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Content ArticleThe NHS in England is about to be reorganised. In April 2022, government passed the Health and Care Act 2022 – the biggest legislative overhaul of the NHS in a decade. The centrepiece of the legislation are integrated care systems (ICSs) – area-based agencies responsible for planning local services to improve health and reduce inequalities. From July 2022, England will be formally divided into 42 ICSs, covering populations of around 500,000 to 3 million people. ICSs have existed informally since 2016, but – until now – lacked formal powers. ICSs face a mammoth task. Staffing shortages in the NHS are chronic, record numbers of people are waiting for routine hospital treatment, and health inequalities in England are wide and growing. But these challenges are not evenly distributed between ICSs – and some systems are better equipped to deal with them than others. Policymakers have allowed some flexibility in how local systems have been developed and organised, which means they vary widely in size, structure, and other characteristics. In this long read, The Health Foundation analyses publicly available data on some of the characteristics of ICSs and context in each area – including the organisational and policy context, health challenges, and capacity within the health care system to address them. It compares areas and discusses implications for policy.
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Content ArticleThe consultancy firm McKinsey & Company explored the effects of the Covid-19 pandemic on the nursing workforce in a global survey that included nurses from United States, the United Kingdom, Singapore, Japan, Brazil and France. The survey findings show a consistency around how nurses feel in their roles today, despite the different healthcare systems and delivery networks in each of the six countries. A substantial population of nurses are expressing a desire to leave direct patient care, with between 28% and 38% of nurse respondents in the United States, the United Kingdom, Singapore, Japan and France indicating that they were likely to leave their current role in direct patient care in the next year. This article explores in detail some of the reasons why nurses are choosing to leave direct patient care, and highlights approaches that might encourage retention, including positive leadership initiatives.
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News Article
Paramedics are ‘leaving in droves’ as ambulance callouts almost double
Patient Safety Learning posted a news article in News
The number of calls for an ambulance in England have almost doubled since 2010, with warnings of record pressures on the NHS that are seeing A&E patients stuck in corridors and many paramedics quitting the job. Ambulance calls have risen by 10 times more than the number of ambulance workers, according to a new analysis of NHS data carried out by the GMB union. An increase in people seeking emergency treatment, GPs unable to cope with demand and cuts to preventive care are all being blamed for the figures. While the figures represent all calls for an ambulance, some of which go unanswered and do not lead to a vehicle being sent, they reveal the increasing pressures that have led to claims that patient safety is being put at risk by ambulance waiting times. There has been a significant increase in the number of the most serious safety incidents logged by paramedics in England over the past year. Paul, a paramedic and GMB deputy branch secretary, said he had recently seen a crew waiting almost 10 hours between arriving at hospital and transferring a patient to hospital care. “They arrived at the hospital at 20.31,” he said. “They then cleared from the hospital at 05.48 in the morning. The impact of the lack of resources is affecting the ambulance service. “We are also seeing people become aggressive to the ambulance crew, because they’ve waited hours upon hours in an ambulance." Read full story Source: The Guardian, 12 June 2022 -
Content ArticleShared decision making and regular communication throughout a patient’s surgery pathway would, a recent HSJ webinar argued, help the NHS move from the concept of waiting lists to one of preparation lists – and to a better way of dealing with the backlog. Claire Read reports.
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News Article
Patients unwashed ‘for three days’ at trust under ‘extreme pressure’
Patient Safety Learning posted a news article in News
The Care Quality Commission (CQC) has issued a trust with a warning notice following an inspection that found wards did not have enough staff to care for patients. Staff at York hospital told inspectors they were not able to interact with individual patients and cater to their needs, with one saying: “We have to choose, do we turn, check, and make sure all patients are not soiled, or do we fully wash ten? Some of these patients haven’t been washed for two to three days.” York and Scarborough Teaching Hospitals CEO Simon Morritt said: “Many of the issues raised by the CQC were known to us, and reflect the extreme pressures facing the trust, the demands of covid and associated staff absence, and the well-documented recruitment challenges. The report demonstrates that, when faced with these pressures, it is not always possible to give the standard of care we would want for all of our patients all of the time.” The CQC said there were “significant safety concerns about fundamental standards of patient care” at the hospital. “The service didn’t have enough nursing staff with the right skills, training and experience to keep patients safe and to provide the right care and treatment,” said Sarah Dronsfield, the CQC’s head of hospital inspection. “It was disappointing that managers didn’t regularly review the situation and change the staffing arrangements to accommodate this.” Read full story (paywalled) Source: HSJ, 9 June 2022 -
Content ArticleIn October 2021 the government announced a review into leadership across health and social care, led by former Vice Chief of the Defence Staff General Sir Gordon Messenger and supported by Dame Linda Pollard, Chair of Leeds Teaching Hospital Trust. The results of the review have now been published and recommendations made.
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Content ArticleMore must be done to avoid harm to patients while waiting for treatment. The backlog for planned care is one of the biggest challenges for the NHS in Wales. Waiting times targets have not been met for many years. This backlog has been made much worse due to the pandemic. In February 2022, there were nearly 700,000 patients waiting for planned care, a 50% increase since February 2020. Over half of the people currently waiting have yet to receive their first outpatient appointment which means that they may not know what they’re suffering from and their care cannot be effectively prioritised. Modelling shows it could take up to seven years or more to return waiting lists to pre-pandemic levels. This report makes five recommendations based on what the Welsh Government needs to do as it implements its national plan.
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Content ArticleA locally engaged health service can lead to a more open, dynamic and pluralist model of NHS governance and accountability. In weighing up the hopes for better integration and collaboration against concerns around operational pressures, Matthew Taylor, Chief executive of the NHS Confederation, discusses the potential positive impact that local government can have in health service decision-making.
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Content ArticleThe last two years have been unprecedented for the NHS. The COVID-19 pandemic has presented a unique set of challenges and required innovative new ways of working to provide an effective response. As part of that response, the NHS adopted special payment arrangements for 2020/21 and 2021/22, removed the requirement for trusts to sign formal contracts and disapplied financial sanctions for failure to achieve national standards. The Commissioning for Quality and Innovation (CQUIN) financial incentive scheme was also suspended for the entire period. To support the NHS to achieve its recovery priorities, CQUIN is being reintroduced from 2022/23. This document sets out the requirements for all providers of healthcare services that are commissioned under an NHS Standard Contract (full-length or shorter-form version) and are within the scope of the Aligned Payment and Incentives (API) rules, as set out in the National Tariff and Payment System. These requirements take effect from 1 April 2022.
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Content ArticleThis animation by The King's Fund explains the changes that are happening to the way the NHS in England is organised and run. It outlines the key organisations that make up the NHS and how they can collaborate to deliver joined-up care. It describes the impact of the Health and Care Act 2022 and talks about how Integrated Care Systems foster collaboration between healthcare and other local services to improve people's experience and health outcomes.
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Content ArticleIntegrated care systems (ICSs) will gain their full statutory footing in July 2021, after years of development. This blog by The King's Fund aims to explain how ICSs will function and includes a diagram showing the main features and interactions within an ICS. It outlines the roles of the integrated care board (ICB) and integrated care partnership (ICP) in each ICS, and describes the different partnership and delivery structures.
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Content ArticleThis analysis from the European Observatory on Health Systems and Policies provides a review of developments in financing, governance, organisation and delivery, health reforms and performance of the health systems in the United Kingdom.
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Content ArticleAlthough compensation increases have played a key role in retaining and recruiting healthcare employees amid a major workforce shortage, perks such as mental health services and education financial assistance have also helped meet staff needs. Six health system CEOs and CFOs share with Becker's Hospital Review their best tips for retention and recruitment that go beyond compensation:
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Content ArticleKeren Levy was fit and healthy when she first felt pain in a molar. After numerous dentists and doctors left it untreated, there were knock-on effects throughout her body. Today she is in constant pain and look almost unrecognisable She went to the dentist a number of times but X-rays showed nothing untoward. However, Karen started to develop a horribly rotting taste and knew the tooth was necrotic. She begged her dentist to give her root canal treatment or extract it, but without a visible sign this was needed she was refused. Instead she was referred to her GP, implying her distress was bereavement due to her mother recently dying. Many months later, Keren was referred to a different dentist who gave her a 3D scan that showed the original tooth to be necrotic, as she had said five months before. Evidence of the infection was clear in the surrounding bone. Her dentist records that the delay in treating the original dental infection appears to have triggered a systemic response in my body’s autonomic or endocrine system. Having had perfect health, eventually I had to have 12 root canals; all those teeth were necrotic. Confronted by the facts, the first dentist Keren saw said that, had he been in his Athens surgery, he would have carried out a root canal on the original tooth. But here, in the UK, he had been concerned he could be held to account by General Dental Council (GDC) regulations, given the X-ray image had not been “definitive”. An editorial in the British Dental Journal (BDJ) as long ago as 2014 described a climate of “fear and distrust” that had led to defensive dentistry because of the prospect of legal action or disciplinary procedures if anything goes wrong. Karen's case is a horrific example of excessive diagnostic testing delay, instead of treatment. Months of referrals to neurologists, maxillo-facial specialists, psychologists, GPs, oral medicine departments and other dentists went against common sense and ensured responsibility could never be laid at a particular dentist’s door. Invariably, the first question was: “What did the last dentist say?”
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Content ArticleNigeria is projected to become one of the most populous countries in the world, and is rightly taking its place on the world stage. The Lancet Nigeria Commission tells the story of the country through a health lens, and details recommendations that will enable the country and its people to fulfil their potential, and seize the opportunity ahead. It has been led by Nigerians for Nigerians. The Commissioners call for the creation of a new social contract that redefines the relationship between citizen and state. They argue that health has, to date, been neglected by successive governments and consequently the citizens of Nigeria, and must be recentred as a vital investment in the population – one that will reap political and economic benefits. Nigeria is poised to define the future of West Africa, the African continent, and the whole world. This Commission lays out how best to realise that ambition.
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Content ArticleIn this article published by Economics By Design, Colin Lewry and Jacque Mallender argue that, despite recent history, treating healthcare staff as a cost and not an asset needs to be reversed when developing workforce plans and approaches in 2022.
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News Article
Midwife-supported home births scrapped in Guernsey
Patient Safety Learning posted a news article in News
Midwife-supported homebirths will not be re-introduced in Guernsey after their suspension due to coronavirus. The committee for health and social care explained it is difficult for a small team to accommodate the births. It said that if the service was reinstated, it may impact deliveries on Loveridge Ward in Princess Elizabeth Hospital. A spokesperson said they were "very sorry" to parents who wanted to give birth at home. The committee said homebirths rely on a demanding on-call commitment from community midwives on top of their contracted hours. To facilitate a birth at home, two of the five midwives are required to be on-call for 24 hours a day, for up to five weeks at a time. Deputy Tina Bury, vice president of the committee for health and social care, said: "The midwifery team is small and it was simply not sustainable or safe in the long-term to provide the kind of on-call cover needed to support homebirths. Read full story Source: BBC News, 5 March 2022 -
Content ArticleThe Covid-19 pandemic has rapidly accelerated a trend of decline in access to and outcomes in healthcare. This situation means that people who have the means to do so are opting for faster, private care, creating a two-tier healthcare system. However, IPPR polling shows that near-universal public support remains for retaining a universal, free, comprehensive and tax-funded NHS. The public highly values the principles of the NHS as a system that universalises the benefits of the best healthcare and shares the cost across the population. This report by The Institute for Public Policy Research (IPPR) think tank proposes policies based on three aims: recovery, building back better and increased sustainability facing an uncertain future.
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EventuntilThe Safety for All campaign has organised this webinar in partnership with NHS Supply Chain and Patient Safety Learning. It will look at the challenges in healthcare supply chain and patient and staff safety. As we emerge from Covid restrictions, it is timely to look back and forward at the challenges facing the supply chain in healthcare, but also to ensure that safety for both patients and staff are prioritised amongst the other challenges facing the NHS and social care in the future. The webinar will be chaired by Jonathan Hazan, Chair of Patient Safety Learning, and will feature a keynote speech from the Chair of NHS Supply Chain, Heather Tierney-Moore. Heather will discuss Supply Chain’s role in supporting the NHS to deliver safe and excellent patient care, safety, sustainability, resilience and efficiency. This will be followed by a panel discussion with representatives from supply chain, patient safety, industry and the MHRA and a further session on how human factors need to be integrated into the process of delivering safety in healthcare. Finally, there will be a case study on a patient and staff safety issue in perioperative care and how better procurement can help deliver better care and safety in infection prevention. The webinar will be hosted on Microsoft Teams, join the webinar using this link. Full Webinar Programme
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Content ArticleThis paper summarises how core NHSEI quality functions are expected to be delivered through Integrated Care Systems from April 2022. The functions covered are not exhaustive and the work is ongoing. This paper is a working draft which represents the current position, based on workshops and engagement with national policy teams, regional teams and systems.
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Content Article
NHS England: Productive Ward (9 June 2020)
Patient Safety Learning posted an article in Other
The Productive Ward focuses on improving ward processes and environments to help nurses and therapists spend more time on patient care, thereby improving safety and efficiency. Productive Ward will allow healthcare teams to redesign the way they work, eliminating waste and releasing staff time to invest in patient care. Teams are enabled to maximise quality, reduce harm, develop more efficient processes, and ensure that patients feel safe and well cared for. -
News ArticleThere is no significant relationship between the number of managers or the amount spent on management and the quality of NHS hospital services, research has concluded. Researchers at the London School of Economics studied the performance of all 129 non-specialist acute trusts between 2012-13 and 2018-19. They measured hospital performance on five indicators covering financial position, elective and emergency waiting times, level of admissions and mortality. This was then compared to the number of managers each trust employed and the amount spent on management staff. The researchers also attempted to measure the quality of management based on answers given to relevant questions in the annual NHS staff survey. Reviewing the evidence they analysed, the LSE team state: “We find no evidence of an association between our measures of quantity of managerial input and quality of management… Furthermore, we find no associations between our measures of quantity of management input and five measures of hospital performance.” They add: “This holds, irrespective of how we define managerial input, whether by number of managers or expenditure on management. These results are generally robust to how we account for variation between hospitals and within hospitals over time.” This leads the researchers to conclude: “Hospitals hiring more managers do not see an improvement in the quality of management leading to better performance, and increasing the numbers of managers does not appear to improve hospital performance through any other direct or indirect mechanism.” Read full story (paywalled) Source: HSJ, 17 January 2022
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Content ArticleThere is a prevailing popular belief that expenditure on management by healthcare providers is wasteful, diverts resources from patient care, and distracts medical and nursing staff from getting on with their jobs. There is little existing evidence to support either this narrative or counter-claims. Asaria et al. explore the relationship between management and public sector hospital performance. They found no evidence of association either between quantity of management and management quality or directly between quantity of management and any of the measures of hospital performance. However, there is some evidence that higher-quality management is associated with better performance. NHS managers have limited discretion in performing their managerial functions, being tightly circumscribed by official guidance, targets, and other factors outside their control.
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Content ArticleIs it realistic to think of separating NHS hospital sites more effectively for “cold” (elective) and “hot” (acute and urgent) care, so that outbreaks or seasonal surges don’t lead to elective care being cancelled or delayed? David Oliver, consultant in geriatrics and acute general medicine, explores this idea in a BMJ article.
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Content ArticleThe brief focuses on the nursing workforce at a time when a global pandemic is raging across the world. The year just ended—2021— has seen unprecedented damage inflicted on health systems and on the nursing workforce. The year just begun—2022— marks no change in the continuing relentless pressure of the pandemic on individual nurses, and on the global nursing workforce. This brief was commissioned by the International Centre for Nurse Migration (ICNM). It provides a global snapshot assessment of how the COVID-19 pandemic is impacting on the nursing workforce, with a specific focus on how changing patterns of nurse supply and mobility will challenge the sustainability of the global nursing workforce. It also sets out the urgent action agenda and global workforce plan for 2022 and beyond which is required to support nurse workforce sustainability, and therefore improve health system responsiveness and resilience in the face of COVID-19.
