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Found 93 results
  1. News Article
    The coronavirus pandemic has made a "difficult situation even worse" for women trying to access contraception, a group of MPs and peers has warned. Their inquiry claims years of cuts means patients "have to navigate a complex system just to receive basic healthcare". It warns damage caused by the pandemic could see a rise in unplanned pregnancies and abortions. Sexual health doctors say the service is "overstretched and underfunded". The All Party Parliamentary Group (APPG) on Sexual and Reproductive Health says cuts to public health funding in England have had a wide-ranging impact, including: service closures reduced opening hours waiting lists staff cuts. The impact of these cuts is often felt by the most marginalised groups. The MPs' group is calling for a single commissioning body to improve accountability. Women are said to be "bounced from service to service" - like Louise, 32, who struggled for years to find a contraception which didn't cause adverse effects. In some cases during lockdown, even essential care provision like emergency fittings and removals of devices have been affected. Lisa's coil fitting in March was cancelled because of the pandemic. She is now pregnant. The inquiry says the underfunding of long-acting reversible contraceptives (LARCs) - intrauterine contraception and implants - means GPs are not incentivised to provide these services, which has contributed to a "postcode lottery" when it comes to services. Read full story Source: BBC News, 11 September 2020
  2. Content Article
    Backlog of care and treatment COVID-19 has placed the health and social care system under unprecedented pressure this year. To meet the demand created by the pandemic, a range of non COVID care and treatment was postponed at the peak of the crisis to free up capacity of the NHS. These decisions have created a long-term challenge, with a significant backlog in treatment and care.[1] Postponing all non-urgent elective operations for a period of three months is estimated as resulting in more than half a million cancelled procedures.[2] This, alongside other challenges to restoring services following the peak in the pandemic, could result in the waiting list reaching 10 million by the end of 2020.[3] Impact on patients The delays in treatment resulting from this backlog will have a significant impact of patients’ quality of life and, in some case, their survival. For those managing chronic diseases, such as arthritis, long delays in fairly common surgeries (for instance knee replacements) can reduce functional capacity gain and lead to increased pain and disability.[4] Meanwhile, a recent study looking at delayed diagnosis and cancelled treatment for cancer cases during the pandemic suggested that this could result in “anywhere between 7,000 and 35,000 additional deaths from the disease over the coming year”.[5] In addition to those waiting to be referred for treatment, there is also the issue of high numbers of patients waiting on follow-up appointment. Clinicians have expressed concerns about the clinical risk to those facing delays on their follow-up outpatient lists, particularly because the scale of this is hard to gauge due to there being “no official, verified data on follow up appointments”.[6] Addressing the backlog safely In its recent ‘Third Phase’ response guidance, the NHS identified one of its three key priorities as “accelerating the return to near-normal levels of non-COVID health services, making full use of the capacity available in the ‘window of opportunity’ between now and winter”.[7] As we do this, it is vital that patient safety considerations are placed at the heart of this process, as the NHS seeks to address the backlog of cases while also meeting regular demand for services. Key points to consider include: How are organisations tackling the treatment backlog? How is access to treatment and care being prioritised? What are the risks to patient safety, and are these being addressed? Who will ensure that patients’ needs are considered, and who will provide information to manage patients’ expectations? Should cases where surgery delays lead to significant health issues, or even death, be considered as serious incidents? Do we have adequate data about the backlog so we can quantify the problem and manage waiting lists, whether referral to treatment or follow-up appointments? Find out more - join the webinar Are you interested in hearing more about these issues? The webinar is scheduled for 11.00am (BST) on Wednesday 16 September and you can sign up here. References Patient Safety Learning, Response to the Health and Social Care Select Committee Inquiry: Delivering Core NHS and Care Services during the Pandemic and Beyond, 8 May 2020; Patient Safety Learning, The return of elective surgery and implications for patient safety, 15 June 2020. Estimates on this figure vary between around 516,000 at the lower end of the scale (University of Birmingham, COVID-19 disruption will lead to 28 million surgeries cancelled worldwide, 15 May 2020) to potentially as high as 749,248 (Alexander Fowler et al, Resource requirements for reintroducing elective surgery in England during the COVID-19 pandemic: a modelling study, medRxiv, 2020). NHS Confederation, Public reassurance needed on slow road to recovery for the NHS, 10 June 2020. Versus Arthritis, Written evidence submitted by Versus Arthritis (DEL0173), May 2020. Health Data Research UK, The Big C isn’t COVID-19 – it’s cancer, 25 August 2020. Health Service Journal, Recovery watch: the NHS' biggest restoration challenge, 2 September 2020. NHS England and NHS Improvement, Third phase of NHS response to Covid-19, 31 July 2020.
  3. Content Article
    Key points Recurrent nurse workforce shortages are a global issue, also in high-income countries. Implementation of safe staffing policy measures largely varies across the world. Mandated patient-to-nurse ratios are the most straightforward policy to ensure staffing levels. Our overview of policies from various high-income countries may guide future decision-making.
  4. News Article
    Five-year survival rates are expected to fall due to delays in getting urgent referrals or treatment at the height of the pandemic. Thousands of lives may be lost to cancer because 250,000 patients were not referred to hospital for urgent checks, says a report to be published this week. Family doctors made 339,242 urgent cancer referrals in England between April and June, down from 594,060 in the same period last year — a drop of 43%. The fall in the number of people seeing their GP with symptoms, and in referrals for scans, is resulting in cancers being spotted too late, according to the research by the Institute for Public Policy Research (IPPR) and Carnall Farrar, a healthcare management consultancy. Full article on The Times website here (paywalled).
  5. News Article
    Almost a million people waited at least half an hour for an ambulance after having a medical emergency such as a heart attack or stroke last year, NHS figures show. Ambulance crews responding to 999 calls in England took more than 30 minutes to reach patients needing urgent care a total of 905,086 times during 2019–20. Of those, 253,277 had to wait at least an hour, and 35,960 – the equivalent of almost 100 patients a day – waited for more than two hours. In addition to heart attacks and strokes, the figures cover patients who had sustained a serious injury or trauma or major burns, or had developed the potentially lethal blood-borne infection sepsis. Under NHS guidelines, ambulances are meant to arrive at incidents involving a medical emergency – known as category 2 calls – within 18 minutes. The Liberal Democrat MP Layla Moran, who obtained the figures using freedom of information laws, said: “It’s deeply shocking that such huge numbers of seriously ill patients have had to wait so long for an ambulance crew to arrive after a 999 call. It shows the incredible pressure our ambulance services were under even before this pandemic struck. “Patients suffering emergencies like a heart attack, stroke or serious injury need urgent medical attention, not to be left waiting for up to two hours for an ambulance to arrive. These worryingly long delays in an ambulance reaching a seriously ill or injured patient could have a major long-term impact on their health.” Read full story Source: The Guardian, 16 August 2020
  6. News Article
    Unprecedentedly poor waiting time data for electives, diagnostics and cancer suggests the chances of NHS England’s ambitions for ‘near normal’ service levels this autumn being met are very unlikely, experts have warned. The statistics prompted one health think tank to urge NHS leaders to be “honest that with vital infection control measures affecting productivity, and a huge backlog, there are no shortcuts back to the way things were”. NHS England data published today revealed there were 50,536 patients who had been waiting over a year for elective treatment as of June – up from 1,613 in February before the covid outbreak, a number already viewed as very concerning. The number represents the highest level since 2009 and 16 times higher than they were in March. Nuffield Trust deputy director of research Sarah Scobie said: “These figures are a serious warning against any hope that the English NHS can get planned care back to normal before winter hits. The number of patients starting outpatient treatment is still a third lower than usual and getting back to 100 per cent by September will be a tall order.” “The increase in patients waiting more than a year has continued to accelerate at a shocking pace, with numbers now at their highest since 2009 and 16 times higher than they were in March. “Unfortunately, despite the real determination of staff to get back on track, some of these problems are set to grow… We need to be honest that with vital infection control measures affecting productivity, and a huge backlog, there are no shortcuts back to the way things were.” Read full story (paywalled) Source: HSJ, 13 August 2020
  7. News Article
    Gloucestershire Hospitals FT declares critical incident after ‘relentless demand’ on emergency care Pressure comes two months after trust downgraded one of its A&Es ‘Tired’ staff warned a ’Herculean effort’ is needed to reset emergency system NHS 111 cited as pinch point A trust has declared a critical incident after experiencing “relentless demand” on urgent and emergency care, months after downgrading one of its emergency departments. The internal critical incident was raised by Gloucestershire Hospitals Foundation Trust yesterday. An internal memo said the previous three days “have seen unprecedented demand fall on the Gloucestershire urgent and emergency care system”. Clinicians have been told that early discharges need to be identified on both its Cheltenham General and Gloucestershire Royal hospital sites, to try to free up bed-space, and that all non-essential meetings, besides those at executive level, should be cancelled. The incident comes after the trust decided in June to downgrade the A&E department at Cheltenham General to a minor injuries unit, operating from 8am to 8pm. Previously, the unit offered a full A&E service between 8am and 8pm, with a “nurse-led” minor injuries service outside these hours. The problems appear to be unrelated to covid-19, although infection control measures are known to have reduced capacity in many A&Es and wards. HSJ understands that local managers believe NHS 111, run by Care UK Health Care, has been a particular cause of the problems in recent days, because it has not been directing enough people to alternative services; as well as workforce pressures and the hot weather. Read full (paywalled) article here in the HSJ.
  8. News Article
    Doctors and surgeons’ leaders have issued a warning that the NHS must not shut down normal care again if a second wave of Covid-19 hits as that would risk patients dying from lack of treatment. Here, one patient tells her story. Marie Temple (not her real name) was distraught when her MRI was cancelled in March, shortly after the UK went into lockdown and Boris Johnson ordered the NHS to cancel all non-urgent treatment. Temple, who lives in the north of England, was diagnosed with a benign brain tumour last year after suffering seizures and shortly afterwards had surgery to remove it. She had been promised a follow-up MRI scan in late March to see if the surgery had been a success, but she received a letter saying her hospital was dealing only with emergency cases and she didn’t qualify. Read the full article here.
  9. Content Article
    The results found there were 129 unique mentions of barriers to patient safety; these barriers were categorised into five major themes. ‘Limited resources’ was the most prominent theme, followed by barriers related to health systems issues, the medical culture, provider training and patient education/awareness. Although inadequate resources are likely a substantial challenge to the improvement of patient safety in India, other patient safety barriers such as health systems changes, training, and education, could be addressed with fewer resources. While initial approaches to improving patient safety in India and other low- and middle-income countries have focused on implementing processes that represent best practices, this study suggests that multifaceted interventions to also address more structural problems (such as resource constraints, systems issues, and medical culture) may be important.
  10. News Article
    A leading doctor has warned that trusts will struggle to get back to anything like pre-covid levels of endoscopy services and will need to prioritise which patients are diagnosed. Endoscopy procedures are part of the diagnostic and treatment pathway for many conditions, including bowel cancer and stomach ulcers. Most hospitals have not done any non-emergency procedures since the middle of March because they are aerosol generating — meaning a greater covid infection risk and need for major protective equipment. Although some areas are now starting to do more urgent and routine work, capacity is severely limited. Kevin Monahan, a consultant gastroenterologist at St Marks’s Hospital, part of London North West Healthcare Trust, and a member of the medical advisory board for Bowel Cancer UK, said the time taken for droplets to settle in rooms after a procedure can be up to an hour and three quarters, depending on how areas are ventilated. Only then can the room be cleaned and another patient seen. Dr Monahan said his trust had restarted some endoscopy work and was currently doing around 17 per cent of its pre-covid activity. “We can provide a maximum of about 20 per cent of normal activity — and that is using private facilities for NHS patients,” he said. “I am not at all confident we will be able to double what we are doing now, even in three to four months’ time." Read full story Source: HSJ, 12 June 2020
  11. News Article
    Thousands of people lost their lives “prematurely” because care homes in England lacked the protective equipment and financial resources to cope with the coronavirus outbreak, according to council care bosses. In a highly critical report, social care directors say decisions to rapidly discharge many vulnerable patients from NHS hospitals to care homes without first testing them for COVID-19 had “tragic consequences” for residents and staff. In many places, vulnerable people were discharged into care facilities where there was a shortage of personal protective equipment (PPE) or where it was impossible to isolate them safely, sometimes when they could have returned home, the report says. “Ultimately, thousands have lost their lives prematurely in social care and were not sufficiently considered as part of wider health and community systems. And normality has not yet returned,” James Bullion, the president of the Association of Directors of Adult Social Services (Adass), said in a foreword to the report. Read full story Source: The Guardian, 11 June 2020
  12. News Article
    Senior doctors repeatedly raised concerns over safety and staffing problems at a mental health trust before a cluster of 12 deaths, an HSJ investigation has found. The deaths all happened over the course of a year, starting in June 2018, involving patients under the care of the crisis home treatment services at Birmingham and Solihull Mental Health Trust. The causes of the deaths included suicides, drug overdoses, and hanging. Coroners found several common failings surrounding the deaths and have previously warned of a lack of resources for mental health services in the city. HSJ has now seen internal documents which reveal senior clinicians had raised repeated internal concerns about the trust’s crisis home treatment teams during 2017 and early 2018. The clinicians warned of inadequate staffing levels, long waiting lists, and a lack of inpatient bed capacity. In the minutes of one meeting in February 2018, just two months before the first of the 12 deaths, a consultant is recorded as saying he had “grave concerns over safety in [the home treatment teams]”. Read full story Source: HSJ, 9 June 2020
  13. News Article
    Dozens of intensive care units are still running well over their normal capacity – in some cases more than double – weeks after the peak of demand, figures seen by HSJ reveal. It contrasts with the picture painted at some government coronavirus press conferences that there is huge “spare capacity” in critical care and has been throughout the outbreak, with Downing Street charts putting England-wide occupancy at around 20% currently. The government’s assertions include the additional “surge” capacity which was hurriedly established at the start of the outbreak. But intensive care staff have been frustrated by this being labelled spare capacity, when the number of patients being treated is still well above normal levels. In addition, the ongoing reliance on keeping surge beds open – with ICUs still spilling over other spaces and calling on staff and equipment from other services – will limit hospitals’ ability to resume normal care, such as planned surgery. Steve Mathieu, a consultant in intensive care medicine in the south of England, said: “The majority of ICUs will currently be operating at over 100 per cent capacity and typically somewhere around 130-150 per cent, although there is significant regional variation". “There are uncertainties whether this will now represent the ‘new normal’ for the foreseeable future and there is a national need to plan for further potential surges in activity requiring more critical care demand." Read full story Source: HSJ, 21 May 2020
  14. News Article
    Intensive care capacity in London must be doubled on a permanent basis following the coronavirus pandemic, according to the chief executive of the city’s temporary Nightingale hospital. Speaking to an online webinar hosted by the Royal Society of Medicine, Professor Charles Knight said London had around 800 critical care beds under normal operations but “there’s a clear plan to double intensive care unit capacity on a permanent basis”. He added: “We must have a system of healthcare in this country that means, if this ever happened again, that we wouldn’t have to do this, that we wouldn’t have to build an intensive care unit in a conference centre because we had enough capacity under usual operating so that we could cope with surge.” It would also mean the NHS would no longer be in a position “where lots of patients, as we all know, get cancelled every year for lack of an ITU bed,” he said. Read full story Source: HSJ, 28 April 2020
  15. Content Article

    Midwifery during COVID-19: A personal account

    Birth choices Our pregnant women are still being offered good choices in their birth experience such as homebirth and water birth, so long as they are well. I did two lovely home births this week. We are definitely seeing a rise in people transferring to our homebirth service. I do think there is a concern nationally about high risk women choosing to homebirth unassisted, in areas where maternity services have suspended homebirth as an option. Because women in my area still have the option of a homebirth, it’s not something we’re experiencing. Birthing partners and limited visits Partners are allowed at births including cesarean sections. Also, we’ve had lots of very positive feedback from the women to say that not having their partners or visitors on the wards hadn’t been as bad as they thought, as they have talked and bonded more with other new mums and made new friends. It’s difficult for them without the support of family in the postnatal period but with encouragement they can usually see it as a positive, a time for them to bond as a family and get to know their little ones. Dads are actually very positive realising that it means they get to spend much more time with their partners and new baby. Appointments and new ways of working My Trust are doing just as many face to face antenatal visits. We do virtual appointments at booking and 16 weeks in the vast majority of cases but GPs locally are refusing to see women at 25 and 31 weeks, so we have changed the schedule to include these in midwifery care. We are using well midwives, who are isolating at home for whatever reason, to do phone clinics for booking and 16 week appointments which lifts the pressure off those of us working clinically. They also ring around all of the women due to be seen to make sure they’re well and understand that they need to attend appointments alone. I’m a case loading midwife so I know my mums to be/new mums well and do feel I’ve been able to support and reassure them effectively. I know that sadly not everyone is in this position though. Staff levels and wellbeing Annual leave has been cancelled. Nobody has complained about this though (or at least nobody that I’m aware of). We were expecting it and realise it’s vital. Lots of staff are also picking up extra shifts. If staffing levels drop though the pressure will be enormous. My trust have been very proactive regarding training and we are all being supported in terms of wellbeing. Accommodation has been provided for staff unable to go home and wellness packages and mental health support is in place. We’ve even been provided with a pop-up supermarket. Our local community are also amazing. Most staff could access a free hot meal most days if they chose to from various donations, school, restaurants and local sports teams. Hand cream, treats, snacks etc are always coming in. We feel so appreciated and loved One of our biggest issues is PPE Even for confirmed COVID-positive women we are given less protection than we are normally given when caring for women with flu. Working in community, this has its own issues. Statistically we know that the chances are that viral loads in homes are likely to be high due to the number of people present in small spaces, more soft furnishings, less stringent cleaning routines etc. The apron and mask we are given are unlikely to offer us any real protection. When we leave the houses we then have to transport the contaminated personal protective equipment (PPE) in our own vehicles, we’re wearing uniform that is likely to be contaminated and we are stood on pavements trying to clean the equipment we have used because that too will be contaminated. We’re not protected in the same way that hospital staff are. We are walking in to homes where there may be 4 or 5 people in the same room that we need to be in, as everyone is at home. We keep being told effective hand washing is key but we’re doing that in environments which are often less than clean, and in cases of COVID-confirmed women we can’t wash our hands at all as we’re unable to remove our PPE until we’ve left the house. It all feels very unsafe both in terms of staff contracting COVID-19 and cross contamination to other women, colleagues and our family. The support we are lacking comes from Public Health England and the Government. PPE guidance and availability is pitiful and dangerous and I believe is based on availability rather than need or any scientific basis. Do you work in maternity services? Or perhaps you are expecting a baby? Does this midwife's account reflect the maternity services in your area at the moment, or are you seeing different positives and challenges? We want to hear from patients and staff, so please sign up to comment below or contact us directly (content@pslhub.org) to share your story.
  16. News Article
    The availability of dialysis equipment used to treat more than a quarter of ventilated COVID-19 patients has reached “critical” levels, HSJ has learned. Concerns are growing over an “exceptional shortage” of specialist dialysis machines used to treat intensive care patients with acute kidney failure. Although hospitals are able to deploy alternative machines which are not typically used in intensive care, this is logistically challenging and can carry increased risks for patients. Read full story Source: HSJ, 22 April 2020
  17. News Article
    Dozens of patients with Covid-19 have been turned away from the NHS Nightingale hospital in London because it has too few nurses to treat them, the Guardian can reveal. The hospital has been unable to admit about 50 people with the disease and needing “life or death” care since its first patient arrived at the site, in the ExCeL exhibition centre, in London’s Docklands, on 7 April. Thirty of these people were rejected because of a lack of staff. The planned transfer of more than 30 patients from established London hospitals to the Nightingale was “cancelled due to staffing issues”, according to NHS documents seen by the Guardian. The revelation raises questions about the role and future of the hospital, which up until Monday had only treated 41 patients, despite being designed to include almost 4,000 beds. One member of staff said: “There are plenty of people working here, including plenty of doctors. But there aren’t enough critical care nurses. They’re already working in other hospitals and being run ragged there. There aren’t spare people [specialist nurses] around to do this. That’s the problem. That leads to patients having to be rejected, because there aren’t enough critical care nurses.” Read full story Source: The Guardian. 21 April 2020
  18. News Article
    One in 10 nurses working in acute hospitals are off work due to coronavirus, according to internal NHS figures seen by HSJ. Internal NHS figures from the COVID-19 national operational dashboard state that, on Saturday, English acute trusts reported that 41,038 nurses and midwives were absent . 28,063 (68%) were COVID-19 related. The total nursing and midwifery headcount in acute trusts is about 280,000 — meaning roughly 10% are off on covid-related absence. There are ongoing complaints from staff about their access to COVID-19 tests — which, it is hoped, will hope reduce the absence rates from suspected cases — while national officials say these are now being made available. Read full story Source: HSJ, 14 April 2020
  19. News Article
    Hospitals are turning to the veterinary workforce to fill staffing gaps on intensive care wards ahead of an expected peak of COVID-19 patients, HSJ can reveal. Torbay and South Devon Foundation Trust has recruited 150 vets to enrol as “respiratory assistants”, amid preparations for a 10-fold increase of intensive care patients. Another trust, Hampshire Hospitals FT, has asked vets and dentists to become “bedside support workers” as part of its response to COVID-19 pressures. Read full story Source: HSJ, 9 March 2020