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Despite advances in treatment, many patients with heart failure still experience delays in diagnosis, variation in care and avoidable hospital admissions. To support systems in addressing these challenges, the Health Innovation Network has developed a suite of practical guides designed to improve the heart failure pathway from early identification through to long-term management and end-of-life care. This resource set brings together two complementary guides: Heart Failure Blueprint for Healthcare Professionals A comprehensive overview of the optimal heart failure pathway, structured across seven stages from case finding and diagnosis to ongoing management and palliative care. It includes data, best practice examples, and innovations from across health systems to support pathway redesign. Improving the Heart Failure Pathway Through Quality Improvement: A How-To Guide A practical, step-by-step guide to help teams identify gaps, design solutions, and implement sustainable improvements using a structured quality improvement approach. These guides are designed to: Support earlier diagnosis and intervention. Improve coordination across primary, community and secondary care. Enable adoption of evidence-based treatments and innovations. Reduce avoidable admissions and improve patient outcomes. Provide a practical ‘playbook’ for local transformation. These resources are intended for multidisciplinary teams working across the pathway, including: Cardiologists, GPs and clinical leads. Nurses, pharmacists and allied health professionals. Service managers and commissioners. Quality improvement and transformation leads. The guides can be used flexibly: As a complete programme to redesign your pathway end-to-end. To target specific challenges such as diagnosis or optimisation. As a facilitation tool for workshops and system-wide collaboration. Used together, they provide both the what (the blueprint) and the how (the improvement approach) to support meaningful and sustainable change.

Latest research from the King's Fund shows no improvement in people’s experiences of NHS admin. NHS admin plays a central role in shaping how people experience and perceive the NHS. Our findings point to a major opportunity for government and NHS leaders to act. Key findings Two thirds (66%) of patients and carers who used NHS services in the past 12 months experienced at least one administrative problem. There has been no improvement since the same polling was conducted the previous year. While the number of people experiencing admin issues has remained unchanged, what has shifted is wider public awareness: administrative failings are increasingly recognised as a frequent and persistent problem across the NHS. In 2025 less than half (43%) of the public said that the NHS is good at communicating with patients about things like appointments and test results, down from 52% in 2024. The percentage of the public who said the NHS was good at keeping people informed about what is happening with their care and treatment has fallen from 42% in 2024 to 32% in 2025. 33% of people who had used NHS services in the previous 12 months said they had not been kept updated about how long they would have to wait for care or treatment. Almost 1 in 4 people who had used NHS services in the previous 12 months (23%) reported being invited to an appointment after the date of the appointment – a 3 percentage point increase since 2024. 3 in 5 people who had experienced admin issues (60%) said it made them think that NHS money is being wasted. People living with a long-term health condition are more likely to say the NHS is poor at keeping people informed about what is happening with their care and treatment (45%), compared with 36% of people who do not have a long-term condition. 4 in 5 patients and carers (81%) who report they are struggling financially have experienced an issue with NHS admin, compared with 63% of those who are comfortable financially. Related reading on the hub: The challenges of navigating the healthcare system

Advice and Guidance (A&G) has been used in the NHS for years. It helps GPs get advice from specialists on a patient’s condition to decide the best course of treatment. The Department of Health and Social Care sets out the facts following media reports with a letter from the Health and Social Care Secretary Wes Streeting, published in the Daily Telegraph on 31 March.

This is the story of a woman who should still be here. A woman who spent her life lifting others, never knowing the danger quietly growing inside her. It is also the story of a husband who loved her with every part of his being, and who now fights to make sure what happened to her never happens to anyone else. Rachel Ball was funny, gentle, stubborn in the best way, and endlessly kind. She lit up classrooms, steadied frightened pupils, and brought out the good in everyone she met. For decades, her body was sending small signs, clues scattered across appointments, hospitals, and years, but no one ever joined them together. By the time the full picture emerged, it was too late. The missing piece revealed itself only at the very end, when nothing could change what it meant. In this memoir, Stuart Ball takes readers through the love they built, the life they shared, the warnings no one recognised, and the final fight that changed everything. Further reading on the hub: How one woman’s missed referrals exposed a systemic gap in hereditary cancer care: Why I'm campaigning for Rachel's Rule

This guidance sets out the core principles and components of high-performing emergency departments. It is accompanied by a detailed guide to the core operating principles for extended emergency medicine ambulatory care (EEMAC) activity. Together, they offer a structured, actionable approach to improving urgent and emergency care pathways and patient experience, as well as reducing waiting times. This guide is designed for providers, including: emergency department leaders (medical, nursing and operational leaders) considering implementing an EEMAC model hospital managers responsible for service implementation and resource allocation emergency department workforce (medical, nursing, allied health professions and administration) involved in patient triage, assessment and treatment. How to implement EEMAC successfully emergency department leadership team should establish the intended role and desired outcomes of EEMAC emergency department leadership team should ensure there is a well-understood model of emergency medicine, purpose and direction of travel Board-level medical, nursing and operational leadership should ensure multidisciplinary collaboration between local service teams emergency department clinical leaders and wider clinical teams should define clear patient pathways that align with the inclusion and exclusion criteria Estates teams and the ED team should together design the physical environment to optimise patient flow and comfort emergency department leadership team should establish a dedicated staffing model with appropriate clinical leadership Business intelligence and analytics teams should support the ED team to implement robust data recording practices for tracking and evaluating service performance. Core principles These principles apply to patients who attend the ED with an acute presentation. this EEMAC model applies to adult patients only the term EEMAC applies to patients expected to be discharged on the same day and whose care can be concluded by the ED team within 8 hours of transfer to the EEMAC unit. Patients requiring longer periods of observation will usually require admission to an inpatient area (for example, a CDU or short-stay ward) in common with other forms of SDEC, some EEMAC patients will require hospital admission – between 5% and 15% is expected patients suitable for existing medical, surgical, frailty or other SDEC pathways should be managed within those pathways as usual. Inclusion criteria patients who at initial assessment or via the rapid assessment and treatment (RAT) process are classified as acuity 3 or 4. Some acuity 2 patients, depending on individual patient needs and local departmental factors patients requiring advanced diagnostics, for example, CT or MRI or troponin result and senior clinical decision-making, but who have a high likelihood of being discharged within 8 hours patients whose investigation, management and treatment of their clinical condition is likely to take more than 4 hours, but who are likely to be suitable for discharge within 8 hours Exclusion criteria patients under the age of 16 patients suitable for existing medical, surgical, frailty or other SDEC pathways should follow those established routes low-risk primary care presentations should be directed to urgent treatment centres (UTCs). Acuity 5 patients are excluded patients requiring resuscitation facilities, those who are clinically unstable or those with presentations highly likely to result in admission should remain in the ED or be directed to appropriate alternative assessment and inpatient pathways patients with an acute mental health crisis who are at risk to themselves or the public or who are likely to require a medical or mental health admission patients who are acutely confused or intoxicated patients who are awaiting discharge or transfer; an EEMAC area is neither a discharge lounge nor an ‘overflow’ unit for other services patients awaiting admission to an inpatient bed patients who are being transferred from the ED without a valid clinical reason, where the only benefit from doing so would be to improve service time-based metrics – that is, the 4-hour standard patients requiring planned care (for example, follow-up or hot clinic activity). Location and environment EEMAC should ideally be co-located with ED but not within the ED footprint this estate should not be used for additional inpatient capacity or as an escalation space as part of a full capacity protocol the environment should be designed as an ambulatory clinic model, with chairs and minimal reliance on trolleys promoting efficient patient turnover. Comfortable waiting areas with access to refreshments should be available, and all other estate requirements should comply with the standards set out in the SDEC specification patients should have access to toilet facilities there should be no thoroughfare for staff or the public EEMAC facilities and estate should not compromise delivery of existing SDEC services or the ED. there should be provision for private discussions with patients, and the design of examination facilities should ensure patient comfort and support patient mobility (for example, access to recliner chairs and trolleys). Staffing and process the EEMAC area should have dedicated staffing, including a designated senior clinical decision-maker available during opening hours to ensure patient safety and maintain flow by ensuring rapid assessment and decision-making. There should be a separate, dedicated staff roster for EEMAC that includes, but is not limited to, senior decision-makers, medical and nursing staff, supported by administrative and operational support staff investigation and diagnostic turnaround times must be the same as for the ED all patients must have observations recorded at initial assessment to support assessment of acuity before transfer to the EEMAC area patients should be transferred to the EEMAC area as soon as possible after initial assessment patients who deteriorate while in EEMAC should be returned to the ED, following the hospital’s local standard process used in other specialty SDEC areas. Patients requiring admission should only remain in EEMAC while they wait for a bed and only if bed allocation is anticipated within the 8-hour time standard.

The NHS in England has introduced various innovations to keep up with the growing demand for elective care, one of which is patient-initiated follow-up (PIFU). This evaluation sought to understand staff experiences of implementing PIFU. The authors of this study conducted a rapid qualitative service evaluation between June 2022 and July 2023, based on semi-structured interviews with operational/managerial and clinical NHS staff from five English NHS Trusts, and an online workshop with 21 additional members of staff from the English NHS. The study found that implementation of PIFU affected staff roles, workload, and job satisfaction. Levels of PIFU uptake, and experience with similar models, affected the extent to which participants experienced the impact of PIFU. How PIFU was implemented varied. Some staff saw changes in their role because of new administrative demands, safety-netting procedures (such as proactive measures by specialty teams to mitigate the risk of patients not initiating appointments when necessary), and selection of suitable patients. PIFU was felt by some staff to increase, and by others to decrease, workload. PIFU affected intensity of work, interrelated with other factors such as the size of waiting lists, and conditions experienced by patients. Whether staff were satisfied with PIFU related to its impact on their role and workload. Satisfaction was also affected by whether staff believed PIFU delivered benefits for patients, and by the aims they felt were driving rollout.

Adam Hussain died from complicated appendicitis with perforation and peritonitis on 16 May 2025. This illness developing over a three day period, with worsening abdominal pain, vomiting and clear evidence of sepsis on the day prior to his final admission, which followed a cardiac arrest at home. The Coroner in their report states that there were many opportunities missed by the East Midlands Ambulance Service (EMAS) and by the Nottingham Emergency Medical Service (NEMS) to recognise the severity of his illness, and to ensure a face to face assessment, most particularly and obviously on 14 May, the day prior to his collapse at home on 15 May. No organisation with whom there was contact, recognised that there were repeated calls for assistance over the days prior to his death. The Coroner lists matters of concern in this case as follows: The urgent care pathway across Nottinghamshire, whilst working well for most patients, poorly serves patients with systemic illness that is serious, but not immediately life threatening, (such as is seen in sepsis), and where clinical assessment disposition reached is for a Category 3 ambulance response. There remains detailed information in the EMAS Computer Aided Dispatch (CAD) transferred from the 111 service that is not reliably read or considered by EMAS staff, when cancelling a requested ambulance response and referring a case on to the Clinical Assessment Service provided by NEMS. Families, waiting for an ambulance response, following a clinical assessment by a 111 clinical adviser are not told by EMAS that an ambulance will not be sent. Category 3 calls are viewed by non- clinicians at the EMAS Emergency Operations Centre, who do not have sufficient skills to safely transfer calls to NEMS, as the inclusion/exclusion criteria are open to interpretation. There is no agreement between EMAS and NEMS as to the criteria for transfer of a category 3 call, including whether or not a previous clinical validation would preclude transfer to NEMS.

This is one of a series of Health Services and Safety Investigations Body (HSSIB) and on the theme of patient safety in mental health inpatient settings. This investigation explored the issue of out of area placements (OAPs) – that is, scenarios where a patient is placed in a mental health inpatient setting that is a long way from their home or usual place of residence. This report examines the reasons for OAPs, the harms caused by them and how patients can be kept safe if an OAP is necessary. In particular it focuses on inappropriate OAPs. These are where a patient is unable to be cared for in their local NHS mental health acute inpatient setting and has to be sent to another, normally independent, mental health provider for ongoing treatment and care. These OAPs can be significant distances from a person’s residence. The investigation recognises that other OAPs exist for specialised commissioned services such as those for patients with eating disorders, but these were not considered in this investigation. The investigation has been informed by work carried out in the other investigations in the series, in particular ‘Creating conditions for learning from deaths and near misses in inpatient and community mental health services’. Findings Relating to patient, family and carer experiences The investigation found that harm (including dying by suicide, physical, psychological, distress and anxiety) was happening to patients, families and carers because of OAPs and the impact of being far away from their normal support network. There was also significant anger, frustration and loss of trust in the mental health system as a result of their experiences. Patients, families and carers rarely want an OAP and their choice and opinions are not always taken into consideration when decisions about sending someone to an OAP are made. The investigation found that OAPs can increase patients’ length of stay in hospital and therefore contribute to harm to patients. Patient, family and carers’ wishes and preferences, as required in the Mental Health Act 1983: Code of Practice, are not documented by health and care staff or routinely monitored during Care Quality Commission inspections. This leaves patient, families and carers feeling they are not listened to and increases anxiety, frustration and anger, leading to harm for people and creating distrust in the system. Advocacy services are vital for a patient to be able to put forward their views for consideration in decision making about their care, but advocacy is not always offered to patients. Relating to conditions in the health and care There is a national drive to reduce OAPs, but there continues to be an increasing trend in their use. OAPs may be the only option for patients if they are acutely unwell and need admission to inpatient services and there are no beds available in their local NHS mental health hospital. If OAPs are not utilised in this situation, people will remain unwell in the community and potentially present a high risk of harm to themselves or others. The rules, governance and legal framework within which health and social care organisations work differ. This can create friction in the system, preventing integration and pooling of funds across organisations, slowing down discharge and patient flow, and is a significant factor in the use of OAPs. It is impossible to look at the mental health inpatient system in isolation; consideration must be given to other health and care services such as community mental health services, social care and social housing provision by local authorities. When patients are sent to OAPs, the sending hospitals do not maintain responsibility for the welfare or clinical oversight of those patients. Limited patient flow through mental health and other services reduces trusts’ ability to discharge patients from hospital, which can increase the use of OAPs. NHS mental health trusts do not always have local authority social workers embedded in their organisations, as used to be the case under previous working arrangements. Embedding social workers within trusts was viewed by social workers and healthcare staff as a benefit to patients and improved patient flow and discharge planning. Some NHS trusts are undertaking some of the functions of local authorities relating to social housing, in order to enable patients to be discharged and reduce the need for OAPs. Beds and patients are managed in an impersonal way without seeing patients as having individual requirements. They are both treated as “commodities” when deciding on the need for an OAP because of the pressure on services and need for acute mental health beds. Crisis resolution and home treatment teams can have a significant influence in the early discharge of patients, that then creates a bed for the most mentally unwell patients in the community. Hospitals that send patients out of area sometimes rely on Care Quality Commission rating to base OAP decisions on, but many of these ratings are out of date and may not reflect the current situation. Many acute mental health patients have neurodevelopmental conditions and would benefit from early testing when they are in contact with community and acute mental health settings. Early assessment makes sure people are placed on the right pathway and may reduce admissions to acute mental health settings and the need for OAP. HSSIB makes the following safety recommendations HSSIB recommends that the Department of Health and Social Care includes the documenting of patient, family and carers’ wishes and preferences within the Mental Health Bill. This will ensure all patient, family and carer voices are considered in decisions relating to where the patient identifies they would like to be close to, for example the patient’s home or a family member, specifically when an out of area placement is needed. HSSIB recommends that the Department of Health and Social Care works across government to review the statutory instruments, business processes and regulations that govern mental health services, social care and housing services impacting on mental health out of area placements and creates a proposal for the future accountability and integration of health and social care. This is to ensure that they are operating to consistent statutory, financial and regulatory frameworks. By addressing system integration and nd local authorities will define accountability and reduce or prevent out of area placements. HSSIB makes the following safety observations NHS organisations can improve patient safety by maintaining clinical and welfare oversight and responsibility for patients being treated in an out of area placement. This can ensure harm is minimised and that patients are returned to their sending hospital as soon as possible. Mental health inpatient services can improve patient safety by offering advocacy to all mental health inpatients at the point of admission, and ensuring that the patient’s decision about whether or not to have an advocate is continually reviewed as their treatment continues and needs may change. This can ensure that patients’ needs and views are taken into account by health and social care staff when decisions about their care are being made, particularly when in an out of area placement. Crisis resolution and home treatment teams can improve patient safety by joining quality networks for crisis resolution and home treatment teams and could consider using continuous clinical reviews of mental health acute inpatients. This can ensure that appropriate patients are discharged early and could maximise acute care bed availability for patients in the community who are at high risk because of their mental health problem, and reduce the need for out of area placements. Health and social care organisations can improve patient safety by working together and embedding mental health social workers from the local authority in mental health acute hospitals. This can ensure that patients’ holistic health and social care needs are considered throughout their acute mental health admission and on into the community, and improve efficiency of working, patient flow and discharge and reduce the use of out of area placements. Mental health services can improve patient safety by reviewing their community mental health services to see if they meet the needs of their population with the aim of keeping as many people as possible out of inpatient services and thus preventing the use of out of area placements. Healthcare services can improve patient safety by conducting assessments for neurodevelopmental conditions such as autism and attention deficit hyperactivity disorder, where it is safe and clinically indicated, at the earliest opportunity when a person is in contact with community and acute mental health services. This can ensure that patients are put on the appropriate pathway early. This can prevent harm that may be caused by receiving inappropriate treatment and reduce admissions to mental health inpatient settings, thus reducing the need to use out of area placements.

Nigel Hammond died at 10:20 on 14 March 2024 at the Addenbrooke’s Hospital, Cambridge. On the 11 March 2024, Nigel fell at his home address. An ambulance was called, and Nigel was initially taken to the Ipswich Hospital but was transferred to the trauma centre at Addenbrooke’s hospital due to the extent of his injuries. Nigel succumbed to the injuries received in the fall, three days later. Nigel had suffered with his mental health for a protracted period, and it is more likely than not that his fall from the window was a deliberate attempt to end his life. The investigation concluded at the end of the inquest on 8th October 2024. The conclusion of the inquest was that the death was the result of:   Suicide, whilst the balance of his mind was disturbed. The medical cause of death was confirmed as: 1a Left Middle Cerebral Artery infarction, Traumatic Brain Injury 2  Depression, Lymphoma. Matters of concern: In late 2018 Nigel became seriously mentally unwell and was admitted to a Mental Health Unit, under the Mental Health Act provisions, for a period of 3 months. Whilst admitted, Nigel was diagnosed with advanced lymphoma (a lymphatic cancer) and upon discharge from the Mental Health Unit spent a further 3 months in hospital being treated for this. Nigel found his Mental Health Unit admission very traumatic and was described as ‘terrified’ of the thought of ever being admitted again. Upon his release, his family, carers, Mental Health Home Treatment team, worked together to provide exemplary care for Nigel, whose health stabilised and in 2020 his care was transferred back to his own General Practitioner. Nigel remained well until Friday 8 March 2024, when due to his decline in mental health he was taken to see his GP, and on the 9 March 2024 Nigel was prevented by family intervention from ending his life by jumping into a river. his incident led to Nigel’s family speaking to the on duty Authorised Mental Health Professional (AMHP) from the Suffolk Emergency Duty Service Team, on the evening of 9th March 2024. An AMHP is a mental health professional approved by a local social services authority to coordinate the mental health assessment and admission to hospital, of individuals requiring admission under the Mental Health Act provisions In evidence, the court heard that the AMHP, in line with Nigel’s family and his own wishes, agreed that an admission to hospital would not be in Nigel’s best interest. The AMHP identified that the successful home treatment regime previously in place would be the ideal care package for Nigel. This arrangement would also be consistent with the ‘least restrictive principle’ which surrounds the application of Mental Health legislation. That said, although Nigel did not meet the criteria for immediate admission, the AMHP believed Nigel was mentally very unwell, and in need of immediate support. The court heard that such support would be available within a 4-hour target time, from the emergency Crisis Resolution and Home Treatment Team. However, the court was told that an AMHP, despite their role in the coordination of the mental health assessment and admission to hospital of a patient, were not permitted to make direct referrals to the emergency Crisis Resolution and Home Treatment Team. The court heard that the normal route for such referrals was via the GP Surgery, or primary care Mental Health Nurse, neither of whom in Nigel’s case would have been available before 08:00 on Monday 11 March 2024. Nigel’s fall which led to his death, occurred at 06:25 that morning. I am concerned, as had the AHMP in Nigel’s case been able to directly refer him to the Crisis Resolution and Home Treatment Team on the 9th March 2024, mental health professionals would have attended, and been able to provide additional support, advice and potentially additional treatment for Nigel, in all likelihood preventing his death.