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  1. News Article
    The UK’s main gender identity development service for children is leaving thousands of vulnerable young people at risk of self-harm as they wait years for their first appointment, according to a highly critical report. The Care Quality Commission (CQC) took immediate enforcement action against the Tavistock and Portman NHS foundation trust when it completed the inspection in November, which rated the service overall “inadequate” and highlighted overwhelming caseloads, deficient record-keeping and poor leadership. The commission, which heard from young people using the service, parents, carers and staff in the course of its inspection, told the trust that services and waiting times in the Gender Identity Development Services (GIDS) in both their London and Leeds clinics “must improve significantly”, demanding monthly updates on numbers on waiting lists and actions to reduce them. The service has faced major scrutiny in recent years, with some former staff and campaigners raising concerns about the “overdiagnosing” of gender dysphoria, the consequences of early medical interventions and the significant increase in referrals of girls questioning their gender identity. Read full story Source: The Guardian, 20 January 2021
  2. News Article
    Nearly a quarter of a million people have been waiting more than a year for operations and other hospital procedures, HSJ has learned. Official NHS England data for November, released on Thursday, showed 192,000 patients had been waiting for treatment for more than a year. However, figures leaked to HSJ of weekly data up to 3 January showed a steep increase to 223,000 patients — the highest reported so far throughout the COVID-19 pandemic and before. According to the leak, just under 4.2 million people are waiting for treatment, of which year-long waiters comprise 5.4%. The data also showed 175 patients across England had waited more than two years for treatment. In February, before the pandemic, 1,613 patients were waiting more than a year — meaning there has been a 138-fold increase. Read full story (paywalled) Source: HSJ, 15 January 2021
  3. News Article
    Patients needing complex dental work might have to wait longer under new NHS targets, dentists warn. The British Dental Association (BDA) fears NHS England will impose penalties on practices that fail to reach 45% of their normal activity level, after negotiations broke down. And practices may have to prioritise routine check-ups over more time-consuming treatments. An NHS official said: "The NHS and the government are working to determine a safe and reasonable contractual arrangement with dentists, which recognises the constraints on practices and the need to maximise access for patients to see their dentist." The waiting list for NHS dentistry could reach eight million by New Year's Eve, according to the Association of Dental Groups. Dave Cottam, who chairs the BDA's General Dental Practice Committee, said: "This move will actively undermine patient care. "Ministers are instructing dentists to churn through routine appointments against the clock, rather than deal with a huge backlog of urgent cases. Dentists wanting to do the right thing by their patients will now be punished for it." Read full story Source: BBC News, 16 December 2020
  4. News Article
    The waiting list for cancer patients has almost doubled over the last seven months, according to internal NHS data which has never been made public. A slide set seen by HSJ suggests the total number of patients waiting for cancer treatment on the 62-day pathway has increased from around 90,000 in mid-May, to around 160,000 at the start of December. However, the data suggests the NHS has made good progress in treating patients waiting the longest. Read full story (paywalled) Source: HSJ, 15 December 2020
  5. News Article
    NHS patients in rural areas of England face extra long waits for treatment, according to a study. The Nuffield Trust think-tank says urban areas benefited most from measures put in place to help the NHS cope with the coronavirus pandemic. Researchers found rural hospitals now faced an uphill challenge when it came to restoring services to normal. NHS England says that funding reflects the higher costs of delivering care in rural communities. The Nuffield Trust report says while the number of Covid cases in rural areas was lower than in big urban centres, the pandemic's impact on services has been much greater. It says the coronavirus crisis highlighted pre-existing problems facing rural trusts. For example, it can be hard to recruit and retain doctors and nurses who are willing to work in smaller hospitals, which means trusts rely more heavily on expensive agency staff to fill gaps in rotas. This, in turn, has a detrimental effect on the finances of hospital trusts which struggle to balance the books. In addition, rural trusts often have only a limited capacity to treat any extra patients as they are often already very busy. Read full story Source: BBC News, 11 December 2020
  6. News Article
    At least 162,000 patients are waiting more than a year for routine NHS operations, the highest number for more than 12 years. Latest statistics from NHS England show 162,888 people were waiting over 52 weeks for hospital treatment in October this year. The total NHS waiting list for routine treatments at the end of October had reached 4.4 million with more than a third of patients waiting over 18 weeks – the NHS target for waiting times from referral to treatment. Earlier this year health think tanks had predicted the waiting list could hit 10 million, but NHS England said this had not come to pass because of the work of hospitals and NHS staff to keel waiting lists lower than they were last year. The median waiting time was just over 11 weeks, NHS England said Some experts have warned of hidden demand for NHS surgeries with many patients yet to be referred to treatment because of the covid pandemic. A spokesperson for NHS England, said: “Although Covid hospitalisations almost doubled during November, for every Covid inpatient the NHS treated, hospitals managed to treat five other inpatients for other health conditions. With cancer referrals and treatments now back above usual levels, our message remains that people should continue to come forward for care when they need it." Read full story Source: The Independent, 10 December 2020
  7. News Article
    A woman has become blind after her monthly eye injections were delayed for four months during lockdown. Helen Jeremy, 73, said everything she enjoyed doing has "gone out of the window" after losing her eyesight. She has glaucoma and was diagnosed with age-related macular degeneration four years ago. Monthly injections controlled the condition and meant she could still drive and play the piano. However, her appointments were cancelled when the pandemic struck and her eyesight deteriorated. "I was panicking. It was terrifying. Because I'm a widow I'm on my own and it was awful," she said. "Suddenly my eyesight was basically gone. By the time of my next appointment I was told there was no point in going on with these injections because the damage had been done to the back of my eye." Thousands more people in Wales are at risk of "irreversible sight loss" because of treatment delays, RNIB Cymru warns. The Welsh Government said health boards are working to increase services. Read full story Source: BBC News, 27 November 2020
  8. News Article
    A transgender boy is taking NHS England to court over delays in accessing gender identity treatment. The 14-year-old, who was referred to the UK’s only youth gender identity clinic in October 2019, has been told he may have to wait at least another year to be seen. He said he was experiencing “fear and terror” while he waits for treatment. Young people are currently facing “extensive waits” to see a therapist, with the average delay being 18 months or more, according to the Good Law Project, which is representing the boy. The not-for-profit organisation said the health service was legally required to ensure patients referred to gender identity development services (GIDS) are seen within 18 weeks. Gender clinics for adults across the country have reported similar delays, with the Devon Partnership NHS Trust reporting “lengthy waiting times” while the Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust said patients were facing delays “in excess of 32 months” for an initial appointment and 62 months from referral to treatment. Trusts have blamed a surge in demand as well as reduced capacity, including staffing problems. The teenager involved in the case said in a statement: “The length of the NHS waiting list means the treatments which are essential for my well being are not available to me." “By the time I get to the top of the list it will be too late, and in the meantime I suffer the fear and terror that gender dysphoria causes, every day.” Read full story Source: The Independent, 23 November 2020
  9. News Article
    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
  10. News Article
    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
  11. Content Article
    Detailed results from the report show: - The regions that have seen the sharpest decline in the number of people referred for routine elective care during the first 8 months of the year are London (37% reduction as compared to 2019), North West (35% reduction) and South East (35% reduction). The South West saw the smallest reduction in the number of people referred for elective care compared to 2019 (29%). The North East and Yorkshire saw a 34% reduction and Midlands and East of England both had a 33% reduction. - Those regions that experienced the lowest rates of COVID-19 during the first wave, namely the South West and East of England, are also those that have made the most progress in reopening elective care services. While there are currently only limited signs that more treatment is being postponed in the regions hardest hit by COVID-19, this may change in the future. - Referrals to clinical areas have declined as follows: oral surgery (43% lower than in 2019, representing 177,591 fewer people) trauma and orthopaedics (42% lower, representing 622,593 fewer people). This includes surgery for hip and knee replacements ophthalmology (41% lower, representing 531,660 fewer people). This includes cataract operations thoracic medicine (29%, or 98,546 fewer people) cardiothoracic surgery (29%, or 7,889 fewer people) neurosurgery (29% lower, or 23,872 fewer people); urology (28% lower, representing 186,119 fewer people).
  12. News Article
    The 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
  13. News Article
    Concerns are growing that long NHS waiting times caused by the coronavirus crisis are exacerbating pre-existing health inequalities and creating a “two-tier” system, as more people turn to the private sector for quicker treatment. As leading doctors warn mass cancellations of NHS operations in England are inevitable this winter after waiting times reached the highest levels on record this summer, data shows a rise in the number of people self-funding treatment or investing in private health insurance. “COVID-19 has not impacted everyone equally, and there is clearly a risk that the backlog in routine hospital treatment is going to add to those inequalities if some people are able to get treatment faster because they’re able to pay,” said Tim Gardner, from the Health Foundation thinktank. As the NHS heads into winter and a growing second wave of the virus, experts stressed the need to help those affected by the backlog now. “There is a need to prioritise the most urgent cases, but simply because someone’s case isn’t urgent doesn’t mean it’s not important. It doesn’t mean that people aren’t waiting in pain and discomfort, or waiting anxiously for a diagnosis,” said Gardner. “We think it’s incumbent on the health service to make the best possible use of the capacity it’s got. But also it needs to make sure it’s supporting people while they’re waiting. We just can’t have people left in limbo.” Read full story Source: The Guardian, 27 October 2020
  14. News Article
    At the age of 49, Sarah Fisher feels her life is on a knife-edge. She had a heart attack during lockdown and has subsequently been diagnosed with heart failure. In July, she was told she needed to have an implantable cardioverter defibrillator (ICD) fitted, which can shock the heart back into rhythm when it detects a potential cardiac arrest. But 12 weeks on, she is still waiting. "I could have a cardiac arrest at any point," Sarah says. "It is awful not knowing what is going to happen. "I am on the urgent list – but the infection rates are rising and the clinics are closing." "I don't know when I will get it. "There are so many people in my position – we don't have Covid but our lives are at risk too. We are the forgotten victims of this pandemic." British Heart Foundation analysis of Office for National Statistics data for England and Wales found almost 800 extra deaths from heart disease among under-65s from March to July - 15% more than would be expected. The rate of death was highest during the full lockdown - but, worryingly, the trend continued afterwards. The charity blames delays in people seeking care, as well as reduced access to routine tests and treatments. And NHS England figures show a sharp rise in the numbers waiting over six weeks for a whole range of key tests, including echocardiograms for hearts. Read full story Source: BBC News, 15 October 2020
  15. Content Article
    Key aims Reassure patients they have not been forgotten during the coronavirus pandemic. Establish the patient's wishes regarding treatment. Good communication with patient and GP. Produce a validated waiting list that allows operating lists to run effectively. All Trusts are required to complete a clinical validation of patients on an admitted patient care pathway by 23 October, and for it to be captured in NHS e-Review. Trusts will be required to identify four user groups for the system; a user to upload patients to the system, an administrator, a super user to upload and download waiting lists and the outcomes from clinical reviews, and a clinical reviewer who is responsible for reviewing a cohort of patients within a specialty. Letter to healthcare providers and bodies Video software overview
  16. News Article
    The numbers waiting over a year for hospital treatment have hit a 12-year high in England as hospitals struggle to get services back to normal. Nearly 2m patients have been waiting more than the target time of 18 weeks for routine care with 111,000 left for over a year, NHS England figures show. The numbers starting cancer treatment and getting urgent checks are also below the levels seen a year ago. But NHS England said "progress" was being made. It pointed out more patients were starting to be seen - although there are now warnings service may have to be cut back on again as admissions for Covid continue to rise. About 500 patients a day are being admitted to hospital with the disease - double the number two weeks ago. Health Secretary Matt Hancock said the UK was in a "perilous" position and the ability of the NHS to see non-Covid patients was under threat. Health minister Nadine Dorries predicted within 10 days hospitals would be a "critical" point. Read full story Source: BBC News, 8 October 2020
  17. News Article
    There could be a "tsunami" of cancelled operations this winter as the NHS copes with rising numbers of coronavirus patients, leading surgeons are warning. Members of the Royal College of Surgeons of England say they doubt the NHS can meet targets to restore surgery back to near pre-pandemic levels. Planned procedures such as hip replacements were paused to free up beds during lockdown in the spring. And hospitals have since been dealing with a backlog. In July, NHS England boss Sir Simon Stevens told trusts hospitals should by September 2020 be performing at least 80% of their September 2019 rates of: overnight planned procedures outpatient or day-case procedures And by October, this proportion should rise to 90%. But data suggests more than two million people have been waiting longer than 18 weeks for routine operations, with 83,000 waiting more than a year - up from 2,000 before the pandemic. Read full story Source: BBC News, 6 October 2020
  18. News Article
    Next Thursday we’ll see more waiting list data released. What is contained in it is probably why Sir David Sloman’s office has taken nearly a month to not answer this question: Your letter to system leaders said you would “eliminate” 52-week waits, by when? The regional director’s office could not answer, nor could it reveal which hospitals were going to be the high-volume centre to burn through the lists in the six major specialities. There are a couple of likely reasons for their not being able to say when the long waiters would be eliminated. NHSI/E’s phase three letter set “mad” targets that don’t feel very real to many on the ground. I/E central will know this and have their own reasons for setting stretching-to-the-point-of-snapping targets, but trusts don’t really want to be held to submitting impossible commitments then being chastised for missing them (management teams have been moved on for this kind of thing in less fraught times). The second reason is that the picture is likely to be scary and also to have an impact on the ongoing three-way negotiation between the NHS, the independent sector - which will be hosting a lot of this work - and the workforce that will actually do it in both places. There is even less transparency than usual from the regional director’s office and I/E generally when asked anything at all about how effectively private sector facilities are being used, or how much it is costing. Much more surprising is the fact that Sir David’s office cannot yet name where each of the ICS’s six high-volume centres will be. Read full story (paywalled) Source: HSJ, 1 October 2020
  19. Community Post
    I've been posting advice to patients advising them to personally follow up on referrals. Good advice I believe, which could save lives. I'm interested in people's views on this. This is the message I'm sharing: **Important message for patients relating to clinical referrals in England** We need a specific effort to ensure ALL referrals are followed up. Some are getting 'lost'. I urge all patients to check your referral has been received, ensure your GP and the clinical team you have been referred to have the referral. Make sure you have a copy yourself too. Things are difficult and we accept there are waits. Having information on the progress of your referral, and an assurance that is is being clinically prioritised is vital. If patients are fully informed and assured of the progress of their referrals in real-time it could save time and effort in fielding enquiries and prevent them going missing or 'falling into a black hole', which is a reality for some people. It would also prevent clinical priorities being missed. Maybe this is happening, and patients are being kept fully informed in real-time of the progress of their referrals. It would be good to hear examples of best practice.
  20. News Article
    Almost one million women in the UK have missed vital breast screening due to coronavirus, a leading charity has estimated. Breast screening programmes were paused in March as the NHS focused resources on tackling the pandemic. Breast Cancer Now calculates that around 8,600 women who have not had a scan have undetected breast cancer. The scanning programme is running again, but social distancing measures have reduced capacity. Combined with the significant backlog of women waiting for a scan, and more women starting to come forward with concerns about possible symptoms, the charity warns the service is under intense pressure. Breast cancer diagnosed at a later stage can be harder to treat. Breast Cancer Now estimates that a total of 986,000 women across the UK missed their mammograms due to breast screening programmes being paused. The estimate is based on the average number of women screened per month, and the approximate length of time the screening programme was suspended, in each part of the UK. This breaks down to almost 838,000 women in England, 78,000 in Scotland, 48,000 in Wales and 23,000 in Northern Ireland. The charity is calling for an action plan and new resources to tackle the problem. Baroness Delyth Morgan, Breast Cancer Now chief executive, said: "That nearly one million women across the UK were caught up in the backlog waiting for breast screening is cause for grave concern. "Mammograms are a key tool in the early detection of breast cancer, which is critical to stopping women dying from the disease. "We understand that the breast screening programme was paused out of necessity due to the global Covid-19 pandemic, but we must now press play to ensure that all women can access breast screening, and we cannot afford for the programme to be paused again." Read full story Source: BBC News, 30 September 2020 Breast Cancer Now press release
  21. Content Article
    On 1 October 2020, the Health and Social Care Select Committee published its inquiry report into ‘Delivering core NHS and care services during the pandemic and beyond’.[1] [2] Patient Safety Learning contributed to this inquiry earlier in the year with two formal submissions of evidence. The first focused on hospital discharge arrangements, in a joint submission with CECOPS.[3] In the second we looked at the impact of COVID-19 on patient safety, specifically considering non-COVIDcare and treatment.[4] For the latter, our insights on this were partly informed by a webinar we held with patients, healthcare professionals and patient safety experts.[5] We welcome the publication of today’s report, which sets out recommendations in five different areas where action is needed to ensure the safe and effective provision of health and social care services both during and after the pandemic. Communication with patients The report recognises the importance of clear communications with patients during the pandemic. It acknowledges that there have been shortcomings in this area, stating that: “… the patient experience for some has been unacceptably poor, leaving them feeling like they have been left in 'limbo' or 'in the lurch'. Unnecessary anxiety and stress has been caused to those patients due to poor communication not just from their local hospital about the scheduling of appointments or access to treatments, but from national bodies, and on key items of guidance such as on shielding.” The Committee calls on the NHS to review the guidance they provide to trusts on how to communicate with patients about treatment changes and medical guidance in the event of a further spike in COVID-19 cases. We agree with this recommendation and reflected concerns about this issue in our submission to the inquiry. We also believe the NHS needs to consider how it communicates with patients who are impacted by the pandemic backlog of treatment and care. There needs to be honest and transparent conversations with patients about how this may affect their personal circumstances. Managing the backlog of care and treatment Recognising the serious challenge that the NHS now faces in managing waiting times and a backlog of appointments resulting from the pandemic, the report considers this in more detail in the areas of elective surgery, mental health, cancer and dental services. This was also an area of focus in our submission to the inquiry, where we highlighted other areas of concern such as chronic disease management and postnatal support.[4] We have also subsequently looked in more detail at the backlog in elective surgery and the patient safety implications of this.[6] We welcome the Committee’s recommendations that the Department of Health and Social Care and NHS should set out plans to address the backlog, along with steps that will be taken in future to manage the overall level of demand across health services. Patient Safety Learning believes that a strategy is needed to tackle the demand on NHS services in a systemic way; a published strategy that will help to ensure that decisions regarding the priority of cases are made transparently and with patient safety at the forefront. Staff access to Personal Protective Equipment (PPE) and routine testing Another area of focus in the report is the protection of staff from infection during the pandemic. The Committee asks for assurances about future supplies of PPE and presses for routine staff testing of staff in health and social care. We completely agree on the importance of this issue and in our recent work for World Patient Safety Day made the case for staff safety being intrinsically linked with patient safety.[7] In terms of physical safety during the pandemic, the case for this is clear – ensuring sufficient suitable PPE is available and that staff have access to testing is essential in both limiting the risk of passing on infection to patients as well as protecting staff themselves. We also note that in discussing PPE requirements the report refers to a specific issue around problems with fitting PPE, particularly for staff from some ethnic groups. We note the Royal College of Nursing has called for equality impact assessments on PPE and fit testing and we think that this should form part of the Department of Health and Social Care response to this report. Burnout and staff wellbeing The report notes the significant impact that the pandemic has had on both the mental and physical wellbeing of staff, advising that the Committee also has launched a separate inquiry on this, 'Workforce burnout and resilience in the NHS and social care'. This is also an area we highlighted in our submission to the inquiry and we have been sharing and highlighting staff perspectives on this during the pandemic on the hub.[8] We are also using the hub to share and publicise tools to help support staff through this period, such as a set of wellbeing resources from the Scottish Patient Safety Programme. We welcome the report’s call on NHS to set out in more detail the steps it will take “to support the mental and physical wellbeing of all staff and a plan to deal with the specific issue of sustained workplace pressure due to the current pandemic and backlog associated with the coronavirus”. Learning lessons from the pandemic The final section of the report considers the fundamental changes that have been ushered into health and social care services by the pandemic, looking in more detail at the 111 dial service, technology and digital innovations, and the independent sector. It calls on the Department of Health and Social Care and the NHS to assess the effectiveness of such changes while also noting the need to “ensure patients’ wellbeing is not jeopardised by the risk of being digitally excluded from accessing medical treatment and advice”. Patient Safety Learning welcomes these recommendations. As we noted in our response to the inquiry, the pandemic has created the opportunity for innovations in health and social care that we should seize upon to improve future services. We also believe that this presents an opportunity to design new models of care and delivery with patient safety and staff safety at their core. References Health and Social Care Select Committee, Delivering core NHS and care services during the pandemic and beyond, 1 October 2020. UK Parliament, Delivering Core NHS and Care Services during the Pandemic and Beyond, Last Accessed 30 September 2020. Patient Safety Learning and CECOPS, Hospital Discharge Arrangements, 7 May 2020. 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, Your voice matters: how it is shaping out work in non Covid-19 care and patient and staff safety, 14 May 2020. Patient Safety Learning, The return of elective surgery and implications for patient safety, 15 June 2020. Patient Safety Learning, Why is staff safety a patient safety issue?, 3 September 2020. Claire Cox, “I know this is burnout. I didn’t want it to be. But it is.”, Patient Safety Learning’s the hub, 11 June 2020.