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Found 123 results
  1. News Article
    A new scheme in Wales to help people who have suffered falls has prevented 50 ambulances being unnecessarily sent this year. St John Ambulance works with Hywel Dda health board in Pembrokeshire to send its people when someone calls 999. The pilot has been used 96 times since January but it needs more health board funding to continue after March. Ageing Well in Wales estimates that between 230,000 and 460,000 over 60s fall each year. When people dial 999, it can be directed to the St John Ambulance falls response team, who are sent to perform an assessment and identify whether the person can stay home or needs an ambulance to take them to hospital. St John Ambulance operational team leader Robert James said in 60% of cases, the person was well enough to stay at home. "You can imagine if you were sending an ambulance crew out and it has wasted 60% of the crew's time, well it's a big saving towards the NHS and the ambulance service in itself," he added. "Provided there are no injuries, or reason for them to go to hospital, they can be discharged on the scene." Read full story Source: BBC News, 10 March 2023
  2. News Article
    Nearly half of NHS patients with a learning disability or autism are still being kept inappropriately in hospitals, several years into a key programme to reduce inpatient care, a national review reveals. The newly published review by NHS England suggests 41% of inpatients, assessed over an eight-month period to May 2022, should be receiving care in the community. Reasons given for continued hospital care in the NHSE review included lack of suitable accommodation, with 19% having needs which could be delivered by community services; delays in moving individuals into the community with appropriate aftercare; legal barriers, with one region citing “ongoing concerns for public safety” as a barrier for discharge; and no clear care plans. In some cases, individuals were placed in psychiatric intensive care units on a long-term basis, because “there was nowhere else to go”, while another instance cited a 20-year stay in hospital. Other key themes included concerns about staff culture, particularly “institutionalisation” and suggestions that discharge delays were not being sufficiently addressed. The report adds: “While the process around discharge can be time consuming, staff may perpetuate this by accepting such delays as necessary or inevitable.” Read full story (paywalled) Source: HSJ, 22 February 2023
  3. Content Article
    The review found that while in many cases care and treatment were appropriate, there were a number of cases that raised specific patient safety concerns. Below is a summary of key themes from this report: Out of area placements An out of area placement occurs when a person with acute mental health needs who requires inpatient care is admitted to a unit that does not form part of the usual local network of services. This review found that there was significant variation for people who are autistic and/or have a learning disability in this regard. This was most striking in the South West of England and Midlands regions, where 73% and 68% of all placements, respectively, were out of area compared to the national average of 57%. The report notes this can have significant impacts on the person affected by this, making it more difficult for them to maintain links with family, local services, communities and clinical/social work professionals. Hospital rather than community care It found that a significant number of patients covered by SWRs did not need to be in a hospital setting to receive the right care and treatment. The national average was 41%, while in the South West of England 53% of individuals did not need to be in hospital settings. The report linked this figure to delays in discharge processes, with patients staying in hospital settings for longer than needed as a result. Concerns about the involvement of family members and carers Concerningly, the report notes that examples of poor communication with family members and carers ‘far outweighed’ examples of effective communication, including: Being excluded from planning and decisions about their loved ones. Not being provided with basic information such as how to contact family members and visiting times. Not being listened to in relation to the care and treatment of their family member, or decisions about their care and wellbeing. There was regional variation in these figures, with one particularly striking case being an Integrated Care System stating that in 39% of their safe and wellbeing reviews, family representatives either could not be contacted for the purposes of the review, they did not want to be contacted or the individual did not want them to be contacted. Advocacy Another area of concern cited was the availability and quality of advocacy for people in hospital, which the report describes as generally inconsistent. Concerns included: Family members having to step into the role of advocates in place of professional advocacy, though they are generally not trained to do so, may not know all the options available and cannot be fully independent. Some provides being resistance to creating a “culture of importance” around advocacy. Poor advocacy awareness in places, which extended to limited attempts by providers to contact advocates and proactively involve them in processes and decisions relating to individuals. Safeguarding In the 3% of cases where safeguarding concerns were raised (50 out of 1,770), serious concerns noted by the report included: Inconsistent and/or high levels of restraint, seclusion and segregation. Patients not being assessed appropriately under the Mental Capacity Act or assessments not being completed in a timely way Harms associated with weight gain during admission (increasing the likelihood of health problems and premature mortality) and long lengths of stay. Issues associated with individuals being placed in inappropriate settings (for example, mixed-gender wards), the absence of CCTV in inpatient settings, issues with staff attitudes and relationships. Low quality and inconsistent of incident reporting. Inappropriate and inconsistent use of medication. The review also said that one region noted that safeguarding referrals were not always made appropriately, and plans were not always implemented to prevent the incidents from happening again. Physical health The report notes that it found multiple references to individuals with a high body mass index and significant weight gain following people being admitted to hospital, including instances where this led to people developing diabetes. This was a key area of concern also raised in the Cawston Park safeguarding adults review. Individual wellbeing and positive mental health The report noted that in many mental health inpatient settings there were not enough activities for people to do and not enough done to help maintain social connections. It noted that meaningful activities were not consistently available and, where they were, were not always age-appropriate, co-planned and person-centred. Workforce The report noted a number of workforce issues, including: Families and advocates raised concerns about whether wards were unsafe when there were significant staff shortages on them. Staff burnout. Heavy reliance on agency and/or temporary staff which can have negative impacts on patients being able to access regular activities and on patient-staff relationships. Reports of staff not having the appropriate training or skillset to effectively meet the needs of individuals. Conclusions and next steps Throughout the report there are a number of sections detailing ‘key considerations’ for providers and Integrated Care Systems, though no specific actions. It notes towards the end of the report that following on from this, NHS England, on a national and regional footprint, working with people with lived experience, family carers, integrated care boards, providers and commissioners, will bring partners together to look at specific actions that will address the challenges and themes highlighted through this thematic review over the next 12 months.
  4. News Article
    "It would be much better if I was out there than in here," said Roger. The 69-year-old looked wistfully across Newport from the window next to his bed at the Royal Gwent Hospital in Wales. He has been here for three weeks after being admitted with an infection and although he is now well enough to leave, and desperate to do so, he can't. Roger has cerebral palsy and the impact of his recent illness means he needs extra care to be arranged before he can safely go home. Roger is not alone. "At least a quarter of patients in our care of the elderly beds are in a similar position," explained Helen Price, a senior nurse at the hospital. "It is very much a waiting game for that care to be available," she said. Hospitals in Wales are fuller than ever, according to the latest statistics. In the final week of January more than 95% of all acute beds in the Welsh NHS were occupied, which is the highest figure ever recorded. Paul Underwood, who manages urgent care in Aneurin Bevan University Health Board, said there are well over 350 patients medically fit enough to leave hospital. "Roughly a third of patients do not need to be accommodated on those sites and that's extremely difficult," he said. Read full story Source: BBC News, 16 February 2023
  5. News Article
    A high-profile £250m government intervention to free up hospital beds has so far failed to deliver any significant reduction in delayed discharges – with multiple systems instead reporting large increases. Steve Barclay announced the fund, including £200m to buy step-down residential care beds to speed up discharges, on 9 January, following a “recovery forum” crisis summit at 10 Downing Street. NHS England said in guidance on 13 January the funding must bring “immediate improvements”, and local leaders were again told to “maximise the impact of their areas’ allocation of the money in the run up to strikes on 6 February”. But according to official data, in the week the new money was announced, there was an average of 14,035 patients who did not meet the clinical “criteria to reside”, but were still waiting to leave hospital, equating to around one in seven occupied beds. The total numbers have barely changed since then, with an average of 13,975 cases reported in the week to 5 February, also representing one in seven occupied beds. Read full story (paywalled) Source: HSJ, 13 February 2023
  6. News Article
    More than a third of delayed discharges for long-stay patients are being caused by factors generally associated with the NHS, according to new data obtained by HSJ. Delayed discharges from hospital are often blamed on issues around social care, but figures for the nine months to January, for patients who have been in hospital for at least 21 days, suggest a significant proportion are due to NHS-related delays. The most common reason is waiting for rehabilitation beds in a community hospital or similar facility, which accounts for 23% of total delayed discharges, based on daily averages. Other reasons generally associated with NHS-related issues included delays around medical decisions (4%), therapist decisions (4 per cent), transfers to another acute site (2%), and diagnostic tests (1%). On top of this, a further 12% of the causes were at least partly associated with the NHS, such as delays relating to transfer of care hubs, which are generally jointly run with councils. Read full story (paywalled) Source: HSJ, 9 February 2023
  7. Content Article
    NHS services are under extreme pressure. Recent testimonies from healthcare professionals, patients and journalists have highlighted the scale of these problems, which go significantly beyond the usual increase in pressure over the winter period. One key area of concern is a lack of hospital bed capacity, which as noted by the Nuffield Trust, is an important indicator of wider pressure on the system: "Hospitals cannot operate at 100% occupancy, as spare bed capacity is needed to accommodate variations in demand and ensure that patients can flow through the system. Demand for hospital beds peaks at different times of the day, week and year. There must be enough beds to accommodate these peaks. A lack of available beds can have widespread consequences in a health system.”[1] An absence of spare bed capacity can significantly impact a hospitals ability to provide safe and timely care. This also has consequences for other parts of the system, such as increased ambulance waiting times because of handover delays. There are multiple causes of these capacity issues: Longer-term structural challenges – such as the number of hospital beds relative to the population and workforce shortages.[2] Medium-term issues – for example the impact of delayed discharges. Short-term problems – such as increases in admissions of patients with seasonal illnesses. In this blog we will consider two specific issues stemming from this lack of hospital bed capacity and consider their impact on patient safety: Increasing cases of patients being cared for in hospital corridors and non-clinical areas, commonly referred to as ‘corridor care’. Current proposals to reduce the number of patients waiting to be discharged. Increasing cases of ‘corridor care’ ‘Corridor care’ can be broadly defined as care being provided to patients in corridors, non-clinical areas or unsuitable clinical areas because of a lack of hospital bed capacity. In recent years this has become an increasing occurrence as pressures and demands on the NHS mount, particularly during the winter months. In February 2020, the Royal College of Nursing (RCN) highlighted its concerns about this becoming normalised, publishing a survey of its members that found that over 90% of respondents said that ‘corridor nursing’ was being used at their Trust.[3] [4] In March 2020, the Royal College of Emergency Medicine (RCEM) also raised this issue as part of a broader campaign around improving emergency care, highlighting the need to significantly increase the number of hospital beds in the NHS.[5] However, during the height of the Covid-19 pandemic, infection control and social distancing rules restricted the use of ‘corridor care’ in hospitals.[6] When providing guidance for emergency care after the initial Covid period, the RCEM reiterated the threats to patient and staff safety from crowding in emergency departments and emphasised the need to avoid a return to corridor care becoming the norm.[7] However, in recent months we have seen growing concerns about a significant increase in care being provided in corridors and non-clinical settings.[8] [9] [10] [11] [12] Patient safety risks Corridor care raises significant patient safety concerns. It can present problems providing appropriate care, as these unsuitable spaces can make it difficult to administer specific treatments, such as intravenous medication, or the ability to access oxygen, medication and lifesaving treatment in an emergency. It also makes it more difficult to monitor patients, which can result in delays in providing further treatment if their condition begins to deteriorate. The constraints on space that working in these conditions impose may mean that relatives are not able to be accommodated, reducing their ability to support patients whose condition may not otherwise be closely monitored. This lack of space can also result in physical hazards, with the potential for escape routes becoming blocked in emergencies.[13] Corridor care also has particularly negative impact on patient dignity and confidentiality: “Our overflow corridor never has fewer than 20 patients on it; people who are too unwell to sit in the waiting room. The corridor is made up of trolleys of patients lined up, top to toe, along a wall. It’s busy, it’s noisy and there’s no dignity there. Patients stuck there are being toileted behind staff holding up sheets on the corridor.”[14] Working in these conditions has a significant impact on healthcare professionals too, who know that they are not able to provide the best care possible to their patients. This can affect their mental health and wellbeing creating the risk of moral injuries: the distress experienced when circumstances clash with one’s moral or ethical code.[15] “Tonight I’ve come close to tears whilst apologising to patients for the standards of care we are able to provide. In my 22 years of being an A&E doctor I’ve never seen things so bad. It’s the same everywhere.”[16] Preventing avoidable harm Patient Safety Learning believes that corridor care should be avoided whenever possible. It is vital that this is not normalised. However, in the current circumstances, in some cases this is clearly unavoidable. In these situations, it is important that: Risk assessments are carried out for service redesign and for individual patients, with mitigating actions being taken to maintain the safest care possible. Trusts have clear guidance and apply learning from examples of good practice that prioritise patient safety. Trusts have plans in place to ensure the introduction of corridor care is only a temporary measure. Staff and patients report any incidents of unsafe care so that action can be taken swiftly to address harm or near misses. There is close oversight by Trust leadership, including the Board, to ensure that patient safety safeguards are in place if corridor care is needed and that this is minimised and not normalised. We also believe more research is needed to fully understand the consequences of corridor care in terms of patient outcomes as well as patient safety. There needs to be more research undertaken to evaluate the impact of this. Reducing the number of patients waiting to be discharged Having considered the patient safety impact of corridor care because of lack of hospital capacity, we now turn to current proposals aimed at increasing capacity by reducing the number of patients waiting to be discharged. Hospital discharges can be complex. To enable a safe and timely transfer of care, they require good co-ordination between hospital and community staff to arrange clinical assessments and to ensure the home or community setting has the appropriate equipment and care plans. A delayed discharges refers to a patient who no longer meets the clinical criteria to reside in hospitals and, therefore, should be discharged to non-acute settings. The Department of Health and Social Care has recently stated that there are around 13,000 patients meeting this description.[17] These patients may end up spending a significant amount of time waiting to be discharged for a range of different reasons: Lack of available places in care and nursing homes. Delays putting in place specialist support, such as home care or short-term rehabilitation, required following discharge. The need to ensure specific criteria for a safe discharge are met for patients who need to access ongoing mental health services and support. The need to ensure that complex needs are met prior to discharge, for example in some cases concerning patients with a learning disability, where these processes may involve a range of different professionals and specialist assessments. Reducing the number of delayed discharges is not a new policy idea, but in recent weeks it has received increased attention as this has been identified as a key measure to increase hospital bed capacity resulting in several new proposals aimed at achieving this. Patient safety risks Any measures aimed at increasing the speed of hospital discharges must have at their heart considerations of how this will impact on the safety of patients and the need to prevent avoidable harm. Below we consider some of the proposals that have recently been made in relation to this and their potential impact on patient safety. 1. Discharging patients without care packages The Welsh Government has recently issued new guidance to Health Boards to discharge patients who are well enough to leave even if they do not have a package of care in place.[18] A package of care is intended to meet a patient’s ongoing care needs, which may relate to healthcare, personal care or care home costs, following discharge. Without this in place, there is a significantly increased risk of avoidable harm, particularly for patients returning to their own homes. Not having in place required adaptations, equipment or access to rehabilitation could result in patients struggling to support themselves, increasing the risk of avoidable harm and re-admission to hospital. Commenting on this proposal, Dr Amanda Young, Director of Nursing Programmes at the Queen’s Nursing Institute, also highlighted concerns that: “… patients being discharged from hospital without appropriate care packages, or inadequate support or reablement, results in poorer outcomes in the short and longer term. Discharges may occur late in the evening with no advance warning to community services, in order to free up hospital beds. Vulnerable people may arrive to cold homes, alone, with community services unaware this has happened until the following day or even the day after.”[19] This also opens up the potential for inconsistent decision-making, transferring significant risk to individual healthcare professionals who may be under significant organisational pressures to make discharge decisions that they don’t believe are safe. 2. Funding additional care home beds The Department of Health and Social Care has announced £200 million in funding to buy thousands of extra beds in care homes and other settings to help discharge more patients who are fit to leave hospital and free up hospital beds.[17] The Scottish Government has also announced a similar package, stating it will provide £8 million in funding for additional care home beds.[20] While these announcements have been welcomed in some places, there are concerns about the ability of the social care system to fulfil this, with a key problem being staff shortages. In England alone it is estimated that there are 165,000 vacant posts in social care.[21] Serious concerns have been raised about how appropriate care can be provided where additional beds may be available but staff are not.[22] [23] In many cases this could lead to this additional bed capacity not being utilised, due to lack of staffing, or is utilised despite under-staffing, increasing the potential risk of avoidable harm. Considering this new funding in the context of these workforce shortages, Martin Green, Chief Executive of Care England, said: “… there has been little consultation with the social care sector on how this can be achieved. Yet again, the Government has talked to the NHS and pretty much nobody else, and this is why their policies never work.”[24] There is also a question about whether patients subject to these accelerated discharge processes will receive the appropriate support they need. Integrated Care Boards will be tasked with using this new national funding for hospital discharges to purchase bedded step down capacity plus associated clinical support for patients.[25] However, concerns have been raised about the potential for rushed placements stemming from this, without appropriate access to rehabilitation and enhanced healthcare, which may increase the risk of patient harm.26] The British Geriatrics Society has noted that this could disproportionately impact older patients: “When older people leave hospital in poor health, they need rehabilitation and support to recover. Without it, their health deteriorates further – already on average 15% of older people being discharged from hospital are readmitted within 28 days. With each admission their level of frailty and care needs increase, generating even more demand for health and social care at home or in a care home.”[27] There have also been practical concerns raised questioning whether this funding can be effectively distributed, and extra beds provided quickly enough, to reduce the current pressures. There are further concerns too around how this is being targeted, with the provision of funding being “decided on a ’weighted population basis‘, rather than adjusted to reflect the current share of delayed discharge patients”.[28] [29] Preventing avoidable harm Patient Safety Learning believes that decisions on the introduction of new measures aimed at accelerating hospital discharges and freeing up hospital bed capacity must have patient safety considerations at their core. Whether they involve discharging patients at an earlier stage without care packages, or increased funding to move patients into care homes, all elements of these changes must be considered through a lens maintaining the safety of patients. This includes ensuring: Patients return home, or move to a care setting, with the correct medications and medical devices. Appropriate handover of information for patients is provided when moving from hospital directly into care settings. Appropriate equipment/adaptations being in place for patients returning home. Patients and their responsible carers have access to timely clinical advice if there is deterioration in the patient’s health, and guidance on the signs and symptoms that may indicate this. Patients and their families are decision makers in their own care and have access to information and advice to enable this. Concluding comments The shortage of hospital bed capacity has a wide range of consequences across the healthcare system with implications for patient safety. Here we have focused on the need to ensure that in two specific areas – managing the increase in cases of corridor care and reducing the numbers of patients waiting to be discharged – patient safety is being placed at the heart of decision-making processes around both. In addition to the areas we have identified, ensuring this happens also requires patient safety leadership at a national level. While far from a desirable state of affairs, corridor care is taking place in parts of the NHS and will continue to do so for the foreseeable period, meaning its impact on patient safety must be understood and mitigated where possible. We believe there needs to be recognition of this from NHS England and the Department of Health and Social Care, along with a proactive effort to share and disseminate knowledge and good practice in this area to prevent avoidable harm to patients. We also believe it is important that there is both a recognition and inclusion of patient perspectives and experience of these issues. This particularly applies to hospital discharge processes, which too often are either discussed as purely a capacity problem or worse disparagingly an issue caused by ‘bed-blockers’.[30] [31] It is vital that we hear and listen to the patients and family members voices on changes aimed at accelerating discharge processes. We need to recognise that these situations involve individuals with specific ongoing healthcare needs who, as well as the safe provision of care, deserve dignity and respect. Share your views and experiences We would welcome your views on the patient safety concerns raised in this blog: Are you a healthcare professional who has experience of delivering corridor care and would like to share your story? Are you a patient or family member who has experience of corridor care or a delayed discharge process? Do you work in social care and have experience of, or concerns about, accelerated discharge processes from hospitals? You can share your views and experiences with us directly by emailing content@pslhub.org or by commenting below (register here for free to activate your membership). References Nuffield Trust, Hospital bed occupancy: We analyse how NHS hospital bed occupancy has changed over time, 29 June 2022. Nuffield Trust, Hospitals at capacity: Understanding delays in patient discharge, 3 October 2022. RCN, ‘Corridor care’ in hospitals becoming the new norm warns RCN, 26 February 2020. RCN, Corridor Care: Survey Results, 26 February 2020. RCEM, RCEM launches new campaign to end corridor care as data shows more than 100,000 patients waiting over 12 hours in A&Es this winter, 3 March 2020. Health and Social Care Select Committee, Delivering core NHS and care services during the pandemic and beyond, 1 October 2020. RCEM, Covid19: Resetting Emergency Department Care, Last Accessed 11 January 2023. Birmingham Live, ‘Worst I’ve ever seen it’: Doctor speaks out about horrors of patients in corridors as NHS crisis deepens, 3 January 2023. Health Service Journal, Trust that banned corridor care ‘reluctantly’ brings it back, 4 January 2023. iNews, Striking paramedics tell of patients having seizures in hospital corridors and relentless 16-hour shifts, 11 January 2023. BBC News, NHS A&E crisis: Staff making ‘difficult decisions in unprecedented times’, 7 January 2023. This is Local London, BHRUT boss apologises to patients ‘care for in corridors’, 11 January 2023. Health Service Journal, NHSE issues fire risk warning over ‘corridor care’, 29 November 2022. The Guardian, It’s beyond dreadful. We’re now running A&E out in the corridor and wating room, 12 January 2023. Health Education England and NHS England, Understanding moral injury a short film, 15 January 2021. The Guardian, ‘It feels terminal’: NHS staff in despair over working at breaking point, 4 January 2023. Department of Health and Social Care, Up to £250 million to speed up hospital discharge, 9 January 2023. Wales Online, Doctors claim hospital discharge guidance could see patients die, 6 January 2022. Nursing in Practice, Welsh hospital patients to be discharged to community with care package in place, 6 January 2023. Scottish Government, Additional Winter support for NHS, 10 January 2023. Skills for Care, The state of the adult social care sector and workforce in England, October 2022. The Times, Fears over plans to move patients into care homes, 10 January 2023. The Independent, Staffing ‘crisis’ means £200m extra care beds plan won’t work, health bosses warn, 10 January 2023. Community Care, Care home discharge plan risks inappropriate placements and neglects the causes of crisis – sector, 9 January 2023. NHS England, Hospital discharge fund guidance, 13 January 2023. The Health Foundation, Hospital discharge funding: why the frosty reception to new money?, 13 January 2023. British Geriatrics Society, Protecting the rights of older people to health and social care, 10 January 2023. Health Service Journal, New discharge fund risks being ‘political theatre’, warn NHS leaders, 9 January 2023. Health Service Journal, Revealed: How much is each ICS getting from the £200m discharge fund, 13 January 2023. Daily Mail, Hospitals are discharging bed-blockers into hotels to free up space on wards, 5 January 2023. iNews, NHS discharges patients into hotels to ease bed blocking and A&E crisis, 4 January 2023.
  8. News Article
    A health board has apologised to the family of a patient after medical staff failed to consult with them over a decision not to resuscitate her. While the decision was clinically justified, the public services ombudsman for Wales said Betsi Cadwaladr health board did not discuss it with the patient and her family. The ombudsman, Michelle Morris, also upheld a complaint by the patient's daughter, identified only as Miss A, that her mother's discharge from Ysbyty Gwynedd in Bangor was "inappropriate" and that insufficient steps were taken to ensure her needs could be safely met at home. The final complaint, which was also upheld, was that medics failed to communicate with the family about the deteriorating condition of the patient, identified as Mrs B, which meant a family visit was not arranged before she died. In her report she said the Covid pandemic had contributed to the failings, but added "this was a serious injustice to the family". As well as apologising to the family, she asked that all medical staff at Ysbyty Gwynedd and Ysbyty Penrhos Stanley be reminded of the importance of following the proper procedure when deciding when a patient should not be resuscitated. Read full story Source: BBC News, 6 February 2023
  9. Content Article
    An evaluation was undertaken for a one-month period (June 2022) in two adult cardiac surgery services which routinely used patient smartphones for PDS, using the secure Islacare (Isla) system. The initial patient response rate for Isla was 87.3%, and the majority of patients (73%) remained engaged throughout the 30-day period. There was no significant difference in age, gender, operation type or distance to hospital between Isla responders or non-responders, or if the hospital provided a photo at discharge or not. Patients using Isla had a shorter post-discharge stay (P = 0.03), although this was not attributed to the platform. Patients not owning a smartphone and a technical issue were the main barriers to participation. Overall, nine SSIs were recorded, eight through the Isla surveillance and one through a hospital transfer readmission. The carbon emission associated with the SSI ranged from 5 to 2615 kg CO2e. The authors concluded that in a real-world setting, using patient smartphones is an effective method to collect PDS, including wound images.
  10. Content Article
    DHSC and NHS England's delivery plan A. Increase capacity, to help deal with increasing pressures on hospitals which see 19 in 20 beds currently occupied. 1. Dedicated funding of £1 billion will pay for additional capacity, including 5,000 new beds as part of the permanent bed base for next winter. 2. Over 800 new ambulances, including 100 specialist mental health ambulances, the majority of which will be on the road by next winter. 3. ‘Same day’ emergency care services will be in place across every hospital with a major emergency department, so patients avoid unnecessary overnight stays. B. Grow the workforce, as increasing capacity requires more staff who feel supported. 4. More clinicians will be available for 111 online and urgent call services to offer support, advice, diagnosis and, if necessary, referral. From this April a new targeted campaign will be launched to encourage retired clinicians, and those nearing retirement, to work in 111 rather than leaving the NHS altogether. 5. The workforce will grow with more flexible ways of working and increase the number of Emergency Medical Technicians next year to respond to incidents and support paramedics. C. Speed up discharge from hospitals, to help reduce the numbers of beds occupied by patients ready to be discharged. 6. Over the next 2 years, and as part of the up to £14.1 billion extra for health and social care, £1.6 billion will be focused squarely on discharge. 7. ‘Care transfer hubs’ in every hospital ahead of next winter will mean faster discharge to the right setting, so that people do not stay in hospital longer than necessary. 8. This year, new approaches to step-down care will start to be implemented so, for example, people who need physiotherapy can access care as they are being discharged from hospital before they need to be assessed by their local authority for long-term care needs. 9. New discharge information will be published, with new data collected from this April. D. Expand new services in the community, as up to 20% of emergency admissions can be avoided with the right care in place. 10. Ahead of next winter the government will offer more joined-up care for older people living with frailty, including scaling urgent community response, frailty and falls services across the whole country – meaning the right people help you get the care you need, without needing an admission to hospital if it’s not necessary. 11. Greater use of ‘virtual wards’, which allow people to be safely monitored from the comfort of their own home, will be achieved by an extra 3,000 beds to provide over 10,000 in total by this autumn, allowing staff to care for up to 50,000 patients a month this way over the longer term. 12. Help people access the right care first time, as 111 should be the first port of call and reduce the need for people to go to A&E. By April 2024, urgent mental health support through NHS 111 will be universally available. 13. From this April, new data will allow the public to easily see and compare the performance of their local services. It will also tackle unwarranted variation in performance in the most challenged local systems. 14. This April, a new clinically-led programme to reduce unwarranted variation will launch, alongside intensive support for those areas struggling the most
  11. News Article
    Devon care homes say they are being asked to accept patients with Covid-19, flu and other infectious diseases to ease the pressure on local hospitals. One owner said it felt like the start of the pandemic again, as the safety of care homes was being "compromised". Devon has some of the longest waits for emergency care in the country, according to NHS figures. Simon Spiller, owner of The Croft Residential Care Home in Newton Abbot, said since the start of winter the home was being asked to shortcut its assessment process to help ease the blockages in Devon's hospitals. He said other local care homes have told him they were facing the same pressure. Mr Spiller said: "We're being encouraged, or really asked, to shortcut our assessment process. Normally, one of our team would go to the hospital to assess people, to really understand their care needs, to ensure they're an appropriate fit for our care home, which specialises in dementia. "Increasingly, because of the speed they're trying to achieve a discharge, we're being asked to accept people at kind of face value, as presented by the NHS." Read full story Source: BBC News, 26 January 2023
  12. News Article
    Simultaneous big waves of Covid and flu - the 'twindemic' experts warned of as people returned to 'normal' pre-pandemic mixing - cost the NHS this winter, say NHS bosses. NHS England chief strategy officer Chris Hopson said hospital pressures in England peaked on 29 December. The workload involved gave hospitals a "significant problem" at the turn of the year, he said. It was at this point that record-long waits at A&E were seen. Since then the pressures have begun to ease a little. Speaking to MPs on the House of Commons' health committee, Mr Hopson said: "The issue was always going to be this winter was the degree to which we saw prevalence of both Covid and flu and the degree to which they combined. "Now we're obviously not through winter yet but the really important point - that I don't think has come out enough - is both Covid and flu peaked so far on 29 December." At the turn of the year one in eight beds were occupied by patients with either Covid or flu. And Mr Hopson added this combined with the 12,000 beds occupied by patients medically fit to leave but unable to be discharged because of the lack of support in the community meant more than a quarter of beds were lost. "It gives a significant problem in terms of patient flow, which then means you get the back up right the way through the system." Read full story Source: BBC News, 24 January 2023
  13. News Article
    The new national target to see 76% of A&E patients within four hours by March 2024 has been described as ‘extremely unambitious’ by senior emergency clinicians. Adrian Boyle, president of the Royal College of Emergency Medicine, also told the Commons Health and Social Care Committee that the objective – included in NHS England planning guidance for 2023-24 and agreed with government – could also drive “perverse incentives” for some emergency department managers. The new target to admit, transfer or discharge 76% of patients by the end of 2023-24 is the first time a specific bar has been set against the four-hour standard for several years. In December, just three acute trusts were hitting the new 76% objective. But Dr Boyle told MPs: “The aspiration from NHS England is that we return to a four-hour target performance of 76%. We think that is too unambitious, and we think that is going to create all sorts of perverse incentives, because it’s going to encourage managers and senior clinicians just to focus on people who can be discharged from hospital, without dealing with our problem, which is exit block [people who cannot be admitted as wards are full]. “We think the 76 per cent is an extremely unambitious target. It was 95% – I know that’s going to be a long way to go back to and we haven’t achieved it since 2015, but we would say we need to have a trajectory to a higher target.” Read full story (paywalled) Source: HSJ, 24 January 2023
  14. News Article
    A mental health trust has spent millions this year on places in “bed and breakfast” accommodation in order to discharge inpatients, HSJ has learned. South London and Maudsley Foundation Trust, which serves four London boroughs, confirmed to HSJ it had spent £3.1m since April for a range of basic bed and breakfast places, and spaces with a specialist housing association, to ease its bed shortage pressures. The trust told HSJ clinicians were often reluctant to discharge patients to street homelessness, and that people with mental health problems can be more challenging to find accommodation for. The trust’s chief executive officer David Bradley told HSJ system leaders had been asked to think “innovatively” about how to mitigate discharge problems. B&Bs are generally a cheaper and more appropriate alternative to a £500 a night mental health hospital bed for people who don’t need acute treatment and have no housing, he said. Read full story Source: HSJ, 24 January 2023
  15. News Article
    A growing number of patients deemed to require a hospital admission are waiting so long in A&E that they end up being discharged before being admitted to a ward, HSJ has been told. A senior emergency clinician, who has delivered improvement support to multiple emergency departments across the NHS, said such cases have become a regular occurrence – describing it as a “terrible experience” for some patients. The clinician, who asked not to be named, said: “I suspect every ED in the country are having patients who are spending 24 to 48 hours in ED under the care of a specialist, that in a better time they would have gone onto a ward. That’s happening every day in every department. “If you have been seen by the ED crew and referred to the medics who say ‘you need to be admitted to hospital’, the chances are that they are sick enough that they really do need that bed. “It’s a terrible experience [for the patients]. EDs are busy, noisy and crowded. This is not the place where, if you were feeling ill, to get better in a calm, relaxing area. This idea that somehow it’s OK because these people are not that sick, it’s pretty poor. “It feels very much like battlefield medicine – slap a patch on and try and get them back into battle as quickly as possible. It shouldn’t be the way with civilian healthcare.” Read full story (paywalled) Source: HSJ, 23 January 2023
  16. News Article
    An NHS trust has introduced pharmacy changes to help patients who are medically fit to leave hospital sooner. Gloucestershire Hospitals NHS Foundation Trust is focusing on getting TTOs (drugs To Take Out) to the pharmacy by 13:00 GMT each day. It says this reduces the length of stay for patients by several hours and can release up to 20 beds a day. "That's 20 people not waiting in the emergency department," said medical director, Professor Mark Pietroni. The plan has been called 'Early Meds to Release Beds' by the trust. Patients whose TTOs are with the pharmacy by 13:00 GMT are usually discharged about four hours later. Read full story Source: BBC News, 20 January 2023
  17. News Article
    Pressures on emergency health services are so bad that the UK government should declare a “national emergency” and call a meeting of the Civil Contingencies Committee (COBRA)—the body summoned periodically to deal with matters of major disruption—peers have said. The cross party House of Lords Public Services Committee said in a report that the government needed to respond with an emergency approach and steps to remedy the situation in the longer term. A recurring theme of the report is the substantial delays highlighted by the media in recent months, which peers said were caused by a “broken” model of primary and community care. This was driving unmet need in directing patients to hospitals where many remained longer than clinically necessary because of inadequate social care. The report recommended that the Department of Health and Social Care should mandate a greater presence of clinical staff in NHS 111 control centres to help boost numbers of clinicians in the 999 and 111 services. This would mean that patients were directed to the right services more quickly thanks to better triaging of calls, which could mean fewer patients being passed to emergency or urgent care services. Another suggestion was for the government to introduce more incentives for faster safe discharges from hospitals, with more capacity in hospitals and social care to help people move through the health system more quickly. Read full story Source: BMJ, 19 January 2023 Further reading on the hub: Patient safety impact of hospital bed shortages – A Patient Safety Learning blog
  18. Content Article
    The report's action plan for emergency health services: An emergency response: Recognising this is a national emergency, the Government should refer the crisis in emergency health services to a COBR Committee. Deliver care at the right place, right time: In the short term, boost the number of clinicians in 999 and 111 services so that patients are being directed to the right services at the right time. Unlock the gridlock: Incentivise faster safe discharges from hospitals and increase capacity in hospitals and social care to make sure people can move through the health system and do not end up stuck in ambulances or at A&E. Understand the problem: Data on A&E waiting times do not accurately reflect the patient experience. Performance data should accurately report the true waiting times experienced by patients so that decision makers have a clear picture of the problem, and so the public can hold them to account. Address unmet need: Boost capacity in hospitals and social care. Make it easier for patients to get care in the community both before they reach crisis point (preventing admissions) and following discharge. A new model for emergency health services: The Government must develop a new model for emergency health services which recognises the current crisis, the type of demand services face and clinical best practice and, for accountability purposes, sets out appropriate performance measures.
  19. News Article
    Hospital staff have to complete 50 separate steps on average to discharge a patient, it has emerged, as the NHS grapples with a bed-blocking crisis. On average, around 14,000 patients deemed fit to leave hospital are stuck in beds every day, according to the latest official figures. The congestion is helping to fuel the backlog in accident and emergency (A&E) departments, where more than 55,000 patients waited 12 hours or longer last month. Steve Barclay, Health Secretary, announced an additional £250 million in funding last week to buy up care beds to help discharge thousands of patients. But doctors, social care experts and families have warned discharges are being delayed by NHS “bureaucracy” and excessive form filling. Dr Matt Kneale, co-chair of the Doctors’ Association UK and a junior doctor in Manchester, said patients are held up by “numerous bottlenecks” before being sent home. “While social care shortages are the predominant issue, smaller factors stack up to create a big problem,” he told The Telegraph. Many hospitals have limits on the times their pharmacies are open, he explained, meaning patients can often be stuck on the ward all day, or an extra night, waiting for their medication. Read full story (paywalled) Source: The Telegraph, 15 January 2023
  20. News Article
    The government has ‘a week to 10 days’ to distribute the £200m it is committing to speed up hospital discharge if the initiative is to have a meaningful impact on reducing the 13,000 patients who are medically fit to leave hospital, national healthcare leaders have told HSJ. Health and social care secretary Steve Barclay announced this morning that the government was effectively reintroducing the national discharge scheme used to fund “short-term care placements” earlier in the covid pandemic, which was scrapped in April last year. NHS Confederation chief executive Matthew Taylor said: “We await the full details of the proposed hospital discharge fund with interest. Given the ongoing delay in distributing the delayed discharge fund announced last autumn any funds will need to be rapidly deployed.” Read full story (paywalled) Source: HSJ, 9 January 2023
  21. News Article
    More and more older people are being “warehoused” in inappropriate care beds, condemned unnecessarily to long-term care, and “lost” to health and care services, due to the rush to discharge from full hospitals and a lack of community rehab services, leaders have warned. Several senior figures in community and social care have raised the issue with HSJ, warning it has been a growing concern over the past 18 months of severe system pressure following on from acute covid peaks. The Health and Safety Investigation Branch has also raised the issue, telling HSJ inappropriate care placements are leading to harm and readmissions, while a major accountability gap remained over the safety of discharges. The average length of hospital stay has increased compared to pre-Covid, with a big jump in those staying more than three weeks. Many in the NHS put this down to a lack of social care capacity meaning more medically fit people are stuck in hospital. Senior staff in community health and social care services told HSJ hospitals were increasingly demanding rapid discharges, often as part of “surge” measures when they are very full and under pressure to reduce ambulance queues. Homecare cannot be organised, and with suitable step-down and care beds also full, trusts are instead “spot purchasing” space in unsuitable homes which may be a long journey from the person’s home area, and in a different council area. Read full story (paywalled) Source: HSJ, 5 January 2023 Further reading HSIB interim bulletin - Harm caused by delays in transferring patients to the right place of care
  22. News Article
    Care providers are demanding double the usual fees to look after thousands of people who need to be discharged from hospitals to ease the crisis in the NHS. Care England, which represents the largest private care home providers, said on Sunday it wanted the government to pay them £1,500 a week per person, citing the need to pay care workers more and hire rehabilitation specialists so people languishing in hospital can eventually be sent home. The rate is about double what most local authorities currently pay for care home beds, an amount Martin Green, the chief executive of Care England, described as “inadequate”. The demand comes as the health secretary, Steve Barclay promised “urgent action” with up to £250m in new funding for the NHS to buy care beds to clear wards of medically fit patients. The money will be used to buy beds in care homes, hospices and hotels where people are looked after by homecare providers, as well as pay for hospital upgrades. Stays will be no longer than four weeks until the end of March. The use of hotels as care homes began during the pandemic and has been controversial, with reports of problems with hygiene and supplies of specialist equipment. The charity Age UK last week criticised their renewed use as “not an appropriate place to provide high-quality care for older people in need of support to recuperate after a spell in hospital”. Read full story Source: The Guardian, 9 January 2023