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Found 40 results
  1. Content Article
    I recently had a hysteroscopy. I was put onto the urgent 2-week wait for gynaecology after some suspicious pelvic and trans-vaginal scans. I am 53, peri-menopausal, and had one vaginal childbirth aged 23. I received no information on the procedure beforehand, just a brief phone call from the clinic to say it would be similar to a smear test, followed by the appointment letter. I researched the procedure myself using the NHS website and took the advised paracetamol/ibuprofen before arrival. On the day I wasn't asked to sign any consent form or the like. I just had to give a urine sample on arrival. After a long wait in reception I was called into a small anteroom with a strange cut-out tilting chair with a bucket underneath. I know I was anxious, but in my high alert state it seemed a very alarming set up. After explaining that I have panic attacks, and worried that this environment could be a trigger, my husband came into the room with me (otherwise I think I'd have ran back out again). They gave me a sheet to wrap around my naked bottom half, no gown with a fastening was available. I did not receive any pain relief or anaesthesia. I was really frightened as I saw the hysteroscope and thought how on earth is that going to get through my cervix and into my uterus! I like to think that I've a good pain threshold; but this was like nothing I've ever experienced. I felt the hysteroscope break through my cervix (this made me cry out in pain), and then saline was pumped into my uterus and that was extremely unpleasant. I was deep breathing to try to control myself but I couldn't stop crying and shaking with the shock of it all. I felt such distress that I couldn't speak. It was a terrible deep searing/dragging pain. The nurses were lovely and held my hand while my husband held the other, but I have to say that it was the most frightening experience I've ever been through. I looked up at my husband who was comforting me and I could see tears in his eyes too. The doctor said that all appeared ok, but took some biopsies just to double check. That cutting into my womb hurt a great deal. They then put in a Mirena coil which I had agreed to just before the procedure started, as the doctor said it would help alleviate my heavy periods and thickened womb lining. No one said that I may experience such intense pain during the hysteroscopy, just likely some period type pain. This comparison is not accurate at all. After the procedure I was asked to get dressed. My husband helped me out of the room and I sat down in the reception area trying to hide my distress from the other people waiting in there. I eventually felt able to walk back to the car and my husband drove me home. I have to say that I've been left feeling horrible after all this and I can’t stop thinking about it. I will never undergo a hysteroscopy procedure in this way again. I’m also already very frightened about when the Mirena coil will need to be removed… and that’s 4 or 5 years in the future. The fear of any future internal procedures is now very real, and I find this sad as I’ve never had any concerns about undergoing these in the past This hysteroscopy is such a brutal outpatient procedure and I can't believe that there was no pain relief or anaesthesia offered. I’m still cramping and bleeding and I feel a bit of a wreck. I felt I needed to get my hysteroscopy experience written down to try help me make sense of it, whilst wondering if this is the norm? I’m so confused if it is. I felt embarrassed by my crying and shaking… but it was shockingly painful. It's also left me feeling upset that this may be happening to other women who are already worried about their health and need to know if there’s anything wrong internally; and, like me, believe that there’s no option other than having to go through this ordeal. This is just my personal experience and I do appreciate that there may be other women who have had a different experience to mine. Even so, regardless of any data collected about this procedure, I find it unacceptable for any woman to be expected to bear this terrible pain and trauma. Further reading on the hub: Hysteroscopy: 6 calls for action to prevent avoidable harm The normalisation of women’s pain What is your experience of hysteroscopy? Share and read other accounts in our Painful hysteroscopy community thread.
  2. News Article
    Trusts have been told today by NHS England that they must book appointments by the end of this month for all patients who have been waiting longer than 78 weeks. A letter from NHS England sent to trust leaders set out the new orders and represents system leaders’ attempt to ramp up progress on this cohort of patients, which the NHS and government elective recovery plan commits to eliminating by March. The appointments must be issued this month, and be dated before the end of March, for these pathways, of which about 48,000 are recorded nationally. The letter also warns trusts that, while NHSE will accept some inpatient cancellations are unavoidable, cancelling outpatient appointments — even during strike action — is viewed as less acceptable. Read full story (paywalled) Source: HSJ, 12 January 2023
  3. Content Article
    Sarah's tips for women when speaking to medical professionals Know your body and come prepared Equip yourself with evidence and knowledge Rule out the worst-case scenarios Bring back-up Treat it like a collaboration Try to understand the challenges your doctor faces
  4. News Article
    More than ten million patients are on “hidden” waiting lists for NHS care. There are 6.7 million patients on the official NHS waiting list, which includes people who have been referred by GPs for hospital treatment such as cataract or hip and knee surgery. However, data released by health service trusts under freedom of information laws suggests there are 10.3 million further patients who need follow-up care, illustrating the scale of the task facing the NHS. Louise Ansari, national director at the patient group Healthwatch England, said: “Waiting a long time for treatment can put a huge strain on patients and their loved ones. But this can be so much worse when there is ‘radio silence’ from the NHS, leaving people uncertain if their referral has been accepted, unclear about how long they may have to wait and often feeling forgotten.” Read full story (paywalled) Source: The Times (30 August 2022)
  5. News Article
    An LMC has created template letters to help practices reject secondary care workload dumping, including rejected referrals and requests to complete work on behalf of hospital trusts. Cambridge LMC said it developed the tools amid a growing ‘tsunami’ of secondary care workload transfer into general practices. One template letter tackles the rejection of a referral ‘on the basis that a proforma was not enclosed or completed in full’. It points out that the GMC requires GPs to refer when they ‘believe it is necessary to do so’ and that their ‘contractual obligations make no mention of a requirement to complete a proforma’. Cambridgeshire LMC chief executive Dr Katie Bramall-Stainer told Pulse that ‘we need the temperature to rise on the understanding around pressures across general practice’. Read full story For more information on the issues raised, read a blog by Patient Safety Learning about the patient safety risks of rejected outpatient referrals. Source: Pulse (19 August 2022)
  6. Content Article
    Key findings: Inpatient activity During 2021/22 there were 510,834 inpatient and day case admissions to hospital in Northern Ireland. This was an increase of 19.4% (83,102) on the number of admissions during 2020/21 but a decrease of 16.1% (97,704) on the number admitted during 2017/18. Of the 510,834 admissions, 49.2% (251,178) were inpatient admissions and 50.8% (259,656) were day cases. The day case rate for Acute services has increased from 80.3% in 2017/18 to 84.3% in 2021/22. The greatest increase occurred between 2020/21 and 2021/22 when the day case rate increased from 82.6% to 84.3%. Between 2020/21 and 2021/22, the average number of available beds increased by 2.3% (131.6) from 5,672.6 to 5,804.2. The greatest increase in average available beds was evident in the Acute programme of care, increasing by 133.4 (3.4%) beds from 3,951.5 in 2020/21 to 4,084.9 in 2021/22. Occupancy rate in hospitals was 79.5% during 2021/22; this was a decrease from 83.5% in 2017/18, but an increase from 69.9% in 2020/21. Average length of stay in hospitals has increased from 6.4 in 2020/21 to 6.7 days in 2021/22. In 2021/22, there were 83,269 theatre cases across all HSC Trust hospitals in Northern Ireland; this was an increase of 39.3% (23,507) compared with 59,762 theatre cases in 2020/21. The total number of hospital births in Northern Ireland increased by 264 (1.2%) from 21,531 births in 2020/21 to 21,795 hospital births in 2021/22. Key findings: Inpatient and day case activity in the independent sector In 2021/22 there were 20,039 admissions to hospital in Northern Ireland for an inpatient or day case procedure with an Independent Sector provider that was commissioned by the Health Service. This was an increase of 11,474 (134.0%) when compared with 2020/21. All Independent Sector admissions occurred within the Acute Programme of Care. Information on Acute services within the Independent Sector is provided by the Strategic Planning and Performance Group in the Department of Health, split by commissioning HSC Trust and specialty (the HSC Trust responsible for the patient’s waiting time). Data on the number of HSC patients treated in the Independent Sector are not National Statistics and have not been validated by the Department. Key findings: Outpatient activity During 2021/22, there were 1,009,034 face-to-face attendances at consultant-led outpatient services within HSC hospitals in Northern Ireland, an increase of 46.3% on attendance levels in 2020/21 (689,898). Almost one third of appointments (32.6%, 328,494) were new attendances, with the remaining 67.4% (680,540) being review attendances. This is a similar breakdown to previous years. Patients cancelled 118,255 appointments, giving a Could Not Attend (CNA) rate of 10.5. Hospitals cancelled a total of 155,987 appointments, giving a hospital cancellation rate of 13.4. Patients missed a total of 93,081 appointments, giving a Did Not Attend (DNA) rate of 8.4. During 2021/22, there were 4,784 outpatient attendances at a Day Case Procedure Centre (DPC) for the treatment of cataracts or varicose veins. During 2021/22, 31,530 patients attended an appointment with an Independent Sector Provider, commissioned by the Health Service. Key findings: Virtual attendances in HSC hospitals During 2021/22 a total of 341,166 virtual attendances took place at consultant led outpatient services within HSC hospitals in Northern Ireland, a decrease of 24.2% (108,662) compared with 2020/21. In 2021/22, around half (49.8%, 169,969) of the 449,828 virtual attendances were within the specialties of: T&O Surgery (28,744), General Surgery (28,040), Gastroenterology (26,213), Cardiology (24,149), Clinical Haematology (23,639), Endocrinology (20,528) and Urology (18,656). Key findings: ICATS activity During 2021/22, 67,978 patients were seen at an ICATS service in Northern Ireland. This was an increase of 15.6% (9,166) on the 58,812 seen during 2020/21. Of the patients seen during 2021/22, 47.1% (32,028) were new attendances, with the remaining 52.9% (35,950) being review attendances. Patients missed a total of 6,764 ICATS appointments during 2021/22, giving a Did Not Attend (DNA) rate of 9.0, compared with a rate of 8.1 reported for 2020/21. Patients cancelled 8,358 appointments during 2021/22, giving a Could Not Attend (CNA) rate of 10.9, higher than the CNA rate of 7.0 reported for 2020/21. Hospitals cancelled 9,269 appointments during 2021/22, giving a hospital cancellation rate of 12.0, compared with a hospital cancellation rate of 12.5 reported during 2020/21.
  7. News Article
    Patients at trusts with long waiting lists should no longer think ‘they have to go to their local hospital’ for outpatient appointments, but should instead be offered virtual consultations elsewhere in the country where there is greater capacity, Sir Jim Mackey has told HSJ. The NHS England elective chief said recent efforts to abolish two-year waiters by July had meant a “very big” surgical focus. However, the next phase of the elective recovery plan would see a major shift of emphasis onto reducing the wait for outpatient appointments. Sir Jim said: “Providers have been split into tiers again with tier one having national oversight and tier two, regional oversight. Behind that we will be pairing up organisations so that organisations with capacity can help those with the biggest challenges from a virtual outpatient perspective. He added: “There still is a lot to work through [on virtual outpatients], we’re going to be testing the concept… We need to work through how all the wiring and plumbing needs to work. For example, what happens if the patient needs a diagnostic locally, having seen a clinician virtually in another part of the country? “It would be great also to try and stimulate more of a consumer drive on this – encouraging patients to ask about virtual outpatients when the waits locally may be too long, so they don’t just think they have to go to their local hospital. I think this could really help shift the model if we can get it right.” Read full story (paywalled) Source: HSJ, 9 August 2022
  8. Content Article
    In the wake of the Covid-19 pandemic, the NHS continues to operate under enormous pressure. It faces the challenge of responding to ongoing Covid infections alongside addressing a growing and complex backlog of care and treatment, with an over-stretched workforce. But this backlog is not limited to the much-covered issue of hospital-based surgical waiting lists. We are also increasingly hearing that GPs are struggling to ensure patients can access outpatient services. There is growing evidence that some hospitals are systematically rejecting new GP referrals to outpatient clinics. NHS England holds no formal data on rejected referrals. However, data relating to Appointment Slot Issues (ASIs) in the NHS e-Referral system, which handles around 95% of GP referrals in England, show that the number of referrals made for which there is no slot available has risen from 238,859 in February 2020 to 441,034 March 2022–an increase of 85%.[1] While these figures show lack of slots rather than specific numbers of rejected referrals, they clearly highlight a chronic lack of capacity in outpatient services. This correlates with the picture that has come out in our conversations with GPs—of patients with complex needs being pushed back to primary care because there is simply no space in outpatient clinics. The situation varies from speciality to speciality and is reportedly worse in areas such as mental health and neurology. When outpatient services reject referrals, it leaves primary care with the burden of sourcing provision from another hospital or directly meeting patients’ needs. Many of these patients have complex issues that require urgent assessment and treatment beyond the expertise of a GP. The issue is not GPs’ unwillingness to work hard for patients, but rather a concern about the impact that shifting large amounts of complex cases to primary care will have on patient safety. As Doncaster-based GP Dr Dean Eggitt told us, "Everyone's on board with shifting care to the community - it's the right thing to do for patients. But if we don't have the capacity to deal with it, people suffer." As the NHS comes under increasing pressure, we ask whether hospitals are changing the criteria for accepting referrals from GPs, and how this is leaving patients unable to access the care and treatment they need. Following discussion with patients and GPs, we have identified six urgent patient safety issues related to rejected referrals. We are calling for NHS England and NHS Improvement to investigate and understand the scale of these risks, and to take urgent action to address them. Rejected outpatient referrals: Urgent patient safety issues 1. Outpatient waiting lists are full Where hospitals are rejecting new GP referrals to outpatient clinics and specialist services, patients are being ‘passed around the system’ and sometimes deteriorating further while waiting for treatment. Recent analysis by the Institute for Government highlighted that “GPs are responsible for the day-to-day management of many chronic conditions and when patients do not receive specialist care these generally get worse and harder to manage.”[2] Our discussions with GPs suggest a lack of clarity on what to do if a patient’s referral is rejected. If a waiting list is full, GPs are being left to work out how to get their patients the specialist treatment they need. This is creating delays in care which has an impact on patient safety; in a recent poll of their members, the Doctors Association (DAUK) found that “90% of respondents believed a patient of theirs had come to harm because of a lack of access to outpatient services.”[3] These delays and rejections are also eroding patient trust in all areas of the healthcare system. In December 2021, DAUK wrote to Sajid Javid MP, Secretary of State for Health and Social Care, about concerns over lack of access to secondary care referral pathways. They highlighted that “allowing specialists who have not assessed the patient themselves to make the decision whether a referral is justified … risks patient safety.”[3] Some GPs have also expressed concern that referrals are being rejected on minor technicalities by administrative staff, without ever being seen by clinicians. 2. Services are not being prioritised on clear and consistent criteria We believe that patients need to be prioritised according to their clinical need rather than constraints within secondary care, and that the NHS needs to be transparent with the public about referral assessment processes. GPs have also told us about difficulties in getting investigation referrals accepted. One GP told us that their Trust has recently changed ultrasound scan request criteria and these referrals are now only being accepted if the referring GP is certain the patient requires surgery. This undermines the ability of GPs to flag potential issues and diagnose patients safely, and many are resorting to workarounds that they know will get the referral accepted. Rejecting referrals based on waiting list capacity, without clear and consistent criteria, will also create a postcode lotteries in care across the country and exacerbate existing health inequalities. To ensure safety, new patients entering waiting lists need to be prioritised according to clinical need against those already on the list, rather than operating on a ‘first come, first served’ basis. In addition to this initial prioritisation, patients waiting for care need to be monitored and reprioritised as their level of need is likely to change as they wait. There is a major question as to who will be responsible for ensuring patient deterioration while waiting for care is picked up and acted upon. 3. ‘Advice and guidance’ is being used to limit waiting lists There is concern amongst GPs that they are being asked to manage patients through the ‘advice and guidance’ (A&G) system when it is not appropriate to do so. A&G aims to reduce outpatient appointments in line with ambitious NHS targets.[4] In their letter to the Secretary of State, DAUK noted, “A&G is a brilliant tool if there is a query over patient care, or some concern over whether a referral is appropriate. However, as GPs, if we have decided a referral is necessary, and the situation is outside our competency then we must refer onwards, in line with GMC advice.”[3] Since October 2021 Barts Health NHS Trust in London has closed other referral pathways across most specialties, so that GPs can only use the advice and guidance system for referrals (now called ‘advice and refer’ within the Trust).[5] NHS England has also introduced nationwide targets to reduce outpatient appointments and increase A&G.[6] While we recognise the value of trialling new approaches, we are concerned that this particular strategy presents a risk to patient safety at a time where pressures across the system mean it may be inappropriately used as a way of keeping hospital waiting lists down. 4. GPs are having to take responsibility for patients they are not qualified or supported to treat All GPs will have specific specialties in which they are less confident and therefore require additional support from secondary care. When this help is denied, patient safety is compromised. Dr Eggit told us about the risks involved in asking GPs to work on cases outside of their expertise: "GPs know what they are doing - if they refer it's because they know they need help. When they don't get the help they need to treat patients, it causes harm." With A&G being promoted as a way to reduce outpatient appointments, GPs are being asked to offer treatment pathways and prescribe medications that have not historically been dealt with in primary care, as they carry higher levels of risk. Without appropriate training and safeguards, this puts patients at potential risk and GPs in a precarious position. It also adds to the stress and decision-making burden of GPs, contributing to burnout, a problem primary care cannot afford at the moment. One GP based in North East England told us, “There is an ever-creeping transfer of management of complex conditions from secondary to primary care, without adequate training or resources to manage this safely. Locally, we have just lost our general geriatric clinic, where we would refer older patients with several serious conditions on numerous medications. As GPs, we do not have the capacity, resources or expertise to do a full geriatric assessment, and yet that is what we have been left to attempt. These patients require specialist assessment to identify the pertinent issues amongst all that complexity, and to decide how best to balance and treat these issues safely and acceptably for the patient. As a GP, this pervasive transfer of responsibility causes me significant anxiety and distress.” 5. Patient choice and shared decision making are being undermined The NHS needs to prioritise tackling the root cause of lack of capacity in secondary care to allow for true patient choice. According to the summary of the NHS England and NHS Improvement March 2022 board meeting, “increasing patient choice is at the core of the delivery plan [for tackling the backlog].”[7] However, patients are currently unable to have much input into how their care and treatment should proceed. We welcome work to improve the electronic referral system to allow patients more choice when referred to secondary care, but if appointments do not exist, this will offer no choice at all. Many patients are currently unable to have full and frank discussions about their priorities and options with a qualified specialist. They are instead having to rely on GPs’ limited knowledge of specialist areas, or guidance from a consultant, relayed by GP. There is no easy way for patients to ask a specialist about their treatment. One GP told us that the use of A&G is also damaging their relationship with patients. “When I relay that a consultant has suggested a treatment to a patient, they ask me why they aren’t seeing the consultant. I have to tell them the consultant has declined to see them, and that I will be treating them instead. It’s worrying for the patient and damages the trust they have in me and in the system.” 6. There is a lack of clarity on accountability When a patient is referred to secondary care and that referral is rejected, it is unclear who is responsible for accessing alternative advice and treatment. If a patient experiences negative outcomes such as their condition deteriorating as a result of delays, who is responsible? If they want to raise concerns or complain, should they do this with the GP that referred them, or the secondary care provider that didn’t accept the referral? There is also concern that GPs will be held legally accountable for advice given by consultants through A&G.[8] A survey of nearly 700 GPs carried out by the Medical Protection Society in 2021 demonstrates that clarity and reassurance for GPs is needed. It found that “nearly four in five GPs in the UK (77%) are concerned about facing investigation if patients come to harm as a result of delayed referrals or… services being unavailable or limited.”[9] Professor Martin Marshall, Chair of the Royal College of GPs, said: “GPs understand the pressures colleagues working in secondary care are facing and will only refer patients if they think it is in their best interests. It’s really important that when GPs refer patients to specialist services, these referrals are taken seriously and not dismissed without good reason. “The patient safety issues raised in this article that relate to unsuccessful GP referrals are concerning and require further investigation. With the health service currently facing immense pressure, it is vital that acute and primary care work together to assess and respond to these concerns.” How should the NHS respond to these issues? As these six areas illustrate, the increase in rejected outpatient referrals is placing new pressures on GPs, with concerning implications for patient safety. We believe that NHS England NHS Improvement, in partnership with the Department of Health and Social Care, should take the following action: Investigate the extent and impact of the current level of rejected outpatient referrals. There is currently no clear way to assess the number of referrals that are being rejected, and the reasons for rejection. Develop an action plan in response to this, which should include specific steps to prevent outpatient referrals being inappropriately rejected or transferred to A&G. Undertake wide patient and public engagement to ensure transparent knowledge and promote wider understanding of these issues and their impact on health services. Acknowledging the immense pressure currently facing secondary care, we also see an opportunity for Clinical Commissioning Groups and incoming Integrated Care Systems to support primary and secondary care to work together on pathways focused on keeping patients safe, prioritising according to clinical need and rebuilding patient trust in the health system. If you are a GP, have you noticed an increase in rejected referrals or changes to the referral system? What has the impact been on your own workload and wellbeing, and the safety of patients? Please share your experiences in our community discussion so that we can continue to highlight these issues. Related reading Tackling the care and treatment backlog safely: Part 1 BMA - On the edge: GPs in despair (18 March 2022) Delivery plan for tackling the COVID-19 backlog of elective care (8 February 2022) NHS England waiting times for cancer referral and treatment at record high References 1 Appointment Slot Issue reports. NHS Digital. Accessed 4 May 2022 2 Performance Tracker 2021: General practice. Institute for Government website. Last accessed 14 April 2022 3 DAUK’s joint letter to the health secretary – lack of access to secondary care referral pathways. Doctors' Association UK. 3 December 2021 4 NHS England: Advice and Guidance. NHS England website. Last accessed 14 April 2022 5 Referrals (advice and refer, formerly advice and guidance). Barts Health NHS Trust website. Last accessed 14 April 2022 6 2022/23 priorities and operational planning guidance: Version 3. NHS England and NHS Improvement. 23 February 2022 7 NHS England and NHS Improvement Board meetings held in common: Elective Recovery Programme update. NHS England and NHS Improvement. 24 March 2022 8 Costanza Potter. 'GPs could be liable for hospital specialists’ advice under A&G, MDO warns'. Pulse Today. 6 April 2022 9 'Four in five GPs fear reprisal over delayed referrals'. Medical Protection. 4 June 2021
  9. Community Post
    Incidents per 1000 bed days – what does this actually mean? How is this sum used to quantify incidents reported in an outpatient setting?
  10. News Article
    Tens of thousands of outpatient video consultations have been carried out by NHS trusts following the national rollout of a digital platform to support the coronavirus response. Digital healthcare service Attend Anywhere was introduced across the country at the end of March after NHSX chief clinical information officer Simon Eccles called for its rapid expansion. There has been a major push to boost digital healthcare services across the country in order to support the national response to coronavirus. Much of primary care has already switched to working virtually. Undertaking hospital outpatient appointments digitally has been identified as a way of keeping patients safe by removing their need to travel. There have now been more than 79,000 consultations with Attend Anywhere. The number of consultations started at around 200 per day, but has rapidly increased to more than 6,000 per day. Data released by NHS Digital showed that GPs moved swiftly to change their practice model in the face of COVID-19. The proportion of appointments conducted face-to-face nearly halved and the proportion of telephone appointments increased by over 600 per cent from 1 March to 31 March as GPs moved to keep patients out of surgeries except when absolutely necessary. However, concerns have been raised over the limitation of remote appointments, particularly in mental health services. Royal College of GPs chair Martin Marshall raised concerns that video appointments could make it difficult for doctors to diagnose and manage patients’ conditions during the pandemic. Read full story Source: HSJ, 11 May 2020
  11. News Article
    NHS England is commissioning a “COVID-19 home treatment service” of primary and community healthcare for self-secluding patients. It is introducing “urgent primary care services to patients diagnosed with COVID-19” who are self-secluded at home. The service will care for patients’ symptoms relating to COVID-19 as well as other conditions until they are discharged from home isolation and referred back to their GP. “There is likely to be a gradual handover of patients to CHMS providers as they come onstream to provide the service,” according to a letter from NHSE’s primary care directors sent to GPs today. “As soon as the new service is up and running in your area, your clinical commissioning group will be able to tell you who will be providing care for patients in your locality.” Read full story (paywalled) Source: HSJ, 11 March 2020
  12. News Article
    Patients were harmed at a Midlands trust because of delays in receiving outpatients and diagnostics appointments, the Care Quality Commission (CQC) has warned. Following the inspection at Northern Lincolnshire and Goole Foundation Trust in September and October last year, the CQC has lowered the trust’s rating in its safety domain from “requires improvement” to “inadequate”. It warned there were insufficient numbers of staff with the right skills, qualifications and experience to “keep patients safe from avoidable harm”. The report noted the trust had identified incidents in 2018 and 2019 where patients had come to harm due to delays in receiving appointments in outpatients, particularly in ophthalmology. Ten patients were found to have come to low harm, one patient moderate harm and two patients severe harm. The CQC also issued a Section 31 letter of intent to seek further clarification in relation to incidents where patients had come to harm because of delays to receiving appointments in outpatients and diagnostic imaging, although it has confirmed the trust has provided details on how it is going to manage the issues raised. The watchdog said it would continue to monitor the issue. Read full story (paywalled) Source: HSJ, 7 February 2020
  13. Content Article
    Key findings: Wide variability in the fidelity of the RED intervention. Engaged leadership and multidisciplinary implementation teams were keys to success. Common challenges included obtaining timely follow-up appointments, transmitting discharge summaries to outpatient clinicians, and leveraging information technology. Eight out of 10 hospitals reported improvement in 30-day readmission rates after RED implementation. The authors concluded that a supportive hospital culture is essential for successful RED implementation. A flexible implementation strategy can be used to implement RED and reduce readmissions.
  14. News Article
    Patients are facing a week of disruption, with more than 10,000 outpatient appointments and surgeries cancelled in Belfast. Some people referred by their GPs on suspicion of cancer could have their diagnosis delayed, the head of the Belfast Trust has said. The trust apologised, blaming industrial action on pay and staffing. Martin Dillon said outpatient cancellations "could potentially lead to a delay in treatment" for cancer. The Department of Health said the serious disruption to services was "extremely distressing". Read full story Source: BBC News, 2 Decmeber 2019