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Found 687 results
  1. Content Article
    Key findingsIntroducing access and waiting time standards for mental health services was an important step towards parity of esteem with physical health services.Overall, the number of people treated by NHS mental health services has increased, but some access targets are not being met. The NHS has achieved its waiting times standards, which aim to get people into treatment quickly, for talking therapy services and early intervention in psychosis services, but not yet for eating disorders services for children and young people.NHS mental health services are under continued and increasing pressure and many people using services are reporting poor experiences. NHS England’s ambitious plan for community-based mental health services is still at an early stage.The impact of initiatives to reduce inequalities in mental health is not yet clear. Although the NHS mental health workforce has increased, staff shortages remain the major constraint to improving and expanding services. The share of funding for mental health services has increased slowly, reflecting the pace set by NHSE’s targetsImprovements to mental health data and information are taking longer than planned in many areas. DHSC and NHSE have not defined what achieving full parity of esteem between mental and physical health services would mean. Plans for service expansion up to 2023-24 still leave a sizeable gap between the number of people with mental health conditions and how many people the NHS can treat.The national programme, led by NHSE, has maintained a consistent focus on expanding services. Increased demand and disruption following the pandemic mean it is likely to take longer for the NHS to close treatment gaps.
  2. Content Article
    NHS services are under extreme pressure. Recent testimonies from healthcare professionals, patients and journalists have highlighted the scale of these problems, which go significantly beyond the usual increase in pressure over the winter period. One key area of concern is a lack of hospital bed capacity, which as noted by the Nuffield Trust, is an important indicator of wider pressure on the system: "Hospitals cannot operate at 100% occupancy, as spare bed capacity is needed to accommodate variations in demand and ensure that patients can flow through the system. Demand for hospital beds peaks at different times of the day, week and year. There must be enough beds to accommodate these peaks. A lack of available beds can have widespread consequences in a health system.”[1] An absence of spare bed capacity can significantly impact a hospitals ability to provide safe and timely care. This also has consequences for other parts of the system, such as increased ambulance waiting times because of handover delays. There are multiple causes of these capacity issues: Longer-term structural challenges – such as the number of hospital beds relative to the population and workforce shortages.[2] Medium-term issues – for example the impact of delayed discharges. Short-term problems – such as increases in admissions of patients with seasonal illnesses. In this blog we will consider two specific issues stemming from this lack of hospital bed capacity and consider their impact on patient safety: Increasing cases of patients being cared for in hospital corridors and non-clinical areas, commonly referred to as ‘corridor care’. Current proposals to reduce the number of patients waiting to be discharged. Increasing cases of ‘corridor care’ ‘Corridor care’ can be broadly defined as care being provided to patients in corridors, non-clinical areas or unsuitable clinical areas because of a lack of hospital bed capacity. In recent years this has become an increasing occurrence as pressures and demands on the NHS mount, particularly during the winter months. In February 2020, the Royal College of Nursing (RCN) highlighted its concerns about this becoming normalised, publishing a survey of its members that found that over 90% of respondents said that ‘corridor nursing’ was being used at their Trust.[3] [4] In March 2020, the Royal College of Emergency Medicine (RCEM) also raised this issue as part of a broader campaign around improving emergency care, highlighting the need to significantly increase the number of hospital beds in the NHS.[5] However, during the height of the Covid-19 pandemic, infection control and social distancing rules restricted the use of ‘corridor care’ in hospitals.[6] When providing guidance for emergency care after the initial Covid period, the RCEM reiterated the threats to patient and staff safety from crowding in emergency departments and emphasised the need to avoid a return to corridor care becoming the norm.[7] However, in recent months we have seen growing concerns about a significant increase in care being provided in corridors and non-clinical settings.[8] [9] [10] [11] [12] Patient safety risks Corridor care raises significant patient safety concerns. It can present problems providing appropriate care, as these unsuitable spaces can make it difficult to administer specific treatments, such as intravenous medication, or the ability to access oxygen, medication and lifesaving treatment in an emergency. It also makes it more difficult to monitor patients, which can result in delays in providing further treatment if their condition begins to deteriorate. The constraints on space that working in these conditions impose may mean that relatives are not able to be accommodated, reducing their ability to support patients whose condition may not otherwise be closely monitored. This lack of space can also result in physical hazards, with the potential for escape routes becoming blocked in emergencies.[13] Corridor care also has particularly negative impact on patient dignity and confidentiality: “Our overflow corridor never has fewer than 20 patients on it; people who are too unwell to sit in the waiting room. The corridor is made up of trolleys of patients lined up, top to toe, along a wall. It’s busy, it’s noisy and there’s no dignity there. Patients stuck there are being toileted behind staff holding up sheets on the corridor.”[14] Working in these conditions has a significant impact on healthcare professionals too, who know that they are not able to provide the best care possible to their patients. This can affect their mental health and wellbeing creating the risk of moral injuries: the distress experienced when circumstances clash with one’s moral or ethical code.[15] “Tonight I’ve come close to tears whilst apologising to patients for the standards of care we are able to provide. In my 22 years of being an A&E doctor I’ve never seen things so bad. It’s the same everywhere.”[16] Preventing avoidable harm Patient Safety Learning believes that corridor care should be avoided whenever possible. It is vital that this is not normalised. However, in the current circumstances, in some cases this is clearly unavoidable. In these situations, it is important that: Risk assessments are carried out for service redesign and for individual patients, with mitigating actions being taken to maintain the safest care possible. Trusts have clear guidance and apply learning from examples of good practice that prioritise patient safety. Trusts have plans in place to ensure the introduction of corridor care is only a temporary measure. Staff and patients report any incidents of unsafe care so that action can be taken swiftly to address harm or near misses. There is close oversight by Trust leadership, including the Board, to ensure that patient safety safeguards are in place if corridor care is needed and that this is minimised and not normalised. We also believe more research is needed to fully understand the consequences of corridor care in terms of patient outcomes as well as patient safety. There needs to be more research undertaken to evaluate the impact of this. Reducing the number of patients waiting to be discharged Having considered the patient safety impact of corridor care because of lack of hospital capacity, we now turn to current proposals aimed at increasing capacity by reducing the number of patients waiting to be discharged. Hospital discharges can be complex. To enable a safe and timely transfer of care, they require good co-ordination between hospital and community staff to arrange clinical assessments and to ensure the home or community setting has the appropriate equipment and care plans. A delayed discharges refers to a patient who no longer meets the clinical criteria to reside in hospitals and, therefore, should be discharged to non-acute settings. The Department of Health and Social Care has recently stated that there are around 13,000 patients meeting this description.[17] These patients may end up spending a significant amount of time waiting to be discharged for a range of different reasons: Lack of available places in care and nursing homes. Delays putting in place specialist support, such as home care or short-term rehabilitation, required following discharge. The need to ensure specific criteria for a safe discharge are met for patients who need to access ongoing mental health services and support. The need to ensure that complex needs are met prior to discharge, for example in some cases concerning patients with a learning disability, where these processes may involve a range of different professionals and specialist assessments. Reducing the number of delayed discharges is not a new policy idea, but in recent weeks it has received increased attention as this has been identified as a key measure to increase hospital bed capacity resulting in several new proposals aimed at achieving this. Patient safety risks Any measures aimed at increasing the speed of hospital discharges must have at their heart considerations of how this will impact on the safety of patients and the need to prevent avoidable harm. Below we consider some of the proposals that have recently been made in relation to this and their potential impact on patient safety. 1. Discharging patients without care packages The Welsh Government has recently issued new guidance to Health Boards to discharge patients who are well enough to leave even if they do not have a package of care in place.[18] A package of care is intended to meet a patient’s ongoing care needs, which may relate to healthcare, personal care or care home costs, following discharge. Without this in place, there is a significantly increased risk of avoidable harm, particularly for patients returning to their own homes. Not having in place required adaptations, equipment or access to rehabilitation could result in patients struggling to support themselves, increasing the risk of avoidable harm and re-admission to hospital. Commenting on this proposal, Dr Amanda Young, Director of Nursing Programmes at the Queen’s Nursing Institute, also highlighted concerns that: “… patients being discharged from hospital without appropriate care packages, or inadequate support or reablement, results in poorer outcomes in the short and longer term. Discharges may occur late in the evening with no advance warning to community services, in order to free up hospital beds. Vulnerable people may arrive to cold homes, alone, with community services unaware this has happened until the following day or even the day after.”[19] This also opens up the potential for inconsistent decision-making, transferring significant risk to individual healthcare professionals who may be under significant organisational pressures to make discharge decisions that they don’t believe are safe. 2. Funding additional care home beds The Department of Health and Social Care has announced £200 million in funding to buy thousands of extra beds in care homes and other settings to help discharge more patients who are fit to leave hospital and free up hospital beds.[17] The Scottish Government has also announced a similar package, stating it will provide £8 million in funding for additional care home beds.[20] While these announcements have been welcomed in some places, there are concerns about the ability of the social care system to fulfil this, with a key problem being staff shortages. In England alone it is estimated that there are 165,000 vacant posts in social care.[21] Serious concerns have been raised about how appropriate care can be provided where additional beds may be available but staff are not.[22] [23] In many cases this could lead to this additional bed capacity not being utilised, due to lack of staffing, or is utilised despite under-staffing, increasing the potential risk of avoidable harm. Considering this new funding in the context of these workforce shortages, Martin Green, Chief Executive of Care England, said: “… there has been little consultation with the social care sector on how this can be achieved. Yet again, the Government has talked to the NHS and pretty much nobody else, and this is why their policies never work.”[24] There is also a question about whether patients subject to these accelerated discharge processes will receive the appropriate support they need. Integrated Care Boards will be tasked with using this new national funding for hospital discharges to purchase bedded step down capacity plus associated clinical support for patients.[25] However, concerns have been raised about the potential for rushed placements stemming from this, without appropriate access to rehabilitation and enhanced healthcare, which may increase the risk of patient harm.26] The British Geriatrics Society has noted that this could disproportionately impact older patients: “When older people leave hospital in poor health, they need rehabilitation and support to recover. Without it, their health deteriorates further – already on average 15% of older people being discharged from hospital are readmitted within 28 days. With each admission their level of frailty and care needs increase, generating even more demand for health and social care at home or in a care home.”[27] There have also been practical concerns raised questioning whether this funding can be effectively distributed, and extra beds provided quickly enough, to reduce the current pressures. There are further concerns too around how this is being targeted, with the provision of funding being “decided on a ’weighted population basis‘, rather than adjusted to reflect the current share of delayed discharge patients”.[28] [29] Preventing avoidable harm Patient Safety Learning believes that decisions on the introduction of new measures aimed at accelerating hospital discharges and freeing up hospital bed capacity must have patient safety considerations at their core. Whether they involve discharging patients at an earlier stage without care packages, or increased funding to move patients into care homes, all elements of these changes must be considered through a lens maintaining the safety of patients. This includes ensuring: Patients return home, or move to a care setting, with the correct medications and medical devices. Appropriate handover of information for patients is provided when moving from hospital directly into care settings. Appropriate equipment/adaptations being in place for patients returning home. Patients and their responsible carers have access to timely clinical advice if there is deterioration in the patient’s health, and guidance on the signs and symptoms that may indicate this. Patients and their families are decision makers in their own care and have access to information and advice to enable this. Concluding comments The shortage of hospital bed capacity has a wide range of consequences across the healthcare system with implications for patient safety. Here we have focused on the need to ensure that in two specific areas – managing the increase in cases of corridor care and reducing the numbers of patients waiting to be discharged – patient safety is being placed at the heart of decision-making processes around both. In addition to the areas we have identified, ensuring this happens also requires patient safety leadership at a national level. While far from a desirable state of affairs, corridor care is taking place in parts of the NHS and will continue to do so for the foreseeable period, meaning its impact on patient safety must be understood and mitigated where possible. We believe there needs to be recognition of this from NHS England and the Department of Health and Social Care, along with a proactive effort to share and disseminate knowledge and good practice in this area to prevent avoidable harm to patients. We also believe it is important that there is both a recognition and inclusion of patient perspectives and experience of these issues. This particularly applies to hospital discharge processes, which too often are either discussed as purely a capacity problem or worse disparagingly an issue caused by ‘bed-blockers’.[30] [31] It is vital that we hear and listen to the patients and family members voices on changes aimed at accelerating discharge processes. We need to recognise that these situations involve individuals with specific ongoing healthcare needs who, as well as the safe provision of care, deserve dignity and respect. Share your views and experiences We would welcome your views on the patient safety concerns raised in this blog: Are you a healthcare professional who has experience of delivering corridor care and would like to share your story? Are you a patient or family member who has experience of corridor care or a delayed discharge process? Do you work in social care and have experience of, or concerns about, accelerated discharge processes from hospitals? You can share your views and experiences with us directly by emailing content@pslhub.org or by commenting below (register here for free to activate your membership). References Nuffield Trust, Hospital bed occupancy: We analyse how NHS hospital bed occupancy has changed over time, 29 June 2022. Nuffield Trust, Hospitals at capacity: Understanding delays in patient discharge, 3 October 2022. RCN, ‘Corridor care’ in hospitals becoming the new norm warns RCN, 26 February 2020. RCN, Corridor Care: Survey Results, 26 February 2020. RCEM, RCEM launches new campaign to end corridor care as data shows more than 100,000 patients waiting over 12 hours in A&Es this winter, 3 March 2020. Health and Social Care Select Committee, Delivering core NHS and care services during the pandemic and beyond, 1 October 2020. RCEM, Covid19: Resetting Emergency Department Care, Last Accessed 11 January 2023. Birmingham Live, ‘Worst I’ve ever seen it’: Doctor speaks out about horrors of patients in corridors as NHS crisis deepens, 3 January 2023. Health Service Journal, Trust that banned corridor care ‘reluctantly’ brings it back, 4 January 2023. iNews, Striking paramedics tell of patients having seizures in hospital corridors and relentless 16-hour shifts, 11 January 2023. BBC News, NHS A&E crisis: Staff making ‘difficult decisions in unprecedented times’, 7 January 2023. This is Local London, BHRUT boss apologises to patients ‘care for in corridors’, 11 January 2023. Health Service Journal, NHSE issues fire risk warning over ‘corridor care’, 29 November 2022. The Guardian, It’s beyond dreadful. We’re now running A&E out in the corridor and wating room, 12 January 2023. Health Education England and NHS England, Understanding moral injury a short film, 15 January 2021. The Guardian, ‘It feels terminal’: NHS staff in despair over working at breaking point, 4 January 2023. Department of Health and Social Care, Up to £250 million to speed up hospital discharge, 9 January 2023. Wales Online, Doctors claim hospital discharge guidance could see patients die, 6 January 2022. Nursing in Practice, Welsh hospital patients to be discharged to community with care package in place, 6 January 2023. Scottish Government, Additional Winter support for NHS, 10 January 2023. Skills for Care, The state of the adult social care sector and workforce in England, October 2022. The Times, Fears over plans to move patients into care homes, 10 January 2023. The Independent, Staffing ‘crisis’ means £200m extra care beds plan won’t work, health bosses warn, 10 January 2023. Community Care, Care home discharge plan risks inappropriate placements and neglects the causes of crisis – sector, 9 January 2023. NHS England, Hospital discharge fund guidance, 13 January 2023. The Health Foundation, Hospital discharge funding: why the frosty reception to new money?, 13 January 2023. British Geriatrics Society, Protecting the rights of older people to health and social care, 10 January 2023. Health Service Journal, New discharge fund risks being ‘political theatre’, warn NHS leaders, 9 January 2023. Health Service Journal, Revealed: How much is each ICS getting from the £200m discharge fund, 13 January 2023. Daily Mail, Hospitals are discharging bed-blockers into hotels to free up space on wards, 5 January 2023. iNews, NHS discharges patients into hotels to ease bed blocking and A&E crisis, 4 January 2023.
  3. Content Article
    Recommendations Technology that is obsolete should be replaced with up-to-date models by employers. The cost of using obsolete devices in terms of lost time and efficiency is likely to far outweigh the cost of purchasing new hardware. Nurses should be consulted at an early stage in the choice of hardware for use in community settings to ensure that it is appropriate and safe for its designated use. Companies that design mobile devices should be called upon to improve future designs of those used by the community nursing workforce, actively seeking nursing feedback. Nurses should be involved at an early stage in the design and development of software programmes that they will use as part of their everyday work. Healthcare provider organisations, commissioners and policy makers should undertake national, regional and local reviews of WiFi internet connectivity in all areas where their services are delivered and understand how this is directly impacting on the work of nurses delivering care in people’s homes and communities. Healthcare services and supporting organisations could usefully campaign for improved internet connectivity and ask for increased investment by mobile phone operators and government. Scheduling tools and related apps should always be designed, developed and used in a manner that is consistent with the nursing process, professional judgement and autonomy, personalised care and patient need. All healthcare providers should have a nurse who is appropriately experienced and skilled to lead on the use of digital technology within the organisation.
  4. News Article
    A mother who has seen her suicidal 12-year-old daughter shuttled between placements and then held in a locked and windowless hospital room says she is frightened for her child’s life. Since going into care in Staffordshire nine months ago, Becky (not her real name) has attempted to take her own life on several occasions. Her case throws fresh light on the chronic nationwide shortage of secure accommodation for vulnerable children. “I am constantly told there is nowhere for her,” said her mother, who cannot be identified for legal reasons. “I fear I’ll soon be arranging her funeral due to the systemic failings in health and social care.” Becky has been alone in a locked hospital room since 27 January. The room has no window or access to the outdoors, no furniture except for a bed, and she is permitted no belongings. All human contact is conducted through a hatch. The child’s court-appointed guardian told the high court at a hearing to discuss Becky’s case that she considered “the risk to Becky’s life to be catastrophic”. Read full story Source: The Guardian, 7 February 2023
  5. News Article
    NHS waiting lists are unlikely to fall in 2023, and the backlog is unlikely to be significantly tackled until mid-2024 despite being one of Rishi Sunak’s priorities for this year, research suggests. The NHS has struggled to increase the number of people it is treating from its waiting lists each month due to ongoing pressures from Covid-19, although there have been signs of improvement in the past month, analysis from the Institute for Fiscal Studies (IFS) has found. Max Warner, an IFS economist and one of the report’s authors, said that although the NHS had made “real progress” to reduce the number of patients waiting a very long time for care, efforts to increase overall treatment volumes had “so far been considerably less successful”. The NHS Providers’ chief executive, Julian Hartley, urged the government to introduce a fully funded workforce plan and to talk to unions about pay for this financial year as strikes were causing huge disruption to services, and risked undoing hard-won progress made on care backlogs. “Mounting pressures on acute, ambulance, mental health and community services, such as chronic workforce shortages, could hamper efforts to cut the backlog further if left unchecked,” he said. Read full story Source: The Guardian, 8 February 2023
  6. News Article
    A record number of eating disorder patients are not getting the life-saving treatment they need due to lengthy waits, leaked NHS data shows. More than 8,000 adults are waiting to be seen for therapy, according to internal figures from NHS England – the highest figure recorded since data collection began in 2019. In March 2021, there were around 6,000 adults waiting, while it was less than 2,000 in March 2019. One leading doctor warned that delays were leading to avoidable deaths, while multiple coroners investigating the deaths of nine patients since 2021 have repeatedly called on the NHS and ministers to improve services to prevent more. An investigation by The Independent can also reveal that long waits have led to a woman, 24, taking her own life while waiting two years for appropriate care, and patients being admitted to hospital because their conditions became so severe they developed life-threatening physical conditions. Dr Agnes Ayton, the Royal College of Psychiatrists’ lead for adult eating disorders, said long waits meant patients were “dying avoidably” because under-resourced services were forced to turn them away or leave them waiting for years. Anorexia has the highest morality rate of any psychiatric disorder. “One important thing is eating disorders are treatable, people can get better with time and treatment. We shouldn’t accept anorexia has the highest mortality rate because a lot of these deaths are avoidable and treatable. We should be aiming to provide high-quality care,” she said. Read full story Source: The Independent, 6 February 2023 Further reading on the hub: People with eating disorders should not face stigma in the health system and barriers to accessing support in 2022 Eating disorders: challenges of the pandemic
  7. News Article
    Commissioners have begun a ‘serious incident review’ across their integrated care system after early indications showed patients may have suffered harm due to long waits for cancer treatment. The review has been launched by Somerset Integrated Care Board into dermatology services after an initial review found five of 50 patients had seen their skin lesions increase in size since being referred to hospital by their GPs. ICB board papers stated “potential patient harm has been identified” for those patients, who were on the two-week wait pathway to be seen by a specialist following a referral by their GP. Read full story (paywalled) Source: HSJ, 3 February 2023
  8. News Article
    A major hospital in the UK has declared a critical incident, warning it is facing “immense pressures” on its services. Wigan’s Royal Albert Edward Infirmary urged people to avoid its A&E unless suffering a “life or limb-threatening emergency”. Wrightington, Wigan and Leigh (WWL) Teaching Hospitals NHS Foundation Trust warned that “unprecedented attendances” meant the emergency department was “full”. It said it is working with partners to discharge patients who are ready to leave hospital. The trust, which previously declared a critical incident in December, said the safety of its patients is the “top priority”. By declaring a critical incident, hospitals are able to take action so that safe services are maintained despite increasing pressures. Read full story Source: The Independent, 1 February 2023
  9. News Article
    NHS England has effectively admitted the backlog of cancer long-waiters will still be higher in March 2024 than before covid hit, in a document seen by HSJ. The consultation document, detailing trajectories for reducing numbers waiting 62 days or more from referral, shows the expected national total in March 2024 is 18,755. NHS England previously committed to reducing this to pre-pandemic levels (14,226) by March 2022, then delayed the target until March this year. There are now significant backlogs in diagnostics, with particular challenges in endoscopy and breast screening. NHS Providers director of policy and strategy Miriam Deakin said: “Cancer is a key priority for trusts. They understand the risk to patients who have to wait. “The pandemic left people waiting longer than NHS trusts wanted for diagnosis or to start treatment, with some people not coming forward, but now urgent referrals for suspected cancer are far higher than pre-pandemic. Read full story (paywalled) Source: HSJ, 1 February 2023
  10. News Article
    The amount of time people over 80 spend in A&E in England has almost doubled in a year, leaving them at increased risk of coming to harm and dying, emergency care doctors are warning. An analysis by the Royal College of Emergency Medicine (RCEM) found that people of that age are spending 16 hours in A&E waiting for care or a bed, a huge rise on the nine hours seen in 2021. The college, which represents the UK’s A&E doctors, warned that long waits, allied to overcrowding in hospitals and older people’s often fragile health, is putting them in danger. Doctors specialising in emergency and elderly care warned that older people forced to spend a long time in A&E are more likely to suffer a fall, develop sepsis, get bed ulcers or become confused. Dr Adrian Boyle, the RCEM’s president, said that it is also likely that some older people are dying as a result of the delays they are facing, combined with their often poor underlying health. The risks older people face while waiting in sometimes chaotic A&E units are so great that they are likely to be disproportionately represented among the 500 people a week who the RCEM estimates are dying as a direct result of delays in accessing urgent medical help. Read full story Source: The Guardian, 31 January 2023
  11. News Article
    “I was worried it would grow and spread,” Charlotte Park, a breast cancer patient tells The Independent. “What happens if I hadn’t been that really pushy person? Sometimes I still go into a dark place and I think: I am so lucky to be here.” The 50-year-old, from Richmond in Yorkshire, found a lump in her breast in June 2020 and went straight to see her GP who informed her she would have to wait two weeks to see a specialist. After a fortnight of waiting, she started to panic and rang the clinic who said they were still working through referrals from four to six weeks prior to her referral. “I was getting frustrated and impatient by this point,” Ms Park recalls. “There was no leeway and they didn’t see if they could squeeze me in. I just felt frustrated. There was nothing I could do. It was all out of my hands. I was feeling teary.” Ms Park is one of thousands of women with breast cancer in England facing delays of weeks or months to see a specialist or receive treatment. Data, shared exclusively with The Independent, shows delays were substantially worse for those with breast cancer than other forms of cancer. In the end, Ms Park was forced to wait 25 days to see a specialist. The wait was “agony”, she said. It was difficult to definitively determine if the delays caused her cancer to grow, she noted. Her comments come in the context of thousands of women with breast cancer being forced to wait longer than the NHS-recommended time of two months to get treatment, in a situation branded “perilous” by healthcare professionals. Exclusive data shows only seven in ten women in England received treatment for breast cancer two months after getting an urgent doctor’s referral between January and November 2022. This amounts to just more than 16,500 women and is way below the NHS target for 85% of breast cancer patients diagnosed via an urgent GP referral to start their cancer treatment within two months of their GP visit. Read full story Source: The Independent. 31 January 2023
  12. News Article
    A dementia home care agency spent as little as three and a half minutes on taxpayer-funded care visits and filed records claiming far more care was given, according to evidence seen by the Guardian. The hasty care was exposed by Susan Beswick’s family, who called it “totally inadequate”. They say they had been told visits to 78-year-old Beswick, who has Alzheimer’s disease, were supposed to last 30 or 45 minutes. Across nine visits this month, care workers formally logged close to six hours of care. But security cameras suggest they were in the house for under one hour 20 minutes – less than nine minutes a visit on average. On one evening visit, footage showed two carers entering, asking if Beswick had eaten and checking her incontinence pad, before leaving three minutes and 15 seconds later. But they appeared to log on a care tracking app that they had been with her for one hour and 16 minutes. Beswick, who for years was a care worker herself, “deserves so much better”, said her daughter-in-law Karen Beswick. “It’s upsetting us the way mum is being cared for here,” she said. “They come in and check her [incontinence] pad and go. They are supposed to be encouraging her to drink. They don’t really talk to mum a lot. It’s not good at all. I will start crying. We are all trying to get the best for mum.” Read full story Source: The Guardian, 30 January 2023
  13. News Article
    More than half a million patients a year will be treated in “hospitals at home” in an attempt to relieve pressure on A&E departments. Under the plans, elderly and frail patients who fall will be treated by video link, with ministers saying that a fifth of emergency admissions could be avoided with the right care. Health officials said the “virtual wards” would be backed up by £14 billion in extra spending on health and care services over the next two years, as the NHS tackles record backlogs, with seven million people on waiting lists. Rishi Sunak said the Urgent & Emergency Care Recovery Plan showed that the NHS was one of his “top priorities”. Read full story (paywalled) Source: The Telegraph, 29 January 2023
  14. News Article
    The government’s target for England to become smoke-free by 2030 – which integrated care systems are expected to pursue – is being undermined by the unavailability of two smoking cessation medicines. The objective, set by government in 2019, is being taken forward by many ICSs, as they seek to prevent premature illness and death, and narrow health inequalities, with smoking rates normally higher in more deprived populations. However HSJ analysis of drug shortages revealed that the two cessation medicines are both currently unavailable for an extended period. Champix (varenicline) has been unavailable since October 2021, a situation exacerbated by the absence of Zyban (bupropion), since December 2022. Both drugs were withdrawn because of concerns about the presence of nitrosamines, which may increase risk of cancer if people are exposed to them above acceptable levels, and will be subject to further tests and regulatory checks if they are to return. Matthew Evison, a lung cancer and tobacco dependency specialist at Manchester University Foundation Trust, said Champix was clinicians’ “most powerful weapon” against smoking. He said the treatment gap would make the target harder because “smoking prevalence declines will be slower without varenicline”. Read full story Source: HSJ, 30 January 2023
  15. News Article
    The NHS faces an alarming mass exodus of doctors and dental professionals, health chiefs have said, as a report reveals 4 in 10 are likely to quit over “intolerable” pressures. Intense workloads, rapidly soaring demand for urgent and emergency healthcare and the record high backlog of operations are causing burnout and exhaustion and straining relationships between medics and patients, according to the report by the Medical Defence Union (MDU), which provides legal support to about 200,000 doctors, dental professionals and other healthcare workers in the UK. In an MDU survey of more than 800 doctors and dental professionals across the UK, conducted within the last month and seen by the Guardian, 40% agreed or strongly agreed they were likely to resign or retire within the next five years as a direct result of “workplace pressures”. Medical leaders called the report “deeply concerning”. There are already 133,000 NHS vacancies in England alone. NHS chiefs said it laid bare the impact of the crisis in the health service on staff, and MPs said it should serve as a “wake-up call” to ministers on the urgent need to take action to persuade thousands of NHS staff heading for the exit door to stay. Read full story Source: The Guardian, 29 January 2023
  16. Content Article
    DHSC and NHS England's delivery plan A. Increase capacity, to help deal with increasing pressures on hospitals which see 19 in 20 beds currently occupied. 1. Dedicated funding of £1 billion will pay for additional capacity, including 5,000 new beds as part of the permanent bed base for next winter. 2. Over 800 new ambulances, including 100 specialist mental health ambulances, the majority of which will be on the road by next winter. 3. ‘Same day’ emergency care services will be in place across every hospital with a major emergency department, so patients avoid unnecessary overnight stays. B. Grow the workforce, as increasing capacity requires more staff who feel supported. 4. More clinicians will be available for 111 online and urgent call services to offer support, advice, diagnosis and, if necessary, referral. From this April a new targeted campaign will be launched to encourage retired clinicians, and those nearing retirement, to work in 111 rather than leaving the NHS altogether. 5. The workforce will grow with more flexible ways of working and increase the number of Emergency Medical Technicians next year to respond to incidents and support paramedics. C. Speed up discharge from hospitals, to help reduce the numbers of beds occupied by patients ready to be discharged. 6. Over the next 2 years, and as part of the up to £14.1 billion extra for health and social care, £1.6 billion will be focused squarely on discharge. 7. ‘Care transfer hubs’ in every hospital ahead of next winter will mean faster discharge to the right setting, so that people do not stay in hospital longer than necessary. 8. This year, new approaches to step-down care will start to be implemented so, for example, people who need physiotherapy can access care as they are being discharged from hospital before they need to be assessed by their local authority for long-term care needs. 9. New discharge information will be published, with new data collected from this April. D. Expand new services in the community, as up to 20% of emergency admissions can be avoided with the right care in place. 10. Ahead of next winter the government will offer more joined-up care for older people living with frailty, including scaling urgent community response, frailty and falls services across the whole country – meaning the right people help you get the care you need, without needing an admission to hospital if it’s not necessary. 11. Greater use of ‘virtual wards’, which allow people to be safely monitored from the comfort of their own home, will be achieved by an extra 3,000 beds to provide over 10,000 in total by this autumn, allowing staff to care for up to 50,000 patients a month this way over the longer term. 12. Help people access the right care first time, as 111 should be the first port of call and reduce the need for people to go to A&E. By April 2024, urgent mental health support through NHS 111 will be universally available. 13. From this April, new data will allow the public to easily see and compare the performance of their local services. It will also tackle unwarranted variation in performance in the most challenged local systems. 14. This April, a new clinically-led programme to reduce unwarranted variation will launch, alongside intensive support for those areas struggling the most
  17. News Article
    Experienced emergency department nurses are “leaving in droves” because they feel unable to do their jobs properly under the current conditions, a doctor has warned. Giving evidence to the Health and Social Care Select Committee yesterday, Dr Adrian Boyle, president of the Royal College of Emergency Medicine, raised concern about nurse retention and morale in emergency departments. “We are haemorrhaging experienced emergency nurses because they are finding it very frustrating" He said: “What I'm also seeing is that a lot of nurses, particularly the experienced nurses, they're almost like the [non-commissioned officers] of the health service, the sergeants who know how to get things done, are leaving in droves.” Dr Boyle added: “We are haemorrhaging experienced emergency nurses because they are finding it very frustrating. “The problem is not because there's too much work but they're unable to do the work that they're trained to do." Read full story Source: Nursing Times, 25 January 2023
  18. News Article
    The UK is facing a “crisis point” in abortion provision, experts say, with rising demand and restricted access to care in many areas putting unprecedented pressure on struggling NHS services. Healthcare professionals described a “terrifying” state of affairs in which women are travelling hundreds of miles for appointments or waiting several weeks before they are seen. Dr Jonathan Lord, the director of MSI Reproductive Choices UK, a major provider of abortion services, told the Guardian’s Today in Focus podcast: “There is no doubt we are seeing absolutely unprecedented levels of demand at the moment. All providers are reporting they are busier than they have ever been.” Lord, who is also an NHS consultant gynaecologist, said the rise was being driven by “the economic downturn, the cost of living crisis and the ability to access good quality contraception” via GPs and sexual health services, which have been affected by the wider NHS crisis. Clare Murphy, the chief executive at the British Pregnancy Advisory Service (BPAS), previously said: “The pandemic, and the policies adopted by the government, have had a clear impact on women’s pregnancy choices.” Faced with “economic uncertainty and job insecurity”, women had been forced to make tough decisions, she said. Read full story Source: The Guardian, 26 January 2023
  19. News Article
    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
  20. News Article
    Devon care homes say they are being asked to accept patients with Covid-19, flu and other infectious diseases to ease the pressure on local hospitals. One owner said it felt like the start of the pandemic again, as the safety of care homes was being "compromised". Devon has some of the longest waits for emergency care in the country, according to NHS figures. Simon Spiller, owner of The Croft Residential Care Home in Newton Abbot, said since the start of winter the home was being asked to shortcut its assessment process to help ease the blockages in Devon's hospitals. He said other local care homes have told him they were facing the same pressure. Mr Spiller said: "We're being encouraged, or really asked, to shortcut our assessment process. Normally, one of our team would go to the hospital to assess people, to really understand their care needs, to ensure they're an appropriate fit for our care home, which specialises in dementia. "Increasingly, because of the speed they're trying to achieve a discharge, we're being asked to accept people at kind of face value, as presented by the NHS." Read full story Source: BBC News, 26 January 2023
  21. News Article
    Simultaneous big waves of Covid and flu - the 'twindemic' experts warned of as people returned to 'normal' pre-pandemic mixing - cost the NHS this winter, say NHS bosses. NHS England chief strategy officer Chris Hopson said hospital pressures in England peaked on 29 December. The workload involved gave hospitals a "significant problem" at the turn of the year, he said. It was at this point that record-long waits at A&E were seen. Since then the pressures have begun to ease a little. Speaking to MPs on the House of Commons' health committee, Mr Hopson said: "The issue was always going to be this winter was the degree to which we saw prevalence of both Covid and flu and the degree to which they combined. "Now we're obviously not through winter yet but the really important point - that I don't think has come out enough - is both Covid and flu peaked so far on 29 December." At the turn of the year one in eight beds were occupied by patients with either Covid or flu. And Mr Hopson added this combined with the 12,000 beds occupied by patients medically fit to leave but unable to be discharged because of the lack of support in the community meant more than a quarter of beds were lost. "It gives a significant problem in terms of patient flow, which then means you get the back up right the way through the system." Read full story Source: BBC News, 24 January 2023
  22. News Article
    A mental health trust has spent millions this year on places in “bed and breakfast” accommodation in order to discharge inpatients, HSJ has learned. South London and Maudsley Foundation Trust, which serves four London boroughs, confirmed to HSJ it had spent £3.1m since April for a range of basic bed and breakfast places, and spaces with a specialist housing association, to ease its bed shortage pressures. The trust told HSJ clinicians were often reluctant to discharge patients to street homelessness, and that people with mental health problems can be more challenging to find accommodation for. The trust’s chief executive officer David Bradley told HSJ system leaders had been asked to think “innovatively” about how to mitigate discharge problems. B&Bs are generally a cheaper and more appropriate alternative to a £500 a night mental health hospital bed for people who don’t need acute treatment and have no housing, he said. Read full story Source: HSJ, 24 January 2023
  23. News Article
    The waiting list for endoscopies has broken the record set during the height of the covid pandemic, as referrals for suspected colorectal cancer surged, HSJ analysis shows. In November 2022, 110,00 people were waiting for a colonoscopy (or flexible sigmoidoscopy) and the median wait was 4.2 weeks, double the median wait in November 2019. The pandemic peak waiting list for these tests was 107,000 in September 2020. Nearly a quarter of those waiting as of November 2022, the most recent figures, were on the list for more than 13 weeks. In November 2019 only 2.9 per cent of the list waited this long. Health policy manager Matt Sample said: “As with all diagnostic services, endoscopies were hit hard by the pandemic, but the service was under considerable strain even before this as staff numbers and equipment simply weren’t rising to match demand. “The latest data shows that more than two in 10 people who started treatment for bowel cancer in England waited more than 104 days since their urgent referral – this is unacceptable. “Without continued efforts to expand diagnostic capacity, and in particular investment in addressing chronic workforce shortages, people affected by cancer will not receive the care they deserve.” Read full story (paywalled) Source: HSJ, 24 January 2023
  24. News Article
    A record number of patients suffered “severe harm” as a result of ambulance delays in December, soaring by nearly 50 per cent in just one month as the NHS crisis deepened. Almost 6,000 suffered permanent or long-term harm due to long waits to hand over patients outside A&Es – up from just over 4,000 in November. A further 14,000 patients were likely to have suffered “moderate harm”, an analysis by The Independent of NHS ambulance data and estimates of harm by the Association of Ambulance Chief Executives (AACE) found. This includes incidents that resulted in patients needing further treatment or procedures, the cancelling of treatment, or being transferred to another area. Miriam Deakin, director of policy and strategy at NHS Providers, said the figures are a “worrying reminder of the huge pressure the NHS is under”. She said: “Trust leaders are doing everything they can to provide patients with safe, high-quality care but they know patients face lengthy handover delays far too often, contributing to avoidable harm.” Read full story Source: The Independent, 20 January 2023
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