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Showing results for tags 'Accident and Emergency'.
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News Article
NHS call handlers quitting over stress amid ‘relentless exposure to trauma’
Patient Safety Learning posted a news article in News
NHS call handlers are quitting amid burnout at dealing with 999 calls about suicides, stabbings and shootings and the long delays before ambulances reach patients. The pressure is so intense that 27% of control room staff in ambulance services across Britain have left their jobs over the last three years, NHS figures show. Many feel overwhelmed by the demands of their roles, unsupported by their employers and powerless to help patients who are facing life-or-death emergencies, according to a report by Unison, with some resigning within a year of starting the role. Call handlers get so stressed that they took an average of 33 sick days a year each between 2021/22 and 2024/25, data obtained by the union also showed. That is far higher than the average four days taken off sick by workers in the UK overall. A report by Unison found that call handlers’ jobs have become increasingly challenging in recent years as the demand for care, which rose during Covid, has remained consistently high since, while ambulance handover delays outside hospitals have worsened. “These findings paint a bleak picture of the conditions faced by 999 control room staff. TV programmes about ambulance services don’t show things as they really are,” said Christina McAnea, the Unison general secretary. Unison’s report said: “Relentless exposure to traumatic and increasingly complex incidents, verbal abuse, long shifts and low pay are contributing to stress, burnout and fatigue. One call handler told Unison: “Some shifts are overwhelmingly traumatic, with 90% of the calls of a distressing nature. One shift, I handled three road traffic accidents and two cardiac arrests.” “There’s a persistent pressure to remain on the phone, no matter how emotionally drained we are.” Read full story Source: The Guardian, 17 June 2025- Posted
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News Article
‘Blame shunting’ by providers leads to poor emergency care, says NHSE
Patient Safety Learning posted a news article in News
The ‘inability or unwillingness’ of some NHS and social care providers to work together has contributed to an ‘unimaginable’ deterioration in emergency care performance, according to NHS England The claim is made in the urgent care recovery plan for 2025-26, released by NHS England and the Department of Health and Social Care. The plan includes a new target to reduce 12-hour accident and emergency waits and pledges to invest £370m of capital funding in improving urgent care and mental health facilities. The plan said, “Each part of the system has responsibility for improving urgent and emergency care performance. However, blame shunting has become a feature in some poorly performing systems and can no longer be tolerated." National urgent care director Sarah-Jane Marsh told HSJ that “the duty to collaborate and work together and do the best for patients is on all trust boards, and it shouldn’t rely on some overseer to make sure that happens. It’s a fundamental part of being a leader”. Trusts will be told to ensure the proportion of patients waiting over 12 hours for admission, transfer or discharge from A&E remains less than 10%. The 45-minute “maximum” ambulance handover time will become mandatory across all trusts ahead of winter, according to the plan. Chief executive of the College of Paramedics, Tracy Nicholls, said, “The plan sets out progressive structural proposals that have the potential to enhance public safety and strengthen paramedic autonomy. However, it may underestimate key challenges, including workforce readiness, the capacity of the mental health system, and practical implications of the Right Care, Right Person model. Without urgent alignment of funding, training, and alternative care pathways, there is a real risk that paramedics could be left navigating a reform process that shifts responsibility without equipping them with the necessary tools and support. Read full story (paywalled) Source: HSJ, 5 June 2025 Related reading on the hub: How corridor care in the NHS is affecting safety culture: A blog by Claire Cox My experience of the 'Wait 45' policy - Florence in the Machine A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift- Posted
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- Organisation / service factors
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News Article
Nearly £450m is being invested in the NHS in England to cut hospital waiting times and tackle persistently failing trusts, the health secretary has announced. Wes Streeting says his NHS reforms aim to deliver around 40 new centres to fast-track treatment for patients, up to 15 mental health crisis assessment units and almost 500 new ambulances. It is part of an attempt to shift patients away from A&E and avoid unnecessary hospital admissions. "No patient should ever be left waiting for hours in hospital corridors or for an ambulance which ought to arrive in minutes," said Mr Streeting. "The package of investment and reforms we are announcing today will help the NHS treat more patients in the community, so they don't end up stuck on trolleys in A&E," he added. In an example of the challenge facing the health secretary, Sky News on Wednesday revealed the scale of England's mental health crisis, exacerbated by a shortage of specialist beds and an overwhelmed social care network. The new Urgent and Emergency Care Plan for England says more needs to be done to drive down long waits, cut delayed discharges and improve care for patients. Read full story Source: Sky News, 6 June 2025 Related reading on the hub: How corridor care in the NHS is affecting safety culture: A blog by Claire Cox My experience of the 'Wait 45' policy - Florence in the Machine A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift- Posted
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- Hospital corridor
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Content Article
NHS England: Urgent and emergency care plan 2025/26
Patient Safety Learning posted an article in NHS England
This report sets out how the NHS will resuscitate urgent and emergency care, with a focus on getting patients out of corridors, keeping more ambulances on the road, and enable those ready to leave hospital to do so as soon as possible. Summary of actions and impact for patients and carers Focus as a whole system on achieving improvements that will have the biggest impact on urgent and emergency care services this winter By the year-end, with improvement over winter, we expect to: Reduce ambulance wait times for Category 2 patients – such as those with a stroke, heart attack, sepsis or major trauma – by over 14% (from 35 to 30 minutes). Eradicate last winter’s lengthy ambulance handover delays by meeting the maximum 45-minute ambulance handover time standard, helping get 550,000 more ambulances back on the road for patients. Ensure a minimum of 78% of patients who attend A&E (up from the current 75%) are admitted, transferred or discharged within 4 hours, meaning over 800,000 people a year will receive more timely care. Reduce the number of patients waiting over 12 hours for admission or discharge from an emergency department compared to 2024/25, so this occurs less than 10% of the time. This will improve patient safety for the 1.7 million attendances a year that currently exceed this timeframe. Tackle the delays in patients waiting to be discharged – starting with the nearly 30,000 patients a year staying 21 days over their discharge-ready-date, saving up to half a million bed days annually. Increase the number of children seen within 4 hours, resulting in thousands of children every month receiving more timely care than in 2024/25. Develop and test winter plans, making sure they achieve a significant increase in urgent care services provided outside hospital compared to last winter Improve vaccination rates for frontline staff towards the pre-pandemic uptake level of 2018/19. This means that in 2025/26, we aim to improve uptake by at least 5 percentage points. Increase the number of patients receiving urgent care in primary, community and mental health settings, including the number of people seen by Urgent Community Response teams and cared for in virtual wards. Meet the maximum 45-minute ambulance handover time standard. Improve flow through hospitals, with a particular focus on reducing patients waiting over 12 hours, and making progress on eliminating corridor care. Set local performance targets by pathway to improve patient discharge times, and eliminate internal discharge delays of more than 48 hours in all settings. Reduce length of stay for patients who need an overnight emergency admission. This is currently nearly a day longer than in 2019 (0.9 days) and needs to be reduced by at least 0.4 days . Reduce the number of patients who remain in an emergency department for over 24 hours while awaiting a mental health admission. This will provide faster care for thousands of people in crisis every month. National improvement resource and additional capital investment is simplified and aligned to supporting systems where it can make the biggest difference Allocating over £370 million of capital investment to support: Around 40 new same day emergency care centres and urgent treatment centres. Mental health crisis assessment centres and additional mental health inpatient capacity to reduce the number of mental health patients having to seek treatment in emergency departments. Expansion of the Connected Care Records for ambulance services, giving paramedics access to the patient summary (including recent treatment history) from different NHS services, enabling better patient care and avoiding unnecessary admissions.- Posted
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- Emergency medicine
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News Article
Mental health A&E centres to open across England
Patient Safety Learning posted a news article in News
Specialist mental health crisis centres will be opened across England over the next decade in an attempt to reduce crowding in accident and emergency (A&E) departments, the NHS has confirmed. Ten hospital trusts have been piloting new assessment centres to deal with people experiencing a mental health crisis. The aim is to get these patients into appropriate care in a calm environment, avoiding long waits in A&E. NHS England said the new units would reduce overcrowding in hospitals and relieve pressure on emergency services, including the police. But Andy Bell, the CEO of the Centre for Mental Health, an independent charity, said any new provision needed to be properly funded. The scheme is expected to be expanded nationally to "dozens of locations", the government said, as part of its 10-year NHS plan. These clinics will be open to walk-in patients as well as those referred by GPs and police, with specialist staff present to treat people in acute mental distress. Speaking to the Times newspaper, NHS England chief Sir Jim Mackey hailed the "pioneering new model of care", external, where people can "get the right support in the right setting". "As well as relieving pressure on our busy A&Es, mental health crisis assessment centres can speed up access to appropriate care, offering people the help they need much sooner so they can stay out of hospital." Read full story Source: BBC News, 24 May 2025 -
News Article
The UK's top A&E doctor has accused the government of “neglecting the oldest and sickest patients” as figures suggest a record 320 people a week may have died needlessly in A&E last year due to waits for hospital beds. Dr Adrian Boyle, the Royal College of Emergency Medicine president, has warned that current government policy on A&E is focused on cutting waits for “cut fingers and sprained ankles” while neglecting older people, who are most likely to die and spend days on trollies. The Royal College of Emergency Medicine (RCEM) estimates there were more than 16,600 deaths of patients linked to long waits for a bed, an increase of a fifth on 2023 and a record since new A&E data has been published. The figures come after the NHS’s target to see 95% of patients within four hours was cut to 78% for 2025/26. There is no national target for the number of people waiting 12 hours, the length of time linked to excess emergency care deaths, but last year more than 1.7 million patients waited 12 hours or more to be admitted, discharged or transferred from A&E. Dr Boyle said the figures were “the equivalent of two aeroplanes crashing every week” and were devastating for families. Read full story Source: The Independent, 15 May 2025- Posted
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- Accident and Emergency
- Lack of resources
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News Article
Thousands of people in a mental health crisis are enduring waits of up to three days in A&E before they get a bed, with conditions “close to torture” for those in such a distressed state. At one hospital, some patients have become so upset at the delays in being admitted that they have left and tried to kill themselves nearby, leading nurses and the fire brigade to follow in an attempt to stop them. A&E staff are so busy dealing with patients seeking help with physical health emergencies that security guards rather than nurses sometimes end up looking after mental health patients. The findings are included in research by the Royal College of Nursing. Its leader, Prof Nicola Ranger, called the long waits facing those in serious mental ill health, and the difficulties faced by A&E staff seeking to care for them, “a scandal in plain sight”. The RCN’s research into “prolonged and degrading” long stays in A&E also disclosed that: Some trusts that previously had no long waits for mental health patients now have hundreds. The number of people seeking help at A&E for mental health emergencies is rising steadily and reached 216,182 last year. The recruitment of mental health nurses has lagged far behind the rise in demand. The number of beds in mental health units has fallen by 3,699 since 2014. Rachelle McCarthy, a senior charge nurse at Nottingham university hospitals NHS trust, said: “It is not uncommon for patients with severe mental ill health to wait three days. Many become distressed and I totally understand why. I think if I was sat in an A&E department for three days waiting for a bed I would be distressed too.” Read full story Source: The Guardian, 13 May 2025- Posted
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- Mental health
- Accident and Emergency
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News Article
More than 1m older people in England waited over 12 hours in A&E last year
Patient Safety Learning posted a news article in News
More than 1 million older people a year in England are forced to wait longer than 12 hours in A&E, with many having to endure “degrading and dehumanising” corridor waits on trolleys. The number aged 60 and over waiting more than 12 hours to be transferred, admitted or discharged increased to 1.15 million in 2024, up from 991,068 in 2023. The figure was 305,619 in 2019, according to data obtained by the Royal College of Emergency Medicine (RCEM) under freedom of information laws. A report by the RCEM also found the risk of a 12-hour wait in an emergency department in England increased with the age of the patient. People aged 60 to 69 had a 15% chance of waiting 12 hours or more. For those aged 90 and over, the likelihood rose to 33%. “The healthcare system is failing our most vulnerable patients – more than a million last year,” said Dr Adrian Boyle, the president of the RCEM. “These people are our parents, grandparents, great-grandparents. “They aren’t receiving the level of care they need, as they endure the longest stays in our emergency departments, often suffering degrading and dehumanising corridor care. It’s an alarming threat to patient safety. We know long stays are dangerous, especially for those who are elderly, and puts people’s lives at risk.” As well as long waits, the RCEM report found many older people were missing out on vital checks in A&E. Of patients aged over 75, only 16% were screened for delirium – a reversible condition linked to an increased risk of death. Fewer than half (48%) of patients were screened for their risk of falls. Read full story Source: The Guardian, 6 May 2025- Posted
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- Older People (over 65)
- Accident and Emergency
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Content Article
More than a million older people faced waits of 12 hours or more in A&Es in England last year – and shockingly, the older a person is, the more likely they are to experience a long stay in the emergency department – new data from the Royal College of Emergency Medicine (RCEM) reveals.It comes as the College publishes a new report looking at the care older people receive in emergency departments.The research, titled ‘Care of Older People 2023-24’, is part of the College’s clinical Quality Improvement Programme which aims to improve the care of patients attending Emergency Departments. This interim report reflects the findings of the second year of the three-year programme. Across the UK, 149 Emergency Departments submitted 24, 865 patient cases from 4 October 2023 – 3 October 2024. A key finding was that among patients over the age of 75, there was insufficient screening for three common conditions which primarily affect this age group: Only 16% of patients were screened for delirium – a reversible condition which can be associated with mortality, characterised by a sudden change in mental function.On average less than half (48%) had screening to assess the risk of falling.An average of 56% underwent screening for general frailty – which if detected can trigger early intervention and support in hospital and in the community.Despite a year-on-year improvement from 2023, these patients are enduring the longest waits in A&Es and are bearing the brunt of an Urgent and Emergency Care system in crisis. Older people are often more likely to suffer with complicated or multiple health issues. This, combined with the wider issues related to a shortage of in-patient beds, mean they can often end up enduring extreme long waits in A&E – often on trolleys in corridors.- Posted
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- Older People (over 65)
- Accident and Emergency
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News Article
Patient suffered diagnosis delay after junior doctor missed 'red flags' in A&E
Patient Safety Learning posted a news article in News
A patient suffering from a perforated bowel had their diagnosis delayed after a junior doctor missed “red flags” during an assessment in A&E. After arriving at the emergency department of an NHS Forth Valley hospital, the patient was initially assessed by a junior doctor who ordered various tests and investigations. They were later moved to the acute assessment unit and diagnosed with a perforated bowel. The patient developed sepsis after undergoing emergency surgery. The patient’s child complained to the Scottish Public Services Ombudsman (SPSO) about their parent’s treatment. Specifically, they complained about the delay in identifying their parent’s condition, which they believe led to a worse outcome. NHS Forth Valley acknowledged that a more senior doctor may have identified the cause quicker, but that the care provided was reasonable, and that the complaint had led to learning and ongoing development. In putting together their report, the SPSO took independent advice from an emergency medicine consultant. It found that there were “a number of red flags” when the patient was admitted and that it did “not appear” they had been reviewed by a senior clinician. Issues were also found in the patient’s documentation; no intimate examination was recorded, and there was a “lack” of documentation around the interpretation of an X-ray. Overall, the report concluded that the initial assessment delayed diagnosis of the perforated bowel and was likely to have had a “significant effect” on the patient’s outcome. Read full story Source: STV News, 29 April 2025- Posted
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- Diagnosis
- Skill-based issue
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Content Article
This King's Fund article sets out how prioritising non-clinical support for people who frequently attend A&E can contribute to the government’s ambition to deliver three major shifts in health and care.- Posted
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- Accident and Emergency
- Emergency medicine
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News Article
Urgent care worse than pre-pandemic, think tank says
Patient Safety Learning posted a news article in News
A leading health think tank says urgent and emergency care in England is performing "far worse" than before the pandemic. The Health Foundation argues that the NHS was "in distress" this winter with A&E waiting times reaching a record high. The group says it would be wrong just to blame relatively high levels of flu. The government is due to publish an urgent and emergency care plan soon. The Department for Health and Social Care said that hospitals were "feeling the strain" but that it was taking "decisive action" to prevent winter crises. The Health Foundation report on the recent winter says that the number of people waiting 12 hours or more in A&E after a decision to admit to a ward was the highest since modern records began. It topped 60,000 in January, or 11% of emergency admissions. The report says that a familiar problem remains as acute as ever – delays discharging patients from hospital who are fit to leave. This, it says, made bottlenecks worse in A&E and for ambulances trying to hand over patients and that delays for those handovers were worse than in previous winters. Read full story Source: BBC News, 28 April 2025- Posted
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- Organisational Performance
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Content Article
The health service in England has endured a punishing winter. Stark warnings about a potential ‘quad-demic’, the ‘busiest year on record’ for A&E and ambulance services, and ’jampacked’ hospitals prompted comparisons with the COVID-19 pandemic. But how bad was winter 2024/25? The Health Foundation present analysis of routinely collected and publicly available data on health service performance and the possible contributing factors. Key points: This winter saw the NHS in distress. Only 73% of A&E patients were treated within 4 hours, similar to the last two winters, and far below the 95% constitutional standard. The number of people experiencing 12-hour waits before admission reached a new record high. Numbers of A&E diverts and ambulance handover delays were worse than over previous winters. Looking at operational performance, winter pressures and other factors, the analysis explores the extent to which disruptions to urgent and emergency care were caused by higher than usual levels of winter illnesses and/or systemic weaknesses within the NHS. Levels of flu and diarrhoea and vomiting were higher than usual. Hospital admissions for flu reached a similar peak to winter 2022/23 but took longer to fall, leading to a 50% higher total number of flu bed days. However, hospital admissions for RSV were similar to previous winters, while admissions for COVID-19 remained low. Winter A&E attendances have risen steadily each year. However, slightly fewer patients attended major A&E departments in winter 2024/25 than in 2023/24, and emergency hospital admissions fell slightly. This suggests the NHS struggled to cope with a small increase in demand from patients needing emergency hospitalisation, while also expanding elective activity in line with government commitments to improve elective performance. Bed occupancy during winter has been rising for the last 15 years, exceeding the NHS 92% threshold for the first time in winter 2017/18, highlighting a system at its limits. Since COVID-19, a substantial increase in delayed discharges is likely to have obstructed the flow of patients out of hospitals, worsening bottlenecks upstream in the care pathway from A&E into wards and from ambulances into A&E. Overall, the conditions this winter, while severe, were similar to those in recent years and not far above what the NHS can normally expect. Attributing operational problems to external factors such as winter illnesses and higher demand risks offering false comfort about the resilience of the health service. The shows the health service performing far worse than before the pandemic and reporting record or near-record levels of operational problems across urgent and emergency care. Ahead of the government’s forthcoming Urgent and Emergency Care Plan, this raises key questions about what might be behind some of the underlying issues contributing to what has now become an annual winter crisis.- Posted
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- Organisational Performance
- Long waiting list
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News Article
Paramedics told to listen to podcasts while queuing for A&E handovers
Patient Safety Learning posted a news article in News
Paramedics have complained of a “disrespectful” instruction to listen to podcasts while queuing to hand over patients to A&E, HSJ has learned. Staff at South Western Ambulance Service made the claim to an NHS England review of the trust, which also heard concerns about “a lack of effectiveness” in the executive team, “fragile relationships” at senior levels, and a “punitive culture” against speaking up. The report does not make clear who “asked” the paramedics to listen to podcasts during handovers, but CEO John Martin said neither he nor the executive teams had given such an instruction. NHSE’s “well led” review of the trust, released to HSJ following a freedom of information request, said: “We heard examples of staff being asked to read [internal trust communications] or listen to podcasts when they were queuing for handover. Staff were not keen on this, as they felt it was disrespectful towards patients, and they preferred engaging with the patients whilst waiting.” It appears to refer to podcasts featuring internal updates. The organisation has been a national outlier, with large numbers of very long handover delays – when ambulance crews are required to queue for hours before they can transfer their patient to accident and emergency staff – particularly over the past three years. Read full story (paywalled) Source: HSJ, 24 April 2025- Posted
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- Paramedic
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News Article
Mental health A&E programme ‘not far away’
Mark Hughes posted a news article in News
A wave of “mental health A&Es” could be built alongside or close to existing emergency departments, HSJ has learnt. The aim would be to free up pressure on acute emergency departments, as well as providing a better experience for patients with mental health needs, who often wait for appropriate care for many hours. Some similar facilities are already operating, such as Essex Partnership Trust’s mental health urgent care department and Central and North West London Foundation Trust’s crisis assessment service. Read full story Source: Health Service Journal (Paywalled), 15 April 2025 -
News Article
Ambulance services hit key recovery target
Patient Safety Learning posted a news article in News
Ambulance services hit a crucial “interim” target for responding to the bulk of emergency calls last month, and showed marked improvements for the most serious category of incidents. Offering a glimmer of hope after another winter of long ambulance waits, average category 2 performance in March was 28:34 (minutes, seconds) – more than five minutes better than March last year. It is only the third time it has dipped below 30 minutes, which has been set by government as an “interim” recovery target, since December 2022. Waits have soared since the covid-19 pandemic, fuelled by long hospital handover delays, and a string of inquests have highlighted the calamitous impact on patients. Read full story (paywalled) Source: HSJ, 13 April 2025- Posted
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- Ambulance
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News Article
Almost three thousand children had tooth decay so severe they attended A&E last year, new data reveals. MPs have called for an end to the “national scandal” facing NHS dental care, as new figures reveal that in some areas of the country, A&E attendances for tooth decay have risen 40-fold since 2019. Figures obtained by the Liberal Democrat Party under the Freedom of Information Act reveal 2,800 children attended A&E due to tooth decay issues last year – up by a fifth since 2019 but slightly down on 2023. Overall, there were 16,100 A&E attendances over tooth decay in 2024, with areas such as Northwest Anglia NHS Trust seeing cases increase from just 6 in 2019 to 238. The figures come after a report this month from the Public Accounts Committee (PAC) said the national dental plan set out by the former government had “comprehensively failed”. The PAC’s report said the current national contract for dentists “remains unfit for purpose”, with current arrangements only sufficient for about half of England’s population to see an NHS dentist over two years. The Liberal Democrats’ health and social care spokesperson Helen Morgan said: "It is a national scandal that children are ending up in A&E in agony because they can’t get a dentist appointment. “Parents are being forced to watch their little ones cry through the night, all because the NHS dental system has been left to rot. We’re now seeing vast swathes of the country being turned into dental deserts, with no sign of things getting better. “This almost medieval situation of people pulling their own teeth out with pliers as they can’t get an appointment must end. That must start with a complete overhaul of the dental contract to boost the numbers of dentists and appointments and finally rid this country of dental deserts.” Read full story Source: The Independent, 14 April 2025- Posted
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- Accident and Emergency
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News Article
Missed and delayed medication putting A&E patients at risk, new report reveals
Patient Safety Learning posted a news article in News
Patients in A&E are being put in potentially life-threatening situations due to missed doses of prescription medicines, according to a new report. The Royal College of Emergency Medicine (RCEM) found people in A&E were not getting their medications on time and were missing doses needed to manage their illnesses – putting them at risk of getting worse. Insulin for diabetes, Parkinson's drugs, epilepsy medicines and tablets for preventing blood clots are all time critical medicines (TCM). If these drugs are delayed or missed, the patient can deteriorate and is at greater risk of complications or death. While patients are advised to remember to bring their medications to A&E and to take them, there is also a responsibility on NHS staff to make sure this happens. Despite the recognised risk of harm, the delivery of TCM is not consistent across emergency departments with long waiting times often contributing to this. The study, which was part of the College's clinical Quality Improvement Programme (QIP) which aims to improve the care of A&E patients, found more than half of these patients were not identified as being on TCM within 30 minutes of their arrival in an emergency department. In addition, 68% of doses were not administered within 30 minutes of the expected time. "The findings contained in this report should serve as a call to action for both emergency medicine staff, as well as patients reliant on time critical medications, to ensure no dose is ever missed in A&E," said Dr Jonny Acheson, an emergency medicine consultant in Leicester who has Parkinson's, led the study. Read full story Source: The Independent, 7 April 2025 Further reading on the hub: Time-critical Parkinson’s medication: the human cost of delays and mistakes HSSIB investigation report: Medication not given: administration of time critical medication in the emergency department Parkinson's UK: Time critical medication guides for health professionals Improving safety for diabetic inpatients: 4 key steps D1abasics: Equipping staff to care safely for inpatients with diabetes- Posted
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- Medication
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Content Article
Patient safety is being put at risk in Emergency Departments due to missed doses of vital prescription medicines. This is one of the findings of a study being carried out by the Royal College of Emergency Medicine (RCEM) which revealed that many patients who rely on prescription medication to manage chronic conditions such as diabetes and Parkinson’s, aren’t always getting these vital drugs when in A&E. These types of drugs are known as ‘time critical medication’ (TCM) and, as the name suggests, it is important they are taken at specific times. If a dose is delayed or missed, it can cause a person’s health to worsen. And if this delay is prolonged, the consequences can be severe. The RCEM’s new report – Time Critical Medication QIP 2023-24 is part of the College’s clinical Quality Improvement Programme (QIP), which aims to improve the care of patients attending Emergency Departments. The three-year QIP examines how time critical medications are dealt with in practice when patients come to the Emergency Department and how clinical methods and patient safety can be improved. This report reflects the findings of the first year of the programme. Across the UK, 136 Emergency Departments collated and analysed data for people living with diabetes and Parkinson’s, who take certain medication such as insulin injections and a drug called levodopa, taken as tablets or capsules. Supported by Parkinson’s UK and Diabetes UK, the QIP found more than half of eligible patients (53.4%) taking TCM weren’t identified within 30 minutes of their arrival in ED. Meanwhile, around 68% of eligible patients’ doses weren’t administered within 30 minutes of the expected time. In response to the findings, the QIP team made the following recommendations: Patients on TCM need to be identified early to start the process of getting all doses whilst in the ED. Systems need to be in place that will facilitate the timely administration of TCM, including self-administration. Local EDs must have a clear governance structure in place to determine who is responsible for the prescribing and administering of TCM in the ED from when the patient arrives, to when they are admitted to the ward or discharged from the ED. Further reading on the hub: Time-critical Parkinson’s medication: the human cost of delays and mistakes HSSIB investigation report: Medication not given: administration of time critical medication in the emergency department Parkinson's UK: Time critical medication guides for health professionals Improving safety for diabetic inpatients: 4 key steps D1abasics: Equipping staff to care safely for inpatients with diabetes- Posted
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- Medication
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News Article
Paramedics across England are watching patients die in the back of ambulances because of delays outside emergency departments, according to a survey by Unison. The gridlock of patients in some of the country’s hospitals has led to queues of up to 20 ambulances outside casualty departments in certain areas. In a number of cases, crews have been forced to wait more than 12 hours before handing over patients. The survey of nearly 600 ambulance workers reveals the toll of the waits on patients and the crews looking after them. Unison warns that “car park care” is increasingly becoming the norm, with hospital medical staff tending to patients in the back of ambulances. More than three-quarters (77%) of paramedics and emergency medical technicians said they have had to look after people in the back of ambulances in the past year while stuck outside emergency departments. Two-thirds (68%) have waited in hospital corridors, or in other locations, with one paramedic often caring for several patients to allow colleagues to respond to other calls. More than two-thirds also reported patients’ health deteriorating during long waits, and one in 20 (5%) said people have died in their care because of long delays in being admitted. Gavin Taylor, 58, a Unison representative and ambulance worker in the north-west of England, said it was now a regular occurrence to be waiting several hours to hand over a patient. He said: “It’s heartbreaking because we are here as a caring profession and the delays have an impact on the care and wellbeing of patients.” Read full story Source: The Guardian, 6 April 2025- Posted
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News Article
Rise in autistic children going to A&E putting pressure on NHS
Patient Safety Learning posted a news article in News
Positive Support Group said one child spent more than 120 days in hospital with ‘no medical need’ and warned that funding cuts were driving the surge Becky, a 46-year-old charity worker. said her 14-year-old daughter Sofia first called the emergency services because she has autism and was in extreme distress during a crisis “At the time, I had no support,” said Becky, a 46-year-old charity worker. “In a way, Sofia calling in the ambulance was a saving grace for us.” Her called the emergency services when she was 13, not because she was in physical danger, but because she has autism and was in extreme distress during a crisis. According to her mother, Sofia has required emergency care to cope with multiple crises over the years. NHS data analysed by the Positive Support Group (PSG) found that there were more than 20,000 episodes where children with autism were admitted to and discharged from emergency hospital care on the same day in 2023-24 — a 86% increase since 2019-20, according to the behavioural health group. Read full story (paywalled) Source: The Times, 2 April 2025- Posted
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Content Article
Ambulance services play a pivotal role in ensuring the safety of mothers and their newborns during urgent and emergency situations. These services act as the frontline responders, providing immediate care and facilitating timely transport to appropriate healthcare facilities. World Patient Safety Day, observed annually on 17 September, serves as a global platform to raise awareness about patient safety and encourage collaborative efforts to reduce harm in healthcare settings. The theme for 2025, 'Safe care for every newborn and every child', underscores the critical importance of safeguarding our youngest and most vulnerable patients from preventable harm. In the UK, ambulance services play a pivotal role in ensuring the safety of mothers and their newborns during urgent and emergency situations. These services act as the frontline responders, providing immediate care and facilitating timely transport to appropriate healthcare facilities. Their contributions are multifaceted, encompassing emergency childbirth assistance, neonatal transfers and the management of obstetric emergencies. In addition, many women and families will use the 999/111 service throughout the childbearing continuum, often using these services as a gateway to accessing maternity care. A recent review of Maternity and Newborn Safety Investigations (MNSI) highlighted that 6 in 10 independent investigations that met the criteria for MNSI involved the ambulance service. Out-of-hospital births, though relatively rare, present unique challenges for ambulance clinicians. Intrapartum care accounts for approximately 0.05% of emergency medical services' caseload, with only about 10% of these cases resulting in deliveries managed by ambulance staff. This limited exposure can lead to a decline in obstetric clinical skills, potentially impacting patient care. To address this, continuous training and simulation exercises are essential. For instance, the London Ambulance Service has developed a bespoke communication tool to support midwives in out-of-hospital settings, ensuring effective communication during the transfer of women or babies in emergencies and delivers bespoke mandated emergency training to its frontline clinicians. Such initiatives enhance the preparedness of ambulance clinicians to manage emergency deliveries safely; however, these are not standardised across services. Challenges and areas for improvement Despite their critical role, UK ambulance services face challenges that can impact maternal and neonatal safety. Incidents of delayed response times have been reported, leading to tragic outcomes. For example, a three-day-old baby named Wyllow-Raine Swinburn passed away after an eight-minute delay in answering a 999 call and a 31-minute wait for the ambulance to arrive. Although the delays were not deemed the direct cause of death, they highlighted inefficiencies in the emergency response system. In other cases, the lack of effective training for ambulance clinicians impacted upon the management of a time critical breech delivery, with tragic consequences. Such cases underscore the need for systemic improvements, including better resource allocation, enhanced training and the implementation of robust protocols to minimise delays in emergency response. Collaboration between ambulance services and midwifery teams is essential for improving outcomes in maternal and neonatal emergencies. The development of communication tools and training programmes exemplifies efforts to standardise information exchange during emergencies, thereby reducing the potential for errors and delays. Furthermore, ambulance services are increasingly recognising the importance of specialised roles focused on maternity care. For instance, paramedics with additional training in neonatal and maternity care can provide more comprehensive support during emergencies. Susie, a paramedic with the Northwest Ambulance Service, highlighted her passion for improving maternity care within the ambulance service, emphasising the importance of continuous professional development in this area. Conclusion As we observe World Patient Safety Day 2025, it is imperative to acknowledge and support the vital role of UK ambulance services in safeguarding mothers and their newborns during and following pregnancy. Continuous training, effective communication tools and collaborative practices are essential to enhance the safety and quality of care provided. By addressing existing challenges and building on successful initiatives, we can move closer to the goal of ensuring safe care for every newborn and every child from the very start. Further reading Exploring the pre-hospital setting for the emergency care and transfer of neonates: the role of UK ambulance and neonatal transport services Displaced risk. Keeping mothers and babies safe: a UK ambulance service lens An exploration of maternity and newborn exposure, training and education among staff working within NWAS Disparities In Access to the Northwest Ambulance Service during pregnancy, birth and postpartum period and its association with neonatal and maternal outcomes World Patient Safety Day 2025- Posted
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News Article
Patient satisfaction with NHS has hit record low of 21%, survey finds
Patient Safety Learning posted a news article in News
Public satisfaction with the NHS is at a record low and dissatisfaction is at its highest, with the deepest discontent about A&E, GP and dental care. Just 21% of adults in Britain are satisfied with how the health service runs, down from 24% a year before, while 59% are dissatisfied, up from 52%, the latest annual survey of patients found. Satisfaction has fallen dramatically from the 70% recorded in 2010, the year the last Labour government left office, and the 60% found in 2019, the year before the Covid-19 pandemic. Mark Dayan, a policy analyst at the Nuffield Trust thinktank, which analysed the data alongside the King’s Fund, said the years since 2019 have seen “a startling collapse in NHS satisfaction. “It is by far the most dramatic loss of confidence in how the NHS runs that we have seen in 40 years of this survey.” A&E is the NHS service the public is least happy about. Satisfaction fell from 31% in 2023 to just 19% last year – the lowest proportion in the 41 years the British Social Attitudes (BSA) survey of the views of patients in England, Scotland and Wales has been carried out. Satisfaction with NHS dentistry has collapsed, too, from 60% as recently as 2019 to just 20% last year. More people (55%) are dissatisfied with dental care than with any other service. Similarly, fewer than a third (31%) of adults are satisfied with GP services. “The latest results lay bare the extent of the problems faced by the NHS and the size of the challenge for the government”, said Dan Wellings, a senior fellow at the King’s Fund. “For too many people, the NHS has become too difficult to access. How can you be satisfied with a service you can’t get into?” Read full story Source: The Guardian, 2 April 2025 -
Content Article
The Nuffield Trust and The King’s Fund join forces each year to analyse and present findings from the gold-standard survey of public attitudes and opinions towards the NHS and social care, as surveyed by NatCen. The 2024 survey results show that the British public are deeply unhappy with the way the NHS runs – just 1 in 5 people said they were satisfied. Key findings Satisfaction with the NHS In 2024, just one in five British adults (21%) were ‘very’ or ‘quite’ satisfied with the way in which the NHS runs. This is the lowest level of satisfaction recorded since the survey began in 1983 and shows a steep decline of 39 percentage points since 2019. Only 2% of respondents were ‘very’ satisfied with the NHS, down from 4% in 2023. The percentage of people who were ‘very’ or ‘quite’ dissatisfied with the NHS rose to 59% in 2024, from 52% in 2023. This represents a statistically significant 7-percentage-point increase from the year before, which already had the highest dissatisfaction seen in 40 years of the British Social Attitudes survey. A higher proportion of people in Wales (72%) were dissatisfied with the NHS compared to the survey average and compared to people in England (59%). Supporters of the Reform party were less likely to be satisfied (13%) than the survey average and this was significant after controlling for other variables like age and income. There is a divide between generations, with satisfaction lower and falling in younger age groups. While the proportion of people who were satisfied rose slightly for those aged 65 and over, from 25% to 27%, among those under 65 it fell significantly, from 24% to 19%. Satisfaction with social care In 2024, only 13% of respondents said they were ‘very’ or ‘quite’ satisfied with social care (the same figure as 2023). 53% of respondents were ‘very’ or ‘quite’ dissatisfied. Respondents in Wales (69%) were again significantly more likely to be dissatisfied than the survey average. Satisfaction with different NHS services Public satisfaction with A&E services has fallen sharply, from 31% to just 19%, and dissatisfaction has risen from 37% to 52%. These are the worst figures on record by a large margin and make A&E the service with lowest satisfaction levels for the first time. Satisfaction with NHS dentistry has continued to collapse. As recently as 2019 this was at 60%, but it has now fallen to a record low of 20%. Dissatisfaction levels (55%) are the highest for any specific NHS service asked about. Satisfaction with GP services continued to fall, mirroring the trend over the last few years. 31% of respondents said they were satisfied with GP services, compared with 34% in 2023. Inpatient and outpatient hospital care is the part of the NHS with the highest levels of satisfaction, with 32% saying they were satisfied and only 28% dissatisfied. Attitudes to standards of care, staffing and efficiency The majority of the public (51%) said they were satisfied with the quality of NHS care. People aged 65 and over were more likely to be satisfied (68%) with the quality of NHS care than those under 65 (47%). Dissatisfaction with waiting times and the ability to get an appointment is widespread, and is consistent across respondents from all ages and UK countries: 62% of all respondents were dissatisfied with the time it takes to get a GP appointment. 23% were satisfied. 65% of respondents said they were dissatisfied with the length of time it takes to get hospital care. 14% said they were satisfied. Dissatisfaction levels are highest regarding the length of time it takes to be seen in A&E. 69% of respondents said they were dissatisfied, while just 12% said they were satisfied. Only 11% agreed that ‘there are enough staff in the NHS these days’. 72% disagreed. NHS funding, principles and priorities 8% of respondents said that the government spent too much or far too much money on the NHS; 21% said that it spent about the right amount, and 69% said that it spent too little or far too little. When asked about government choices on tax and spending on the NHS, the public would narrowly choose increasing taxes and raising NHS spend (46%) over keeping them the same (41%). Only 8% would prefer tax reductions and lower NHS spending. Only 14% of respondents agreed that ‘the NHS spends the money it has efficiently’. 51% disagreed with this statement. Respondents felt the most important priorities for the NHS should be making it easier to get a GP appointment (51%) and improving A&E waiting times (49%), with increases in staff (48%) and better hospital waiting times close behind (also 48%). A&E has now slightly overtaken staffing as a priority, reflecting the sharp fall in satisfaction described above. People under 65 were more likely to prioritise improving mental health services (34%) than those aged 65 and over (21%). As in previous years, a strong majority of respondents agreed that the founding principles of the NHS should ‘definitely’ or ‘probably’ apply in 2024: that the NHS should be free of charge when you need to use it (90%); the NHS should primarily be funded through taxes (80%); and the NHS should be available to everyone (77%). The percentage of people saying that the NHS should ‘definitely’ be available to everyone decreased from 67% in 2023 to 56% in 2024. This is the only statistically significant change year-on-year across all three principles. Supporters of the Reform party (20%) were significantly less likely to say that the NHS should ‘definitely’ be available to everyone than the survey average.- Posted
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News Article
Departing NHSE boss ‘calls out’ A&E variation
Patient Safety Learning posted a news article in News
NHS England’s outgoing chief operating officer has claimed there is too much unwarranted variation in the service’s emergency care performance. Dame Emily Lawson made the comment at last week’s NHSE board meeting ahead of her departure from the organisation yesterday. She told the board that she “wanted to call out variability” in the spread of 12-hour A&E waits across the county. Dame Emily said: “If we look at the last six months of data, 17.6 per cent of trusts have deteriorated in 12-hour breaches, 25.8 per cent have improved, and the rest have sustained their 12-hour performance. “When we look at headline numbers, we often miss both the improvement that’s going on, but also some of the tensions that are happening and needing to be managed locally.” Dame Emily added that emergency care “still has some opportunity” to improve its productivity, adding that long A&E waits for people in mental health crisis “remain too common”. Read full story (paywalled) Source: HSJ, 1 April 2025- Posted
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