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News Article
Thousands exposed to severe harm due to ambulance wait times last month
Patient Safety Learning posted a news article in News
Record numbers of patients suffered severe harm last month because they spent so long in the back of ambulances waiting to get into A&E, new NHS figures reveal. An estimated 57,000 people in England “experienced potential harm”, of whom 6,000 were exposed to “severe harm”, in December – both the largest numbers on record – because they had to wait at least an hour to be handed over to hospital staff, according to NHS ambulance service bosses. The health union Unison, which represents many ambulance staff, said the data showed that the ambulance service “is barely coping” with the huge number of calls it is receiving. A senior ambulance service official said the high volume of patients being put at risk because they had to wait outside A&E so long before receiving medical attention, and paramedics being prevented from answering other 999 calls, was “horrific” and “astronomical”. He added: “These figures also show that whatever NHS England say they are doing to try to resolve this huge problem, it clearly isn’t working.” Martin Flaherty, Association of Ambulance Chief Executives (AACE) managing director, said: “Our December 2022 data for handover delays at hospital emergency departments shows some of the worst figures we have recorded to date and clearly underlines that not enough is being done to reduce and eradicate these dangerous, unsafe and harmful occurrences.” Read full story Source: The Guardian, 25 January 2023 -
Content Article
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News Article
Ambulances ‘lose’ 55,000 hours in one week during handover delays
Patient Safety Learning posted a news article in News
Hours lost to ambulance handover delays, and the numbers of ambulances waiting more than an hour outside hospitals hit new highs in the week after Christmas. Data published this morning by NHS England revealed nearly 55,000 hours were lost to delays between 26 December and 1 January and 18,720 ambulances had to wait more than an hour to handover patients as emergency departments struggled, with many trusts declaring critical incidents. The number of hour-plus delays followed previous years’ trend of a slight dip in the week leading up to Christmas followed by an acceleration afterwards. However, levels this year were more than twice those seen in 2021 and three times those of the previous two years. Read full story (paywalled) Source: HSJ, 6 January 2023 -
News ArticleParamedics will only wait with patients for 45 minutes before leaving them on a trolley in A&E, one ambulance trust has said. One in five ambulances are waiting at least an hour outside accident and emergency departments to hand over patients, the latest data show, despite NHS standards stating it should only be 15 minutes. Now, London Ambulance Service (LAS) leaders have told hospitals their staff will only remain with patients for a maximum of 45 minutes for handover due to “the significant amount of time being lost” waiting in A&E departments. A leaked letter, seen by ITV News, from the LAS said: "From January 3 we are asking that any patients waiting for 45 minutes for handover... are handed over immediately to ED (emergency department) staff allowing the ambulance clinicians to leave and respond to the next patient waiting in the community. "If the patient is clinically stable the ambulance clinicians will ensure the patient is on a hospital trolley or wheelchair/chair and approach the nurse in charge of the emergency department to notify them that the patient is being left in the care of the hospital and handover the patient." The email added that if the patient was not clinically stable, ambulance crews would stay with the patient until handover is achieved but added that the clinical responsibility for the patient lied with the hospital. Read full story (paywalled) Source: The Telegraph, 3 January 2023
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News Article
The targets the NHS no longer has to meet
Patient Safety Learning posted a news article in News
NHS England has shelved priorities on Long Covid and diversity and inclusion – as well as a wide range of other areas – in its latest slimmed down operational planning guidance, HSJ analysis shows. NHSE published its planning guidance for 2023-24, which sets the national “must do” asks of trust and integrated care systems, shortly before Christmas. HSJ has analysed objectives, targets and asks from the 2022-23 planning guidance which do not appear in the 2023-24 document. The measures on which trusts and systems will no longer be held accountable for include improving the service’s black, Asian and minority ethnic disparity ratio by “delivering the six high-impact actions to overhaul recruitment and promotion practices”. Another omission from the 2023-24 guidance compared to 2022-23 is a target to increase the number of patients referred to post-Covid services, who are then seen within six weeks of their referral. Several requirements on staff have been removed, including to ”continue to support the health and wellbeing of our staff, including through effective health and wellbeing conversations” and ”continued funding of mental health hubs to enable staff access to enhanced occupational health and wellbeing and psychological support”. Read full story (paywalled) Source: HSJ, 4 January 2022 -
Content Article
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News Article
Emergency patients staying an extra day in ‘congested’ hospitals
Patient Safety Learning posted a news article in News
Patients are spending an extra day in hospital on average when admitted as an emergency compared to before covid, consuming millions of additional ‘bed days’, HSJ analysis has found. The finding explains in part why fewer people are being treated in hospitals, but more resources are being consumed to do so. This has prompted concerns about an apparent big drop in productivity. NHS England chief finance officer Julian Kelly told HSJ the marked increase in length of stay meant hospitals needed to focus on “discharge and decongest” of emergency care, to help recover activity rates and productivity in elective care. The NHS also needs to create more elective capacity insulated from emergency care, he said, and for “local leadership [to] keep people focused”. Read full story (paywalled) Source: HSJ, 19 December 2022 -
News Article
Every ambulance trust on highest alert level
Patient Safety Learning posted a news article in News
All ambulance services have declared the highest level of alert due to ‘extreme pressures’ facing the urgent and emergency care system. One senior ambulance chief told HSJ that ambulance response times have dropped dramatically in the last few days, while A&E handover delays have surged. They said: “The wheels are falling off [the emergency care system] now, we’re in a really awful situation.” They said ambulance leaders have major concerns about the planned strike action by nurses on Thursday, fearing this will exacerbate discharge delays and have a knock-on effect on ambulance handover problems. It also comes ahead of strike action planned by ambulance staff for next week. HSJ has seen internal communications which confirm all ten ambulance trusts in England are now in level four of their “resource escalation action plan”, which means they can seek assistance from other nearby trusts or services. However, this is more difficult when an entire sector is under pressure, as is the case currently. Read full story (paywalled) Source: HSJ, 13 December 2022 -
Content Article
University Hospital Southampton: Use of NEWS2 and SBAR poster
Patient Safety Learning posted an article in Handover
To download the poster, click on the attachment below: news.pdf -
News Article
My mum's 40-hour wait to get to A&E with hip break
Patient Safety Learning posted a news article in News
When 85-year-old Koulla fell at home, her family immediately rang for an ambulance. She was in agonising pain - she had broken her hip. It was around 8pm. It took another 14 hours for an ambulance to get to her, leaving her pregnant granddaughter to care for her through the night. When they arrived the crews were able to give her pain relief and quickly transported her to the Royal Cornwall Hospital. But there the wait continued - there were around 30 ambulances queuing to handover patients to A&E staff. It was another 26 hours before she was taken inside to A&E. She then faced many hours in A&E before being taken for surgery. Koulla's daughter, Marianna Flint, 53, said: "It was awful. You feel helpless because you're giving your trust over to them to look after a family member who's in agony and who needs surgery." She has since received a written apology from the Royal Cornwall for the care provided to her mother in August. Ms Flint said: "I almost feel sorry for those looking after her. It's not down to them. There was no room inside to accept her in." Read full story Source: BBC News, 1 December 2022 -
News Article
NHS faces ‘perfect winter storm’ with tenfold rise in hospital flu cases
Patient Safety Learning posted a news article in News
The NHS in England is facing a “perfect winter storm” with 10 times more people in hospital with flu than this time last year, and ambulances experiencing deadly delays when arriving at A&E with sick patients. There were an average of 344 patients a day in hospitals in England with flu last week, more than 10 times the number at the beginning of last December. And as many as 3 in 10 patients arriving at hospitals by ambulance are waiting at least 30 minutes to be handed over to A&E teams. Health chiefs say the crisis is leading to deaths. The figures on flu and ambulance delays were published by NHS England on Thursday and offered the first weekly snapshot of how hospitals are performing this season. Matthew Taylor, the chief executive of the NHS Confederation, which represents the healthcare system in England, said: “These figures really hammer home just how stretched services already are as we head into a perfect winter storm. Significantly higher numbers of people are in hospital because of flu compared to this time last year, coupled with the fact that Covid-19 has not gone away.” He added: “The life-saving safety net that NHS ambulance services provide is being severely compromised by these unnecessary delays, and patients are dying and coming to harm as a result on a daily basis.” Read full story Source: The Guardian, 24 November 2022 -
News Article
Nine trusts account for third of ambulance ‘hours lost’
Patient Safety Learning posted a news article in News
Nine acute trusts accounted for a third of all ‘hours lost’ to ambulance handover delays last week, according to new data. The first NHS England winter sitrep data showed wide variation between providers on ambulance handover performance, with a small number of providers accounting for a huge proportion of delays. There were nine trusts where, for each ambulance arrival in the week to 20 November, an average (mean) of more than an hour was lost to handover delays. The providers accounted for around 7,000 hours lost, 33% the national total, despite only accounting for 7% of ambulance arrivals. At University Hospitals Plymouth an average of 2.3 hours were lost. The other trusts were; Norfolk and Norwich University Hospitals; East and North Hertfordshire; The Queen Elizabeth Hospital King’s Lynn; Great Western Hospitals; University Hospitals of Leicester; Torbay and South Devon; University Hospitals of North Midlands; and Worcestershire Acute Hospitals. Many of the worst performing hospitals were in the South West and East of England regions, which have previously been identified as areas which struggle on handover delays. Read full story Source: HSJ, 24 November 2022 -
News Article
Ministers ditch NHS England’s A&E target review
Patient Safety Learning posted a news article in News
Ministers have effectively ditched NHS England’s planned new bundle of A&E targets and want trusts to be firmly regulated on the existing four-hour standard and 12-hour breaches, HSJ understands. Multiple senior figures familiar with the process, from inside the NHS and government, said the performance focus for the next two years will be on the two existing accident and emergency waiting time measures, as well as ambulance handover delays. For the last three years, NHS England has been lobbying government to scrap the headline four-hour target, and replace it with a bundle of measures which have been trialled at around a dozen providers. This work has been led by medical director Steve Powis. HSJ understands the decision to continue using the existing four-hour target was driven by concerns among ministers and senior NHS figures that the bundle of measures was too confusing, both for patients and as a means for government to hold the service to account. Read full story (paywalled) Source: HSJ, 23 November 2022 -
News ArticleAmbulance crews could not respond to almost one in four 999 calls last month – the most ever – because so many were tied up outside A&Es waiting to hand patients over, dramatic new NHS figures show. An estimated 5,000 patients in England – also the highest number on record – potentially suffered “severe harm” through waiting so long either to be admitted to A&E or just to get an ambulance to turn up to help them. Ambulance officers warned that patients were dying every day directly because of the delays since the service could no longer perform its role as a “safety net” for people needing urgent medical help. “The life-saving safety net that NHS ambulance services provide is being severely compromised by these unnecessary delays and patients are dying and coming to harm as a result on a daily basis,” said Martin Flaherty, managing director of the Association of Ambulance Chief Executives (AACE), which represents the heads of England’s 10 regional NHS ambulance services. Flaherty added: “Our national data for hospital handover delays during October 2022 is extremely worrying and underlines the fact that in some parts of the country efforts to reduce or eradicate these devastating and unnecessary delays are simply not working.” Read full story Source: The Guardian, 23 November 2022
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News Article
Ambulance waits quadruple in handover hotspots
Patient Safety Learning posted a news article in News
Ambulance waiting times for stroke and suspected heart attacks have quadrupled in four parts of England since before Covid-19 – whereas others have only grown by half – underlining the severe impact of long accident and emergency handovers. Response times have leapt across England over the past two years, particularly for category 2 and 3 incidents, but the data makes clear that the steepest increases are in areas where hospitals have the biggest handover delay problems. Of the 10 patches with the largest increases in average category 2 performance between 2018-19 and 2021-22, four are served by major hospitals which make up NHS England’s “cohort one” of trusts selected for the worst handover problems; and four more are on government’s list of 15 which accounted for the most long handover delays last winter. The increase in handover delays – in turn linked to delayed discharge, staffing, lack of community services and social care’s collapse – are the stand-out reason for areas with a steep rise in response times. Read full story (paywalled) Source: HSJ, 18 November 2022 -
News Article
Half of ambulance arrivals ‘inappropriate’, says acute trust
Patient Safety Learning posted a news article in News
An audit conducted by an acute trust has found more than half the patients taken to one of its hospitals by ambulance were deemed “inappropriate for conveyance”. The assessment at Scarborough Hospital in Yorkshire, obtained by HSJ through a freedom of information request, examined a random sample of 100 patients, of which around 50 arrived by ambulance. Of those arriving by ambulance, half were deemed not to have required an ambulance conveyance. The Missed Opportunities Audit, which the trust said was “routine” and looked at a range of areas where the emergency department could streamline operations, said: “Fifty-two per cent of conveyance[s] by ambulances were deemed as inappropriate". “The reviewer did not have access to the policies of Yorkshire Ambulance Service, which may account for the low number of appropriate conveyances. However, based on clinical judgment for cases presenting by ambulance the arrivals should have presented either to a community service (33%) or via their own transportation methods (38%), as their documented clinical condition and social circumstances allowed for this.” Read full story (paywalled) Source: HSJ, 9 November 2022 -
Content ArticleThe analysis suggests three ways to improve ambulance service performance: Reduce handover delays by increasing hospital capacity and flow through hospital with more beds, more staff and investment in out-of-hospital care, including social care. Increase ambulance service capacity by further increasing staff numbers and reducing sickness absence by addressing the causes of poor mental health. Reduce demand for ambulances through greater investment in community services, such as mental health services, which can prevent health conditions becoming crises.
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Content ArticleSafety recommendations HSIB has made three safety recommendations so far as a result of this ongoing investigation: HSIB recommends that the Department of Health and Social Care leads an immediate strategic national response to address patient safety issues across health and social care arising from flow through and out of hospitals to the right place of care. HSIB recommends that the Department of Health and Social Care conduct an integrated review of the health and social care system to identify risks to patient safety spanning the system arising from challenges in constraints, demand, capacity and flow of patients in and out of hospital and implement any changes as necessary. HSIB recommends that NHS England includes staff health and wellbeing as a critical component of patient safety in the NHS Patient Safety Strategy. Safety observations It may be beneficial for there to be a whole-system patient safety accountability and responsibility framework that spans health and social care. It may be beneficial for NHS organisations to provide time and safe spaces for staff to engage in reflective practice and talk about the emotional impact of their work, with support from people with expertise in staff wellbeing.
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News Article
CQC inspection approach helping fuel emergency care crisis, says trust chief
Patient Safety Learning posted a news article in News
A trust chief executive says the Care Quality Commission’s (CQC) inspection regime is still overly focussed on individual organisations, rather than systems, and this is driving the “risk aversion” which is partly responsible for the emergency care crisis. Mid Yorkshire Hospitals Trust CEO Len Richards acknowledged the CQC has started to scrutinise system-wide issues but suggested the “heat” of its regulation is still on individual providers. Mr Richards told the House of Lords’ public services committee on Wednesday that care homes and nursing homes in his area have declined to take patients ready to be discharged from hospital, due to concerns it would put their CQC accreditation at risk. He said: “[Last winter] we asked nursing homes and care homes to take patients and they couldn’t take them beyond a certain limit because it would put their accreditation at risk. “We went to the CQC to try and create some flexibility. Their perspective was very much of an independent regulatory body that would look at the organisation and not look at the system. I think we’ve got an awful long way to go there. “I think regulation does drive risk aversion… [and] the heat of regulation right at the moment is on individual organisations. “Therefore, when the CQC come and look at my organisation, they will talk about congestion in the A&E department. They won’t talk about the assessment that we made around there being a greater risk in the community if we didn’t offload ambulances.” Read full story (paywalled) Source: HSJ, 28 October 2022 -
Content ArticleSafety observations It may be beneficial if local healthcare systems consider how best to support the investigation of cross-organisation safety events as they implement the Patient Safety Incident Response Framework. It may be beneficial if national and regional bodies consider how healthcare organisations can be supported to develop effective systems-based solutions to identified patient safety risks. It may be beneficial if healthcare organisations develop processes to identify safety improvement themes from patient safety investigation reports. It may be beneficial if providers of NHS care consider low-harm and no-harm safety events as sources of learning in local patient safety incident response plans. The pilot investigations made safety recommendations to the local healthcare organisations. They aimed to highlight issues identified, that if addressed would reduce the risk of future, similar events occurring.
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Content Article
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News Article
‘Gross’ care delays could become ‘new normal’, says CQC report
Patient Safety Learning posted a news article in News
The Care Quality Commission (CQC) has urged system leaders to move away from “quick fixes” to the “enormous gap in resources and capacity” in urgent and emergency care. A report by the CQC and a large group of emergency clinicians and other health and care leaders calls for a ”move away from reactive ‘quick fixes’ such as tents in the car park or corridor care to proactive long-term solutions and to address the enormous gap in resources and capacity”. The use of tents and treating more patients in corridors have been increasingly adopted by hospitals in recent months, sometimes encouraged by NHS England, particularly when they are under pressure to reduce handover delays from ambulances. The report, 'People First: a response from health and care leaders to the urgent and emergency care system crisis', suggests: expanding use of urgent community response teams to attend minor injuries 999/111 calls, giving acute and social care providers direct access to GP and community service booking systems, and providing “rapid access” to support packages to help people avoid hospital admission. Read full story (paywalled) Source: HSJ, 22 September 2022 -
Content Article
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News Article
London hospitals set to double up patients in wards to tackle winter crisis
Patient Safety Learning posted a news article in News
NHS trusts across London are set to start moving patients from A&E onto wards “irrespective” of whether there are beds available, The Independent has learned. The new model, which involves moving patients every two hours out of A&E and onto wards called acute medical units, has prompted concerns that patients could be “double lodged” on hospital wards. The move follows the trial of a new system by North Bristol NHS Trust last month, which said it would be moving three patients every hour from A&E onto wards in a bid to address severe ambulance handover delays. On Thursday, health secretary Steve Barclay said that the “number one” priority for the NHS currently is tackling ambulance handover delays, with a “small” number of trusts accounting for half of all delays. In a memo seen by The Independent, NHS clinicians in one hospital were told that London trusts would be rolling out the North Bristol model at “pace” ahead of winter. The system involves moving one patient from A&E onto a ward every two hours “irrespective of bed availability”. Speaking to The Independent, one NHS director said the move would lead to “double lodging” patients, which means squeezing more patients into wards, and that this could be “dangerous” for patients. However, A&E doctors told The Independent that the move should be welcomed, as it spreads the crowding and risk for patients across hospital departments rather than confining it to A&E. Read full story Source: The Independent, 4 September 2022 -
News Article
'Sticking plaster' NHS winter plan criticised for lacking workforce strategy
Patient Safety Learning posted a news article in News
Doctors and health service providers welcomed publication of an NHS strategy for managing demand ahead of another busy winter for health and social care, but said it failed to address underlying problems with the system. In a letter to the heads of NHS trusts and integrated care boards, NHS England chiefs said they had begun planning for capacity and operational resilience in urgent and emergency care ahead of "significant challenges" during the coming months. The British Medical Association (BMA) said the strategy was a "step in the right direction", but "lacks detail", while the Royal College of Emergency Medicine (RCEM) said it amounted to little more than "a crisis mitigation plan". The package of measures included creating the equivalent of 7000 extra general and acute beds through a mix of new physical beds, scaling up 'virtual' beds, and "improvements in discharge and flow". The letter acknowledged that there was "a significant number of patients spending longer in hospital than they need to" and that whilst "the provision of social care falls outside of the NHS’s remit, the health service must ensure patients not requiring onwards care are discharged as soon as they are ready and can access services they may need following a hospital stay." Read full story Source: Medscape, 15 August 2022
