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Found 448 results
  1. News Article
    NHS call handlers are quitting amid burnout at dealing with 999 calls about suicides, stabbings and shootings and the long delays before ambulances reach patients. The pressure is so intense that 27% of control room staff in ambulance services across Britain have left their jobs over the last three years, NHS figures show. Many feel overwhelmed by the demands of their roles, unsupported by their employers and powerless to help patients who are facing life-or-death emergencies, according to a report by Unison, with some resigning within a year of starting the role. Call handlers get so stressed that they took an average of 33 sick days a year each between 2021/22 and 2024/25, data obtained by the union also showed. That is far higher than the average four days taken off sick by workers in the UK overall. A report by Unison found that call handlers’ jobs have become increasingly challenging in recent years as the demand for care, which rose during Covid, has remained consistently high since, while ambulance handover delays outside hospitals have worsened. “These findings paint a bleak picture of the conditions faced by 999 control room staff. TV programmes about ambulance services don’t show things as they really are,” said Christina McAnea, the Unison general secretary. Unison’s report said: “Relentless exposure to traumatic and increasingly complex incidents, verbal abuse, long shifts and low pay are contributing to stress, burnout and fatigue. One call handler told Unison: “Some shifts are overwhelmingly traumatic, with 90% of the calls of a distressing nature. One shift, I handled three road traffic accidents and two cardiac arrests.” “There’s a persistent pressure to remain on the phone, no matter how emotionally drained we are.” Read full story Source: The Guardian, 17 June 2025
  2. Content Article
    ‘The Month’ is a new publication from NHS England which provides a strategic update for health and care leaders. This edition includes details of the 100 day plan for Sir Jim Mackey’s first few months as NHS England Chief Executive, information about the new Urgent and emergency care plan 2025/26 and highlights of other recent healthcare publications and developments.
  3. News Article
    Nearly £450m is being invested in the NHS in England to cut hospital waiting times and tackle persistently failing trusts, the health secretary has announced. Wes Streeting says his NHS reforms aim to deliver around 40 new centres to fast-track treatment for patients, up to 15 mental health crisis assessment units and almost 500 new ambulances. It is part of an attempt to shift patients away from A&E and avoid unnecessary hospital admissions. "No patient should ever be left waiting for hours in hospital corridors or for an ambulance which ought to arrive in minutes," said Mr Streeting. "The package of investment and reforms we are announcing today will help the NHS treat more patients in the community, so they don't end up stuck on trolleys in A&E," he added. In an example of the challenge facing the health secretary, Sky News on Wednesday revealed the scale of England's mental health crisis, exacerbated by a shortage of specialist beds and an overwhelmed social care network. The new Urgent and Emergency Care Plan for England says more needs to be done to drive down long waits, cut delayed discharges and improve care for patients. Read full story Source: Sky News, 6 June 2025 Related reading on the hub: How corridor care in the NHS is affecting safety culture: A blog by Claire Cox My experience of the 'Wait 45' policy - Florence in the Machine A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift
  4. Content Article
    This report sets out how the NHS will resuscitate urgent and emergency care, with a focus on getting patients out of corridors, keeping more ambulances on the road, and enable those ready to leave hospital to do so as soon as possible. Summary of actions and impact for patients and carers Focus as a whole system on achieving improvements that will have the biggest impact on urgent and emergency care services this winter By the year-end, with improvement over winter, we expect to: Reduce ambulance wait times for Category 2 patients – such as those with a stroke, heart attack, sepsis or major trauma – by over 14% (from 35 to 30 minutes). Eradicate last winter’s lengthy ambulance handover delays by meeting the maximum 45-minute ambulance handover time standard, helping get 550,000 more ambulances back on the road for patients. Ensure a minimum of 78% of patients who attend A&E (up from the current 75%) are admitted, transferred or discharged within 4 hours, meaning over 800,000 people a year will receive more timely care. Reduce the number of patients waiting over 12 hours for admission or discharge from an emergency department compared to 2024/25, so this occurs less than 10% of the time. This will improve patient safety for the 1.7 million attendances a year that currently exceed this timeframe. Tackle the delays in patients waiting to be discharged – starting with the nearly 30,000 patients a year staying 21 days over their discharge-ready-date, saving up to half a million bed days annually. Increase the number of children seen within 4 hours, resulting in thousands of children every month receiving more timely care than in 2024/25. Develop and test winter plans, making sure they achieve a significant increase in urgent care services provided outside hospital compared to last winter Improve vaccination rates for frontline staff towards the pre-pandemic uptake level of 2018/19. This means that in 2025/26, we aim to improve uptake by at least 5 percentage points. Increase the number of patients receiving urgent care in primary, community and mental health settings, including the number of people seen by Urgent Community Response teams and cared for in virtual wards. Meet the maximum 45-minute ambulance handover time standard. Improve flow through hospitals, with a particular focus on reducing patients waiting over 12 hours, and making progress on eliminating corridor care. Set local performance targets by pathway to improve patient discharge times, and eliminate internal discharge delays of more than 48 hours in all settings. Reduce length of stay for patients who need an overnight emergency admission. This is currently nearly a day longer than in 2019 (0.9 days) and needs to be reduced by at least 0.4 days . Reduce the number of patients who remain in an emergency department for over 24 hours while awaiting a mental health admission. This will provide faster care for thousands of people in crisis every month. National improvement resource and additional capital investment is simplified and aligned to supporting systems where it can make the biggest difference Allocating over £370 million of capital investment to support: Around 40 new same day emergency care centres and urgent treatment centres. Mental health crisis assessment centres and additional mental health inpatient capacity to reduce the number of mental health patients having to seek treatment in emergency departments. Expansion of the Connected Care Records for ambulance services, giving paramedics access to the patient summary (including recent treatment history) from different NHS services, enabling better patient care and avoiding unnecessary admissions.
  5. News Article
    "We've got two," explains Emer Szczygiel, emergency department head of nursing at King George Hospital, as she walks inside a pastel coloured room. On one wall, there's floral wallpaper. It is scored through with a graffiti scrawl. The words must have been scratched out with fingernails. There are no other implements in here. Patients being held in this secure room would have been searched to make sure they are not carrying anything they can use to harm themselves - or others. "So this is one of two rooms that when we were undergoing our works, we recognised, about three years ago, mental health was causing us more of an issue, so we've had two rooms purpose built," Emer says. "They're as compliant as we can get them with a mental health room - they're ligature light, as opposed to ligature free. They're under 24-hour CCTV surveillance." There are two doors, both heavily reinforced. One can be used by staff to make an emergency escape if they are under any threat. What is unusual about these rooms is that they are built right inside a busy accident and emergency department. The doors are just feet away from a nurse's station, where medical staff are trying to deal with acute ED (emergency department) attendances. On a fairly quiet Wednesday morning, the ED team is already managing five mental health patients. One, a diminutive South Asian woman, is screaming hysterically. She is clearly very agitated and becoming more distressed by the minute. Despite her size, she is surrounded by at least five security guards. She has been here for 12 hours and wants to leave, but can't as she's being held under the Mental Capacity Act. Her frustration boils over as she pushes against the chests of the security guards who encircle her. "We see about 150 to 200 patients a day through this emergency department, but we're getting on average about 15 to 20 mental health presentations to the department," Emer explains. "Some of these patients can be really difficult to manage and really complex." "If a patient's in crisis and wants to harm themselves, there's lots of things in this area that you can harm yourself with," the nurse adds. "It's trying to balance that risk and make sure every emergency department in the country is deemed a place of safety. But there is a lot of risk that comes with emergency departments, because they're not purposeful for mental health patients." Read full story Source: Sky News, 4 June 2025
  6. Content Article
    A tracheostomy is a common procedure done for patients who need prolonged mechanical ventilation, are unable to protect their airway or have pathologies of the oropharynx leading to the potential for upper airway obstruction. While a tracheostomy is relatively safe, complications are common, and it is essential to understand the management steps to ensure that the patient’s tracheostomy functions as intended. In a single centre study of 100 patients undergoing tracheostomy, the complication rate was 47% during the initial hospitalisation. The most common complications included obstruction of the tracheostomy (19%), bleeding (16%), infection (14%), and accidental decannulation (13%). While these complications are common, if managed appropriately, mortality directly related to the tracheostomy has a very low incidence. This article in the Anaesthesia Patient Safety Foundation newsletter discusses how to keep patients safe during emergency tracheostomy management.
  7. Content Article
    Anaesthetic emergencies, though infrequent, pose a significant threat to patient safety. Simulation-based training offers participants the opportunity to immerse themselves in safe, realistic clinical scenarios, allowing them to hone their skills without risking patient harm. For the educator, the challenge lies in balancing the vast array of emergencies to be taught with limited resources available. This study explored whether focusing on transferable skills, specifically human factors, can improve confidence in managing these emergencies.
  8. Content Article
    The transition of older adults from the emergency department (ED) to home remains a potential area of preventable harm. Through a human-centred design process, the authors developed a patient-centred intervention aimed at improving communication and coordination between ED staff and patients. The intervention included a new electronic health record (EHR)-based template for physicians to enter discharge instructions, a redesigned after-visit-summary (AVS), enhanced nurse training for patient teach-back, and EHR-embedded tips for nurses at the time of follow-up call. The research objective was to evaluate this patient-centred ED discharge process redesign from multiple perspectives. The authors used A SEIPS 3.0 model to evaluate the intervention, in particular work system barriers and facilitators in the three subprocesses of the redesigned ED discharge process: physician writing discharge instructions, nurse/patient communication at discharge, and nurse/patient communication at follow-up call. The authors used multiple methods to collect quantitative and qualitative data from the perspectives of patients, and ED physicians and nurses. Overall, the redesigned patient-centred discharge process was perceived positively by ED physicians and advanced practice providers, ED nurses, and patients. All three groups identified work system facilitators regarding the intervention, in particular the usability of the AVS. Work system barriers pointed to areas for future improvement of the intervention, such as adding prepopulated information to the AVS. Using a human-centred design process, the authors improved ED discharge for older adults. The SEIPS-based research and evaluation fit with the learning health system concept as it provides input for future work system and patient safety improvement.
  9. News Article
    The health minister has said the recruitment of up to 26 emergency medicine consultants will help stabilise and strengthen the healthcare workforce in Northern Ireland. The Department of Health said some of the consultants are already in post, with the others set to begin in their roles across all five health trusts by the end of the year. It said funding for the new posts comes from reducing spending on locum doctors in emergency departments and that it comes as part of work to find roles for newly-qualified consultants in the health system. Mike Nesbitt said everyone was "acutely aware of the very significant pressures" on emergency departments. "Both staff and patients want us to do all we can to alleviate those pressures and that's been a central focus for my department and trusts in recent months." Prof Lourda Geoghegan, deputy chief medical officer, said she was "very encouraged" by early reports on the impact of the new consultants, who had not only helped reduce locum spending but also increased the "presence of senior decision-making in emergency departments". Read full story Source: BBC News, 27 May 2025
  10. Content Article
    The images on the left highlight the increased delays in ambulance responses and the potentially catastrophic consequences. Equally, the panic-inducing headlines of measures brought in to resolve the crisis. I work on the healthcare frontline and I’d like to share my experience of the 'Wait 45' policy in my trust and the impact it is having. Implementation of a new policy In December 2024, all ambulance trusts in England were told to implement a new policy, ‘Release to Respond’, also known as the ‘Wait 45’ policy, which means ambulances will only wait at Emergency Departments (ED) for 45 minutes before patients are left and the crews make their way to the next call. This was initiated following increasing waits for crews to handover patients to the ED. These waits were not inconsiderable periods of time, with many reports of crews spending their entire shift parked outside the ED with just one patient. This has resulted in some appalling headlines—for example, elderly people being left waiting for up to 15 hours for an ambulance to arrive and people having cardiac arrests where ambulances are not available to respond. Based on this, the adoption of the ’Release to Respond' policy makes sense. However, the introduction of this policy has been met with some scepticism and equally horrendous headlines about patients being dumped while crews run. The policy states that crews will not dump and run, and that handovers will be given, and patients will be placed on a chair, trolley or wheelchair in a dedicated space. But this policy is another example of not identifying the whole problem and bringing in a measure that only addresses the needs of one part of the healthcare system, while making it considerably worse for other parts! What is the point of an integrated care system (ICS) and board (ICB) if they do not look at an integrated intervention to address this situation? What is the reality of the ’Wait 45’ policy? The Wait 45 policy in my trust has completely changed the way the ED manages patients. Corridor care is a term used to describe the practice of providing medical attention to patients in hallways or other non-designated clinical areas due to overcrowding or resource shortages. It used to be that corridor care was for patients who had been seen, had a plan and who were either waiting to go home or for a bed on a ward. Now, in my trust, the corridor is for undifferentiated patients (patients who present with symptoms that have not yet been diagnosed or categorised) that come in directly from the ambulances. This has increased the risk to patients and staff. The corridor is used as soon as the department is full and then, only when the corridor is full to capacity, does the Wait 45 policy get initiated. At this point it is almost guaranteed that the corridor will need additional staffing from somewhere, while the first crew need to wait their 45 minutes—the hospital now has 45 minutes to find these additional staff otherwise the nurse: patient ratio increases in the corridor. The ratios of nurse to patients differs depending on the area of the hospital: in major treatment areas it is 1:4 but in the corridor it is 1:6; however, there is no upper limit of patients in the corridor and staff are often moved from other in-patient areas to work in the ED where they are invariably working in the corridor. These nurses will not have a ED background and will find it challenging and may miss the subtle signs that an experienced ED nurse may spot. There is often a lack of support for nurses in the corridor, leaving additional staff having to rely on their previous experience and judgement to guide them on what needs to be done. Handover criteria not being met Ambulance trust and the acute trust staff should at handover discuss the criteria for placing patients in a corridor—i.e., patients are supposed to be independent, able to move themselves to the toilet, be clinically stable and not have an infectious presentation However, in my experience this criteria is often not followed, as highlighted in the following examples I have seen and heard: Suspected neutropenic patients placed in the corridor. These patients have a low neutrophil count (a type of white blood cell) and are more vulnerable to infections. The concern for those on immunosuppressants seems to be non-existent now; there was a significant concern during the Covid-19 pandemic, but now being immunosuppressed is met with a tut, roll of the eyes and a shrug of the shoulders. It rarely features in handovers. Ambulance crews handing over patients that needed a hoist transfer at their nursing home; it is clearly not appropriate to care for these patients in a corridor where they should be mobile to use bedpans or commodes. Elderly patients who have fallen—either with significant trauma or with no apparent injuries—placed in the corridor. One patient had pain in their neck and received a trauma CT scan in the corridor—surely this patient should not have been in a corridor in the first place! Patients with diarrhoea and vomiting placed in the corridor, sometimes next to the neutropenic patients. Those with significant respiratory symptoms suggestive of influenza or Covid-19 placed in the corridor, despite the known risks to those that are in the corridor with them. I have even had a patient with a Glasgow Coma Scale of 10 (this is a tool that healthcare providers use to measure decreases in consciousness) handed over to the corridor… Wouldn’t resuscitation be a better location for them? Unintended consequences It is easy to understand why ‘Release to Respond’ policies are needed. With no external pressure, it appeared that many trusts lacked the willingness to investigate changes to reduce the overcrowding in the ED. However, while I recognise that the ambulance trusts need to have their staff available and not tied up at hospitals, this is making the ED unsafe. Another unintended consequence of these policies is that the working relationships between the ED nurses and the ambulance crews has deteriorated. I have noticed an increasing lack of willingness to help each other and incivility is growing. Asking simple questions results in dirty looks and aggressive questioning about ’who are you‘. The natural feeling is now one of defence, protecting each other against comments, pulling back into areas of comfort and knowledge. The standard replies are now ‘no’ and a feeling that this is not my problem or my fault. Unilateral measures that do not address the whole problem I cannot help but think implementing a unilateral solution like the ‘Release to Respond’ policy is based entirely on ‘work as imagined’ and benefits only one part of a highly complex area. It places additional burdens on already overstretched resources. The worst of which is that EDs are still seen as being made of elastic, with the ability to continually expand even when the evidence shows every hospital is beyond capacity every day of the year! When I first heard about ICSs and ICBs, I really hoped we would start to see a time of collaboration, working together to solve some of the issues within healthcare. Sadly, there does not yet seem to have been a change. In fact, it feels very much that we renamed but stayed the same. Probably, because all that has happened since the ICSs were introduced is restructuring after restructuring. They are not being allowed to work. Please, don’t get me wrong. I can see why these policies are in place. If I called an ambulance, I would like it to be available to respond and unfortunately currently they are not and have not been for a while. But I cannot help but think that until the ICS and regional NHS organisations take ownership of these problems, and all the stakeholders are represented at the table to analyse, design, implement and, most important of all, EVALUATE an intervention, we are condemned to keep implementing unilateral measures that do not address the whole problem. Further reading on the hub The crisis of corridor care in the NHS: patient safety concerns and incident reporting A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift A nurse's response to the NHSE guidance on their principles for providing safe and good quality care in temporary escalation spaces How corridor care in the NHS is affecting safety culture: A blog by Claire Cox Share your insights Do you have experience of corridor care either as a patient or a healthcare professional? What impact have you seen on patient safety? You can comment below (sign up here for free first) or email the editorial team at [email protected]
  11. News Article
    More than 1 million older people a year in England are forced to wait longer than 12 hours in A&E, with many having to endure “degrading and dehumanising” corridor waits on trolleys. The number aged 60 and over waiting more than 12 hours to be transferred, admitted or discharged increased to 1.15 million in 2024, up from 991,068 in 2023. The figure was 305,619 in 2019, according to data obtained by the Royal College of Emergency Medicine (RCEM) under freedom of information laws. A report by the RCEM also found the risk of a 12-hour wait in an emergency department in England increased with the age of the patient. People aged 60 to 69 had a 15% chance of waiting 12 hours or more. For those aged 90 and over, the likelihood rose to 33%. “The healthcare system is failing our most vulnerable patients – more than a million last year,” said Dr Adrian Boyle, the president of the RCEM. “These people are our parents, grandparents, great-grandparents. “They aren’t receiving the level of care they need, as they endure the longest stays in our emergency departments, often suffering degrading and dehumanising corridor care. It’s an alarming threat to patient safety. We know long stays are dangerous, especially for those who are elderly, and puts people’s lives at risk.” As well as long waits, the RCEM report found many older people were missing out on vital checks in A&E. Of patients aged over 75, only 16% were screened for delirium – a reversible condition linked to an increased risk of death. Fewer than half (48%) of patients were screened for their risk of falls. Read full story Source: The Guardian, 6 May 2025
  12. Content Article
    More than a million older people faced waits of 12 hours or more in A&Es in England last year – and shockingly, the older a person is, the more likely they are to experience a long stay in the emergency department – new data from the Royal College of Emergency Medicine (RCEM) reveals.It comes as the College publishes a new report looking at the care older people receive in emergency departments.The research, titled ‘Care of Older People 2023-24’, is part of the College’s clinical Quality Improvement Programme which aims to improve the care of patients attending Emergency Departments. This interim report reflects the findings of the second year of the three-year programme. Across the UK, 149 Emergency Departments submitted 24, 865 patient cases from 4 October 2023 – 3 October 2024. A key finding was that among patients over the age of 75, there was insufficient screening for three common conditions which primarily affect this age group: Only 16% of patients were screened for delirium – a reversible condition which can be associated with mortality, characterised by a sudden change in mental function.On average less than half (48%) had screening to assess the risk of falling.An average of 56% underwent screening for general frailty – which if detected can trigger early intervention and support in hospital and in the community.Despite a year-on-year improvement from 2023, these patients are enduring the longest waits in A&Es and are bearing the brunt of an Urgent and Emergency Care system in crisis. Older people are often more likely to suffer with complicated or multiple health issues. This, combined with the wider issues related to a shortage of in-patient beds, mean they can often end up enduring extreme long waits in A&E – often on trolleys in corridors.
  13. News Article
    While millions of Americans have turned to popular weight loss drugs to shed pounds in recent years, taking them isn’t without some risks. Now, research led by the scientists at the Centers for Disease Control and Prevention has found that tens of thousands of Americans have ended up in the emergency room after taking semaglutide: the active ingredient in GLP-1 drugs, including drugmaker Novo Nordisk’s Ozempic and Wegovy. The findings may be an indicator that more patient education is necessary when it comes to taking the drugs. “We found that it’s very infrequent that semaglutide leads to very serious adverse events that would land a patient in the hospital, but that they do occur,” Dr. Pieter Cohen, an associate professor of medicine at Harvard Medical School, told Health. Using national surveillance data collected at dozens of hospitals, they estimated that semaglutide had been a contributing factor in nearly 25,000 emergency room visits from 2022 to 2023. More than 82 percent of those visits occurred in 2023, and the reason was usually gastrointestinal complications. Patients experienced nausea, vomiting, stomach pain, and diarrhoea. Some people also came into emergency rooms with allergic reactions and hypoglycemia, which is also known as low blood sugar. A handful of patients were diagnosed with pancreatitis and just four were diagnosed with biliary disease, which impacts the gallbladder. Read full story Source: The Independent, 1 May 2025
  14. News Article
    A patient suffering from a perforated bowel had their diagnosis delayed after a junior doctor missed “red flags” during an assessment in A&E. After arriving at the emergency department of an NHS Forth Valley hospital, the patient was initially assessed by a junior doctor who ordered various tests and investigations. They were later moved to the acute assessment unit and diagnosed with a perforated bowel. The patient developed sepsis after undergoing emergency surgery. The patient’s child complained to the Scottish Public Services Ombudsman (SPSO) about their parent’s treatment. Specifically, they complained about the delay in identifying their parent’s condition, which they believe led to a worse outcome. NHS Forth Valley acknowledged that a more senior doctor may have identified the cause quicker, but that the care provided was reasonable, and that the complaint had led to learning and ongoing development. In putting together their report, the SPSO took independent advice from an emergency medicine consultant. It found that there were “a number of red flags” when the patient was admitted and that it did “not appear” they had been reviewed by a senior clinician. Issues were also found in the patient’s documentation; no intimate examination was recorded, and there was a “lack” of documentation around the interpretation of an X-ray. Overall, the report concluded that the initial assessment delayed diagnosis of the perforated bowel and was likely to have had a “significant effect” on the patient’s outcome. Read full story Source: STV News, 29 April 2025
  15. 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.
  16. News Article
    An IT system that prevents 999 call-handling services from being overwhelmed is set to be withdrawn by NHS England in an effort to save money. NHS England has confirmed it will not renew the contract for the Intelligent Routing Platform (IRP), and that the service will cease to be available within three months. NHS England now proposes that individual ambulance trusts will be responsible for tackling delays in answering calls, as was the case before the pandemic. HSJ understands that ambulance leaders are very concerned by the decision and the speed with which it is to be implemented. Read full story Source: Health Service Journal (Paywalled), 14 April 2025
  17. News Article
    Patients in A&E are being put in potentially life-threatening situations due to missed doses of prescription medicines, according to a new report. The Royal College of Emergency Medicine (RCEM) found people in A&E were not getting their medications on time and were missing doses needed to manage their illnesses – putting them at risk of getting worse. Insulin for diabetes, Parkinson's drugs, epilepsy medicines and tablets for preventing blood clots are all time critical medicines (TCM). If these drugs are delayed or missed, the patient can deteriorate and is at greater risk of complications or death. While patients are advised to remember to bring their medications to A&E and to take them, there is also a responsibility on NHS staff to make sure this happens. Despite the recognised risk of harm, the delivery of TCM is not consistent across emergency departments with long waiting times often contributing to this. The study, which was part of the College's clinical Quality Improvement Programme (QIP) which aims to improve the care of A&E patients, found more than half of these patients were not identified as being on TCM within 30 minutes of their arrival in an emergency department. In addition, 68% of doses were not administered within 30 minutes of the expected time. "The findings contained in this report should serve as a call to action for both emergency medicine staff, as well as patients reliant on time critical medications, to ensure no dose is ever missed in A&E," said Dr Jonny Acheson, an emergency medicine consultant in Leicester who has Parkinson's, led the study. Read full story Source: The Independent, 7 April 2025 Further reading on the hub: Time-critical Parkinson’s medication: the human cost of delays and mistakes HSSIB investigation report: Medication not given: administration of time critical medication in the emergency department Parkinson's UK: Time critical medication guides for health professionals Improving safety for diabetic inpatients: 4 key steps D1abasics: Equipping staff to care safely for inpatients with diabetes
  18. Content Article
    Patient safety is being put at risk in Emergency Departments due to missed doses of vital prescription medicines. This is one of the findings of a study being carried out by the Royal College of Emergency Medicine (RCEM) which revealed that many patients who rely on prescription medication to manage chronic conditions such as diabetes and Parkinson’s, aren’t always getting these vital drugs when in A&E. These types of drugs are known as ‘time critical medication’ (TCM) and, as the name suggests, it is important they are taken at specific times. If a dose is delayed or missed, it can cause a person’s health to worsen. And if this delay is prolonged, the consequences can be severe. The RCEM’s new report – Time Critical Medication QIP 2023-24 is part of the College’s clinical Quality Improvement Programme  (QIP), which aims to improve the care of patients attending Emergency Departments. The three-year QIP examines how time critical medications are dealt with in practice when patients come to the Emergency Department and how clinical methods and patient safety can be improved. This report reflects the findings of the first year of the programme. Across the UK, 136 Emergency Departments collated and analysed data for people living with diabetes and Parkinson’s, who take certain medication such as insulin injections and a drug called levodopa, taken as tablets or capsules. Supported by Parkinson’s UK and Diabetes UK, the QIP found more than half of eligible patients (53.4%) taking TCM weren’t identified within 30 minutes of their arrival in ED. Meanwhile, around 68% of eligible patients’ doses weren’t administered within 30 minutes of the expected time. In response to the findings, the QIP team made the following recommendations: Patients on TCM need to be identified early to start the process of getting all doses whilst in the ED. Systems need to be in place that will facilitate the timely administration of TCM, including self-administration. Local EDs must have a clear governance structure in place to determine who is responsible for the prescribing and administering of TCM in the ED from when the patient arrives, to when they are admitted to the ward or discharged from the ED. Further reading on the hub: Time-critical Parkinson’s medication: the human cost of delays and mistakes HSSIB investigation report: Medication not given: administration of time critical medication in the emergency department Parkinson's UK: Time critical medication guides for health professionals Improving safety for diabetic inpatients: 4 key steps D1abasics: Equipping staff to care safely for inpatients with diabetes
  19. Content Article
    Ambulance services play a pivotal role in ensuring the safety of mothers and their newborns during urgent and emergency situations. These services act as the frontline responders, providing immediate care and facilitating timely transport to appropriate healthcare facilities. World Patient Safety Day, observed annually on 17 September, serves as a global platform to raise awareness about patient safety and encourage collaborative efforts to reduce harm in healthcare settings. The theme for 2025, 'Safe care for every newborn and every child', underscores the critical importance of safeguarding our youngest and most vulnerable patients from preventable harm. In the UK, ambulance services play a pivotal role in ensuring the safety of mothers and their newborns during urgent and emergency situations. These services act as the frontline responders, providing immediate care and facilitating timely transport to appropriate healthcare facilities. Their contributions are multifaceted, encompassing emergency childbirth assistance, neonatal transfers and the management of obstetric emergencies. In addition, many women and families will use the 999/111 service throughout the childbearing continuum, often using these services as a gateway to accessing maternity care. A recent review of Maternity and Newborn Safety Investigations (MNSI) highlighted that 6 in 10 independent investigations that met the criteria for MNSI involved the ambulance service. Out-of-hospital births, though relatively rare, present unique challenges for ambulance clinicians. Intrapartum care accounts for approximately 0.05% of emergency medical services' caseload, with only about 10% of these cases resulting in deliveries managed by ambulance staff. This limited exposure can lead to a decline in obstetric clinical skills, potentially impacting patient care. To address this, continuous training and simulation exercises are essential. For instance, the London Ambulance Service has developed a bespoke communication tool to support midwives in out-of-hospital settings, ensuring effective communication during the transfer of women or babies in emergencies and delivers bespoke mandated emergency training to its frontline clinicians. Such initiatives enhance the preparedness of ambulance clinicians to manage emergency deliveries safely; however, these are not standardised across services. Challenges and areas for improvement Despite their critical role, UK ambulance services face challenges that can impact maternal and neonatal safety. Incidents of delayed response times have been reported, leading to tragic outcomes. For example, a three-day-old baby named Wyllow-Raine Swinburn passed away after an eight-minute delay in answering a 999 call and a 31-minute wait for the ambulance to arrive. Although the delays were not deemed the direct cause of death, they highlighted inefficiencies in the emergency response system. In other cases, the lack of effective training for ambulance clinicians impacted upon the management of a time critical breech delivery, with tragic consequences. Such cases underscore the need for systemic improvements, including better resource allocation, enhanced training and the implementation of robust protocols to minimise delays in emergency response. Collaboration between ambulance services and midwifery teams is essential for improving outcomes in maternal and neonatal emergencies. The development of communication tools and training programmes exemplifies efforts to standardise information exchange during emergencies, thereby reducing the potential for errors and delays. Furthermore, ambulance services are increasingly recognising the importance of specialised roles focused on maternity care. For instance, paramedics with additional training in neonatal and maternity care can provide more comprehensive support during emergencies. Susie, a paramedic with the Northwest Ambulance Service, highlighted her passion for improving maternity care within the ambulance service, emphasising the importance of continuous professional development in this area. Conclusion As we observe World Patient Safety Day 2025, it is imperative to acknowledge and support the vital role of UK ambulance services in safeguarding mothers and their newborns during and following pregnancy. Continuous training, effective communication tools and collaborative practices are essential to enhance the safety and quality of care provided. By addressing existing challenges and building on successful initiatives, we can move closer to the goal of ensuring safe care for every newborn and every child from the very start. Further reading Exploring the pre-hospital setting for the emergency care and transfer of neonates: the role of UK ambulance and neonatal transport services Displaced risk. Keeping mothers and babies safe: a UK ambulance service lens An exploration of maternity and newborn exposure, training and education among staff working within NWAS Disparities In Access to the Northwest Ambulance Service during pregnancy, birth and postpartum period and its association with neonatal and maternal outcomes World Patient Safety Day 2025
  20. News Article
    NHS England’s outgoing chief operating officer has claimed there is too much unwarranted variation in the service’s emergency care performance. Dame Emily Lawson made the comment at last week’s NHSE board meeting ahead of her departure from the organisation yesterday. She told the board that she “wanted to call out variability” in the spread of 12-hour A&E waits across the county. Dame Emily said: “If we look at the last six months of data, 17.6 per cent of trusts have deteriorated in 12-hour breaches, 25.8 per cent have improved, and the rest have sustained their 12-hour performance. “When we look at headline numbers, we often miss both the improvement that’s going on, but also some of the tensions that are happening and needing to be managed locally.” Dame Emily added that emergency care “still has some opportunity” to improve its productivity, adding that long A&E waits for people in mental health crisis “remain too common”. Read full story (paywalled) Source: HSJ, 1 April 2025
  21. Content Article
    A wide ranging and comprehensive independent review of emergency departments within NHS Greater Glasgow and Clyde has found a system under pressure, where unacceptable practices such as patients waiting on trolleys in corridors, have become normalised. The report published by Healthcare Improvement Scotland concludes that relationships need to be repaired between various groups of staff, supported by compassionate leadership. The poor relationships highlighted in the review are impeding the NHS board’s ability to address the problems – this was particularly prominent within the Queen Elizabeth University Hospital. The report finds that a culture of “disrespectful behaviours, poor teamwork and incivility” is having a negative impact on staff morale and wellbeing, and it is likely having a detrimental impact on patient care. The report makes 30 recommendations for NHS Greater Glasgow and Clyde, but the findings also have national implications with a further 11 recommendations for Scottish Government and national agencies. The review – chaired by experienced, independent experts Dr Pamela Johnston and Prof Hazel Borland – was carried out as a result of concerns raised by a group of emergency department clinicians at Queen Elizabeth University Hospital, who believed that patient care was being compromised and that their concerns were not being listened to. National recommendations Scottish Government Scottish Government should commission Healthcare Improvement Scotland to lead the development of a national approach to improving the quality and safety of urgent and unscheduled care in NHS Scotland, consistent with the Quality Management System, including the development of national standards in partnership with a range of agencies including the Royal Colleges. This will build on work already commenced by The Centre for Sustainable Delivery and include urgent work needed to work towards eliminating the unacceptable use of non-standard care areas given the risks to patients and the impact on staff. This will require significant national focus and support. Scottish Government should explore with Healthcare Improvement Scotland how best to gather patient views about experiences of accessing urgent and unscheduled care services and waiting in emergency departments to inform more detailed national recommendations on how to improve the patient experience and shape services for the future. Scottish Government should engage with relevant national agencies to commission a review of the national guidance for specific health and care demand, capacity escalation and business continuity, which recognises the need to ensure a credible, robust and practical whole system response. This is essential and complementary to the current Multi Agency Major Incident Guidance. Scottish Government should engage with relevant national agencies to commission a review of the professional advisory committee arrangements in NHS boards to ensure they have a transparent, independent and objective mechanism for the board to consider matters of safety and concern. There is an opportunity to refresh the previous national guidance and make these arrangements clearer and more open for all professions to understand. Public Health Scotland Reliable and comparable whole-system datasets are essential to support improvement in urgent and unscheduled care and optimise flow through the health and social care system. Public Health Scotland should be commissioned by Scottish Government to work with other national and local partners with the aim of progressing existing work and further developing datasets that are designed with, and available to NHS boards to support continuous improvement. The Centre for Sustainable Delivery The Centre for Sustainable Delivery should strengthen its collaboration with territorial and national NHS boards to engage in improvement activities aimed at: Reducing unwarranted variation in urgent and unscheduled care performance to enhance the quality and experience of care, as well as patient outcomes. Rethinking access to urgent and unscheduled care to ensure equity and that individuals are treated in the right place, the first time. • Ensuring appropriate representation, including clinical leaders, in the recently formed Strategic Delivery Groups to drive improvement, set standards, and deliver change. Participating in the acute hospital site visit process to ensure that change is driven by clinical teams and tailored to meet the needs of local communities. NHS Education for Scotland NHS Education for Scotland should strengthen and further develop structured development programmes to identify and support clinical and non-clinical leaders in NHS Scotland. These programmes will enable NHS boards to focus on developing whole system multidisciplinary working and relationships which foster innovation, improvement and inclusivity in decisions that explicitly benefit quality of care and patient safety NHS Education for Scotland should be supported by Scottish Government to explore the implications, and work towards the shift to whole time equivalent medical trainee recruitment in order to strengthen the learning experience, reduce gaps in service and build a more sustainable, effective medical workforce for the future. The review has highlighted the critical role of effective and supportive leadership by the NHS Board. It is recommended that the Scottish Government commission NHS Education for Scotland to evaluate the current national and local induction and support arrangements for NHS Non-executive Board Members. This evaluation should aim to identify and implement any necessary improvements to ensure that Non-executive Board Members can perform their roles as effectively as possible, and consistent with the requirements set out in the NHS Scotland Blueprint for Good Governance. Healthcare Improvement Scotland The review has identified that the tools for appropriate staffing levels with regard to emergency departments are not sufficiently robust. Healthcare Improvement Scotland’s Healthcare Staffing Programme should prioritise the development of new tools which reflect the current operating context and multi-disciplinary working to ensure safe and effective care. Healthcare Improvement Scotland should collaborate with the Independent National Whistleblowing Officer, and other relevant bodies, to develop clear and unambiguous guidance for staff in NHS boards on the national routes for staff to raise concerns under Whistleblowing and the Public Interest Disclosure Act. This will enable NHS boards to ensure that they have effective arrangements in place and improve staff awareness and understanding.
  22. News Article
    A major emergency department described by a national team as “undoubtedly causing patient harm and distress to staff” told HSJ it believes it has started to crack some of its problems. The review of the Royal Sussex County Hospital in Brighton — a major trauma centre for much of the South East — found it had the lowest score in England for patient flow. It was carried out by Getting It Right First Time, which is part of NHS England. Only half of patients waited less than 12 hours from arrival — much worse than elsewhere in Sussex — and on average they spend more than 26 hours in the department before admission, the review said. It used data from May last year, and said there had been deterioration over the previous two years. The review, dated July 2024 and obtained by HSJ under the Freedom of Information Act, paints a grim picture based on a visit by the GIRFT team. They saw the hospital ”stacking” patients in the ED, making “infection prevention control almost impossible”, and creating a potential fire risk. It highlighted problems with mental health patients, who often are left in its care in short stay beds because of a shortage of mental health beds. However, since the review was conducted last year, University Hospitals Sussex Foundation Trust says it has taken strides to improve flow. “We felt we needed to invest time and effort, paradoxically, outside the four walls of the hospital,” said Mae Sullivan, operational flow manager for the trust’s eastern medicines division. Read full story Source: HSJ, 17 March 2025
  23. News Article
    The Care Quality Commission has reported on an emergency department with 55-hour A&E corridor waits, and some frail patients being told to soil themselves because there was no one to take them to the toilet, while another had to urinate into a bottle without privacy curtains. The CQC received dozens of reports of “information of concern” from patients and staff about the A&E at Medway Maritime Hospital, run by Medway Foundation Trust, in the months before it visited in February last year. When they did so, inspectors were told staff feared reprisals if they raised concerns and that band 7 nurses “lived in fear of punishment from senior leaders”. Less than half of ED staff felt safe about speaking up, according to analysis of NHS staff survey results. The department was rated “requires improvement“ overall – previously it had been “good” – but was labelled “inadequate” in the area of safety, and for “kindness, compassion and dignity”. Under a new CQC scoring system, the department was rated 38 out of 100 for safety. Inspectors found many patients had a poor experience, with inadequate staffing, overcrowding and medication delays. Read full story (paywalled) Source: HSJ, 5 March 2025
  24. News Article
    Ambulance services would still struggle to respond effectively to a mass-casualty event like the Manchester Arena bombing, HSJ has learned, as nearly all have been denied the funding needed to bolster preparedness. The public inquiry report on the May 2017 attack, which killed 22, was sharply critical of the emergency services’ response, including North West Ambulance Service Trust. The inquiry’s November 2022 report made nearly 150 recommendations to prepare for future attacks. Crucially, ambulance trusts were told to review their capacity to respond to a mass-casualty incident – including whether they had enough trained specialist staff – then tell commissioners what extra funding they need to ”respond effectively”. Gaps identified included the availability of 24/7 “critical care cars”, specialist practitioners in hazardous area response teams, and tactical commanders in operations centres. But eight out of England’s 10 ambulance trusts have confirmed to HSJ – through Freedom of Information requests and follow-up enquiries – that they have not received funding from commissioners to cover what they found was needed. HSJ understands that, while some trusts have strengthened specialist teams using other income, they have not received funding for the majority of what the reviews said was needed, and there are therefore still significant gaps in readiness. Read full story (paywalled) Source: 14 February 2025
  25. News Article
    NHS North East London in collaboration with Health Navigator and UCLPartners have launched a new, three-year programme, providing preventative care for patients with long-term conditions. This comes at a time when urgent and emergency care services in North East London are facing unprecedented pressure and demand is at an all-time high. Through advanced AI screening technology and targeted, phone-based clinical coaching, patients at high risk of needing unplanned emergency care will be identified and offered personalised support from healthcare professionals trained in delivering preventative care and self-management techniques. The initiative is designed to identify and better support people with long-term conditions, like asthma, by taking a proactive and preventative approach to healthcare delivery. Forecasting models estimate that the programme will save 26,673 unplanned bed days in North East London hospitals across the three years of the programme, with an anticipated reduction of 13,000 A&E attendances annually. Read full story Source: UCL Partners Health Innovation, 12 December 2025
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