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Showing results for tags 'Accident and Emergency'.
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Content Article
The Patients Association: A&E waiting times survey
Patient Safety Learning posted an article in Emergency medicine
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News ArticlePatients calling NHS 111 in London could face a 30-hour wait before being admitted to a hospital bed, the capital’s ambulance service has warned. Slides presented by London Ambulance Service Trust at a webinar with NHS London this week showed “category three” patients faced long delays at all stages of the process. The length of each stage was said to be as follows: having calls answered at 111 centres (20 mins); the “revalidation” of the call before it is passed to 999 (two hours); 10 to 12 hour waits for an ambulance; and similar waits in emergency departments before being admitted to a bed. Category three calls are considered urgent, but not immediately life-threatening. The calls could involve abdominal pain, uncomplicated diabetic issues and some falls. Category three patients are among those the NHS is encouraging to call first, rather than going straight to accident and emergency, as part of the flagship “111 first” drive designed to produce pressure on emergency care. Normally, the pathway from a 111 call being made to a patient being admitted to a bed would take nine hours with a faster response at all stages, the slides suggest. But the pressure across the NHS from covid cases is leading to much longer waits. Read full story (paywalled) Source: HSJ, 8 January 2021
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News ArticleLondon’s hospitals are less than two weeks from being overwhelmed by covid even under the ‘best’ case scenario, according to an official briefing given to the capital’s most senior doctors this afternoon. NHS England London medical director Vin Diwakar set out the stark analysis to the medical directors of London’s hospital trusts on a Zoom call. The NHS England presentation, seen by HSJ , showed that even if the number of covid patients grew at the lowest rate considered likely, and measures to manage demand and increase capacity, including open the capital’s Nightingale hospital, were successful, the NHS in London would be short of nearly 2,000 general and acute and intensive care beds by 19 January. The briefing forecasts demand for both G&A and intensive care beds, for both covid and non-covid patients, against capacity. It accounts for the impact of planned measures to mitigate demand and increase capacity. Read full story (paywalled) Source: HSJ, 6 January 2021
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News Article
Leaks reveal record waits for emergency care due to covid pressures
Patient Safety Learning posted a news article in News
Very long waits for emergency hospital care have surged in London since mid December, due to a rapid rise in COVID-19 admissions combined with limited capacity, according to figures leaked to HSJ. Data sent to HSJ indicates that December will set a new record high nationally for the number of 12-hour “trolley waits”. This is when there are 12 hours or longer from the decision is made to admit a patient from the emergency department to hospital, to when they are actually admitted to a bed. It adds to fears about what will happen if rising covid occupancy — which has left some hospitals running out of staff and acute beds, and intensive care well over normal capacity — combines with potential additional winter demand in coming weeks. Several senior hospital managers in areas heavily affected by covid said there were two main factors. One is shortage of beds and operational issues: there are about 6,300 fewer general and acute beds open nationally this winter, due to infection prevention measures. The beds that remain have to be split between covid positive and negative, often taking time to convert more. Two sources said bed shortages were exacerbated by problems with discharge, particularly of covid patients who no longer need acute care, including “local authorities taking their eye off the ball on designated settings and covid-positive pathways”, according to one. And another reason behind delays is waiting for covid test results before admitting patients. Read full story (paywalled) Source: HSJ, 4 January 2021 -
EventuntilMany clinicians are involved in the complex care of the trauma patient from the pre-hospital arena through the Emergency Department and often into theatre and critical care. Interventions at all these stages could reduce Nociception and pain in order to facilitate recovery and rehabilitation for survivors. In this two-part Royal Society of Medicine (RSM) webinar series, hear about innovative approaches that cover the entire patient journey rather than only focusing on a single specialty. This thought provoking webinar is an opportunity for 'traumatogist' as well as the generalist to learn how to limit the long-term burden of painful trauma and its early treatment. Register
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News ArticleAn ambulance crew had to wait seven hours to hand over a patient in the West Midlands, it has been revealed. The case on 11 December was highlighted in the West Midlands Ambulance Service's in-house magazine, which said average waits had "ballooned". It said average waits at one hospital were running at nearly three hours in early December. The ambulance service said it hoped to put another 40 crews on the road by January. Delays in hospitals taking over care of patients is considered "risky", NHS England said, because it not only delayed patients receiving specialist assessment and treatment, but also reduced the number of ambulances available to respond to emergencies. The West Midlands trust's weekly briefing magazine, published on 17 December, said only the East of England trust had experienced a similar level of "horrendous" delays. It added that another four hospitals in the West Midlands had average delays of about two hours. The "knock-on" effect it said was some high-risk patients were waiting longer for an ambulance than they should. Meanwhile, some staff had to work late beyond their shifts and missed meal breaks. Read full story Source: BBC News, 23 December 2020
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News ArticleAcutely ill patients requiring emergency care are being diverted to their GP via the new NHS 111 First call-before-you-walk A&E triage system, Pulse has learned. GPs have reported receiving inappropriate NHS 111 referrals including: an acutely dizzy elderly patient who was later confirmed to have had a posterior circulation stroke; a patient with acute coronary syndrome; and a patient with acute UTI symptoms. Meanwhile, GPs are also warning that patients are using the triage system as a way of ‘jumping the queue’ because the route is likely to get them an appointment quicker than calling their practice. From this month, patients in England are being asked to call 111 before attending A&Es – with 111 triaging them to the most appropriate service, including GP practices. Scottish patients are also being asked to phone ahead of attending A&E; while pilots are ongoing in Northern Ireland; and Wales is in the process of rolling out a ‘contact first’ model following summer pilots. The BMA has said the influx of inappropriate referrals by NHS 111 is likely being ‘compounded’ by the new 111 First system, which is ‘contributing to the immense pressures currently facing primary care’. GPs have raised concerns about several cases in which patients should not have been sent to them by 111 because they required more urgent care. One GP, who asked not to be named, told Pulse: "I had a patient with UTI symptoms – a temperature of 39°C, a heart rate of 140, nausea and abdomen/loin pain. They were told: speak to your GP." Read full story Source: Pulse, 21 December 2020
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News Article
CQC: No evidence that remote GP consultations increase A&E attendance
Patient Safety Learning posted a news article in News
The increase in the number of remote GP consultations during the COVID-19 pandemic has not appeared to increase A&E attendances, according to the Care Quality Commission (CQC). The regulatory body discussed concerns about access to GP services during its September meeting, including the suggestion that the increase in remote consultations and a perceived lack of face-to-face appointments were potentially leading to ‘increased attendance at A&E’. However, chief inspector Rosie Benneyworth has confirmed that – having looked into this – the organisation has ‘not seen evidence’ to suggest a link between the two. Despite this, she noted ‘anecdotal concern’ about people attending A&E departments if they ‘feel their needs are not being met elsewhere’. GPs have faced media criticism in the past few months for the perception that they have are failing to provide face-to-face appointments, with some believing that patients attend A&E as a result. Minutes from the September CQC board meeting said: ‘Concerns about access to GP services were… discussed, including the suggestion that digital appointments were not meeting the needs of some patients and how this could potentially lead to increased attendance at A&E. Work to quantify the extent of the problem and to monitor it was underway.’ But Dr Benneyworth told Pulse this week: ‘While there may be some anecdotal concern about people attending Emergency Department (ED) if they feel their needs are not being met elsewhere, we have not seen evidence to suggest a link between digital appointments and ED attendance. The latest figures also show there has not been a sharp rise in online/video appointments (according to NHS Digital they are not currently at pre-COVID-19 levels). Read full story Source: Pulse, 7 December 2020 -
News Article
Trusts warned they are being ‘complacent’ on A&E over-crowding
Patient Safety Learning posted a news article in News
Emergency medics are writing to hospital chief executives warning them that some trusts are being ‘complacent’ about crowding in A&E, they have told HSJ. The Royal College of Emergency Medicine (RCEM) is sending a letter to trust chiefs today calling on them to urgently plan for how they will stop corridor waits and exit blocking ahead of January and February, typically the busiest months. It says some trusts were not treating emergency department crowding as a “high priority”, despite covid risks and pressures. It is also calling for overcrowding in the emergency department (ED) to be classed as a “never event” — a set of major safety risks. RCEM’s concern comes amid apprehension over long ambulance queues at hospitals across the UK, and difficulties enabling social distancing between patients in many EDs. Read full story (paywalled) Source: HSJ, 3 November 2020 -
EventA Westminster Health Forum policy conference with: Dr Clifford Mann, National Clinical Director, Urgent and Emergency Care, NHS England and NHS Improvement Dr Katherine Henderson, President, Royal College of Emergency Medicine Jessica Morris, Nuffield Trust; Dr Nick Scriven, The Society of Acute Medicine; Sandie Smith, Healthwatch Cambridgeshire and Peterborough; and Deborah Thompson, NHS Acute Frailty and Ambulatory Emergency Care Networks and NHS Elect Delegates will discuss key developments and challenges in the context of service changes in response to the COVID-19 pandemic, and the ongoing implementation of the NHS Long Term Plan. Register
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News Article
New trust’s ‘inexperienced’ leadership criticised as CQC serves warning
Patient Safety Learning posted a news article in News
The Care Quality Commission (CQC) has criticised a new trust’s leadership after issuing it with a warning notice to improve care in its two emergency departments. The watchdog warned North Cumbria Integrated Care Foundation Trust that patients were not always receiving timely and appropriate care, while delayed transfers of care had “resulted in significant delays in admitting patients on to wards”. The CQC — which carried out focused inspections at the trust in August and September after concerns were raised about risks to patient and staff safety — added there was evidence of “insufficient numbers of suitably qualified, skilled, competent and experienced clinical staff”. The CQC also said there was a lack of an effective system to mitigate risks, including infection control in the emergency department escalation areas and on some medical wards. Of the trust’s Cumberland Infirmary and West Cumberland hospitals, the CQC said: “People could not access the urgent and emergency care and medicine service when they needed them and often had long waits for treatment.” The CQC’s inspection report, published today, also said the trust had an “inexperienced leadership team” which “did not always have the necessary skills and abilities to lead effectively”. It added there were “few examples of leaders making a demonstrable impact on the quality or sustainability of services”. Read full story (paywalled) Source: HSJ, 30 November 2020 -
News Article
111 First to go live imminently amid ‘vehement’ opposition in some EDs
Patient Safety Learning posted a news article in News
Emergency care leaders are warning it will take up to six more months to determine whether pilots of a radical change to accident and emergency are working, even though it is due to go live nationally next week, HSJ has learned. HSJ understands the new “111 First” system — where walk-in patients not in medical emergencies call 111 to “book” urgent care — is set to “go live” across England from next week following pilots in acute trusts which have been run since the summer. From 1 December, people will be able to call NHS 111 from anywhere in the country and have urgent care “booked” for them if needed, it is understood. NHS England has been pursuing the 111 First model to help reduce overcrowding and the risk of nosocomial infections in A&Es. The service is also intended to be able to book them into GP practice appointments. Well-placed sources confirmed most acute trusts have now implemented some form of 111 First and the model is set to be part of their standard operations when the national system “goes live” next week. A national advertising campaign is expected to promote the approach. But the Royal College of Emergency Care Medicine said there was a “vocal minority” of clinicians who are “vehemently against” 111 First as they believe it will increase demand in emergency departments. Read full story (paywalled) Source: HSJ, 25 November 2020 -
News Article
Top teaching trust blames surge in long A&E waits on covid measures
Patient Safety Learning posted a news article in News
A top teaching hospital has blamed covid measures for a dramatic rise in the number of trolley waits in its accident and emergency department. In October, 111 patients at Cambridge University Hospitals (CUH) Foundation Trust, which runs Addenbrooke’s Hospital, waited more than 12 hours for admission, despite the region’s relatively low covid rates. CUH recorded just nine 12-hour waits in September and 27 in August. It had no 12-hour waits in either June or July this year, and in October 2019, it had only one. The trust also had 761 patients who waited more than four hours from the decision to admit to admission last month, out of a total of 2,998 emergency admissions. CUH director of operations Holly Sutherland said: “We have had to reorganise the hospital to meet infection control requirements and to reduce the risk of covid-19 transmission. With limited side room availability due to the age of our facilities, this has reduced the number of beds in the hospital by around 100 and has impacted on patient flow from the emergency department." “We would like to apologise to anyone affected by this, and to reassure our patients that their safety is our utmost priority and we are doing everything we can to treat them as quickly as possible.” Read full story (paywalled) Source: HSJ, 18 November 2020 -
Content Article
I think you’re on mute… a blog by Sally Howard
Sally Howard posted an article in Culture
Anyone who has the pleasure of virtual meetings in the current climate will hear the phrase "I think you’re on mute" at least two or three times a week. And this may not be the only place where people feel they are ‘on mute’. The dangers we know: voices unheard, frustrations hidden, staff feeling overwhelmed, undervalued. So if this is you, here’s three simple tips that may help: Make time to talk things through 1:1 Create a safe space to talk things through with a trusted colleague, maybe your boss or a colleague, a good friend or a trained coach. The NHS Leadership Academy offers access to trained coaches: https://www.leadershipacademy.nhs.uk/resources/coaching-register/. Make time for a 5–10 minute daily check-in with people around you Less a luxury more a necessity, especially now. A lot of teams have daily huddles in place. It’s a time to listen, a time to ask the right questions and have your say. What you think, what you see; your great ideas matter. Appreciate those around you Nancy Kline recommends a 5 to 1 ratio of praise to criticism. It really does work. And finally be kind to yourself Years ago a brilliant colleague recommended her three treats approach: A daily treat Maybe a special coffee or a just take a bit of fresh air during another long shift A weekly treat Long walk, lovely meal, whatever gets you in a happy place, A monthly treat Very long walk (only joking) – you’ll think of something. "You can buy your employees' time and muscle... but their hearts and minds come free.” Stephen Covey- Posted
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News ArticlePatients, including those with the coronavirus, are being kept “head to toe” on trolleys in accident and emergency departments in Manchester, with some forced to wait up to 40 hours for a bed. The “dangerous” situation has sparked warnings from the president of the Royal College of Emergency Medicine over the “potentially lethal” crowding of patients in A&Es across the country this winter. Katherine Henderson said she was “absolutely terrified” by what was happening in some departments. She said she had warned NHS England about the dangers of crowding patients in A&E but that not enough action had been taken. She told The Independent: “Crowding in A&E is unsafe, but with coronavirus it is potentially lethal. We have said this endlessly to NHS England." “Everyone agrees crowding is bad, but what they’re not doing is translating that into action.” After hearing of the situation in Manchester, she added: “Exactly what we said should not happen is happening. I am absolutely terrified by this. What more can I do? I have highlighted this risk everywhere I can over the past few months.” Read full story Source: The Independent, 11 November 2020
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Content ArticleThe session described three things. Firstly, the importance of improving flow in hours – so when a bed is available and how quickly can we fill it. Secondly, reducing length of stay in days and, thirdly, working to safely keep more patients at home. During this event, where 70 people joined the conversation, colleagues in the Netherlands described the methodology of ‘Real Time Demand Capacity’ which they have implemented. It is Improvement Cymru's aim in 2021 to help improve the understanding of the science of flow using lean and to support implement these principles into our health and social care systems, which they think will have a significant impact on this problem. Watch the webinar and read the accompanying blog from Iain Roberts, Head of Programmes.
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News ArticleSenior clinicians say their trust board has caved into political pressure by making an ‘unsafe’ decision to re-open a small emergency department — having previously suggested this would not happen if there was a second wave of coronavirus. In a letter to management at Lancashire Teaching Hospitals Foundation Trust, seen by HSJ, a group of 17 emergency medicine consultants have raised serious concerns over the planned re-opening of the accident and emergency department at Chorley and South Ribble Hospital next week. The unit, which has long suffered from staffing shortages and temporary closures, was again closed on a temporary basis at the start of the coronavirus pandemic. When covid subsided in the summer, plans were put forward to reopen it in the autumn. However, when announcing this, chief executive Karen Partington said: “It is really important that everybody recognises that if covid-19 cases begin to rise significantly, or other safety concerns are identified, we will need to revisit the situation.” The letter from the clinicians, addressed to trust clinical director Graham Ellis, said: “We consider that the trust has been subjected to an undercurrent of external pressure which has resulted in an unsafe decision being taken to re-open the ED prematurely…" Read full story (paywalled) Source: HSJ, 30 October 2020
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News ArticleAmbulance chiefs have warned coronavirus precautions in hospital emergency departments are putting patients’ lives at risk because of long delays before patients are being treated. West Midlands Ambulance Service has written a formal warning to three hospitals in the region over the delays to handing over patients from ambulance to hospital staff. In one case, a patient was left waiting with ambulance crews for up to three and a half hours. According to the letter, obtained by the Health Service Journal, the delays are being caused because of tougher infection control measures with ambulance bosses warning the situation is “dangerous”. Director of nursing Mark Docherty said the delays meant ambulances could not be sent to “life threatening emergencies”, and warned: “Lives will be put at risk and patients will come to harm as a result”. He added: “I alerted you to a serious concern about patients being kept on ambulances outside your hospital. Of great concern is the fact that a hospital risk assessment identifies this process as a mitigation to reduce risk in your hospital…" Read full story Source: The Independent, 29 October 2020
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News Article
England's 'fragile' care sector needs immediate reform, says regulator
Patient Safety Learning posted a news article in News
The government must immediately deliver a new deal for social care with major investment and better terms for workers, the Care Quality Commission (CQC) has said, as it warned that the sector is “fragile” heading into a second wave of coronavirus infections. In a challenge to ministers, the regulator’s chief executive, Ian Trenholm, said overdue reform of the care sector “needs to happen now – not at some point in the future”. Boris Johnson said in his first speech as prime minister, in July 2019: “We will fix the crisis in social care once and for all.” But no reform has yet been proposed, and more than 15,000 people have died from COVID-19 in England’s care homes. Trenholm said Covid risked turning inequalities in England’s health services from “faultlines into chasms” as the CQC published its annual State of Care report on hospitals, GPs and care services. The report reveals serious problems with mental health, maternity services and emergency care before the pandemic, and says these areas must not be allowed to fall further behind. The regulator argued that the health system’s response to the pandemic needs to change. After focusing on protecting NHS services from being overwhelmed, health leaders must now adapt to prevent people who need help for non-Covid reasons from being left behind, it said. These include people whose operations were cancelled and people from black and minority ethnic backgrounds, people with disabilities, and people living in deprived areas who have suffered more severely from the impact of Covid. “Covid is magnifying inequalities across the health and care system – a seismic upheaval which has disproportionately affected some more than others,” said Trenholm. Read full story Source: The Guardian, 16 October 2020 -
News Article
Maternity scandal hospital fined for not triaging A&E patients fast enough
Patient Safety Learning posted a news article in News
An NHS hospital which has faced repeated criticism by regulators for poor standards of care has been fined £4,000 for failing to assess A&E patients quickly enough. The Shrewsbury and Telford Hospitals Trust has been fined by the Care Quality Commission (CQC) after patients were not triaged within 15 mimutes of arrival in A&E – in breach of conditions set by the regulator last year and a national target. The care of emergency patients at the hospital trust, which is also facing an inquiry into poor maternity care, has been a long running concern for the watchdog which has rated the trust inadequate and put it in special measures in 2018. Earlier this year the CQC’s chief inspector of hospitals, Professor Ted Baker, wrote to NHS England warning of a “worsening picture" at the Midlands hospital and demanding action be taken. The CQC said it had issued the fixed penalty notice to the trust because it failed to comply with national clinical guidance that all children and adults must be assessed within 15 minutes of arrival. It also failed to implement a system that ensured all children who left the emergency department without being seen were followed up. After inspections in April 2019 and November 29 the CQC imposed seven conditions on the hospital over emergency care. The regulator said it was now clear the trust had not stuck to the conditions and had breached them both at Royal Shrewsbury Hospital and Princess Royal Hospital. Professor Baker said: "The trust has not responded satisfactorily to previous enforcement action regarding how quickly patients are assessed upon entering the urgent and emergency department." “We have issued a penalty notice due to the severity of the situation and to ensure the necessary, urgent improvements are made. It is essential that patients are seen in a timely way when they arrive at an emergency department; failure to do so could result in deteriorating health, harm, or even death, which is why national guidelines exist and must be followed." Read full story Source: The Independent, 12 October 2020 -
Content Article
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News ArticleAlmost nine in ten maternity services experienced a decline in emergency pregnancy appointments during the pandemic due to women avoiding healthcare providers amid coronavirus chaos, a study has found. The Royal College of Obstetricians and Gynaecologists, who carried out the research, said women refrained from attending appointments due to anxiety around going into a hospital and fears of overwhelming the NHS, as well as not being clear if the appointments were essential. Researchers found 70% of maternity services reported a reduction in antenatal appointments, while 60% of units stopped the option of giving birth at home or in a midwife-led unit. Over half of services said postnatal appointments after childbirth had been reduced. The findings come as maternity services warn staff must not be sent to work in other parts of the hospital in the wake of a second wave of coronavirus. Royal College of Obstetricians & Gynaecologists and the Royal College of Midwives, who together represent the overwhelming bulk of maternity staff, say there must not be a repeat of the acute and widespread maternity staff shortages which played out during the health emergency’s peak. Read full story Source: The Independent, 30 September 2020
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News Article
Overcrowded A&Es ‘much more dangerous now because of covid’
Patient Safety Learning posted a news article in News
Emergency departments across England are reporting ‘dangerous’ overcrowding similar to levels seen pre-covid, and struggling to maintain social distancing, A&E leaders have warned. The Royal College of Emergency Medicine said it was concerned about covid spreading among the most vulnerable patients, as overall transmission rates continue to rise sharply across the UK. It was always anticipated that A&E activity would return to pre-covid levels this winter, following a significant drop-off in A&E activity during the spring and early summer, and that service transformation would be needed to help maintain social distancing. But the emergence of widespread overcrowding so far ahead of winter is of serious concern to system leaders. A&E staff were already being forced to make difficult trade-offs over which patients to isolate, the college’s vice president told HSJ. He also urged NHS leaders not to place unrealistic expectations on the impact a new model involving walk-in patients booking slots by phone could make on addressing overcrowding in emergency departments. RCEM vice president Adrian Boyle said the NHS was “largely back to the pre-covid levels of crowding” but it was “much more dangerous now because of covid”. He said: “We are hearing that most emergency departments can’t maintain social distancing safely and staff are having to make fairly difficult trade-offs about which people need to be isolated. No one can be safely social distanced in a corridor.” Read full story (paywalled) Source: HSJ, 21 September 2020 -
News ArticlePeople requiring A&E will be urged to book an appointment through NHS 111 under a trial in parts of England. The aim is to direct patients to the most clinically-appropriate service and to help reduce pressure on emergency departments as staff battle winter pressures, such as coronavirus and flu. The pilots are live in Cornwall, Portsmouth, Hampshire and Blackpool and have just begun in Warrington. If they are successful, they could be rolled out to all trusts in December. However, people with a life-threatening condition should still call 999. Under the new changes, patients will still be able to seek help at A&E without an appointment, but officials say they are likely to end up waiting longer than those who have gone through 111. More NHS 111 call handlers are being brought in to take on the additional workload, alongside extra clinicians, the Department of Health and Social Care said. A campaign called Help Us Help You will launch later in the year to urge people to use the new service. Read full story Source: BBC News, 17 September 2020
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News ArticleMinisters have given the green light for NHS England and Improvement to consult before December on a proposed new basket of metrics to replace the four-hour accident and emergency target. The Department of Health and Social Care announced the move, a significant step towards ditching the target, while confirming another batch of winter capital funding allocations, and confirming a national “111 first” model. The announcement does however mean the process of replacing the four-hour target with new A&E standards will move slower than NHSE/I had outlined this summer. It said in July it wanted the new A&E standards in place before winter, a plan also backed by the Royal College of Emergency Medicine as revealed by HSJ. These moves come amid mounting concern that people unable to get COVID-19 tests are heading to emergency departments; and that some emergency departments are now becoming busy with growing non-covid demand. The proposals for the consultation have not yet been finalised. HSJ understands they will consist of work largely drawn up by NHSE’s clinical review of standards group before March but put on hold when the COVID-19 outbreak hit the UK. Likely choices for the metrics are: time to initial clinical assessment in A&E, time to emergency treatment for critically ill, mean waiting time, and a new 12-hour metric where the clock starts from when the patient arrives at the emergency department rather than at decision to admit as is currently the case. Read full story (paywalled) Source: HSJ, 17 September 2020
