalled) Source: HSJ, 1 February 2023
  5. News Article
    The NHS will start publishing “hidden” figures on A&E waiting times following several leaks reported by The Independent. After unveiling its emergency care plan on Monday, NHS England confirmed it would release internal data each month - currently only made public once a year - showing how many people are waiting for longer than 12 hours after arriving at an emergency department. The Independent has published several leaks of this data, which shows that these waiting times can be up to five times higher than publicly available NHS figures. Official monthly figures only count the number of hours patients wait after a decision to admit them has been made, and so mask the true scale of the problem. The move comes after health secretary Steve Barclay said the NHS would, from April, publish this “real” number in a bid for “greater transparency.” Writing in The Telegraph, he said: “Too much of the debate about A&E and ambulance services is based on anecdotal evidence. I want NHS managers and the wider public to have access to the same facts from the front line, starting with publishing the number of 12-hour waits from the time of arrival in A&E from April.” Read full story Source: The Independent, 31 January 2023
  6. News Article
    All three acute trusts in an integrated care system are failing to meet national requirements to tackle health inequalities after being overwhelmed by emergency and elective care pressures. A report by Devon Integrated Care Board found progress on addressing variation in poor health outcomes had “slipped due to capacity issues.” Both Royal Devon University Healthcare Foundation Trust and Torbay and South Devon FT were rated “red” for a lack of headway. All trusts were told by NHSE in 2021 to undertake a range of actions as part of work to reduce health inequalities during 2022-23. These included publishing analyses of waiting times disaggregated by ethnicity and deprivation, using the waiting list data to identify disparities between different patient groups, and measuring access, experience and outcomes for patients from a deprived community or an ethnic minority background. Sarah Sweeney, interim chief executive of National Voices, which represents health and care charities and patients, said she was “really concerned to see that some ICSs are not making as much progress on reducing health inequalities as expected and hoped”. “These inequalities are completely unjust and preventable,” she said. Read full story (paywalled) Source: HSJ, 30 January 2023
  7. News Article
    NHS England has revealed a new intervention regime, as it seeks to deliver on its new urgent and emergency care recovery plan. Systems will be placed in three “tiers of intervention”, with those systems deemed “off-target on delivery” being given “tier three intensive support” from NHSE, which will include on-the-ground planning, analytical and delivery capacity, “buddying” with leading systems and “targeted executive leadership”. The approach follows that which has been taken over the past year for elective and cancer care recovery. The urgent care plan, published by NHSE and the Department of Health and Social Care today, says: “NHS England will identify and share good practice so that all can learn from the best. For those systems that are struggling, we will offer support to ensure that they have the best opportunities to drive improvement locally.” Read full story (paywalled) Source: HSJ, 30 January 2023
  8. Content Article
    DHSC and NHS England's delivery plan A. Increase capacity, to help deal with increasing pressures on hospitals which see 19 in 20 beds currently occupied. 1. Dedicated funding of £1 billion will pay for additional capacity, including 5,000 new beds as part of the permanent bed base for next winter. 2. Over 800 new ambulances, including 100 specialist mental health ambulances, the majority of which will be on the road by next winter. 3. ‘Same day’ emergency care services will be in place across every hospital with a major emergency department, so patients avoid unnecessary overnight stays. B. Grow the workforce, as increasing capacity requires more staff who feel supported. 4. More clinicians will be available for 111 online and urgent call services to offer support, advice, diagnosis and, if necessary, referral. From this April a new targeted campaign will be launched to encourage retired clinicians, and those nearing retirement, to work in 111 rather than leaving the NHS altogether. 5. The workforce will grow with more flexible ways of working and increase the number of Emergency Medical Technicians next year to respond to incidents and support paramedics. C. Speed up discharge from hospitals, to help reduce the numbers of beds occupied by patients ready to be discharged. 6. Over the next 2 years, and as part of the up to £14.1 billion extra for health and social care, £1.6 billion will be focused squarely on discharge. 7. ‘Care transfer hubs’ in every hospital ahead of next winter will mean faster discharge to the right setting, so that people do not stay in hospital longer than necessary. 8. This year, new approaches to step-down care will start to be implemented so, for example, people who need physiotherapy can access care as they are being discharged from hospital before they need to be assessed by their local authority for long-term care needs. 9. New discharge information will be published, with new data collected from this April. D. Expand new services in the community, as up to 20% of emergency admissions can be avoided with the right care in place. 10. Ahead of next winter the government will offer more joined-up care for older people living with frailty, including scaling urgent community response, frailty and falls services across the whole country – meaning the right people help you get the care you need, without needing an admission to hospital if it’s not necessary. 11. Greater use of ‘virtual wards’, which allow people to be safely monitored from the comfort of their own home, will be achieved by an extra 3,000 beds to provide over 10,000 in total by this autumn, allowing staff to care for up to 50,000 patients a month this way over the longer term. 12. Help people access the right care first time, as 111 should be the first port of call and reduce the need for people to go to A&E. By April 2024, urgent mental health support through NHS 111 will be universally available. 13. From this April, new data will allow the public to easily see and compare the performance of their local services. It will also tackle unwarranted variation in performance in the most challenged local systems. 14. This April, a new clinically-led programme to reduce unwarranted variation will launch, alongside intensive support for those areas struggling the most
  9. News Article
    The new national target to see 76% of A&E patients within four hours by March 2024 has been described as ‘extremely unambitious’ by senior emergency clinicians. Adrian Boyle, president of the Royal College of Emergency Medicine, also told the Commons Health and Social Care Committee that the objective – included in NHS England planning guidance for 2023-24 and agreed with government – could also drive “perverse incentives” for some emergency department managers. The new target to admit, transfer or discharge 76% of patients by the end of 2023-24 is the first time a specific bar has been set against the four-hour standard for several years. In December, just three acute trusts were hitting the new 76% objective. But Dr Boyle told MPs: “The aspiration from NHS England is that we return to a four-hour target performance of 76%. We think that is too unambitious, and we think that is going to create all sorts of perverse incentives, because it’s going to encourage managers and senior clinicians just to focus on people who can be discharged from hospital, without dealing with our problem, which is exit block [people who cannot be admitted as wards are full]. “We think the 76 per cent is an extremely unambitious target. It was 95% – I know that’s going to be a long way to go back to and we haven’t achieved it since 2015, but we would say we need to have a trajectory to a higher target.” Read full story (paywalled) Source: HSJ, 24 January 2023
  10. Content Article
    The report's action plan for emergency health services: An emergency response: Recognising this is a national emergency, the Government should refer the crisis in emergency health services to a COBR Committee. Deliver care at the right place, right time: In the short term, boost the number of clinicians in 999 and 111 services so that patients are being directed to the right services at the right time. Unlock the gridlock: Incentivise faster safe discharges from hospitals and increase capacity in hospitals and social care to make sure people can move through the health system and do not end up stuck in ambulances or at A&E. Understand the problem: Data on A&E waiting times do not accurately reflect the patient experience. Performance data should accurately report the true waiting times experienced by patients so that decision makers have a clear picture of the problem, and so the public can hold them to account. Address unmet need: Boost capacity in hospitals and social care. Make it easier for patients to get care in the community both before they reach crisis point (preventing admissions) and following discharge. A new model for emergency health services: The Government must develop a new model for emergency health services which recognises the current crisis, the type of demand services face and clinical best practice and, for accountability purposes, sets out appropriate performance measures.
  11. Content Article
    The number of NHS staff quitting their jobs has reached worrying new heights. According to the latest official data, over 42,400 staff voluntarily resigned from the health service in quarter two of this year – the highest number in any equivalent quarter over the last decade. Some trusts have been very open about the measures they are being forced to resort to just to keep things running. The University Hospitals of North Midlands Trust confirmed corridor care has been officially brought back and risk-assessed, with staff recruited specifically to look after patients in corridors. The trust has been clear – it does not want to treat patients in this way, but has no choice. There is a risk to patients and to the staff who care for them. Helen Hughes, chief executive of charity Patient Safety Learning, said it would be valuable for trusts to have clear guidance and examples of good practice of corridor care that “prioritise patient safety”. However, she stressed this should be a temporary measure and not be normalised. But many frontline staff would argued this has already happened – they have had to contend with corridor care off and on for the last decade. Ms Hughes also stressed the negative impact caring for patients in corridors and other areas has on healthcare professionals themselves, “raising the risk of moral injury if they are unable to provide the appropriate level of care”.
  12. News Article
    An ICS chief has said the NHS workforce crisis is not the result of a ‘funding issue’ but caused by an inefficient use of resources. Patricia Miller, chief executive of Dorset Integrated Care Board, told a board meeting on Thursday that “constantly talking about the NHS needing more money” was undermining leaders’ case to government. She said: “We have got a workforce issue in the NHS, there is no doubt about that. I don’t actually believe we have got a funding issue. We just don’t use our resources very efficiently and I don’t think we do our case any positive favour with government when we’re constantly talking about the NHS needing more money when we can’t demonstrate that what we do is efficient. “So I don’t actually accept we’ve got a funding issue unless we start to work at the optimum and then we can absolutely demonstrate that. “I think what this comes down to is that our systems are too complicated and that starts at the centre, where every initiative we have is not about redesigning service models end-to-end but about layering on different solutions to different ends of the pathway and it just makes it more complicated. “I’ve no doubt that we’ve probably got 50-plus entrance and exit points to our urgent emergency care service, it’s ridiculous. I can’t navigate my way around 50 or 60, so there’s no way a patient can do it.” Read full story (paywalled) Source: HSJ, 6 January 2023
  13. News Article
    NHS England has shelved priorities on Long Covid and diversity and inclusion – as well as a wide range of other areas – in its latest slimmed down operational planning guidance, HSJ analysis shows. NHSE published its planning guidance for 2023-24, which sets the national “must do” asks of trust and integrated care systems, shortly before Christmas. HSJ has analysed objectives, targets and asks from the 2022-23 planning guidance which do not appear in the 2023-24 document. The measures on which trusts and systems will no longer be held accountable for include improving the service’s black, Asian and minority ethnic disparity ratio by “delivering the six high-impact actions to overhaul recruitment and promotion practices”. Another omission from the 2023-24 guidance compared to 2022-23 is a target to increase the number of patients referred to post-Covid services, who are then seen within six weeks of their referral. Several requirements on staff have been removed, including to ”continue to support the health and wellbeing of our staff, including through effective health and wellbeing conversations” and ”continued funding of mental health hubs to enable staff access to enhanced occupational health and wellbeing and psychological support”. Read full story (paywalled) Source: HSJ, 4 January 2022
  14. News Article
    Some integrated care systems (ICSs) still require “an awful lot of control” from the centre, Patricia Hewitt has told HSJ, tempering any expectations that her government-commissioned review will bring about a wholesale roll-back of national performance management. The former Labour health secretary, who is also an integrated care board chair, was commissioned in November by chancellor Jeremy Hunt and health secretary Steve Barclay to review ICS autonomy and accountability. In her first interview since she started the work, Ms Hewitt also said: She had not ruled out “legislative tweaks” as a result of her review, but emphasised ICBs already had substantial ”soft power”; Some ICBs were still indulging in ‘old school’ combative behaviour, and stressed they should not become ‘top down regulators’; She wanted to “catalyse” the Care Quality Commission’s move to focus on systems and integration; and It appeared there were probably too many non-clinical support staff in the NHS, but not too many managers, and she would look more closely at the issue. Read full story Source: HSJ, 30 December 2022
  15. News Article
    A teaching hospital that was lauded for its culture and championed by ministers has been downgraded from ‘outstanding’ to ‘requires improvement’ by the Care Quality Commission. CQC inspectors found multiple issues at Salford Royal Hospital during an inspection in August and September. These included nurse staffing, governance, and some cultural concerns. The trust’s urgent and emergency services were rated “inadequate” for safety. The hospital in Greater Manchester had been rated “outstanding” since 2015, and was frequently hailed as a leader on the patient safety agenda, particularly by former health secretary Jeremy Hunt. Read full story (paywalled) Source: HSJ, 22 December 2022
  16. Content Article
    In less than 1 year they increased patient safety incident reporting by 37% while simultaneously decreasing: falls with injury by 39% pressure injury rates by 37% central line–associated blood stream infections by 34%. They also improved medication reconciliation rate by 3.3% and decreased their irretrievable specimen rate to 0. Finally, they noted increased awareness around patient safety within clinical teams, with open discussions about patient safety becoming a routine part of patient care. Read the summary via the link below (full access is paywalled). Authors conclude by highlighting the learning for patient safety that could be applied by peers.
  17. Content Article
    Key points The study found successful strategies are typically associated with a concert of activities that simultaneously ensure sufficient supply of health care, manage demand and optimise the conditions within the health care system itself. In England in the 2000s, a number of activities were associated with reduced waiting times. These activities were concentrated within the categories of increasing supply and optimising conditions within the health care system itself to achieve the goal of an 18‑week referral to treatment target by 2008. These activities were underpinned by a bigger idea about what the health service as a whole should look and feel like, and incorporated how waiting times are brought down as much as what activities might be used. For the experts interviewed, the achievement of the 18 weeks target was made possible as a result of: valuing and investing in people working in the NHS; a clear, central vision and goal for waiting and an ambition that those working within health care felt equipped to take on; cultivating relationships and leadership at all levels of the health care system; accountability, incentives and targeted support to encourage performance against waiting times targets and other measures of quality of care; and seizing the momentum of wider NHS reform. Whereas the improvement in waiting times performance of nearly 20 years ago took place in a very different political and economic context, the research highlighted not only hope but opportunities to reduce waiting times in the present day: by addressing shortages of health care staff and physical resources urgently; by working with integrated care systems in the spirit of prevention, collaboration, inclusion and community‑based models of care; and by aligning a vision for the health services with a plan that brings staff, patients and the public along on the journey to get there.
  18. News Article
    Ministers have effectively ditched NHS England’s planned new bundle of A&E targets and want trusts to be firmly regulated on the existing four-hour standard and 12-hour breaches, HSJ understands. Multiple senior figures familiar with the process, from inside the NHS and government, said the performance focus for the next two years will be on the two existing accident and emergency waiting time measures, as well as ambulance handover delays. For the last three years, NHS England has been lobbying government to scrap the headline four-hour target, and replace it with a bundle of measures which have been trialled at around a dozen providers. This work has been led by medical director Steve Powis. HSJ understands the decision to continue using the existing four-hour target was driven by concerns among ministers and senior NHS figures that the bundle of measures was too confusing, both for patients and as a means for government to hold the service to account. Read full story (paywalled) Source: HSJ, 23 November 2022
  19. Event
    Developing a culture of continuous improvement is an imperative as healthcare organisations face unprecedented challenges and strive for sustainability. Join an executive leadership panel for a virtual roundtable discussion and learn about crucial lessons from Warwick Business School's recently published independent study of the NHS-VMI partnership. The research reveals the effectiveness of applying a systems approach to learning and improvement across five NHS trusts in partnership with NHS Improvement. It will explore crucial lessons for leaders as they work to improve patient outcomes, population health, access, equity, and the overall patient experience, even during disruptions like the Covid pandemic. This includes: Leadership models, behaviours and practices that were observed to be essential components of leading change in organisations. How to enable “partnership” ways of working through practices and mechanisms that foster and maintain collaborative ways of working. Cultural elements necessary for the successful adoption of an organisation-wide improvement programme. Register
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