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Found 283 results
  1. Content Article
    The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) has published Recovery Beyond Survival, a review of the quality of rehabilitation care provided to patients following an admission to an intensive care unit. Based on 1,018 patients aged 18 and over who were admitted as an emergency to an ICU for four or more days between 1st October and 31st December 2022 (and who survived to hospital discharge), this report covers a range of specialities and ward areas, and identifies areas for improvement. Themes that emerge include the need for co-ordinated multidisciplinary care and good communication between professional groups, patients and their families. It also contains examples of excellent practice, such as early assessment for rehabilitation, the setting of short-term rehabilitation goals, the use of patient diaries, providing a leaflet on discharge with information about the availability of ongoing support, and the provision of follow-up appointments with the critical care team. This report goes on to make recommendations to support national and local quality improvement initiatives: Improve the co-ordination and delivery of rehabilitation following critical illness at both an organisational level and at a patient level. Develop and validate a national standardised rehabilitation screening tool to be used on admission to an intensive care unit. Undertake and document a comprehensive, holistic assessment of the rehabilitation needs of patients at risk of morbidity. Ensure that multidisciplinary teams are in place to deliver the required level of rehabilitation in intensive care units and across the recovery pathway. Standardise the handover of rehabilitation needs and goals for patients as they transition from the intensive care unit to the ward, and ward to community services. Provide patients and their family/carers with clear information.
  2. Event
    until
    The King's Fund is pleased to invite you to their moving care closer to home event in October. For years there has been an ambition to move care closer to home – now it’s time to make it a reality. This timely event, now in its second year, moves beyond local implementation to ask a critical question: what will it take to scale community-based care across the entire health and care system? It will bring together policy leaders, operational managers, innovators and practitioners to tackle the entrenched challenges, such as workforce, funding and infrastructure, and to spotlight the real-world innovations already changing care delivery. This in-person event is a perfect opportunity for you to connect with key stakeholders from across the system and clarify the role you can play in making care closer to home a reality. Register
  3. News Article
    Marie Curie said one in five hospital beds in Wales were occupied by people in the last year of their lives and "bold, radical" action was needed for services which were at "breaking point". One family said they had to fight to ensure their 85-year-old father could die peacefully at home rather than in a hospital ward. The Welsh government said it provided more than £16m a year to ensure people had access to the best possible end-of-life care. Marie Curie said gaps in care meant "too many people are spending their final days isolated, in pain, and struggling to make ends meet". "End-of-life care in Wales is at breaking point," said Senior Policy Manager Natasha Davies. "Services and staff are struggling to deliver the care people need, when and where they need it. There is an urgent need for change." The charity recognised while hospital was the best place for many palliative care patients, better community and out-of-hours care would allow people to be cared for in their homes. "It also means having meaningful conversations with dying people about their care preferences, so their wishes are heard and respected," added Ms Davies. The Welsh government said good palliative and end-of-life care could make a "huge difference" to helping people die with dignity. Read full story Source: BBC News, 2 June 2025
  4. Content Article
    Community mental health care support the largest number of patients within England’s mental health services. Yet, when it comes to research on patient safety in these settings, there’s still a lot we don’t know. To address this gap, (Averill, Sevdalis and Henderson, 2025) undertook a first-of-its kind study looking at the free-text information that is routinely reported by staff in incident reports. This approach is crucial in mental health settings, where most staff-reported observational data lack numeric scales for comparison and is instead entered as free-text. While the National Reporting and Learning System (NRLS), does compile quantitative information from the National Health Service (NHS) and make this freely available, most of these data are counts of incident types, rather than detailed notes written by staff. These notes contain a rich source of information – and yet, they have not previously been studied for patterns or themes, and therefore the information is not widely available to disseminate outside of the NHS. It is important that dedicated researchers are involved in this process. They have skills and experience in mitigating potential biases that could arise when looking at the data – and help discern real or truthful relationships that ultimately improve the quality of care.
  5. Content Article
    This King's Fund article sets out how prioritising non-clinical support for people who frequently attend A&E can contribute to the government’s ambition to deliver three major shifts in health and care.
  6. Content Article
    On the 10 April 2025, the Health Services Safety Investigations Body (HSSIB) published a report looking at how care is co-ordinated for people with long-term conditions. In particular, the investigation considered the role of ‘care co-ordinator’ to understand how care is co-ordinated within the existing workforce. In this blog, Patient Safety Learning sets out its reflections on the findings and recommendations in this report. HSSIB investigates patient safety concerns across the NHS in England and in independent healthcare settings where safety learning could also help to improve NHS care. Their latest report looks at primary and community care co-ordination for people with long-term conditions, specifically considering the role of ‘care coordinator’ in this context.[1] While language around the care coordination is varied, the role of care co-ordinated is defined by NHS England as follows: “Care co-ordinators help to co-ordinate and navigate care across the health and care system, helping people make the right connections, with the right teams at the right time. They can support people to become more active in their own health and care and are skilled in assessing people’s changing needs. Care co-ordinators are effective in bringing together multidisciplinary teams to support people’s complex health and care needs.”[2] In this blog we set out our reflections on the findings and recommendations in this HSSIB investigation. Challenges navigating the healthcare system Navigating the healthcare system in the UK can be complex and frustrating for patients, families and carers. At Patient Safety Learning we hear time and time again about the lack of joined up care and communication within and across organisations. Failing to share the right information at the right time can create significant patient safety risks. Poor communications, both with patients and between healthcare professionals, can result in misunderstandings and mistakes resulting in poor outcomes and potentially patient harm. In a recent series of blogs published on the hub, patients and their relatives shared with us the challenges and barriers they have faced when trying to navigate the healthcare system.[3] The concerns and issues raised in this HSSIB investigation echo many of the key themes we identified in our new blog series. Confusing communications HSSIB’s report refers to the case of a child prescribed anti-epileptic medication by a specialist hospital to reduce the number and severity of their seizures. It then details the difficulties the parents subsequently found in getting this medication through their GP or consultant. The parents highlighted concerns about the lack of communication between the separate services, with the report noting: “The parents told the investigation that they were ‘exhausted’ because of the effort they had had to put in over the years to connect services together, having to tell the same story over and over again, while having to provide care for their child.” Delays to treatment The investigation report also highlights the case of a middle-aged professional working man who suffered a stroke. He received hospital care to treat and manage his healthcare needs; however, once discharged he encountered significant difficulties when seeking appropriate support for his additional healthcare needs. HSSIB highlighted how he had told them it required significant effort from him directly to ensure the right level of care was maintained for his needs. Recounting his experience, the report states: “He said that these multiple agencies ‘all operate in their own silos’ and not as a team, and that ‘there was nobody to create that team [a cross-system team aware of all his health and care concerns]’. The way that he and his wife cope with this situation is that they ‘manage the team’ to connect the individual parts of the system and get the care he needs.” Impact on mental health HSSIB also spoke to a man in his late seventies who is the main carer for his wife. She has multiple long-term conditions that require primary, secondary and community care. Reflecting on the impact that coordinating her care had on their lives, the report noted: “The husband explained that his role of care co-ordinator had placed a considerable burden on him, which led him to ‘feel overwhelmed’. He said that because he needing to act as her ‘co-ordinator’ he was unable to spend time with his wife as her husband. He also described having to administer medication and dress his wife’s wound which caused her considerable pain.” HSSIB’s investigation also highlights broader areas of concern relating to the coordination of care in the healthcare system, again mirroring themes raised we heard from patients in our recent blog series. Difficulties sharing information The investigation highlights a recurring concern around problems sharing patient information and the negative impact of this on coordinating a patient’s care. It highlights both issues of digital systems in different organisations not being compatible with one another and other barriers, stating: “Healthcare professionals described the challenges in information sharing. Digital patient records could not be viewed across primary, community, secondary and tertiary care because information technology systems are unable to ‘talk to each other’. They also said that sometimes they were unsure whether patient information could be shared as it was ‘protected information’. This was a particular problem when trying to share information between health and social care.” A complex and confusing system The report also reflects more broadly on how accessing and navigating health and care services can be difficult and complex, and potentially overwhelming for patients. This was highlighted by examples such as this from the investigation: “A GP practice told the investigation that it had tried to put together an easy-to-read document explaining the care pathway for patients with dementia, including contact numbers and ways to access services. The GP practice went on to say that the system was so complex that it was unable to bring together all the information. It stated: ‘We are healthcare professionals and we can’t do this, so how can patients cope?’” Safety recommendations A theme that runs throughout HSSIB’s investigation is that there is a clear need and support for the role of care co-ordination. It highlights that while patients and carers can, and often do, themselves act in this role, when they are unwell or unable to do so a patient’s care can be significantly impacted. The report states that the availability of care co-ordination varies widely across the system. This is a particular issue for those living with multiple long-term conditions as there is no single centralised care co-ordination function to span across primary, secondary and tertiary care. Concluding its investigation, HSSIB recommends that: NHS England/Department of Health and Social Care, working with other relevant organisations, reviews and evaluates the implementation of the care co-ordinator role. This is to ensure that all patients with long-term conditions have their care co-ordinated and that they have a single point of contact 24 hours a day, 7 days a week, to help them with any queries or concerns that they may have. The Department of Health and Social Care works with NHS England and other stakeholders to develop a strategy that ensures that all diseases are given parity and that all people with a long-term condition in primary, secondary, tertiary and community or social care have their care effectively co-ordinated across multiple agencies. This is to ensure that people with long-term health conditions have co-ordinated care plans with effective communication between services and a single point of contact for concerns or questions. Patient Safety Learning agrees that there needs to be greater time and investment into care coordination. On the first recommendation, we would note that seeking to ensure all patients with long-term conditions have a single point of contact 24 hours of day, 7 days a week, would be a significant shift from the status quo. This would require a clear commitment of both financial and workforce resources from NHS England and the Department of Health and Social Care to deliver. In considering how this might be approached, it would also be important to consider: How this can be flexible depending on the long-term condition in question. Different conditions will require different levels and types of coordination. Systemic barriers that result in many of the difficulties navigating the care system would not be addressed by implementing this recommendation. For example: – We would continue to have various digital systems in primary, secondary and tertiary care that lack interoperability (the ability of computer systems or software to exchange and make use of information). – Non-digital communication barriers that prevent cross-organisational sharing of information in the NHS, ranging from data sharing restrictions to cultural attitudes within organisations, would also remain. On the second recommendation we agree with the principle of this, that there needs to be parity for people with a long-term condition and an expectation that their care is effectively co-ordinated across multiple agencies. Poorly coordinated care is not only confusing and frustrating for patients but also creates safety risks that can result in serious avoidable harm. Concluding comments The challenges of navigating the healthcare system discussed in this report are not a new issue, but a long-standing set of problems that do not have a simple solution. Their impact on patient experiences and outcomes is exacerbated in the current environment, when our healthcare system that is under increasing pressure and in a “critical condition”.[4] Patient Safety Learning believes that care co-ordination should form an important area of focus for the UK Government’s forthcoming 10 Year Health Plan. If it is to achieve its strategic ‘shift’ of moving the future of the NHS from "hospital to community" this will require a healthcare system where patients aren’t simply left to "join the dots for patient safety".[5] This will require organisational and leadership commitment to take forward the issues raised in this HSSIB investigation. The needs of patients should be central to improving health and care services, actively listening and acting on their experiences and insights when things go wrong for safety improvement. References HSSIB. Workforce and patient safety: primary and community care co-ordination for people with long-term conditions, 10 April 2025. NHS England. Care co-ordinators, Last accessed 10 April 2025. Patient Safety Learning. The challenges of navigating the healthcare system, 24 February 2025. UK Parliament. NHS: Independent Investigation, Hansard, Volume 753, 12 September 2024. Department of Health and Social Care, Independent report: Review into the operational effectiveness of the Care Quality Commission, 15 October 2024. Related reading Digital-only prescription requests: An elderly woman sent round the houses How the Patients Association helpline can help you navigate your care Lost in the system? NHS referrals Navigating the healthcare system as a university student: My personal experience The challenges of navigating the healthcare system: David's story The challenges of navigating the healthcare system: Sue's story Share your story What has been your experience of navigating the healthcare system? What is and isn’t working? How does it feel as a patient or carer when you hit barriers? Has your health been affected? Share your story in our community forum or contact our editorial team at [email protected].
  7. Content Article
    People who have a long-term condition may be in contact with multiple health and care organisations and may experience harm if their care is not co-ordinated. This investigation focuses on people with long-term conditions and how their care is co-ordinated, specifically considering the role of ‘care co-ordinator’. It is intended for healthcare organisations, policymakers and the public to help improve patient safety in relation to co-ordinating care for people with long-term or complex healthcare needs.  Findings The NHS has produced a definition of the professional role of NHS care co-ordinator. However, there is variation in how this role is implemented. Other national organisations have different definitions of care co-ordination and care navigation, which can create ambiguity for people overseeing these roles. There is not a single person/role/organisation responsible for co-ordinating care for people with long-term or complex health and care needs across multiple health and care organisations. The health and care system frequently fails to support care co-ordination across multiple care pathways and instead focuses on individual diseases or issues. This can leave people who have complex long-term conditions with uncoordinated care. Accessing and navigating health and care services can be difficult and complex, and patients and carers would like improved service integration and care co-ordination. Patients and carers act as a central point for information and contact for providers, but when they are unwell or unable to do this, care can be impacted. People who are unable to navigate the health and care system can experience deterioration of health, miss appointments or their care may become delayed or forgotten about, meaning they may need more intense treatment in the future or longer stays in hospital. Patients and carers have to retell their health history to different health and care providers. They believe the system is not joined up and that information does not flow across health and care organisations, or that different parts of the system cannot access information from other providers. When patients are discharged from a health or care setting out of normal working hours they do not always know who they can speak to about any concerns or their ongoing care. Different methods of sharing health and care information can create an information gap, particularly out of hours and at the weekend, resulting in a situation where not all health and care staff have the appropriate information to make decisions. Patients and carers can feel exhausted, burnt out, frustrated, angry and guilty, among other emotions. Patients and carers physical and mental health may deteriorate because of the extra burden of navigating the health and care system. Patients and carers may disengage with the health and care system because they are exhausted and frustrated. This may lead to poor outcomes for both patients and carers. There are different ways of supporting care co-ordination across the system, some of which are assisted by the charity sector. Safety recommendations HSSIB recommends that NHS England/Department of Health and Social Care, working with other relevant organisations, reviews and evaluates the implementation of the care co-ordinator role. This is to ensure that all patients with long-term conditions have their care co-ordinated and that they have a single point of contact 24 hours a day, 7 days a week, to help them with any queries or concerns that they may have. HSSIB recommends that the Department of Health and Social Care works with NHS England and other stakeholders, to develop a strategy that ensures that all diseases are given parity and that all people with a long-term condition in primary, secondary, tertiary and community or social care have their care effectively co-ordinated across multiple agencies. This is to ensure that people with long-term health conditions have co-ordinated care plans with effective communication between services and a single point of contact for concerns or questions. Safety observation Health and care organisations can improve patient safety by allocating a point of contact for patients and/or their carers when people are discharged from services out of normal working hours. This will ensure patients and their carers are able to escalate any concerns relating to their ongoing care and drive improvements in care co-ordination. Related reading on the hub: Read Patient's Safety Learning's response to the findings and recommendations of this HSSIB report
  8. News Article
    Health workers will be sent door-to-door under drastic new NHS plans to tackle sickness rates across England, according to reports. A community health worker will be allocated 120 homes to visit every month to see if help is needed under plans set to be rolled out in June, The Daily Telegraph reports. Health secretary Wes Streeting said trials of the scheme showed “encouraging signs” in slashing the number of heavy NHS users which he called “frequent flyers” of A&E departments. A pilot scheme in Westminster, London, showed a dramatic 10% drop in hospital admissions over a year, The Daily Telegraph reports. “We’re seeing some really encouraging signs about what can happen if you’ve got the right care in the right place at the right time,” Mr Streeting said. The scheme, set to be rolled out in 25 parts of England, is part of Mr Streeting’s 10-year plan for the NHS, which could also see younger people directed to pharmacy care using the NHS app, leaving GPs to devote their time to sicker and older patients. The health secretary said a modernised version of the health service’s phone app could mean the NHS could “do a much better and faster job of making sure patients get the right care at the right time in the right place”. Read full story Source: The Independent, 7 April 2025
  9. Event
    Following Lord Darzi’s investigation in 2024 and a ‘national conversation’ on how to fix our ‘broken’ NHS, a new 10 Year Health Plan charged with setting out government plans to deliver its three shifts – from hospital to community, analogue to digital and sickness to prevention – will publish in the spring. The spending review, which will set out government spending plans for the next three years, and the publication of a revised long-term workforce plan, are also expected over the coming months. About the event This King's Fund conference will explore how implementation of the three shifts can deliver improved care, outcomes and experience for the public, while ensuring our health and care system is compassionate, equitable and sustainable. Our expert speakers will outline the actions and decisions needed to transform the health service into a prevention-focused service by 2035. Conference sessions will provide practical guidance on: how the 10 Year Health Plan can support the government’s overall health mission the impact of the comprehensive spending review and radical options for how funding is allocated and flows through the system how the plan can only be delivered successfully if there is similar attention and support for adult social care managing the trade-offs, including implementing the changes and shifts over the long term while prioritising resources on current pressures building on the approach in the development of the plan to work differently with people (patients, staff and communities) and ensure services are co-designed to meet needs and deliver care that is truly patient-centred how to achieve a managed shift in resources and power away from the acute sector towards primary, community and preventive services creating digitally enabled services that are inclusive and trusted by engaging with people and communities. Register
  10. Content Article
    Hospital at home and virtual wards provide safe alternatives to hospital care in the community. There is considerable variation in how they are operationalised at a local level. In general, their common feature is to provide healthcare in people’s homes through a multidisciplinary clinical team. Care is delivered both remotely and face to face. They aim to help avoid admission as well as facilitate rapid discharge. The models vary in terms of who leads the service; the hours of operation; the staffing model; the conditions they support; the length of support; how technology is used; and how patients and professionals access the service. In March 2025, NIHR Evidence held a webinar showcasing research on two home-based alternatives to hospital care from three evidence reviews: admission avoidance hospital at home and virtual wards for people with frailty. The webinar addressed: the key elements of hospital at home and virtual wards their impact on outcomes their impact on service costs factors that contribute to their success.
  11. News Article
    The rate of patients dying by suicide shortly after discharge from mental health units has increased in recent years, with researchers calling for better post-discharge support. According to the National Confidential Inquiry into Suicide and Safety in Mental Health annual report – an audit published by the Health Quality Improvement Partnership – the number and rate of deaths after discharge from a ward have been gradually increasing since 2017, after falling from 2013-17. The rate in 2022, the most recent figures reported, was 14.1 per 10,000 discharges. Isabelle Hunt, senior research fellow at the Manchester University and report co-author, told HSJ the most recent figures should be “treated with caution”, but added that the rise in post-discharge suicides could be attributed to the case mix of patients. A “reduction in inpatient beds” could mean “a higher-risk group of patients are being managed by services” and being discharged when more unwell. Dr Hunt said the increases could also be associated with changes in the circumstances patients are being discharged to. “Around a quarter of patients who died by suicide within three months of discharge were known to have been discharged to housing, financial or employment problems and a fifth were discharged to poor social support,” Dr Hunt said. “Awareness of the stressors patients may face after leaving hospital is a key element when judging the appropriateness of discharge, and greater involvement of families and carers is likely to provide a clearer picture of the circumstances a patient is returning to.” Read full story (paywalled) Source: HSJ, 12 March 2025
  12. News Article
    A lack of supported housing was the biggest reason for delayed discharges from mental health hospitals in England last year, costing the NHS about £71m, according to a report. Analysis from the National Housing Federation (NHF) found that in 2023-24 there were 109,029 days of delayed discharge because mental health patients were waiting for supported housing, and the number of people stuck in hospital as a result of housing-related issues had more than tripled since 2021. In September 2024, waiting for supported housing was the single biggest reason mental health patients, fit for discharge, were unable to leave, accounting for 17% of all delays. This lack led to a strain on NHS capacity and a rise in patients being sent out of area for hospital admission, the report found. Rhys Moore, director of public impact at the NHF, said: “Not only are tens of thousands of people, who deserve the opportunity to live a healthy, happy and independent life, being failed, but the shortage of these homes is increasing pressure on public services, increasing homelessness, and costing the NHS and ultimately the taxpayer more in the long run.” A man in his 30s, who asked to remain anonymous, had struggled with drug addiction issues and was evicted shortly before he was admitted to a mental health hospital ward where he spent a number of weeks. “I feel like I’m much better off in here than in hospital,” he said. “[The hospital] felt like I was all right. The way we were talking, I could tell they thought, you’re wasting my bed, you don’t need to be here. But I had been evicted, I had nowhere to go. “I was really struggling in there, it was noisy and stressful at times. Living here, I feel like I can breathe and start getting myself back together again.” Read full story Source: The Guardian, 11 February 2025
  13. Content Article
    Relatively little is known about mental healthcare-related harm, with patient safety incidents (PSIs) in community-based services particularly poorly understood. This study aimed to characterise PSIs, contributory factors, and reporter-identified solutions within community-based mental health services for working-age adults. Data was obtained on PSIs reported within English services from the National Reporting and Learning System. Of retrieved reports, the authors sampled all incidents reportedly involving ‘Death’, ‘Severe harm’, or ‘Moderate harm’, and random samples of a proportion of ‘Low harm’ or ‘No harm’ incidents. Of 1825 sampled reports, 1443 were eligible and classified into nine categories. Harmful outcomes, wherein service influence was unclear, were widely observed, with self-harm the modal concern amongst ‘No harm’ (15.0%), ‘Low harm’ (62.8%), and ‘Moderate harm’ (37.6%) categories. Attempted suicides (51.7%) and suicides (52.1%) were the most frequently reported events under ‘Severe harm’ or ‘Death’ outcomes, respectively. Incidents common to most healthcare settings were identified (e.g. medication errors), alongside specialty-specific incidents (e.g. Mental Health Act administration errors). Contributory factors were wide-ranging, with situational failures (e.g. team function failures) and local working conditions (e.g. unmanageable workload) widely reported. Solution categories included service user-directed actions and policy introduction or reinforcement.
  14. News Article
    "I feel very angry, upset, worthless, and like my mental health and my life does not matter," says Jessie, propped up in a hospital bed. She is recording this in a video diary. Blue NHS curtains are drawn around the bed and all her possessions are stacked up in the tiny chaotic space this creates. Among the piles of boxes and bags sit the dolls she holds to keep her calm. Thirty-five-year-old Jessie spent 550 days in Northampton General Hospital. For nearly all that time, she was medically fit to leave but finding her a suitable place to go to was difficult. The BBC has followed her story for more than five months as the NHS trust took costly High Court action against her, to have her evicted from the hospital bed she was occupying. Jessie was eventually arrested and taken to a care home where she says she feels anxious. Her story is an extreme example, but it demonstrates the acute pressures faced by a care system coping with more complex cases, the knock-on effect to the NHS, and how the person at the heart of it can feel lost. North Northamptonshire Council, which is responsible for her housing and care, says it cannot comment because of an ongoing police investigation into Jessie's behaviour. The hospital says it "is not the best environment for patients who are not in need of acute medical care". The Department of Health and Social Care has told the BBC: "This is a troubling case which shows how our broken NHS discharge system is failing vulnerable people." Read full story Source: BBC News, 8 February 2025
  15. News Article
    Integrated care boards are warning they are failing to carry out health checks for vulnerable children in care because of a lack of paediatricians and rising demand, HSJ has found. ICBs are required to commission initial health assessments within 20 working days of a child entering care, arranged by a local authority, then a review six to 12 months later. HSJ has identified several ICBs warning they are not or may not meet the requirement – citing workforce pressures, complex cases and rising demand. Missing the checks for children in care risks harming their physical and mental health, school attainment and future wellbeing, according to paediatricians. A community paediatrician working in the South East told HSJ delayed assessments could have significant long-term impact — delaying intervention in developmental concerns, alcohol and drug use, oral health, immunisation and medications. “These children are incredibly vulnerable,” they said. “The quicker we get issues addressed, often putting them on SEN [special educational needs] or other support, the better they often do in school and in life.” Read full story (paywalled) Source: HSJ, 5 February 2025
  16. News Article
    The UK spends £11.7bn on people’s health in the last year of their life, largely on hospital care even though most would rather die at home or in a hospice. The stark disparity is “robbing many tens of thousands of dying people of the chance to remain where they want to be in the final chapter of their life”, according to Marie Curie. A report from the charity has revealed that, in all, Britain spends £22bn a year on health care, social care and welfare benefits for people who will be dead within 12 months. Of the £11.7bn spent on health needs, £9.6bn (81%) goes to hospitals and out of that, more than two-thirds, £6.6bn, is used to provide emergency care such as in A&E. The findings come as MPs consider how to introduce assisted dying for people with a terminal condition who have less than six months to live. The Labour MP Kim Leadbeater’s private member’s bill has prompted widespread agreement that end of life care needs a dramatic expansion. “Through inadequate community care for people in the final year of life, we are currently robbing many tens of thousands of dying people of the chance to remain where they want to be in the final chapter of their life. It is inexcusable and it cannot be ignored any longer,” said Dr Sam Royston, Marie Curie’s executive director of research and policy. “No one wants to be calling an ambulance in the middle of the night because they can’t get the support they need at home, or facing long stays in hospital when they don’t want or need to be there, but that is the shocking reality for far too many dying people.” Read full story Source: The Guardian, 5 February 2025
  17. Event
    This conference focuses on recognising and responding to the deteriorating patient in primary and community care. The conference will include National Developments including the new Sepsis 2024 NICE guidance, the national rollout of Martha’s Rule, and focus on best practice in primary care. The conference will include practical case study based sessions on identifying patients at risk of deterioration, improving practice in patient observations, the role of human factors in responding to the deteriorating patient, improving escalation and understanding success factors in escalation, involving patients and families in recognising deterioration, using clinical judgement, and improving the communication and use of NEWS2 in primary care, the community including care homes, and at the interface of care. For further information and to book your place visit https://www.healthcareconferencesuk.co.uk/virtual-online-courses/deteriorating-patient-summit=primary-care or email [email protected] Follow on Twitter @HCUK_Clare #DeterioratingPatient hub members get a 20% discount. Email [email protected] for discount code.
  18. News Article
    More than a dozen national priorities have been dropped from the national planning guidance, but several new targets for 2025-26 have been revealed. The government and NHS England said the 2025-26 planning guidance features fewer priorities than last year’s edition so that local leaders can have greater freedom in how they balance their budgets, and meet the core priorities of improving elective, emergency and primary care performance in the context of a very tight financial settlement. The most significant targets dropped from the 2025-26 list of objectives include: All the workforce objectives included in the 2024-25 planning guidance have been removed. They were to improve “the working lives of all staff and [increase] staff retention and attendance”, especially those of “doctors in training”, and to “provide sufficient clinical placements and apprenticeship pathways”. The 2025-26 guidance, however, does ask the service to continue a focus on retention. “Improve community service waiting times, with a focus on reducing long waits.” The removal of the target comes amid a sharp rise in children waiting more than a year, and two years, for help from community services. Increase the percentage of cancers diagnosed at stages 1 and 2 in line with the 75% early diagnosis ambition by 2028. Several mental health priorities have been cut from the guidance. They include increasing access to adult community mental health and perinatal mental health, and ensuring that people with severe mental illness or a learning disability receive a physical health check. A target to increase dementia diagnosis has also been dropped. Implementing the “patient safety incident response framework”. This is thought to have been widely implemented already Read full story (paywalled) Source: HSJ, 30 January 2025
  19. News Article
    England’s top doctor has warned the equivalent of half the country’s population will be attending emergency departments every year within a decade unless more work is done to move healthcare out of hospitals. NHS national medical director Professor Sir Stephen Powis said if the health system wants to avoid a situation of overcrowded A&Es by 2034 then it “must go for broke” by moving more care into communities. A&Es in England faced the busiest year on record in 2024, with 27.42 million attendances across the year, 7.1 per cent higher than in 2023, according to NHS England. In a speech at Liverpool Medical Institution on Wednesday evening, Professor Powis said caring for more patients outside of hospitals was key to reducing pressure on accident and emergency departments long term. “Because we know that if A&E attendances increase at the same rate as they have over the past 10 years – NHS staff will need to manage six million more A&E attendances every year from 2034,” he is expected to say. “That would mean the equivalent of almost half the population attend A&E at least once every year – that is simply not feasible for a 21st-century health system. “If the NHS is to avoid a situation of overcrowded A&Es in 10 years’ time – we must go for broke in moving care from hospital to the community.” Read full story Source: The Independent, 22 January 2025
  20. News Article
    The NHS should create a “single 24/7 service” for urgent and emergency care for every A&E department’s catchment area to address what is currently a “fragmented and disjointed” system, six expert groups have said. The recommendation is part of a wide-ranging plan to reform the urgent and emergency care system, which has been jointly authored by bodies including the Royal College of Emergency Medicine, the Royal College of GPs and the Association of Ambulance Chief Executives. The expert groups’ reform blueprint, titled Our Urgent and Emergency Care Improvement Proposals, comes ahead of the government’s anticipated “improvement plan” for the sector. It concludes the NHS has “got the winter it prepared for” and has “normalised and accepted” poor care. Proposed actions in the plan include creating a “single 24/7 service” for each emergency department catchment area, bringing together teams in EDs, urgent community response services and virtual wards, which would be focused on caring for people in their communities. Read full story (paywalled) Source: HSJ, 22 January 2025
  21. Content Article
    Every winter, the NHS faces immense pressure, with poor standards of care becoming an expected part of the "winter crisis." The Patients Association, the Royal College of Emergency Medicine, the Royal College of General Practitioners, the College of Paramedics, the National Association of Primary Care, and the Association of Ambulance Chief Executives have joined together to propose practical solutions for meaningful, long-term improvement. The joint statement identifies four core issues at the heart of the crisis: Primary care does not have the capacity to meet its patient demand. We are not pro-actively looking after patients who are currently the most frequent users of urgent and emergency care to stop them getting so unwell. The urgent and emergency ‘system’ in the NHS remains fragmented and disjointed, making it hard to navigate patients to the right place to get their care. Emergency departments (EDs) have become hugely congested because of lack of flow into and out of hospital beds. Proposals to address these issues 1) Increasing primary care capacity by: In 2025/26 ensuring the uplift in funding promised by the government does translate into the ability of practices to employ more GPs. In subsequent years increase the share of NHS funding for general practice to match the increased workload involved in the planned shift of care from hospitals to the community. Freeing up GP time, so they have more time to spend with the patients who most need continuity by cutting bureaucratic red tape, supporting practices to improve triage systems to help navigate patients to the right part of primary care and the wider NHS. This could also contribute to freeing up capacity in 111. Introducing a national alert system to flag unsafe levels of workload and allow GP practices to access additional support. Every Integrated Care System (ICS) should be required to establish alert systems for general practice, similar to the ‘operational pressures escalation levels framework’ in hospitals. Beginning the implementation of integrated neighbourhood working by aligning community services to each primary care network so we can better use existing resources across the primary and community care sector to focus on prevention and keeping people well in their communities. Making the best use of the paramedic workforce to support primary care with home visiting and face to face services. 2) Improving care for the patient groups who are currently using urgent and emergency care the most by: Resource is needed to enable every older person in a high risk group to have a full health ‘MOT’ every year, including consideration of loneliness and isolation risks, a known driver of ill-health. These should be conducted by integrated neighbourhood health teams with multi-disciplinary team input particularly from primary, community and mental health colleagues. The resulting care plans should be readily accessible to all healthcare professionals with whom they come into contact. All people in residential and nursing homes should have the NHS delivered to them. This should be led by GP and community teams with the expectation that care is provided to them in their place of residence and the first point of contact for most urgent care episodes is those teams and not 999. All patients known to be on a palliative care pathway should have a care plan, accessible to clinicians across the emergency care pathway that is explicit about where the patient would like to die so that we can honour their last wishes. Identifying the highest users of urgent and emergency care in each ICS footprint, in order to agree a care plan for these individuals and to reduce their use of ED. Providing more support to patients in deprived communities by reviewing all funding streams (including primary care) to channel more spending to areas of greatest need. Identifying patients who are at high risk of emergency admissions (supported by AI) with a particular focus on adults with chronic breathing and cardiac conditions to create bespoke care plans (including using wearable devices) with pro-active monitoring to minimise the spikes in demand we see every winter. Consider making the flu vaccination available, subject to JCVI approval, to a much broader group than currently defined, and then making sure we maximise both the uptake and speed of vaccination. 3) Joining the urgent and emergency system back together by: Creating a single 24/7 service for each ED catchment area that is focused on caring for people in their normal place of residence that brings together the current urgent community response teams, virtual ward teams and ED teams into a single multi-disciplinary team. Supporting the development of the principle of senior clinical decision making in community as well as the ED environment. Making it an expectation that community-based clinicians and hospital staff routinely discuss their patients to ensure they get the right care, blurring the boundaries between hospital and community / primary care. Integrating urgent mental health services into ambulance, ED and 111 delivery and training many more clinicians with mental health skills for managing patients in mental health crisis. Allowing the ambulance service the time to do a fuller clinical assessment for all patients who call 999 who do not obviously need conveying to an ED. Having a patient’s medical record that is accessible by all providers who can read and update it and that patients can see themselves. Re-wiring the NHS financial flows to incentivise the system to work together and to reward providers who deliver the interventions in this paper. Creating a workforce strategy for the urgent and emergency care system looking at capacity needed for in and out of hours GP services, community nursing, mental health and paramedics, aligning training and careers together. Create an improvement culture in urgent and emergency care by routinely evaluating, learning and adapting initiatives. 4) Improving the flow through emergency departments: We have to improve flow in hospitals by beginning to resolve the bottlenecks that delayed discharges create, primarily because of insufficient bed capacity and lack of social care funding. Rather than rehearse the arguments that have been made in recent weeks, we endorse all the feedback being voiced by many, that the solutions for social care cannot wait until 2028 and we must begin to increase social care capacity before next winter. Implementing many of the recommendations from the Cavendish review from 2022 would be a good place to start. We also need to maximise opportunities to prevent deconditioning of our frail or elderly patients when they are inpatients through improved therapy and dietetic support.
  22. Content Article
    In this blog, Hope Virgo, author and Secretariat for the All Party Parliamentary Group (APPG) on Eating Disorders, examines the crisis that continues in eating disorder services in the UK and the devastating impact this is having on patients and their families. She highlights how failures in services lead to avoidable deaths. Hope shares the key recommendations from a new report by the APPG and calls for adequate funding and attention to ensure people with eating disorders receive the help they need to recover. Eating disorders are among the most serious and life-threatening mental illnesses but have been overlooked and underfunded for far too long. Because of this, eating disorders have one of the largest treatment gaps in modern healthcare. In the past decade, we have seen an alarming rise in eating disorders, a trend that only worsened during the Covid-19 pandemic.[1] What was already a struggling support system for people affected by eating disorders has collapsed under this pressure. Too many people are waiting for support from treatment services that have been grossly underfunded and neglected for many years. In addition, public perception of eating disorders is still dominated by narrow stereotypes—but eating disorders don't discriminate and affect people of all ages, genders and ethnic backgrounds. Understanding the situation for people with eating disorders in the UK Over the last six months, the All-Party Parliamentary Group (APPG) on Eating Disorders has been meeting with people affected by eating disorders, clinicians, researchers and campaigners to gain an accurate picture of what is going on in the UK. The stories we have heard are harrowing and eye-opening to the epidemic of eating disorders that our healthcare system faces. We have heard stories of people: being denied treatment for not being thin enough. spending nights in A&E being hydrated, only to be discharged out into the community with no follow-up plan or treatment package. people being discharged from inpatient and outpatient treatment at low BMIs. In some cases, this has resulted in organ failure, suicide or repeat admissions to A&E where people have been crying out for support, only to be blamed for their condition. avoidable deaths. These stories have added to the evidence seen in the pre-pandemic survey of adult community eating disorder services, which highlighted significant shortcomings in community services’ capacity to manage risk. Only around 40% of services provided complete medical monitoring and/or had good links with acute hospitals.[2] Unfortunately, as the severity of a patient's illness increases, the likelihood of them seeking and accepting help decreases significantly. This means that the inability of 50% of services to provide follow ups or assertive outreach to patients who do not engage further increases the risk of deterioration these patients in the community. The statistics we have from the Office for National Statistics (ONS) show much lower mortality figures than we believe to be the case, which is likely due to inaccuracies in recording practices. For those with anorexia, deaths are often caused by physical complications such as malnutrition, gastrointestinal issues, metabolic disturbances, cardiovascular events or infections, and recorded as such. Type 1 diabetes with disordered eating (T1DE) significantly increases the risk of premature mortality. These risks can be reduced with improved services and targeted medical training. Several psychiatric conditions can occur alongside eating disorders, including substance misuse, personality disorders and self-harm. This further heightens the risk of a person dying, which is why we need integrated care to bridge gaps between eating disorder and other mental health services. International studies have shown that integrated, timely services can improve outcomes and prevent deaths.[3] Zara had an eating disorder and tragically died from suicide. Zara’s mum, Debs, believes her daughter would still be alive if she had received the support she needed and asked for. “My beautiful daughter, Zara—intelligent, sassy, kind, and compassionate—took her own life on 22 September 2021 after struggling with an eating disorder for nearly 10 years. Zara was diagnosed with Anorexia Nervosa in May 2013 and was admitted to an Eating Disorder Unit almost immediately. Instead of being good news for her recovery, this is when the nightmare began. From May 2013 to June 2021, Zara endured 13 inpatient admissions across seven different units, including three years as a continuous inpatient—nearly two of which she spent without ever leaving one of the units or going outside. With each admission, her eating disorder and mental health deteriorated further. During this time, she was restrained daily, often by a minimum of six people holding her down. She received very little therapy, and instead, there was a culture of patient blaming and shaming. In the last two years of her life, Zara was crying out for help, but no one would listen. The Eating Disorder Unit discharged her completely, handing her over to the community mental health team. I spent nearly every day taking ligatures off her, lifting her down from her wardrobe when I found her near unconscious, and performing CPR when I found her in the shower. There was little to no support from our community psychiatrist; we were left to cope alone. No matter how much we pleaded for help, it was a constant battle, and we never received the support Zara so desperately needed. My beautiful daughter should never have died from this illness. There was a whole world out there for her, and she had so much to give. But ultimately, Zara felt like everyone had given up on her. She was only 24 when she died, but she was exhausted, and didn’t know any other way to keep going without support." Zara's story is one of many similar stories that are unfolding for countless others across the country. Behind these tragedies are systemic failures, often overlooked and hidden behind a lack of national data, questionable legal decision-making and cost-saving agendas. New APPG report—The Right to health: people with eating disorders failed The APPG on eating disorders has released its first report into the state of eating disorder services in the UK. It makes five recommendations for the Government, including the call for a confidential inquiry into all eating disorder deaths. Development of a national strategy for eating disorders. This strategy will encompass adults and young people, with sufficient funding to reform all services. The goal is to provide timely, evidence-based treatment for every individual with an eating disorder. The national strategy will include: - mandatory eating disorder training for all healthcare workers (including GPs, dentists and nurses). - investment in a public health campaign to clarify messaging around obesity and eating disorders. - funding for the implementation and integration of evidence-based treatment practices, including collaboration between services. - mandatory health screening for high-risk groups. - training for carers. Additional funding for eating disorder services. This funding should address the demand for both adult and children's services. Confidential inquiry into all eating disorder deaths. Increased research funding for eating disorders. The aim is to enhance treatment outcomes and ultimately discover a cure for eating disorders. Non-executive director oversight for eating disorder services. This oversight and accountability should be implemented in all NHS Trusts and Health Boards in the UK. James Downs, a Researcher and Campaigner who shared his own lived experience as part of the APPG evidence sessions, told us that, “Patient safety must be at the heart of reform. Transparency and accountability about the failures in eating disorder services are long overdue, and every NHS Trust and Health Board must include non-executive directors focused on eating disorder services to provide ongoing scrutiny and progress.” With integrated, well-resourced, and evidence-based treatment, recovery is possible, even in the most severe cases and after many years of suffering. Despite this, coroners, families and communities continue to see too many lives needlessly lost. This should not be happening. Eating disorders are treatable illnesses. They are dangerous and life-threatening when untreated, undertreated or poorly treated. But this risk to life is preventable, and deaths from eating disorders are not inevitable. Suzanne Baker, Carer Representative at F.E.A.S.T., gave evidence for the APPG and said, “It is a national scandal that this basic treatment expectation is not being met, leading to preventable deaths. Recovery should be the goal for every patient—a goal that is entirely achievable with the right treatment.” A confidential inquiry is urgently needed to identify modifiable factors that contribute to preventable deaths. We need to see targeted interventions, service improvements and enhanced professional training to address gaps in care delivery. Our question for the Government and the NHS is this: Why in the face of crisis is so little being done to support those affected by eating disorders? Join the conversation Do you have an eating disorder or care for someone who does? We'd like to hear about your experience of accessing services and support. Are you a healthcare professional working in eating disorder services? Share your reflections about how care and treatment can be improved and made accessible to all. You can join the conversation by commenting below (you'll need to sign up to join the hub first) or get in touch with us directly by emailing [email protected] References 1 NHS Benchmarking Network. Accessed 12 January 2025 2 Viljoen D, King E, Harris S et al., 'The alarms should no longer be ignored: Survey of the demand, capacity and provision of adult community eating disorder services in England and Scotland before COVID-19'. BJPsych Bull. 2023; 48(4):1-9 3 Castellini G, Caini S, Cassioli E et al, 'Mortality and care of eating disorders'. Acta Psychiatr Scand. 2023; 147(2): 122-133 Related reading In conversation with Hope Virgo: “The withdrawal of treatment from people with eating disorders is a national crisis that’s being ignored.” Your illness worsens – so care is cut off. This is the scandal playing out in eating disorder treatment (Guardian, 25 February 2024) The right to health: People with eating disorders are being failed (22 January 2025)
  23. News Article
    Rachel Reeves’ Budget measures will devastate care providers, leaving vulnerable disabled and elderly people without care next year, healthcare experts are warning. The disastrous scenario could also bankrupt local authorities, care providers say. The rise in employers’ national insurance in April, together with increases in the minimum wage and national living wage, will threaten the future of care companies, according to the Homecare Association, a membership body for care providers. The association says that if care providers fold, the UK risks widespread failure of care provision, which could “leave people without care, overwhelm family carers and cripple NHS services”. Read full story Source: The Independent, 15 December 2024
  24. Event
    The health and care system in England is undergoing significant change. With a new government setting its priorities, an ambitious 10-year health plan in development, and ongoing challenges such as workforce shortages and health inequalities, understanding these complexities is more important than ever. This is a two-day event led by The King’s Fund’s policy and leadership experts. Whether you’re navigating integrated care systems, grappling with social care reforms or seeking clarity on the pressures facing health and care, this event offers essential knowledge and balanced insights. Register
  25. News Article
    About 300 hospice inpatient beds are currently closed or out of use in England, hospice leaders have warned. They say a lack of funding and staff are the primary reasons why some of England's 170 hospices have had to close beds permanently or take them out of use. Hospice UK, which represents the sector, is now calling for an urgent package of government funding to prevent further cuts. The Department of Health said it was looking at how to financially support hospices to ensure they are sustainable. Annette Alcock, Hospice UK's director of programmes, said the way that hospices are funded and commissioned by the NHS is "acting as a huge cap on what they can do", while also blaming "underlying pressures like staff shortages". She added: "If the government can act in both the short and long term to resolve these problems, these figures are clear evidence that hospices can do a lot more for patients, and a lot more for the NHS. "That's true out in the community too, where most of hospice care is actually delivered. "With better funding and commissioning, hospices could provide so much more care where people most want it - at home." Read full story Source: BBC News, 4 December 2024
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