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News Article
Trusts warned they are being ‘complacent’ on A&E over-crowding
Patient Safety Learning posted a news article in News
Emergency medics are writing to hospital chief executives warning them that some trusts are being ‘complacent’ about crowding in A&E, they have told HSJ. The Royal College of Emergency Medicine (RCEM) is sending a letter to trust chiefs today calling on them to urgently plan for how they will stop corridor waits and exit blocking ahead of January and February, typically the busiest months. It says some trusts were not treating emergency department crowding as a “high priority”, despite covid risks and pressures. It is also calling for overcrowding in the emergency department (ED) to be classed as a “never event” — a set of major safety risks. RCEM’s concern comes amid apprehension over long ambulance queues at hospitals across the UK, and difficulties enabling social distancing between patients in many EDs. Read full story (paywalled) Source: HSJ, 3 November 2020 -
News Article
NHS workforce ‘could not cope’ with third wave
Patient Safety Learning posted a news article in News
The government has admitted the NHS in England does not have enough nurses and doctors to keep all its services running if there is a third spike in coronavirus cases as leaked figures show the number of staff off work because of the virus rising. An analysis of the impact of coronavirus, released by Downing Street on Monday, warned that even with a 6% growth in NHS staff since August 2019 and extra funding “there is a trade-off between the NHS’s ability to deliver COVID-19 and non-Covid-19 care in the event that COVID-19 hospitalisations rise”. It also warned of the psychological effects on staff saying: “It would be expected that higher rates of post-traumatic stress disorder (PTSD) would be seen amongst health and social care staff.” New leaked NHS data for England on Monday shows more than 82,000 NHS staff are absent from work with more than two-fifths, 42 per cent, linked to coronavirus either due to sickness or because they need to self-isolate. This includes almost 27,000 nurses and 4,000 doctors absent from NHS wards. Hospital leaders reiterated the strain the NHS was under in a briefing to MPs ahead of the vote on local tier restrictions today. Read full story Source: The Independent, 1 December 2020 -
News ArticleMore than a million patient operations could be delayed because of widespread shortages of anaesthetists in the NHS – with 9 out of every 10 hospitals reporting at least one vacancy. As coronavirus paralysed the NHS earlier this year, more than 140,000 NHS patients have already waited over a year for treatment. The Health Foundation has warned that 4.7 million fewer patients have been referred for treatment because of the impact of coronavirus on NHS services. The Royal College of Anaesthetists (RCOA) told The Independent the scale of the vacancies was getting worse and labelled it a “workforce disaster” that could cost patients’ lives and have a widespread impact on hospital services. Read full story Source: The Independent, 22 November 2020
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News Article
NHS going into winter with 5,500 fewer beds than last year
Patient Safety Learning posted a news article in News
The NHS is going into this winter with 5,500 fewer general acute beds than last year, NHS England data has revealed. The numbers of general and acute beds open overnight from July to September this year was 94,787 compared with 100,370 for the same period in 2019, a fall of 5.6% or 5,583 beds. The reduction in bed numbers is thought to be partly because of covid infection control measures, such as creating more distance between beds. HSJ reported this week that Cambridge University Hospitals Foundation Trust had taken nearly 100 beds out of use to allow for better social distancing. The figures showed significant regional differences. London had 8% fewer beds available compared with last year, while the East of England and the North East only had 3.4% fewer. The North West, which has been badly affected by the second wave of covid, had 6.6% fewer beds than last year. NHS Providers deputy chief executive Saffron Cordery said: “We have been arguing for some time that the NHS is short of beds as we head into winter… This is a real problem as trusts deal with pressures posed by the virus, growing demand for urgent and emergency care and the work to recover the backlog of routine operations.” Nuffield Trust deputy director of research Sarah Scobie said: “This drop in the number of beds available bears out our warning that infection control will mean a loss of capacity even between waves of the virus. Many of these will have been beds too close to others for physical distancing. This is why it will be so difficult to return to previous rates of activity while the virus remains at large, worsening waiting times and forcing difficult decisions about who gets priority." Read full story (paywalled) Source: HSJ, 19 November 2020 -
News ArticleA hospital trust in Bristol has been accused of risking lives after raising its patient-to-nurse ward ratio to dangerously high levels, having allegedly dismissed staff concerns and national guidance on safe staffing. University Hospitals Bristol and Weston NHS Foundation Trust (UHBW) has introduced a blanket policy across its hospitals that assigns one nurse to 10 patients (1:10) for all general adult wards. This ratio, which previously stood at 1:6 or 1:8 depending on the ward, rises to 1:12 for nights shifts. The new policy, which is applicable to Bristol Royal Infirmary (BRI) and Weston General Hospital, also extends to all specialist high-care wards, which treat patients with life-threatening conditions such as epilepsy and anaphylaxis. Nurses at the trust have expressed their anger over the decision, saying they were never fully consulted by senior officials. Many are fearful that patient safety will be compromised as the second coronavirus wave intensifies, culminating in the unnecessary loss of life. “Patients who would have extra nursing staff because they are very acutely unwell and need close observation I think are going to unnecessarily die,” one nurse at BRI told The Independent. “Or if they survive, they’ll suffer long-term conditions because things were missed as they don’t have the staff at their bed side to watch the deterioration.” Read full story Source: The Independent, 18 November 2020
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News ArticleAn Essex maternity department has been served with further warnings by the Care Quality Commission (CQC) and again rated “inadequate”. Serious concerns were raised about the services at Basildon University Hospital in the summer, after several babies were found to have been starved of oxygen and put at risk of permanent brain damage. Despite the CQC issuing warning notices to Mid and South Essex Foundation Trust in June 2020, a subsequent visit on 18 September found multiple problems had persisted. The CQC’s findings at Basildon included: the service was short-staffed and concerns were not escalated appropriately multidisciplinary team working was “dysfunctional”, which sometimes led to safety incidents doctors, midwives and other professionals did not support each other to provide good care. Read full story (paywalled) Source: HSJ, 19 November 2020
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News Article
Top teaching trust blames surge in long A&E waits on covid measures
Patient Safety Learning posted a news article in News
A top teaching hospital has blamed covid measures for a dramatic rise in the number of trolley waits in its accident and emergency department. In October, 111 patients at Cambridge University Hospitals (CUH) Foundation Trust, which runs Addenbrooke’s Hospital, waited more than 12 hours for admission, despite the region’s relatively low covid rates. CUH recorded just nine 12-hour waits in September and 27 in August. It had no 12-hour waits in either June or July this year, and in October 2019, it had only one. The trust also had 761 patients who waited more than four hours from the decision to admit to admission last month, out of a total of 2,998 emergency admissions. CUH director of operations Holly Sutherland said: “We have had to reorganise the hospital to meet infection control requirements and to reduce the risk of covid-19 transmission. With limited side room availability due to the age of our facilities, this has reduced the number of beds in the hospital by around 100 and has impacted on patient flow from the emergency department." “We would like to apologise to anyone affected by this, and to reassure our patients that their safety is our utmost priority and we are doing everything we can to treat them as quickly as possible.” Read full story (paywalled) Source: HSJ, 18 November 2020 -
News Article
Labour demands new NHS investment as patients wait longer for surgery
Patient Safety Learning posted a news article in News
Labour is demanding new investment for the NHS as part of the government’s spending review next week, after analysis shows hundreds of thousands of patients are waiting for life-changing operations. The party’s shadow health secretary, Jonathan Ashworth, will challenge Matt Hancock in Parliament on today over the latest NHS data, which reveal almost 500,000 patients are waiting for surgery on their hips, knees and other bones. Last week, NHS England published new data showing more than 1.7 million people were waiting longer than the NHS target of 18-weeks for treatment. The target was last met in February 2016. An analysis of NHS England data reveal which specialities have been hardest hit by the growing backlog of operations, which has soared since the first wave of coronavirus caused widespread hospital cancellations earlier this year. There were 4.3 million patients on NHS waiting lists for hospital treatments in September. Labour said this included 477,250 waiting for trauma and orthopaedic surgery, with 252,247 patients waiting over 18 weeks. The next worst specialty was ophthalmology, which treats eye disorders, with 444,828 patients on waiting lists, 233,425 of whom have waited more than 18 weeks. There were six figure waiting lists over 18 weeks for other specialties including gynaecology, urology, general surgery, and ear, nose and throat patients. Read full story Source: 17 November 2020 -
News Article
More than 75% of NHS midwives think staffing levels unsafe, says RCM
Patient Safety Learning posted a news article in News
More than three-quarters of midwives think staffing levels in their NHS trust or board are unsafe, according to a survey by the Royal College of Midwives (RCM). The RCM said services were at breaking point, with 42% of midwives reporting that shifts were understaffed and a third saying there were “very significant gaps” in most shifts. Midwives were under enormous pressure and had been “pushed to the edge” by the failure of successive governments to invest in maternity services, said Gill Walton, the chief executive of the RCM. “Maternity staff are exhausted, they’re demoralised and some of them are looking for the door. For the safety of every pregnant woman and every baby, this cannot be allowed to continue,” she said. “Midwives and maternity support workers come into the profession to provide safe, high-quality care. The legacy of underfunding and underinvestment is robbing them of that – and worse still, it’s putting those women and families at risk.” RCM press release Read full story Source: The Guardian, 16 November 2020 -
News ArticleThe number of people waiting over a year for hospital treatment in England has hit its highest levels since 2008. Patients are meant to be seen within 18 weeks - but nearly 140,000 of the 4.35 million on the waiting list at the end of September had waited over a year. Surgeons said it was "tragic" patients were being left in pain while they waited for treatment, including knee and hip operations. And others warned the situation could become even worse during winter. In recent weeks, major hospitals in Bradford, Leeds, Nottingham, Birmingham and Liverpool, which have seen high rates of infection, have announced the mass cancellation of non-urgent work. Read full story Source: BBC News, 12 November 2020
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Content ArticleAs a result of the investigation, one recommendation has been made to the Care Quality Commission (CQC) on assessing factors such teamwork and psychological safety in its regulation of maternity units. Based on the evidence gathered, the report also sets out a series of questions to consider in order to help staff identify strengths and opportunities for improvement within their own maternity unit. Safety recommendation It is recommended that the Care Quality Commission, in collaboration with relevant stakeholders, includes assessment of relational aspects such as multidisciplinary teamwork and psychological safety in its regulation of maternity units. Questions to consider Does your unit have a role, or another means, separate from the labour ward co-ordinator, dedicated to monitoring and anticipation of activity across the maternity service and troubleshooting, such as a roving bleep holder? Do you have regular multidisciplinary ward rounds throughout the day? Do you have regular safety huddles and multidisciplinary handovers using a structured information tool? Do you hold multidisciplinary in situ simulation and facilitated debriefing that includes both technical and non-technical skills? Are scenarios and incidents encountered in your unit included in the training? Do you know what your staff’s perceptions of teamwork, psychological safety and communication are within your unit? Are actions taken in response? How are midwifery staff empowered to contact consultants directly if they have concerns? Is time and resource dedicated to regular multidisciplinary forums that provide a safe space to openly discuss scenarios where things did not go well? Do these forums also include discussion and reflection on scenarios where things went well despite unexpected events? Are senior midwifery staff assigned to triage and assessment areas? Is there adequate medical presence in these areas? In larger units, is the workload on the labour ward separated into elective and emergency work? If so, are there separate labour ward co-ordinators for each? How does the physical infrastructure support work? For example, use of DECT telephones, availability of equipment, consultant offices on/near the labour ward, proximity of antenatal ward and neonatal unit to the labour ward. How are issues with staffing and workload escalated and responded to? Are senior trust personnel aware and involved?
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News ArticlePatients, including those with the coronavirus, are being kept “head to toe” on trolleys in accident and emergency departments in Manchester, with some forced to wait up to 40 hours for a bed. The “dangerous” situation has sparked warnings from the president of the Royal College of Emergency Medicine over the “potentially lethal” crowding of patients in A&Es across the country this winter. Katherine Henderson said she was “absolutely terrified” by what was happening in some departments. She said she had warned NHS England about the dangers of crowding patients in A&E but that not enough action had been taken. She told The Independent: “Crowding in A&E is unsafe, but with coronavirus it is potentially lethal. We have said this endlessly to NHS England." “Everyone agrees crowding is bad, but what they’re not doing is translating that into action.” After hearing of the situation in Manchester, she added: “Exactly what we said should not happen is happening. I am absolutely terrified by this. What more can I do? I have highlighted this risk everywhere I can over the past few months.” Read full story Source: The Independent, 11 November 2020
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News Article
Nurse gaps must be considered in NHS winter planning, warns RCN
Patient Safety Learning posted a news article in News
Planning around what the NHS can deliver this winter must be based on how many nursing staff are available and the workload they can safely take on, the Royal College of Nursing (RCN) has warned. Amid widespread nursing shortages, the union has called on the government to “be honest” about nurse vacancies and address what steps need to be taken to keep staff and patients safe. “It is essential that learning is applied to planning for this winter, including what service can be delivered safely with the workforce available” Last week NHS England moved to its highest level of emergency preparedness. But the RCN warned it still had grave concerns around how services would be safely staffed, claiming it was too late to find the nurses needed to meet the anticipated demands of the incoming winter. Despite an increase in the number of nurses registered with the Nursing and Midwifery Council this year, the college said there were still around 40,000 nurse vacancies in the NHS in England alone. These shortages, which were felt across all areas of nursing, had been exacerbated because of staff self-isolating or being off sick because of COVID-19, the RCN noted. The impacts of workforce shortages meant there was “enormous responsibility” on the nurses working and “intolerable pressure” on senior nursing leaders, it said. Unless local staffing plans prioritised safe and high-quality care, the few nurses in post were at risk of “burn out” this winter, the college added. Read full story (paywalled) Source: Nursing Times, 9 November 2020 -
News Article
Covid: Cancer delays 'could cause 2,000 deaths in Wales'
Patient Safety Learning posted a news article in News
As many as 2,000 people could die because of Covid-related delays in the Welsh NHS, a cancer expert has said. With virus cases rising, Prof Tom Crosby, of the Wales Cancer Network, fears cancer cases missed in the first lockdown may now be harder to treat. Health Secretary Vaughan Gething said it would be "foolish" to have a plan for backlogs before the pandemic is over. But he said work was under way to address the issue with health boards. Alongside the spread of the virus, medical professionals are very worried about deaths that could occur not because of Covid, but due to the backlog of appointments and surgery it is causing. BBC Wales Investigates has been uncovering the full extent of the looming problem facing the NHS. Delays caused by the pandemic are a serious concern to Prof Crosby, who is medical director at the Wales Cancer Network. He said when the pandemic first hit, acute COVID-19 cases became the focus in hospitals at the expense of cancer, cardiac and orthopaedic appointments. "Some of the conversations we've had with patients in the clinic have been really, really challenging," he said. "Then there are thousands of patients who have not come through to the system that usually would have. Some of those are going to have had cancer, and they will not have been diagnosed now." Prof Crosby has been looking at possible outcomes for cancer patients because of delays in diagnosis and treatment. "We have done some modelling work with England, and it has suggested that between 200 and 2,000 excess deaths will occur as a result of undiagnosed or untreated cancer in Wales," he said. "I think the effects on cancer services are going to be here for two to three years." Read full story Source: BBC News, 9 November 2020 -
News Article
Covid: Lack of ventilator supplies 'hit' disabled people
Patient Safety Learning posted a news article in News
Some disabled people in the UK have been struggling to obtain essentials such as medication and breathing equipment during the Covid pandemic, research for the BBC suggests. Some 60% of those who rely on social care told a YouGov survey they were finding it hard to obtain at least one of their necessities. Charity WellChild said people felt more "forgotten than they ever have been". But ministers say the needs of disabled people were being considered. The Department of Health and Social Care says it has sufficient stocks and patients should contact their local care provider. Like one in 20 of those survey respondents who receive social care, Fi Anderson, a mother of two with muscular dystrophy from Bolton in Greater Manchester, said she has faced problems obtaining breathing apparatus. Her local hospital told her to re-use the filter for her portable ventilator, recommending she boil it, because supplies were so short. Disabled people who rely on social care - which funds equipment and other support to allow them to live independent lives - also said they had struggled to obtain personal protective equipment (PPE) such as face masks. Many of them receive funding directly to employ carers in their home, so they also need to provide them with PPE during the coronavirus crisis. The survey, which the BBC commissioned to mark the 25th anniversary of the Disability Discrimination Act, asked more than 1,000 people about life in the UK with a disability and how it has changed in the shadow of a pandemic. More than 65% felt their rights had regressed, and 71% said disabled people's needs had been overlooked. The Coronavirus Act, which granted the government emergency powers, gave local councils the ability to reduce care, education and mental health provision for disabled people if it became necessary during the pandemic. According to the latest figures from the Office for National Statistics, nearly six out of 10 deaths from COVID-19 were of disabled people. Read full story Source: BBC News, -
News ArticleWidespread nursing shortages across the NHS could lead to staff burnout and risk patient safety this winter, the Royal College of Nursing has warned. The nursing union said a combination of staff absence due to the pandemic, and around 40,000 registered nursing vacancies in England was putting too much strain on the remaining workforce. The government says more than 13,000 nurses have been recruited this year. It has committed to 50,000 more nurses by 2025. It also hopes England's four-week lockdown will ease pressure on the NHS. The RCN has expressed concern that staff shortages are affecting every area of nursing, from critical care and cancer services to community nursing, which provides care to people in their own homes. The union said it was worried the extra responsibility and pressure placed on senior nurses could lead to staff "burnout", as hospitals struggle to clear the backlog of cancelled operations from the first wave of coronavirus and cope with rising numbers of new Covid patients, as well as the annual pressures that winter typically brings. Read full story Source: BBC News, 7 November 2020
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News ArticleVulnerable patients at a major NHS hospital at the centre of England’s coronavirus second wave have been left without help to eat or drink because wards are so dangerously understaffed, The Independent can reveal. Dozens of safety incidents have been reported by doctors and nurses at the Liverpool University Hospitals Trust since April, citing the lack of nurses as a key patient safety risk. Across several wards, just two registered nurses per ward were being expected to look after dozens of sick patients – a ratio of nurses to patients far below recommended safe levels. On one ward there were 36 patients to two registered nurses – with the nurse in charge of the ward having only qualified six months earlier. The safety concerns also include a diabetic patient – where there was no evidence nurses had monitored their blood glucose levels and insulin medication, which if left unchecked could prove fatal. Other patients have been forced to eat food and drink which has gone cold by the time staff are ready to help them. The hospital is among the worst affected by the surge in coronavirus cases in the north of England. It’s medical director warned on Friday that it was at 100 per cent capacity and unable to maintain standards of care. Read full story Source: The Independent, 5 November 2020
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News Article
NHS bosses accused of ‘putting politics before patient safety’
Patient Safety Learning posted a news article in News
An NHS hospital at the epicentre of the coronavirus second wave is facing the threat of action by the care watchdog as it struggles to keep patients safe, The Independent has learned. Senior NHS bosses in the northwest region have been accused of putting politics ahead of patient safety and not doing enough to help the hospital to cope with the surge in Covid patients in recent weeks. The Care Quality Commission (CQC) warned the Liverpool University Hospitals Trust on Friday that it could face action after an inspection carried out last week in response to fears raised with the regulator. In a message to his colleagues on Friday, Liverpool University Hospitals (LUH) Trust medical director Tristan Cope warned the hospital had been overwhelmed by coronavirus and standards of care could no longer be maintained. He criticised NHS England and said the trust had been “abandoned” as coronavirus cases surged. He confirmed the CQC’s intention to take action against the trust but said the regulator had failed to appreciate the pressure staff in the hospital were under. Dr Cope, a consultant in anaesthesia and critical care, said: “LUH is now essentially overwhelmed by the demand. We cannot maintain patient flow and usual standards of care. We have put forward a proposal to further reduce elective [planned] activity, but maintaining capacity for the most urgent cases that would suffer from a two-four week delay." “It is a very sound plan that our divisional teams have worked up. However, NHS England are prevaricating and delaying with the usual request for more detail, more data, etc. It is clear to me that the politics is outweighing the patient safety issues of the acute crisis." Read full story Source: The Independent, 3 November 2020 -
News ArticleSeveral hospitals in the north of England are already at full capacity and may have to start moving patients to other regions, doctors have warned. Consultants fear that if Covid infection rates do not begin to fall significantly the NHS will be overwhelmed in less than a month from now. Members of the British Medical Association have reported that Intensive Care Units (ICU) in a number of regions, including Manchester, Liverpool and Hull, are close to capacity as the number of people hospitalised with COVID-19 continues to grow. Dr Vishal Sharma, chairman of the BMA’s consultants committee, told The Telegraph: “Capacity in the north of England is at the limits and in some places above the limit. Our next concern is ICU capacity, which is always tight at this time of year, even without Covid.” Dr Sharma said some general ward beds could be adapted to provide intensive breathing support for Covid patients, and the re-opening of Manchester’s Nightingale Hospital may also take the pressure off ICU departments. But more radical steps may have to be taken if numbers of hospitalised patients continue to rise. “We may have to move patients around the country to create extra capacity, but if the whole country starts to struggle things will get very difficult." Read full story Source: The Telegraph,
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News Article
Tens of thousands of NHS staff off sick because of COVID-19, data reveals
Clive Flashman posted a news article in News
Almost half of all staff absence linked to coronavirus in parts of northern England Tens of thousands of NHS staff are off sick or self-isolating because of coronavirus, according to data shared with The Independent as the second wave grows. In some parts of northern England, more than 40% – in some cases almost 50% – of all staff absences are linked to COVID-19, heaping pressure on already stretched hospitals trying to cope with a surge in virus patients. The problem has sparked more calls for wider testing of NHS staff from hospital leaders and nursing unions who warned safety was being put at risk because of short staffing on wards. Across England, more than 76,200 NHS staff were absent from work on Friday – equivalent to more than 6% of the total workforce. This included 25,293 nursing staff and 3,575 doctors. Read full article Source: The Independent, 1 November 2020 -
News ArticleCancer patients have had surgery cancelled because of coronavirus for the first time as pressure mounts on hospitals from the second wave, The Independent has learnt. Nottingham University Hospitals Trust has confirmed it had to postpone the operations because of the number of patients needing intensive care beds. While hospitals across the north of England have been forced to start cancelling routine operations in the last 10 days, maintaining cancer and emergency surgery had been a red line for bosses given the risk to patients from any delays. Cancer Research UK said it was “extremely concerning” that some operations had been postponed and called for urgent action and investment to make sure treatments were not curtailed further. In a statement to The Independent, Nottingham University Hospitals medical director Keith Girling said: “We’ve had to make the extremely difficult decision to postpone operations for four of our cancer/pre-cancer patients this week due to pressure on our intensive care units from both Covid-19 and non-covid related emergencies." “We expect to treat one of the postponed patients next week, and we’re in contact with the others to arrange a new date, which will be imminent. This delay, however short, will be incredibly hard for the patients and their families, and I’m truly sorry for any distress this will have caused. Read full story Source: The Independent, 27 October 2020
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News ArticleMass cancellations of routine operations in England are inevitable this autumn and winter despite an NHS edict that hospitals must not again disrupt normal care, doctors’ leaders have said. Organisations representing frontline doctors, including the British Medical Association (BMA), also criticised NHS England for ordering hospitals to provide “near normal” levels of non-Covid care in the second wave of the pandemic, and demanded that fines for failing to meet targets be scrapped. "Things are very, very difficult at the moment, very challenging at the moment. It feels like a juggling act every day,” said one official in the South Yorkshire NHS. “The problem is both the growing numbers of patients coming into hospital with Covid and the numbers of staff we have off sick due to Covid, either because they are ill themselves or because someone in their household has symptoms, so they are isolating.” Read full story Source: The Guardian, 23 October 2020
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News Article
Hospital cancels operations as Covid patient numbers soar
Patient Safety Learning posted a news article in News
A hospital in Yorkshire has said it is cancelling planned surgeries for at least two weeks as the number of coronavirus patients there hits levels not seen since May. Bradford Teaching Hospitals said it was being forced to stop non-urgent surgery and outpatient appointments for two weeks from Tuesday because of the numbers of severely ill COVID-19 patients. In statement the hospital said it had seen a spike in admissions in the last few days with 100 coronavirus patients now on the wards with 30 patients needing oxygen support – the highest number of any hospital in the northeast and Yorkshire region. It also said more patients were needing ventilators to help them breathe in intensive care. The trust is the latest to announce cancellations, joining the University Hospitals of Birmingham, Nottingham University Hospitals and Plymouth Hospitals as well as those in Liverpool and Manchester where hundreds of Covid patients are being looked after. Read full story Source: The Independent, 21 October 2020 -
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