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News Article
ADHD services shutting door to new NHS patients as demand soars, BBC finds
Patient Safety Learning posted a news article in News
Specialist ADHD services for adults in England are stopping taking on new patients as they struggle to cope with demand, a BBC investigation has shown. The BBC has identified 15 local areas that have closed waiting lists and another 31 that have introduced tighter criteria, making it more difficult to access support. Reacting to our investigation, Prof Anita Thapar, chair of NHS England's ADHD taskforce, said the findings were "disturbing", adding there were "enormous risks" for patients. It comes as she publishes her report into the state of ADHD services on Thursday, which recommends an overhaul of the way people are supported. ADHD - attention deficit hyperactivity disorder - affects the way the brain works and can cause people to act impulsively and become easily distracted. The taskforce report said it was being under-diagnosed and under-treated and calls for more joint-working across health, education and the criminal justice system to identify people with ADHD. It said this would require staff to get training and for community NHS staff, such as GPs and pharmacists, to get more involved in supporting people with ADHD. Currently, specialist services take responsibility for this. Read full story Source: BBC News, 6 November 2025 -
Content ArticleThe 'State of Care' is the Care Quality Commission (CQC) annual assessment of health care and social care in England. The report looks at the trends, shares examples of good and outstanding care, and highlights where care needs to improve. Areas of specific concern The 2023/24 report highlights some areas of specific concern. The concerns involve issues around safety, quality, workforce, and inequalities, including: Too many women are still not receiving the high-quality maternity care they deserve. Of the 131 locations we inspected in our national maternity inspection programme, almost half were rated as either requires improvement (36%) or inadequate (12%). We have concerns that children and young people are not always able to access services in a timely way – both planned and in an emergency. Anecdotal evidence suggests that parents and carers are well placed to recognise when their child is very unwell, but many feel they are not being listened to. The number of health visitors, who give individual support for young children and their parents, has declined by 45% over the last 9 years. Only around a quarter of people with a learning disability were recorded on the learning disability register, which means that many people are missing out on the proactive care and treatment they are entitled to. Despite fewer new referrals for autism diagnoses over 2023/24, the average waiting time to start an assessment reached a peak of nearly a year (328 days) in April 2024, rather than the recommended 3 months. People in Black or Black British ethnic groups are over 3 and a half times more likely to be detained under the Mental Health Act than people in white ethnic groups. Work on our cross-sector dementia strategy is highlighting the compassionate care and initiatives that are improving people’s lives, but staff do not always understand the specific needs of people with dementia.
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Content ArticleThis National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report highlights the care provided to adults presenting to hospital with a diagnosis of community-acquired pneumonia and gives recommendations. Community-acquired pneumonia (CAP) is one of the most common infectious diseases seen in clinical practice. It results in many hospital admissions and has a high mortality, primarily as the patient group is often frail and older with multimorbidity. The diagnosis of CAP is not always apparent at the time of first clinical assessment, and in many hospitals, there is no specialist team that takes overall responsibility for the care of patients with CAP. Clinical teams need to be more accurate in making the diagnosis of CAP, assessing its severity and ensuring appropriate antibiotic therapy. Local leadership is key in developing an infrastructure to ensure the care of patients with pneumonia is organised appropriately and a programme of ongoing monitoring and improvement is introduced. In this study, the quality of care provided to patients aged 18 years and over, who had a diagnosis of CAP during the sampling period of 1st October 2021 to 31st December 2021, was assessed by analysing data from 767 clinician questionnaires, 149 organisational questionnaires and the output from the peer review of 401 sets of case notes.
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News Article
Doing nothing on social care 'untenable', MPs warn
Patient Safety Learning posted a news article in News
A failure to fix England's social care system is costing the country in financial and human terms, cross-party MPs have warned. Doing nothing to reform social care for older and disabled adults is an "active" and "untenable" decision, according to a report from Health and Social Care Select Committee. It says successive governments have put too much emphasis on the cost of reforming the system, and future plans will be doomed to fail unless the government understands and measures the "cost of inaction". The government, which has set up an independent commission which has just started work, said it had "hit the ground running" but acknowledged there was "much more to do". "Taxpayers are currently paying £32 billion a year for a broken system" propped up by contributions from unpaid carers "equivalent to a second NHS", the report said. The committee found that social care is consuming an increasing proportion of councils' budgets, crowding out spending on other services. It added that social care makes up an integral part of the government's NHS reforms and cannot be a separate process. Read full story Source: BBC News, 5 May 2025 -
News Article
More than half of adults worldwide will be overweight or obese by 2050
Patient Safety Learning posted a news article in News
More than half of adults and a third of children and young people worldwide will be overweight or obese by 2050, posing an “unparalleled threat” of early death, disease and enormous strain on healthcare systems, a report warns. Global failures in the response to the growing obesity crisis over the past three decades have led to a staggering increase in the numbers affected, according to the analysis published in the Lancet. There are now 2.11 billion adults aged 25 or above and 493 million children and young people aged five to 24 who are overweight or obese, the study shows. That is up from 731 million and 198 million respectively in 1990. Without urgent policy reform and action, the report says, more than half of those aged 25 or above worldwide (3.8 billion) and about a third of all children and young people (746 million) are forecast to be affected by 2050. Read full story Source: The Guardian, 3 March 2025 -
News ArticleOne in five UK adults are living with diabetes or pre-diabetes as diagnoses have reached an all-time high, new data shows. Charity Diabetes UK called this a “hidden health crisis” and urged the government to act immediately. Some 4.6 million people are now diagnosed with the condition, compared to 4.4 million a year ago. This includes about 8% with type 1 diabetes, which happens when a person cannot produce insulin, a hormone that helps the body turn glucose into energy. Some 90% have type 2 diabetes, which happens when the body does not use insulin properly, while 2% have different and rarer forms of the condition. A further 1.3 million are estimated to be living with undiagnosed type 2 diabetes. The chief executive of the charity, Colette Marshall, said: “These latest figures highlight the hidden health crisis we’re facing in the UK and underline why the government must act now. “There must be better care for the millions of people living with all types of diabetes, to support them to live well and fend off the risk of developing devastating complications. “With more people developing pre-diabetes and type 2 diabetes at a younger age, it’s also critical that much more is done to find the missing millions who either have type 2 diabetes or pre-diabetes but are completely unaware of it. The sooner we can find and get them the care they need, the more harm we can prevent.” Read full story Source: The Independent, 6 February 2025
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EventuntilThis session aims to bring together a range of Caldicott Guardians to learn, share and explore the growing role of a Caldicott Guardian in adult social care. CGs from both local authorities and care provider organisations are invited to join. The purpose is to provide support to all those across the care sector who have the Caldicott Guardian role as part of their jobs, offer a networking, sharing and learning space for them all as well as promote the role as best practice and the importance of having one/ access to one in social care services. To encourage and explore innovation in relation to the role and influence future ways of working. Principles of CG Networks & Collaboration Collaborate and cooperate, to strengthen the Caldicott Guardian's role in data governance across social care Be open. Communicate openly about concerns, issues, or opportunities relating to Caldicott Guardians and information governance in social care. Learn, develop, and seek to achieve full potential. Share information, experience, materials, and skills to learn from each other and develop effective collaboration. Adopt a positive outlook. Behave in a positive, proactive, and timely manner. Keep the group up to date on data governance developments to Caldicott Guardians in the sector, feeding back key information and potential of new approaches/ practice Who should attend? These sessions have been designed for Caldicott Guardians working in adult social care. This can include staff in care organisations who undertake the role of Caldicott Guardian or have a Caldicott function in their job role, for example: Owners Registered Managers Nurses Senior Care Staff Administrators IT Professionals Quality & Compliance Leads Register
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Content ArticleThis study in Intensive and Critical Care Nursing examined the association between safety attitudes, quality of care, missed care, nurse staffing levels and the rate of healthcare-associated infection (HAI) in adult intensive care units (ICUs). The authors concluded that positive safety culture and better nurse staffing levels can lower the rates of HAIs in ICUs. Improvements to nurse staffing will reduce nursing workloads, which may reduce missed care, increase job satisfaction, and, ultimately, reduce HAIs. Key findings ICUs with strong job satisfaction had lower incidence and nurse-reported frequency of CLABSI, CAUTI, and VAP. Missed care was common, with 73.11% of nurses reporting missing at least one required care activity on their last shift. The mean patient-to-nurse ratio was 1.95. Increased missed care and higher workload were associated with higher HAIs. Nurses’ perceptions of CLABSI and VAP frequency were positively associated with the actual occurrence of CLABSI and VAP in participating units.
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Content ArticleThere are an estimated 363,000 adults experiencing multiple disadvantage in England—they may be experiencing a combination of homelessness, substance misuse, mental health issues, domestic abuse and contact with the criminal justice system. The Changing Futures programme works in partnership in local areas and across government to test innovative approaches and drive lasting change across the whole system, in order to provide better outcomes for adults experiencing multiple disadvantage. This prospectus provides information for partnerships interested in submitting an expressions of interest to be part of the Changing Futures programme.
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Content ArticleThis framework sets out what good digital working looks like for care providers and local authorities with responsibility for adult social care in England.
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Content ArticleA study from Jackson et al. looked at how the prevalence of psychological distress in the adult population of England has changed since 2020. The study found that the proportion reporting any psychological distress was similar in December 2022 to that in April 2020 (an extremely difficult and uncertain moment of the COVID-19 pandemic), but the proportion reporting severe distress was 46% higher. These findings provide evidence of a growing mental health crisis in England and underscore an urgent need to address its cause and to adequately fund mental health services.
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Content ArticleHealth Education England (HEE) commissioned the Royal College of Physicians (RCP) to undertake the development of a training programme to meet the medical needs of adults with a learning disability. The training programme consists of two modules and applicants are expected to complete both modules which will result in a post graduate certificate. The second module is under development but will be available in the autumn of 2023. Funded places for both modules are available. The training programme is designed for doctors, nurses and allied health professionals working at a senior level and caring for people with a learning disability within their role. It will enhance their skillset and to address a number of cross cutting themes. This is key to enable practitioners to provide high quality and person-centred care for adults with a learning disability. The training programme has been developed and will be delivered with the input of experts by experience. The first module has been developed by RCP and Edge Hill University. The Learning Disabilities Mortality Review Programme (LeDeR) reported on the preventable inequalities in health experienced by people with a learning disability who die on average 15-20 years sooner than people without a learning disability. The medical module will enable practitioners to critically appraise and synthesise information that will support the implementation of evidence based best practice to treat and support individuals and promote quality of care. This will support and address a number of recommendations. The LeDeR programme highlighted the need to: develop the concept of learning disability physicians reduce specific risks from aspiration pneumonia and therefore understanding of dysphagia, specifically diagnosis, assessment and treatment improve multi-disciplinary care coordination adapt early warning system (EWS) for people with learning disability including soft signs and response to known baseline assessments improve safety of people with epilepsy improve the diagnosis and management of chronic constipation - including managing its underlying causes.
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Content Article
The Child Health Clinical Outcome Review Programme has produced this review of the barriers and facilitators in transitioning children and young people with complex chronic health conditions into adult health services. Based on data on children and young people with one of 12 complex conditions identified from a sample period between 1st October 2019 and 31st March 2021, the report concludes that there is no clear pathway for the transition from healthcare services for children and young people to adult healthcare services. The report finds that the process of transition and subsequent transfer is often fragmented, both within and across specialties, and that adult services often sit only with primary care. It argues that developmentally appropriate healthcare should be everyone’s responsibility, with adequate resources needed to allow this to happen. The Inbetweeners also calls for services to: involve young people and parent/carers in transition planning and transition to adult services improve communication and coordination between all specialties be organised to enable young people to transfer to adult services effectively, and provide strong leadership at Board and specialty level at all stages of transition and transfer. The report’s recommendations highlight areas that are suitable for regular local clinical audit and quality improvement initiatives by those providing care to this group of patients. It suggests that the results of such work should be presented at quality or governance meetings, and action plans to improve care should be shared with executive boards. -
Content ArticleHospitalised adults whose condition deteriorates while they are on hospital wards have considerable morbidity and mortality. Early identification of patients at risk of clinical deterioration has traditionally relied on manually calculated scores, and outcomes after an automated detection of clinical deterioration have not been widely reported. The authors of this article published in The New England Journal of Medicine developed an intervention program involving remote monitoring by nurses who reviewed records of patients who had been identified as being at high risk. Results of this monitoring were then communicated to rapid-response teams at hospitals. They compared outcomes among hospitalised patients whose condition reached the alert threshold at hospitals where the system was operational, with outcomes among patients at hospitals where the system had not yet been implemented. The authors found that using an automated predictive model to identify high-risk patients, for whom interventions could then be implemented by rapid-response teams, was associated with decreased mortality.
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Content ArticleAn estimated 90,000 people are living with dementia in Scotland, with that number expected to increase to 164,000 by 2036. These national clinical guidelines from Health Improvement Scotland, the first to be published in nearly 20 years, provide recommendations on the assessment, treatment and support of adults living with dementia. It calls for greater awareness of pre-death grief for people with dementia, their carers and their loved ones, as they fear the loss of the person they know. To accompany the guidelines, a podcast has been produced by Health Improvement Scotland speaking to professionals, including Dr Adam Daly, Chair of Healthcare Improvement Scotland’s Guideline Development Group and a Consultant in old age psychiatry, and Jacqueline Thompson, a nurse consultant and the lead on pre-grief death for the guideline. We also hear from Marion Ritchie, a carer who experienced pre-death grief while caring for her husband.
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Content ArticleThe aim of this investigation and report is to help improve the inpatient care of adults with a known learning disability in acute hospital settings. It focuses on people referred urgently for hospital admission from a community setting, such as a person’s home or residential home. In undertaking this investigation, the Health Services Safety Investigations Body (HSSIB) looked to explore the factors affecting: The sharing of information about people with a learning disability and their reasonable adjustment needs following admission to an acute hospital. How ward-base staff are supported to delivery person-centred care to people with a learning disability. Reference event The investigation used as a reference event a patient safety incident involving a 79-year-old man who was recorded on his GP’s learning disability register as having a mild learning disability. After being admitted to hospital due to his worsening health. Throughout the patient’s stay, up to his death following a cardiac arrest, his individual needs were not always identified and reasonable adjustments to meet his care needs were not always made. Findings The health and care system is not always designed to effectively care for people with a learning disability. People with a learning disability who are admitted to an acute hospital are often cared for by staff without specialist training, skills and experience in working with people with a learning disability. These staff often have limited support and are unable to take the time they would like to meet the person’s needs. There is no standard model or national guidance for an acute learning disability liaison service (that is, teams that are specifically trained in caring for people with a learning disability). Consequently, there is variation in how these services are funded, their availability, the size of teams and what they are expected to do. The quality of learning disability services is currently monitored via the learning disability improvement standards annual benchmarking survey which is funded until the end of 2023/24. Decisions on future years have yet to be made. Staff in acute hospitals may lack confidence and support in assessing the mental capacity of people with a learning disability, in line with the Mental Capacity Act (2005). There is no national shared system with a single point of access for storing and managing information about the needs of people with a learning disability and the reasonable adjustments required for each individual. Current mechanisms for sharing information about a person – such as ‘care passports’ (a document that gives staff helpful information about the person’s health and social needs, including their preferred method of communication, likes and dislikes) and alert flags (a way to highlight key information to staff) on the electronic patient record – can be unreliable. Instead, information is often gathered from friends and family. Evidence exists that people with a learning disability experience health inequities. Long-held societal beliefs about the abilities of people with a learning disability may influence the provision of and decisions made around their care. Safety recommendations As a result of this investigation, HSSIB recommended that NHS England should: Develops and issues learning disability liaison nursing service best practice and workforce guidance to all acute hospitals. This is to help local decision making about specialist learning disability provision and enable appropriate support for people with a learning disability and the staff who care for them. Ensure that the national learning disability improvement standards annual benchmarking survey for the care of people with a learning disability is continued for acute hospitals in order to help assure that local population needs are met. Commission the development and dissemination of guidance on the practical assessment of the mental capacity of people with a learning disability in acute hospitals. This is to ensure that appropriate decisions are made about the person’s care. With support from key stakeholders including the Professional Record Standards Body, work collaboratively to develop and publish a set of guidelines on information to be included in a health and care passport (which could be paper based, digital, or both) for people with a learning disability with consideration of the reasonable adjustments that people may need. This is to ensure the most current and accurate information about reasonable adjustments to the person’s care is accessible when and wherever it is needed. Safety observations HSSIB made four safety observations as a result of this investigation: Health and care providers can improve patient safety by ensuring that local configuration of electronic patient record systems consider the accessibility and usability of the digital record reasonable adjustments flag in patient records. Health and care curricula can improve patient safety by aligning with the national code of practice on statutory learning disability and autism training, when finalised. Health and care providers can improve patient safety by advocating for all people with a learning disability to have an up-to-date care passport.
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Content ArticleMonitoring and responding to deterioration in social care settings is critical to providing safe, effective and responsive care. Front-line staff are pivotal for highlighting change to wider teams and managing low to medium risk individuals in their place of residence. However, there is a core set of principles that most systems use which may not be used by non-clinical staff in residential settings. This case study explores an intervention to empower non-clinical staff to take observations. The Whzan blue box contains a digital tablet and equipment to take temperature, pulse, oxygen saturation levels and blood pressure measurements. Staff were trained and supported on site to use the system and set up a digital platform to share measurements with wider teams. Staff fed back that they felt empowered and able to better engage in conversation with health care professionals, highlighting the importance of having a common language. This case study was submitted to the Care Quality Commission (CQC) by North East and North Cumbria ICB.
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News Article
System admits 10-year diagnostic waits
Patient Safety Learning posted a news article in News
Adults across an integrated care system area are facing ‘unacceptable’ 10-year waits for an NHS assessment for attention deficit hyperactivity disorder, the longest known wait for such services in England. Herefordshire and Worcestershire integrated care board has warned in board papers of “exceptionally high waiting times for ADHD assessment and treatment for Worcestershire patients (10 years+), with workforce challenges and service fragility compromising service delivery”. HSJ understands the long waits for ADHD diagnosis, which is a national problem, is predominately affecting adults with approximately 2,000 people on Herefordshire and Worcestershire’s ADHD list alone. Local provider Herefordshire and Worcestershire Health and Care Trust also warned on its website that its paediatric services were also “experiencing unprecedented demand”. Read full story (paywalled) Source: HSJ, 19 July 2023 -
News Article
ADHD and autism campaigners plan legal action against NHS over referral limits
Patient Safety Learning posted a news article in News
Campaigners are planning to launch legal action after NHS chiefs in North Yorkshire placed limits on which adults can get referrals for autism and attention deficit hyperactivity disorder (ADHD) assessments. North Yorkshire and York Health and Care Partnerships introduced a pilot programme in March in which adults seeking an NHS assessment for autism or ADHD are triaged via an online screening tool. NHS chiefs say this screening process prioritises those with the most severe needs, rather than processing referrals in chronological order. These priority needs reportedly include the patient being at risk of immediate self-harm or harming others, at risk of being unable to have lifesaving hospital treatment or care placement, or an imminent risk of family court decisions being determined on diagnosis. Those who do not meet the criteria are given guidance and signposted to other support networks. But campaigners say that in practise that means that most people cannot get a referral for an assessment – GPs can no longer make referrals themselves. Read full story Source: The Big Issue, 19 July 2023 Related reading on the hub: Long waits for ADHD diagnosis and treatment are a patient safety issue -
Content ArticleThe MindEd all-age eating disorders hub is aimed at all professionals, from universal to specialist. It contains key trusted evidence-based learning, curated and approved by an expert panel. The hub contains the following information:NHS policy guidanceProfessional bodies' guidanceProfessional associations' reportsCharitiesNHS learning and good practiceLegislation and reportsKey and influential textsUnder-served populations
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Content Article
Attention deficit hyperactivity disorder (ADHD) is a condition that affects people's behaviour. It has a wide range of symptoms and can affect both children and adults—people with ADHD may find it hard to focus on or complete tasks, feel restless or impatient, experience impulsiveness and find it hard to organise their time and their things.[1] ADHD can have devastating mental health implications and research studies have linked ADHD to increased suicide and mortality rates. This means that being unable to access effective treatment can be a patient safety risk for people with ADHD. In this blog, Lotty Tizzard, Patient Safety Learning’s Content and Engagement Manager, explores the state of ADHD diagnosis and treatment in the UK. She looks at why many are concerned about the waiting times for adults and children seeking an ADHD assessment and speaks to Elsa*, who was diagnosed with ADHD in her 30s, about her experiences. *Name changed ADHD affects a significant number of people in the UK—The National Institute for Health and Care Excellence (NICE) cites research estimating that 5% of children and 3-4% of adults in the UK have ADHD.[2] Most people with ADHD never receive a diagnosis, but over the past few years, an increasing number of adults and children have sought help from the NHS for ADHD. However, for many, long waiting lists have delayed their diagnosis and treatment by several years. Living with ADHD can have a profound effect on people’s lives, with symptoms causing stress in relationships, work and finance. Elsa, who was diagnosed with ADHD as an adult in 2021, said, “Before I was diagnosed, I felt like I was rubbish at life. Knowing there's a name for the way my brain works has helped my self-esteem and helped me find strategies to deal with my symptoms.” ADHD petitions and parliamentary debate In February 2023, MPs held a Westminster Hall debate in response to two petitions that highlighted the issues of long waiting lists for diagnosis and treatment for ADHD and autism in the UK.**[3] During the debate, MPs discussed the issues caused by these long waits, including the mental health impacts on adults and children with undiagnosed ADHD. In her response to the debate, Maria Caulfield MP, Minister for Mental Health and the Women’s Health Strategy, acknowledged a number of these issues and the need for improvements in assessment services, stating, "I am the first to admit that we are not where we want to be, and that there is a lot of work to be done.”[4] Why has ADHD diagnosis increased? Various factors have been suggested as reasons for the increasing number of people seeking ADHD diagnosis[5] in recent years. One potential reason is greater awareness about ADHD and its possible treatments amongst the general public, with various high profile celebrities seeking to break the stigma around the condition by sharing their stories of diagnosis. This may have led to more adults asking whether their symptoms might be due to ADHD.[6] Greater awareness amongst parents and teachers has also led to more children being referred for assessment[7][8] and more applications for Education, Health and Care plans (EHCPs)[9], which set out a child or young person's special educational needs and the support they require. The Covid-19 lockdowns were shown to have a greater impact on the mental health and wellbeing of children [10][11] and adults [12] with ADHD than the general population. This may also have contributed to the increase in both adults and children seeking ADHD assessment.[13] There are also questions about whether environmental factors have led to an increase in incidence, and further research is needed to determine whether things like increased screen use, exposure during pregnancy to certain substances or pesticides used in food production, might be causing more people to develop ADHD.[14] It has also been suggested that the recent high profile of ADHD has led to overdiagnosis.[15] However, experts on the condition urge caution around this assumption as population estimates suggest the majority of people with ADHD remain undiagnosed. They are keen to stress the importance of seeking help if you suspect you have ADHD traits.[16] Current access and waiting times for ADHD assessment Lack of national data makes it very hard to determine the number of people waiting for an ADHD assessment, an issue repeatedly raised in the Westminster Hall debate. Elliot Colburn MP initially highlighted this, saying: “I asked about national data on assessment waiting times and the number of individuals diagnosed. The answer I got was, quite simply, 'We don’t know'—or, at least, the NHS and the Government do not know.”[4] As the debate progressed, a number of MPs talked about the situation in their local area and read accounts of constituents who had been waiting many years for an ADHD assessment. One reason given for long waiting times is that the UK has a lack of ADHD specialists. Dr Ulrich Müller-Sedgwick, a consultant psychiatrist recently told The Guardian that “The NHS simply doesn’t have enough clinicians with appropriate training, experience and time to deliver good quality clinical work”[5] in the field of ADHD. The impact of health inequalities There are a number of health inequalities at play, and the Westminster Hall debate highlighted that there is a ‘postcode lottery’ when it comes to ADHD diagnosis and treatment, with waiting times varying significantly depending on where you live. One MP highlighted that some areas in the UK have no adult ADHD service at all, and many others have waits of five years-plus.[4] In addition, women and girls can find it harder to get an ADHD diagnosis due to the different symptoms they tend to display—they do not always present with ‘classic’ signs of ADHD,[17] but that does not mean the impact on their lives is any less significant. Lack of knowledge about these differences amongst healthcare professionals is a key factor exacerbating this inequity of access. Elsa described her experience when she eventually saw a psychiatrist. “When I finally got an appointment after two years, the psychiatrist told me I couldn’t have ADHD because I was wearing the right clothes for the weather and could make eye contact. I was told I was ‘just comparing myself to other women’. When I went back to the service and asked for a second opinion, I ended up seeing the same doctor again! Another issue Elsa raised is the lack of clear information on the NHS process. “I wasn’t given accurate information about what to expect. I knew the waiting list could be very long, but in my initial NHS assessment I was told I’d be referred straight to an ADHD clinic, which didn’t happen.” People with ADHD may have additional barriers to overcome to access services, so it’s particularly important that the process of diagnosis is made as accessible as possible. In order to be seen by the right services, Elsa describes how “you really have to advocate for yourself. For a lot of people who have ADHD, executive function is a challenge. So organising appointments and remembering to chase things up can be a big struggle.” Issues with private ADHD clinics These long waits for NHS treatment are driving some patients to pay for private assessments, and as the demand for assessment increases and outstrips NHS capacity, the NHS is also paying private companies to diagnose and treat ADHD. This is the route Elsa eventually took after finding out via a Facebook group about ‘right to choose’ on the NHS, and asking her GP to refer her privately. She was seen about six months later and given a diagnosis of ADHD. This approach is helping many people to access assessment more quickly. However, a recent Panorama investigation raised some concerns about the depth and rigour of private assessments, with some patients being diagnosed and prescribed medication over Zoom in a matter of minutes. Patients and healthcare professionals interviewed by Panorama voiced concerns that private assessments felt like a ‘tick box exercise’ compared with more thorough assessments carried out in NHS clinics which—the programme stated—last around 3.5 hours. One mental health nurse felt the process at the private ADHD assessment service she had previously worked for was “unsafe.”[18] People with ADHD have responded to the programme on social media, highlighting that it does nothing to address the issue of lack of capacity within the NHS. Some concerns have also been raised about the programme’s approach to this investigation and its methodology.[19][20] Patient safety implications of ADHD diagnosis and treatment delays Waiting years for ADHD assessment and diagnosis can have significant implications for patient safety. Without a diagnosis, people may not receive the support they need, and research shows that the mental health impacts can have serious consequences. Undiagnosed ADHD has been shown to lead to low self-esteem, depression, anxiety and a higher likelihood of turning to substance misuse,[21] and people with ADHD are five times more likely to have attempted suicide than the general population.[22] If ADHD is misdiagnosed due to low quality or unreliable assessment practices, it raises a serious patient safety concern that people may be prescribed strong medications that they don’t need, sometimes for years. ADHD medications can have serious side effects and can worsen mental health conditions such as psychosis, if they are not appropriately prescribed and monitored. A 2015 study found that people with ADHD also have a higher mortality rate than the general population. The researchers found that people who receive a diagnosis in adulthood have an even higher mortality rate ratio than people who receive a correct ADHD diagnosis in childhood.[23] Getting an accurate diagnosis and appropriate treatment can be life-changing for people with ADHD. Elsa described the positive impact ADHD medication has had on her life: “I’ve been able to come off my long-term antidepressant as I’m on the right medication now—one which actually helps. It has quieted my brain and I am much more able to focus on tasks and conversations. Instead of lots of ‘tabs’ being open in my mind at the same time, I can just have one.” Dr Rob Baskind, a Consultant Psychiatrist highlighted in a recent Forbes article that, “Medication can be an extremely effective intervention alongside other environmental interventions and psychological support, to significantly reduce the deficits ADHD manifests whilst allowing the individual to maximise their strengths.”[24] What can be done to improve waiting times for ADHD assessment? The first step in dealing with the huge demand for ADHD diagnosis is to understand the extent of the problem. At the moment, there is no mandated national data collection, so establishing the number of people waiting for assessment is impossible. If the NHS were to adopt routine reporting processes, it would allow for a more strategic approach to tackling waiting times and inequalities in diagnosis and treatment. ADHD services are in need of sustained investment in specialist training for healthcare professionals working with people with ADHD, as well as a focus on improving access to therapy. Elsa told me her medication is recommended to be taken alongside therapy. “But I can’t access therapy on the NHS, which is very frustrating.” One approach to reducing waiting times suggested by a 2022 research study involves equipping primary care to effectively diagnose and support people with ADHD.[25] If GPs were less likely to misdiagnose ADHD as other conditions, people would be more able to access appropriate treatment. However, there are risks associated with this approach, and adequate planning and safety-netting would need to be in place to ensure patient safety. The Panorama investigation also raises questions about how ADHD services are regulated.[18] Where ADHD assessments are not provided directly by the NHS, patients need assurance that they will still be carried out with the same level of rigour and quality. It is important to ensure that all assessments and treatment decisions follow guidelines issued by the National Institute of Heath and Care Excellence (NICE) and are carried out by appropriately trained professionals. One recent positive development was the Government’s publication of its Special Educational Needs and Disabilities (SEND) and Alternative Provision (AP) Improvement Plan [26] in March 2023, which will benefit children with ADHD. If implemented effectively, the plan should improve waiting times for diagnosis and access to specialist support for children in education. Providing early intervention and support for children and adults with ADHD is better for everyone. As well as improving mental health outcomes for individuals, it reduces the pressure on mental health services, reducing the likelihood of people developing issues that require crisis treatment. **Although people waiting for autism diagnosis face similar barriers, this blog will focus on ADHD diagnosis. Get involved Do you or your child have ADHD? Are you on a waiting list for ADHD diagnosis or treatment? Are you a healthcare professional that works with people with ADHD? We’d love you to share your experiences with us by: Commenting below (you’ll need to sign up for free to become a hub member). Contributing to our community conversation about ADHD waiting times. Getting in touch with the hub team to share your experience. Related reading ADHD services ‘swamped’, say experts as more UK women seek diagnosis References 1 Attention deficit hyperactivity disorder (ADHD). NHS England, 21 December 2021 2 Attention deficit hyperactivity disorder: How common is it? National Institute for Health and Care Excellence, November 2022 3 E-petition debate relating to assessments for autism and ADHD. House of Commons Library, 2 February 2023 4 Volume 727: Autism and ADHD assessments debate. UK Parliament, 6 February 2023 5 Topping A. ADHD services ‘swamped’, say experts as more UK women seek diagnosis. The Guardian, 13 January 2023 6 15 celebrities describe what it's like living with ADHD. Cosmopolitan, 25 November 2021 7 Huang H, Ougrin D. Impact of the COVID-19 pandemic on child and adolescent mental health services. BJPsych Open, 5 August 2021 8 Oldman I. Bury CAMHS sees huge increase in children referred. Bury Times, 25 July 2022 9 Education, health and care plans. UK Government website, 12 May 2022 10 Davoody S, Goeschl S, Dolatshahi M et al. Relation between ADHD and COVID-19: A narrative review to guide advancing clinical research and therapy. Iran J Psychology, 2022; 17(1): 110–117 11 Shah R, Venkatesh Raju V, Sharma A et al. Impact of COVID-19 and lockdown on children with ADHD and their families—an online survey and a continuity care model. J Neurosci Rural Pract, 2021; 12(1): 71–79 12 Hollingdale J, Adamo N, Tierney K. Impact of COVID-19 for people living and working with ADHD: A brief review of the literature. AIMS Pubic Health. 2021; 8(4): 581–597 13 Joiner A. Is ADHD overdiagnosed in the UK? Focus on Adult ADHD website, last accessed 15 May 2023 14 Is there an increase in ADHD? Children and Adults with Attention-Deficit/Hyperactivity Disorder website, 11 July 2021 15 Herndon J. What we know about ADHD overdiagnosis. Healthline, 21 September 2021 16 Colombo C. ADHD isn’t ‘overdiagnosed’ – quite the opposite, actually. Independent, 25 November 2022 17 Kok F, Groen Y, Fuermaier A et al. The female side of pharmacotherapy for ADHD—A systematic literature review. PLOS One, 18 September 2022 18 Panorama: Private ADHD clinics exposed. BBC, 15 May 2023 19 Bloodworth J. ADHD – the truth about is misdiagnosis, 16 May 2023 20 Response to BBC Panorama “Private ADHD Clinics Exposed”. ADHD Foundation, 15 May 2023 21 Iavarone K. What to know about untreated ADHD in adults. Medical News Today, 9 February 2023 22 New study to understand the relationship between ADHD and suicide risk. University of Glasgow website, 27 September 2022 23 Dalsgaard S, Østergaard S, Leckman J et al. Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study. Lancet. 2015;30;385(9983):2190-6 24 Doyle N. ADHD crisis in the UK: Under diagnosed, lacking support and stigmatized. Forbes, 14 January 2022 25 Asherson P, Leaver L, Adamou M et al. Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations. BMC Psychiatry, 11 October 2022 26 Special Educational Needs and Disabilities (SEND) and Alternative Provision (AP) Improvement Plan. HM Government, March 2023. -
News ArticleHundreds more middle-aged adults have been dying each month since the end of the pandemic, as obesity and NHS backlogs drive a surge in excess deaths. New analysis of official statistics has revealed that there were an extra 28,000 deaths in the UK during the first six months of 2023, compared with levels in the previous five years. The biggest rise in unexpected deaths has been among adults aged 50 to 64, who are increasingly dying prematurely from preventable conditions including heart disease and diabetes. The Covid inquiry is now being urged to shift its focus from “tactical decisions made by politicians” and to examine the lasting disruption that has kept deaths persistently high since the virus peaked. Experts believe that difficulties in accessing GPs since lockdown and record NHS waiting lists mean that middle-aged patients are missing out on life-saving preventative treatment such as blood pressure medication. Unhealthy lifestyles, obesity and widening health inequalities are also contributing to a rise in avoidable deaths. Professor Yvonne Doyle, who led Public Health England during the pandemic, warned that the official Covid inquiry risks “missing the point” by focusing on the drama and WhatsApps of Westminster politicians. In an article for The Times, Doyle, who gave evidence to the inquiry six weeks ago, says that the tens of thousands of excess deaths since Covid “represent an underlying pandemic of ill health” that should be addressed. Read full story (paywalled) Source: The Times, 13 December 2023
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News Article
Depression in British adults doubles during pandemic, new data shows
Patient Safety Learning posted a news article in News
The number of adults experiencing depression has almost doubled during the pandemic, according to new figures. Data from the Office for National Statistics showed that almost one in five adults (19.2 per cent) were likely to be experiencing some form of depression in June. This had risen from around one in 10 (9.7%) between July 2019 and March 2020, before the imposition of the nationwide lockdown. Dame Til Wykes, a professor of clinical psychology and rehabilitation at King’s College London, warned of a looming “mental health crisis” once the pandemic passes. “This study tells us, yet again, that we might have a mental health crisis after this pandemic. The social effects of distancing and isolation for some affects their emotional wellbeing. Dr Billy Boland, chairman of the General Adult Faculty at the Royal College of Psychiatrists, said the UK’s mental health services would be faced with a “tsunami of referrals” in the coming months. “Isolation, bereavement and financial insecurity are some of the reasons why the nation’s mental health has deteriorated since the start of the pandemic. “The government must speed up the investment to mental health services if we are to treat the growing numbers of people living with depression and other mental illnesses.” Read full story Source: The Independent, 18 August 2020 -
News ArticleFollowing four deaths and more than 300 incidents with steroid replacement therapy involving patients with adrenal insufficiency in the past two years, patients at risk of adrenal crisis will be issued with a steroid emergency card. All adults with primary adrenal insufficiency (AI) will be issued an NHS steroid emergency card to support early recognition and treatment of adrenal crisis, a National Patient Safety Alert has said. The cards will be issued by prescribers — including community pharmacists — from 18 August 2020. AI is an endocrine disorder, such as Addison’s disease, which can lead to adrenal crisis and death if not identified and treated. Omission of steroids in patients with AI, particularly during physiological stress such as an additional illness or surgery, can also lead to an adrenal crisis. The alert has requested that “all organisations that initiate steroid prescriptions should review their processes/policies and their digital systems/software and prompts to ensure that prescribers issue a steroid emergency card to all eligible patients” by 13 May 2021. Read full story Source: The Pharmaceutical Journal, 17 August 2020
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Content Article
Guidance for: Prone positioning in adult critical care (2019)
Sam posted an article in Respiratory conditions
Guidance from the Faculty of Intensive Care Medicine and Intensive Care Society on prone positioning in adult critical care. It is hoped that the adoption of the guidance set out within this document will help improve safety and reduce complications associated with the prone positioning of mechanically ventilated patients. This document also hopes to standardise the approach to manging a cardiac arrest in the prone position, and has some guidance on prone ventilation in ECMO patients as well as considerations for performing bronchoscopy in the prone position. Assuming adequate staffing and equipment is available, the intervention of prone positioning involves very low costs and provided additional patient complications and long-term injuries to staff do not occur, would almost certainly be a cost-effective intervention.
