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Found 109 results
  1. News Article
    The parents of a baby who died from sepsis said their son deserved a "fighting chance" after concerns were raised over his care in hospital. Ten-week-old Tommy Gillman was admitted to King's Mill hospital on 7 December 2022 but died the next day. Tommy Gillman, from Coddington, Nottinghamshire, was "extremely unwell" with what proved to be Salmonella Brandenburg meningitis when admitted to the Sutton-in-Ashfield hospital at 12:35 GMT. His assessment was delayed, and then the severity of his condition missed, meaning correct treatment with antibiotics and fluids did not start until 17:00. A coroner's report identified a lack of experienced paediatric nurses and confusion in handovers between staff. "I am not reassured that necessary actions to address these serious issues identified are in place," the coroner said. Sherwood Forest Hospitals NHS Foundation Trust said it welcomed the review and a "rapid" programme of improvements was being worked on. Tamzin Myers and Charlie Gillman said their son deserved "a fighting chance" by getting prompt treatment Read full story Source: BBC News, 17 April 2024
  2. Content Article
    Tommy Gillman died on 8 December 2022 from sepsis and multi organ failure secondary to Salmonella Brandenburg meningitis. There were missed opportunities to provide him with earlier antibiotics, fluid resuscitation and intensive monitoring from 12.35pm on the 7 December 2022 at Kings Mill Hospital. Once the severity of his illness had been recognised at approximately 17:00 hours on that day, he was provided with prompt treatment for septic shock and meningitis. Sadly however he did not respond to this treatment and died the following day following transfer to Leicester Royal Infirmary. Whilst there were serious missed opportunities to provide earlier treatment of sepsis and meningitis.
  3. News Article
    Stroke patients in England are waiting an average of almost seven hours for a specialist bed, double the wait reported before Covid. National performance against key measures collected by the Sentinel Stroke National Audit Programme has nosedived, with patients in England waiting an average of almost seven hours to be admitted to a specialist unit in 2022-23, compared to three and a half hours in 2019-20. NHS England guidance states that every patient with acute stroke should be given rapid access to a stroke unit within four hours. This time frame is considered critical, as patients can only be given clot-busting drugs, and treatments such as thrombectomy, which surgically removes a clot, within the first few hours of stroke onset. However, this was achieved in just 40% of cases last year (2022-23), down from 61% in 2018-19. Juliet Bouverie, CEO of the Stroke Association, urged ministers to give trusts what they needed to reverse the decline, saying: “Stroke is a medical emergency and every minute is critical. “We are very concerned to see that, far from improving over the last year, the proportion of stroke patients being admitted to a stroke ward within the timescale for thrombolysis has continued to decline. This is putting patient recoveries at risk and strain on the rest of the health system. “We believe that early supported discharge, when done correctly, with adequately resourced community teams, can help to alleviate capacity pressures in acute stroke units. However, this is not a silver bullet. There are longstanding workforce issues which are affecting patient flow in, through and out of stroke units and we call on DHSC to properly address these in the workforce plan.” Read full story (paywalled) Source: HSJ, 2 January 2024
  4. Content Article
    Rob Behrens reflects on the work the Parliamentary and Health Service Ombudsman (PHSO) has done over the last year to drive improvements in patient safety.
  5. News Article
    Ambulance handover delays rose last week with close to 13,000 crews waiting more than an hour to offload patients — marginally more than the comparable week last year. Week of 27 November 2023 figures were missing data for several days from some trusts, NHSE said. The number of hour-plus waits for ambulancs to pass patients to emergency departments was 12,797, according to new NHS England data. That appeared to be steeply up from about 8,000 in the past two weeks, although NHSE said last week’s was not directly comparable due to missing data. It was just ahead of the 12,534 recorded for the week ending 11 December last year. Last year the numbers rose to over 16,000 in the third week in December then peaked at 18,720 in the week running up to New Year, in what many said was the worst winter crisis for decades, amid a sharp, early wave of flu. This year the numbers of long waits have risen earlier than last, and several ambulance trusts have reported coming under severe pressure in the last few days. NHS England has warned junior doctors strikes next week and in the new year may compound hospital flow problems. Read full story (paywalled) Source: HSJ, 15 December 2023
  6. News Article
    Regulators have warned hospital leaders they may have to ‘depart from established procedures’ over winter to minimise ambulance handover delays. In a joint letter to nursing and medical leaders, NHS England, the Care Quality Commission and professional regulators said it was “vital that we have a whole system approach to risk across the urgent and emergency care pathway”. The push has come amid a huge increase in instances of crews being held outside emergency departments, resulting in extended response times for time-critical 999 calls. The letter added: “We… understand there will be concerns about working under pressure, and that you and your teams may need to depart from established procedures on occasion to provide the best care. “Please be assured that your professional code and principles of practice are there to guide and support your judgments and decision making in all circumstances. This includes taking into account local realities and the need to adapt practice at times of significantly increased pressure. “In the unlikely event of a complaint to your professional regulator they will, as is their usual practice, consider carefully whether they need to investigate. If an investigation is needed, they will consider all relevant factors including the context and circumstances in which you were working. “One area that may be an example of this is in handing patients over to emergency departments from ambulance services. There is a strong correlation between ambulance handover delays at emergency departments and ambulance category 2 response delays, meaning longer handovers increase the chances those in need will wait longer for an ambulance.” Read full story (paywalled) Source: HSJ, 11 December 2023
  7. News Article
    Ministers must intervene over systemic failures which are “too big for hospital or ambulance trusts to fix on their own” and have led to multiple preventable deaths, a senior coroner has warned. In a move usually considered rare for such an official, Cornwall and Isles of Scilly coroner Andrew Cox has written to the Department of Health and Social Care a second time over ongoing delays to ambulance responses and long ambulance handovers in the area. Last year he warned the NHS was “broken” after he ruled ambulance and emergency care delays contributed to the deaths of four people. Now, he has sent a similar report on the same types of failings in the deaths of John Seagrove, Pauline Humphris, and Patricia Steggles at Royal Cornwall Hospital to new health secretary Victoria Atkins. Mr Cox wrote: “I set out in my [prevention of future death report] last year my understanding of the reasons for the difficulties that are continuing in the Cornwall & Isles of Scilly coroner area. I do not believe those reasons will have changed significantly. ”The challenges are systemic in nature. They are too big for a single doctor, nurse or paramedic to fix. They are too big for either the hospital trust or the ambulance trust to fix on their own.” Read full story Source: HSJ, 1 December 2023
  8. News Article
    Patient safety is being put at risk by the “toxic” behaviour of doctors in the NHS, the health ombudsman has said. Rob Behrens, who investigates complaints about the NHS in England, warned that the hierarchical and high-handed attitude of clinicians was undermining the quality of care in some hospitals. He called for medical training to be redesigned to encourage a more empathetic and collaborative approach from doctors. Pointing to failings in the treatment of sepsis and the problems in maternity services, Behrens said he was “shocked on a daily basis” by what he saw as ombudsman. Too often, “organisational reputation has been put above patient safety”, he told The Times Health Commission. The ombudsman warned of a “Balkanisation” of health professionals, with rivalries between doctors and nurses or midwives and obstetricians harming patient care. “For all the brilliance of clinicians quite often they’re not very good at working together,” he said. “Time and again, the handover from one clinician to another, from one shift to another, or the inability to raise the issue at a senior level has been a key factor in what has gone wrong.” Read full story (paywalled) Source: The Times, 18 November 2023
  9. News Article
    Hospitals are being prevented from adopting models which spread risk away from emergency departments because other teams refuse to take on the extra work, according to a top accident and emergency doctor. In a recent interview with HSJ, North Bristol Trust chief executive officer Maria Kane praised her trust’s risk-sharing approach to emergency care, which involves moving patients each hour from accident and emergency to the most appropriate ward for their needs and where a discharge is expected, even if it is full. Commenting on the article, Royal College of Emergency Medicine president Adrian Boyle said: “The NBT trust leadership deserve significant credit for maintaining this. All too often there is an acceptance of unacceptable delays (and risk) in ambulance handovers and long ED stays. “Where this fails, it is usually because inpatient teams (both nursing and medical) have objected to the extra workload, without appreciating the real harm elsewhere. The more interesting question is why isn’t this being done more widely?” Read full story (paywalled) Source: HSJ, 15 November 2023
  10. News Article
    Ambulance chiefs say handover delays have got worse at some trusts in recent months, despite the picture improving nationally since last winter. A report from the Association of Ambulance Chief Executives says there are continuing concerns about handover delays at emergency departments. Jason Killens, the body’s lead chief executive for operations, told HSJ: “There’s been some improvement [at some sites] since February, but what we’ve also seen is a commensurate or bigger decay in other sites across that same period.” Mr Killens said “it’s difficult to be precise” about why some trusts have struggled more than others but that challenged hospitals are often affected by “pathway issues” including delayed discharges. “And then maybe there are challenges around stable leadership or the visibility of the leadership, the culture there about managing that risk dynamically, and so on,” he added. Read full story (paywalled) Source: HSJ, 14 September 2023
  11. News Article
    The NHS has lost almost 25,000 beds across the UK in the last decade, according to a damning report says the fall has led to a sharp rise in waiting times for A&E, ambulances and operations. The Royal College of Emergency Medicine said the huge loss of beds since 2010-11 was causing “real patient harm” and a “serious patient safety crisis”. At least 13,000 more beds are urgently needed, it added, in order to tackle “unsafe” bed occupancy levels and “grim” waiting times for emergency care and handover delays outside hospitals. Patients are increasingly “distressed” by long waiting times, the college said, as are NHS staff who face mounting levels of burnout, exhaustion and moral injury. The UK has the second lowest number of beds per 1,000 people in Europe at 2.42 and has lost the third largest number of beds per 1,000 population between 2000 and 2021 (40.7%), the report said. There are currently 162,000 beds in the NHS across the UK, according to the college. “The situation is dire and demands meaningful action,” said Dr Adrian Boyle, the college’s vice-president. “Since 2010-11 the NHS has lost 25,000 beds across the UK, as a result bed occupancy has risen, ambulance response times have risen, A&E waiting times have increased, cancelled elective care operations have increased. “These numbers are grim,” Boyle added. “They should shock all health and political leaders. These numbers translate to real patient harm and a serious patient safety crisis. The health service is not functioning as it should and the UK government must take the steps to prevent further deterioration in performance and drive meaningful improvement, especially ahead of next winter.” Read full story Source: The Guardian, 31 May 2022
  12. News Article
    A struggling ambulance trust could face a ‘Titanic moment’ and collapse entirely this summer if the region’s worsening problems with hospital handover delays are not taken more seriously, its nursing director has told HSJ. Mark Docherty, of West Midlands Ambulance Service (WMAS), said patients were “dying every day” from avoidable causes created by ambulance delays and that he could not understand why NHS England and the Care Quality Commission were “not all over” the issue. He revealed that handover delays at the region’s hospitals were the worst ever recorded, that rising numbers of people were waiting in the back of ambulances for 24 hours, and that serious incidents have quadrupled in the past year, largely due to severe delays. More than 100 serious incidents recorded at WMAS relate to patient deaths where the service has been unable to respond because its ambulances are held outside hospitals, according to the minutes of the trust’s March quality and safety committee. "Around 17 August is the day I think it will all fail,” he said. “I’ve been asked how I can be so specific, but that date is when a third of our resource [will be] lost to delays, and that will mean we just can’t respond. Mathematically it will be a bit like a Titanic moment. ”It will be a mathematical certain that this thing is sinking, and it will be pretty much beyond the tipping point by then.” Read full story (paywalled) Source: HSJ, 25 May 2022
  13. News Article
    Nearly 600 patients waited 10 hours or more in the back of an ambulance to be transferred into emergency departments last month – with one taking 24 hours, HSJ can reveal. The 24-hour wait was the longest handover delay recorded in the past year, and probably ever, according to information released by ambulance trust chief executives. In May last year the longest recorded rate was seven hours. This has risen steadily during the year to hit 24 hours in April. In March a patient in the West Midlands had to wait 23 hours. The figures also show 11,000 patients waited more than three hours for handover last month, with 7,000 of them taking more than four hours and 4,000 over five hours. Some 599 waited more than 10 hours. The Association of Ambulance Chief Executives estimates 35,000 patients were potentially at risk of harm from delayed handovers last month, with just under 4,000 of those risking severe harm. This is based on work it did looking at patients waiting more than 60 minutes in 2021 and was a slight fall on March. They are based only on handover delays and do not include harm from patients left waiting for an ambulance response. Hours lost to ambulance handover delays restrict ambulance trusts’ ability to reach other patients waiting for an ambulance in the community. Read full story (paywalled) Source: HSJ, 16 May 2022
  14. News Article
    Health leaders in Lincolnshire have admitted they do not have a ‘robust’ response to managing the risks posed by ambulance handover delays and poor response times. The system’s acute provider, United Lincolnshire Hospitals Trust (ULHT), was consistently among the trusts accounting for the highest proportion of ambulance delays over winter. In a document submitted to NHS England, the county’s integrated care system said: “While the system has good visibility of the level of risk across the system, and there are discussions about this on daily system calls, it is recognised that the system doesn’t currently have a robust response approach to ambulance handover delays. “A request has been made to regional NHSE/I team for support in developing a Lincolnshire system risk and response approach to ambulance handover delays.” ULHT’s board has recently noted “increasing concerns” from regulators. Its board papers have described capacity outside the acute sector as key, but there was “currently… not a sense of collective impact to scale and scope that would make a difference to reach the trajectory described”. Read full story (paywalled) Source: HSJ, 5 May 2022
  15. News Article
    An ambulance service has raised concerns over the record number of ‘hours lost’ to handover delays at an acute hospital on its patch, which it says is happening despite the number of arrivals being at its lowest level in seven years. West Midlands Ambulance Service University Foundation Trust has said the situation at Royal Stoke Hospital presents a “significant risk to patient safety”, but “we don’t currently see actions being taken that are reducing this risk”. It comes amid rising frustrations from ambulance chiefs around the country at a perceived lack of support from acute hospitals around handover delays. Ambulance response times for some of the most serious 999 calls have ballooned in recent months, in part due to lengthy handover delays at emergency departments. In a letter sent to a member of the public on 31 March, Mark Docherty, director of nursing at WMAS, said: “WMAS [is] experiencing difficulties as a direct result of delays in patient handovers at acute hospitals. We have been highlighting our concerns for over six years as the situation has become progressively worse every year." Read full story (paywalled) Source: HSJ, 10 April 2022
  16. News Article
    Stroke and heart attack victims are now routinely waiting more than an hour for an ambulance, after a further fall in performance in recent weeks, and with hospital handover delays hitting a new high point, HSJ reveals. Figures for ambulance performance this week, seen by HSJ, showed average response times for category two calls at more than 70 minutes for successive days. 3,000 patients may have suffered “severe harm” from delays in February, ambulance chief executives say. Several well-placed sources in the sector said response times had deteriorated further this month, and that more than half of ambulance trusts were this week seeing average category two responses of longer than an hour. Some cited an average category two response last week of around 70 minutes, with the services under huge pressure from a combination of demand, long handover delays, and covid-related sickness. Category two calls include patients with suspected heart attacks and strokes, and the national target for reaching them is 18 minutes. The figures seen by HSJ for this week showed average response times for category one calls — the most serious, including cardiac arrests and other immediately life threatening emergencies — of more than 10 minutes on Wednesday, against a target of just 7 minutes. Monthly average performance for category one has never reached 10 minutes. Read full story (paywalled) Source: HSJ, 1 April 2022
  17. News Article
    NHS England and the Care Quality Commission have asked systems with large numbers of ambulance handover delays to urgently hold a meeting to try to fix the problem by “balancing the risks” of long 999 waiting times. The request was made in an email to chief executives, which warned the service was “in a difficult position with all parts of the urgent and emergency care pathway under considerable strain… most acutely in ambulance response times which in turn is linked to challenges in handing patients over to emergency departments”. The NHSE headed letter was signed by its chief operating officer, nursing director and medical director, but also by the CQC’s chief inspector of hospitals Ted Baker. It said there was a “strong correlation” between handover delays at hospitals — which take place where A&Es are unable to receive patients from ambulances — and long delays for category two ambulances. This is because ambulances have to wait for long periods outside the hospitals. The letter said: ”It is vital that we have a whole-system approach to considering risks across the urgent and emergency care pathway to provide the best outcomes for our patients. This may mean consideration of actions to be taken downstream to help improve flow and reduce pressures on emergency departments.” Read full story (paywalled) Source: HSJ, 17 February 2022
  18. News Article
    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
  19. News Article
    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
  20. News Article
    The NHS has broken its “fundamental promise” to the public that life-saving emergency care will be available when they need it, a top NHS doctor has said, as ambulances continue to lose tens of thousands of hours waiting outside hospitals. Katherine Henderson, the president of the Royal College of Emergency Medicine, said that what she described as the fundamental promise of the NHS to provide an ambulance in a real emergency has been “broken”. Her comments come as the West Midlands Ambulance Service (WMAS) University NHS Trust predicted it would lose 48,000 ambulance hours waiting outside A&E departments in July. This would make it the worst month on record. In papers published on Thursday, WMAS said the impact of handover delays means that patients are waiting longer than needed for an emergency response, including patients in category one, which includes those needing immediate life-saving care. It added: “This means that patients who are immediately time-critical medical emergencies do not get the response they need and may suffer significant harm or death.” Read full story Source: The Independent, 26 July 2022
  21. News Article
    Serious incidents causing patient harm have increased steeply compared to previous years at an ambulance service whose nursing director still expects will “fail” next month under mounting service pressures. There were 98 patient harm incidents at West Midlands Ambulance Service in June, official data obtained by HSJ suggests, up from 49 in the same month last year. The figures show that from April-June this year, 262 harm incidents have been logged – a 240% on 77 in the same period in 2019 and a 71% on 153 last year. Nursing director Mark Docherty, who previously warned the service was facing a “Titanic moment” and would “all fail” around a specific date of 17 August, said much of the increase can be attributed to worsening hospital handover delays. More than 700 people at one time waited for ambulances “that were not going to turn up” on Monday, according to Mr Docherty, who described the situation as a “really dangerous place to be”. Mr Docherty explained how the harm incidents, including deaths, resulted from growing delays: ”You can’t underplay the risk. If you’ve got 750 patients like we did on Monday waiting, none of those patients have been assessed. “Sadly, amongst them there will have been patients with stroke who won’t be treated because they’ve waited too long." Read full story (paywalled) Source: HSJ, 15 July 2022
  22. News Article
    NHS England’s director of community health has said a new strategy for rehabilitation care is needed, because present coverage is sometimes ‘bizarre’, with other services ‘masquerading’ as rehab. Matthew Winn, who is also Cambridgeshire Community Services Trust CEO and senior responsible officer of the “ageing well” programme in the NHS long-term plan, made the comments in a webinar for local senior clinicians and managers in the sector. He said there was an intention to roll out a national “intermediate care strategy”, describing it as “the essence” of providing rehabilitation and helping hospital patients to “optimise, to recover, to rehab through a skilled multiprofessional team”. They would leave hospital in a “timely pathway” and not need as much social care support afterwards. It comes amid huge pressure to speed up hospital discharge, which often relies on rehab services. Read full story (paywalled) Source: HSJ, 14 July 2022
  23. News Article
    A spike in Covid absences and the extended heatwave have left NHS hospitals and ambulance services struggling to cope. The hot weather is also driving more patients to A&E departments, and callers are being urged not to use 999 except in serious emergencies. All 10 ambulance trusts in England are on black alert, the highest level, while health leaders warn that “ill-equipped” hospital buildings are struggling to store medicines correctly amid the abnormally high temperatures. Martin Flaherty, managing director of the Association of Ambulance Chief Executives, said: “The NHS ambulance sector is under intense pressure, with all ambulance services operating at the highest level of four within their local resource escalation action plans, normally only ever reserved for major incidents or short-term periods of unusual demand. “Severe delays in ambulance crews being able to hand over their patients at many hospital emergency departments are having a very significant impact on the ambulance sector’s ability to respond to patients as quickly as we would like to, because our crews and vehicles are stuck outside those hospitals.” Read full story Source: The Independent, 12 July 2022
  24. News Article
    An ambulance trust lost 1,700 hours of working time in one week in April due to vehicles waiting outside a hospital. The BBC has discovered that the figure was reached twice during April as ambulance crews waited outside Gloucestershire Royal Hospital in Gloucester to handover patients. That equates to about 70 days worth of waiting time each week. The trust that runs the hospital said it was facing "significant challenges" as it dealt with "unrelenting demand". Figures show that since the end of January, South Western Ambulance Service NHS Foundation Trust (SWASFT) has lost a minimum of 800 hours of working time each week due to ambulances having to wait outside Gloucestershire Royal Hospital, unable to get patients into A&E. The national target for transferring patients from ambulances in to A&E is 15 minutes, but in some cases people had to wait up to 10 hours in ambulance queues in Gloucester. Read full story Source: BBC News, 12 July 2022
  25. News Article
    Hospital leaders say they have been pressured to deliver more ‘corridor care’ as a result of efforts to ease the ambulance handover crisis. Due to the collapse in ambulance response times over the last year, hospitals have been told to receive patients from ambulance crews more quickly, to enable those crews to respond to new incidents in the community. This can mean patients being kept on trolley beds in corridors, with a lack of appropriate staff to care for them. Tracy Bullock, chief executive of University Hospitals of North Midlands, told HSJ her trust almost eradicated “corridor care” before the pandemic. But she added: “There have been discussions about going back to corridor care, but we have resisted that, as it brought significant patient safety and staff wellbeing issues… although these never received the same airtime as ambulance waits as they are unseen and only impact on the acutes. “The terminology has now changed and instead of corridor care it’s ‘cohorting’, and the space is not necessarily a corridor but a designated space for ambulances to drop more patients off.” She said this only works with enough staff, “otherwise you end up with the same safety issues that we had delivering corridor care pre-pandemic”. Read full story (paywalled) Source: HSJ, 11 July 2022
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