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Found 338 results
  1. Content Article
    The transition of older adults from the emergency department (ED) to home remains a potential area of preventable harm. Through a human-centred design process, the authors developed a patient-centred intervention aimed at improving communication and coordination between ED staff and patients. The intervention included a new electronic health record (EHR)-based template for physicians to enter discharge instructions, a redesigned after-visit-summary (AVS), enhanced nurse training for patient teach-back, and EHR-embedded tips for nurses at the time of follow-up call. The research objective was to evaluate this patient-centred ED discharge process redesign from multiple perspectives. The authors used A SEIPS 3.0 model to evaluate the intervention, in particular work system barriers and facilitators in the three subprocesses of the redesigned ED discharge process: physician writing discharge instructions, nurse/patient communication at discharge, and nurse/patient communication at follow-up call. The authors used multiple methods to collect quantitative and qualitative data from the perspectives of patients, and ED physicians and nurses. Overall, the redesigned patient-centred discharge process was perceived positively by ED physicians and advanced practice providers, ED nurses, and patients. All three groups identified work system facilitators regarding the intervention, in particular the usability of the AVS. Work system barriers pointed to areas for future improvement of the intervention, such as adding prepopulated information to the AVS. Using a human-centred design process, the authors improved ED discharge for older adults. The SEIPS-based research and evaluation fit with the learning health system concept as it provides input for future work system and patient safety improvement.
  2. News Article
    The UK's top A&E doctor has accused the government of “neglecting the oldest and sickest patients” as figures suggest a record 320 people a week may have died needlessly in A&E last year due to waits for hospital beds. Dr Adrian Boyle, the Royal College of Emergency Medicine president, has warned that current government policy on A&E is focused on cutting waits for “cut fingers and sprained ankles” while neglecting older people, who are most likely to die and spend days on trollies. The Royal College of Emergency Medicine (RCEM) estimates there were more than 16,600 deaths of patients linked to long waits for a bed, an increase of a fifth on 2023 and a record since new A&E data has been published. The figures come after the NHS’s target to see 95% of patients within four hours was cut to 78% for 2025/26. There is no national target for the number of people waiting 12 hours, the length of time linked to excess emergency care deaths, but last year more than 1.7 million patients waited 12 hours or more to be admitted, discharged or transferred from A&E. Dr Boyle said the figures were “the equivalent of two aeroplanes crashing every week” and were devastating for families. Read full story Source: The Independent, 15 May 2025
  3. News Article
    More than 1 million older people a year in England are forced to wait longer than 12 hours in A&E, with many having to endure “degrading and dehumanising” corridor waits on trolleys. The number aged 60 and over waiting more than 12 hours to be transferred, admitted or discharged increased to 1.15 million in 2024, up from 991,068 in 2023. The figure was 305,619 in 2019, according to data obtained by the Royal College of Emergency Medicine (RCEM) under freedom of information laws. A report by the RCEM also found the risk of a 12-hour wait in an emergency department in England increased with the age of the patient. People aged 60 to 69 had a 15% chance of waiting 12 hours or more. For those aged 90 and over, the likelihood rose to 33%. “The healthcare system is failing our most vulnerable patients – more than a million last year,” said Dr Adrian Boyle, the president of the RCEM. “These people are our parents, grandparents, great-grandparents. “They aren’t receiving the level of care they need, as they endure the longest stays in our emergency departments, often suffering degrading and dehumanising corridor care. It’s an alarming threat to patient safety. We know long stays are dangerous, especially for those who are elderly, and puts people’s lives at risk.” As well as long waits, the RCEM report found many older people were missing out on vital checks in A&E. Of patients aged over 75, only 16% were screened for delirium – a reversible condition linked to an increased risk of death. Fewer than half (48%) of patients were screened for their risk of falls. Read full story Source: The Guardian, 6 May 2025
  4. Content Article
    More than a million older people faced waits of 12 hours or more in A&Es in England last year – and shockingly, the older a person is, the more likely they are to experience a long stay in the emergency department – new data from the Royal College of Emergency Medicine (RCEM) reveals.It comes as the College publishes a new report looking at the care older people receive in emergency departments.The research, titled ‘Care of Older People 2023-24’, is part of the College’s clinical Quality Improvement Programme which aims to improve the care of patients attending Emergency Departments. This interim report reflects the findings of the second year of the three-year programme. Across the UK, 149 Emergency Departments submitted 24, 865 patient cases from 4 October 2023 – 3 October 2024. A key finding was that among patients over the age of 75, there was insufficient screening for three common conditions which primarily affect this age group: Only 16% of patients were screened for delirium – a reversible condition which can be associated with mortality, characterised by a sudden change in mental function.On average less than half (48%) had screening to assess the risk of falling.An average of 56% underwent screening for general frailty – which if detected can trigger early intervention and support in hospital and in the community.Despite a year-on-year improvement from 2023, these patients are enduring the longest waits in A&Es and are bearing the brunt of an Urgent and Emergency Care system in crisis. Older people are often more likely to suffer with complicated or multiple health issues. This, combined with the wider issues related to a shortage of in-patient beds, mean they can often end up enduring extreme long waits in A&E – often on trolleys in corridors.
  5. Event
    As part of Care Forward, a national movement focused on making care better for over a million people across the country, Healthcare Excellence Canada with supporting organisations are launching new offerings that provide participants with funding, resources and coaching to drive impact on four key priorities: expanding care access, helping more people age where they call home, advancing person-centred long-term care and strengthening the health workforce. Join this webinar series to explore these offerings and how you can get involved: Right Care Challenge supports health and social care organizations to launch or enhance initiatives that ensure patients receive the right care, at the right time, in the right place—all while helping reduce avoidable emergency department visits.   Enhancing Integrated Care supports primary and community care organisations to strengthen integrated team-based care models, including virtual care, making access easier and reducing pressure on emergency departments. Paramedics and Social Prescribing helps paramedic teams use social prescribing to connect clients with local community services, improving overall health and wellbeing. Primary Care Access Improvement helps team-based primary care organisations  create efficiencies and optimise team functioning, so patients receive timely care, regardless of urgency or demand.   Nursing Home Without Walls supports jurisdictions across the country to bring nursing home support and services to older adults in their own homes, helping them age safely and comfortably where they already live. Sparking Change in Appropriate Use of Antipsychotics Awards Program provides long-term care homes across Canada with support to use person-centered approaches to reduce potentially inappropriate antipsychotic use. Register
  6. News Article
    The health secretary is taking inspiration from Japan in his bid to change how Britons are treated by the NHS. Wes Streeting has said he's interested in the idea of "health MOTs" for Britain's older citizens, evoking how the Asian island nation relies on personalised medical plans for its ageing population. Japan combines genomics and AI machine learning to offer hyper-bespoke programmes for individuals, helping to predict and prevent illnesses before they really take hold. Mr Streeting said such an approach could be a "game-changer" in the UK, as he prepares to publish his 10-year plan for the health service later in 2025. He has repeatedly spoken about his desire to move more of the NHS's work out of hospitals and into local communities, focusing more on preventative care than more expensive and invasive emergency treatment. Read full story Source: Sky News, 19 April 2025
  7. News Article
    Men across the country are, on average, living four fewer years than women – but there are stark disparities across the UK, new analysis shows. Research from the Centre for Ageing Better found from 2021-2023, the average life expectancy at birth is 79 years for men and 83 years for women. The charity’s 2025 State of Ageing report found men living in the bottom fifth of areas of the country in terms of wealth can expect to live 4.4 fewer years on average than those living in the wealthiest areas of England. There is a clear north-south divide in average life expectancy at birth across England, the report found. The lowest life expectancy at birth for men and women is in the North East (77.4 and 81.4 years respectively), according to the Centre for Ageing Better. Dr Carole Easton OBE, Chief Executive at the Centre for Ageing Better, said: “The substantial regional inequalities highlighted in our new State of Ageing report are truly a matter of life and death. Living in a part of the country where good quality jobs and opportunity is scarce, and where financial insecurity and poverty is rife, is robbing people of their health in later life and depriving them of years spent with loved ones. This is the true human cost of our very unequal society. “The really worrying trend is that inequality in life expectancy is increasing almost everywhere. The bombardment of shocks from austerity, Covid and the cost-of-living crisis have compounded longer-term health and inequality issues to ensure we truly are the sick man of Europe.”
  8. Content Article
    Although death in old age is unavoidable, premature death—defined here as death before age 70 years—is not. To assess whether halving premature mortality by 2050 is feasible, this paper examined the large variation in premature death rates before age 70 years and trends over the past 50 years (1970–2019), covering ten world regions and the 30 most-populous nations. Halving premature death by 2050 is feasible, although substantial investments in child and adult health are needed to sustain or accelerate the rate of improvement for high-performing and medium-performing countries. Particular attention must be paid to countries with very low or a worsening rate of improvement in probability of premature death. By reducing premature mortality, more people will live longer and more healthy lives. However, as people live longer, the absolute number of years lived with chronic disease will increase and investments in services reducing chronic disease morbidity are needed.
  9. Content Article
    Wrist-based wearables in the US have been FDA approved for atrial fibrillation (AF) detection. However, the health behaviour impact of false AF alerts from wearables on older patients at high risk for AF are not known. In this work, the authors analysed data from the Pulsewatch (NCT03761394) study, which randomised patients with history of stroke or transient ischemic attack to wear a patch monitor and a smartwatch linked to a smartphone running the Pulsewatch application vs to only the cardiac patch monitor over 14 days. At baseline and 14 days, participants completed validated instruments to assess for anxiety, patient activation, perceived mental and physical health, chronic symptom management self-efficacy, and medicine adherence. The authors used linear regression to examine associations between false AF alerts with change in patient-reported outcomes. Receipt of false AF alerts was related to a dose-dependent decline in self-perceived physical health and levels of disease self-management. The authors developed a novel convolutional denoising autoencoder (CDA) to remove motion and noise artifacts in photoplethysmography (PPG) segments to optimize AF detection, which substantially reduced the number of false alerts. A promising approach to avoid negative impact of false alerts is to employ artificial intelligence driven algorithms to improve accuracy.
  10. Content Article
    This is the second in a series of investigations exploring why medications intended to be provided to patients were not provided. Patients who need medications can suffer harm if these are not provided. This investigation explored the systems and processes in place to support staff when a patient who is usually taking an anticoagulant undergoes a procedure. An anticoagulant is a medication that reduces the ability of a patient’s blood to clot. The investigation also explored the role played by electronic prescribing and medication administration (ePMA) systems and electronic patient record (EPR) systems in supporting care in this area. The investigation explored a patient safety event involving a man aged 87 who was admitted to hospital. He usually took an anticoagulant medication (apixaban) to reduce the risk of having a stroke. A stroke is a serious medical condition that occurs when the blood supply to part of a person’s brain is lost. The patient was taken to hospital with shortness of breath and nose bleeds. He was transferred from the emergency department to a medical ward while waiting for a procedure. The medical team paused the patient’s regular apixaban, initially because of his nose bleeds. The apixaban continued to be paused while the patient was waiting for his procedure. However, delays to the procedure taking place meant that apixaban was not given for a total of 10 days. After the procedure, the apixaban was not restarted as intended. Two days after the procedure the patient had a stroke and later died. Medical staff needed to make informed prescribing decisions, balancing the patient’s risk of developing a blood clot, his everyday risk of bleeding, with the risk of bleeding from the required medical procedure. The investigation explored the range of complex, dynamic and interacting clinical and wider hospital factors that led to the difficulties in managing the patient’s anticoagulation. Findings The patient’s apixaban was appropriately paused in the emergency department. Past clinical information about the patient that would have supported anticoagulant risk assessments was not easily available to staff. Variations in the hospital care processes supported some working practices, but created uncertainty about when the patient’s procedure could happen. This made dynamic clinical decision making challenging. A lack of specialist nursing and/or administrative support limited the ability for respiratory referrals to be followed up by the respiratory team in a timely way. There was no reassessment of the ongoing decision to pause the patient’s apixaban when the procedure did not happen as expected. It was clear to staff that the patient’s apixaban was paused on the ePMA system, but the system did not prompt staff to re-review the paused apixaban. An assessment of the risks and benefits of pausing the patient’s apixaban was not documented which prevented a shared understanding of the decision for other staff involved in the patient’s care. Workforce challenges created conditions on the acute general medical ward that limited the resources available to follow up on the patient's medication status and delayed discussions around the patient’s transfer to the respiratory ward. A mismatch between demand and capacity within the respiratory service prevented the patient being transferred to the respiratory ward or receiving regular specialty respiratory input while he was being cared for on the acute general medical ward. Some local clinical guidance available to staff on the management of patients’ anticoagulant medication was overdue for a review and did not reflect updated national guidance. Local clinical guidance was sometimes hard to access using the Trust’s computer systems and some staff were unaware of relevant guidance that was in place. There were no cues in the post-procedure documentation to prompt staff to consider restarting the patient’s anticoagulation medication. Phased implementation of the Trust’s EPR system meant that sometimes staff were duplicating entries across paper and electronic record systems. Local level learning prompts for acute hospitals HSSIB investigations include local-level learning where this may help organisations and staff identify and think about how to respond to specific patient safety concerns at the local level. The following prompts are provided by HSSIB to help acute hospitals to improve the safety of patients who are taking anticoagulation medication who need to have a procedure. These prompts may also be useful in other settings. Anticoagulant prescribing How does your organisation support staff to identify and document decision making at critical decision points where anticoagulation should be reviewed? How does your patient record system support staff to document and clearly display the rationale behind any decision to pause anticoagulant medication? Does your organisation have systems and processes in place that support regular risk assessment of anticoagulants that have been paused? Does your organisation have a process for ensuring that guidelines that cross-refer to other relevant guidelines are reviewed together to ensure they provide consistent advice? How do you ensure that all members of the multidisciplinary team with relevant expertise are included in clinical guideline reviews? Does your organisation have processes in place to ensure that when new evidence on newer anticoagulants becomes available it is considered for inclusion in local guidance as soon as possible? How does your organisation support staff to find and readily access anticoagulation related guidelines? Care processes supporting inpatients on anticoagulants Do your organisation’s bed management meetings include a review of patients who have been waiting more than 24 hours for transfer to a specialty ward? Does your organisation have effective processes in place to ensure inpatients accepted by a speciality, but awaiting a specialty bed, receive a specialty review on a regular basis? Does your organisation have a process in place for the prioritisation of inpatient transfer to specialty services? Does your organisation have a process in place for the prioritisation of inpatients who need investigations (including imaging) and procedures? Do your organisation’s post procedure processes include a prompt to review anticoagulation? EPR/ePMA systems supporting anticoagulation Does your organisation ensure it is easy for staff to access information in patients’ records relevant to decision making about anticoagulant medication? Does your ePMA system identify patients with paused time-critical medication that may warrant a review? How does your organisation consider factors relating to equipment which may affect the successful implementation of EPR/ePMA systems?
  11. Content Article
    Examples of how two NHS trusts have designed a virtual ward using the system-wide digital healthcare platform, Luscii. The team at Maidstone and Tunbridge Wells NHS Trust (MTW) in collaboration with the Home Treatment Service (HTS) have designed a virtual ward to cater for frailty patients, allowing them to provide acute-level care without the need for hospital admission. MTW’s innovative approach means patients are empowered to live fuller and freer lives with access to hospital care from the comfort of their own homes. Maidstone and Tunbridge Wells NHS Trust_ Frailty Case Study.pdf Nurses at London North West University Healthcare NHS Trust (LNWH) have created a virtual ward caring for hundreds of heart failure patients. The new virtual heart failure ward is a fascinating case study of the power and potential for technology to optimise the use of critical resources and improve care outcomes. The Future of Care - Inside LNWH's Virtual Heart Failure Ward (1).pdf
  12. News Article
    An 87-year-old woman who waited around 12 hours at A&E on three separate occasions has been left “traumatised” by her experience of the NHS, her daughter has said. Ann Traynor, 61, from East Lothian, said her mother Winifred Bolland found the ordeal “frightening and degrading”. Ms Bolland, a former teacher, was taken to the Royal Infirmary of Edinburgh last September after fracturing her hip. She was later discharged but in October was readmitted after struggling to stand on one of her legs. She waited nine hours before an ambulance arrived and was looked after by ambulance staff in a corridor, her daughter, who is a nurse, said. Ms Bolland was again then forced to wait in A&E for around 12 hours. In January, Ms Bolland, who is visually impaired, fell and fractured her other hip at home. Ms Traynor said she and her mother, who was in pain, had to wait around another 12 hours in “freezing” conditions. She said her mother was discharged from the hospital and told she did not meet the criteria for rehabilitation, but was later given access to it. She told how she had to take nearly a month off of work to ensure her mother was safe at home. “She doesn’t ever want to go back to the Royal Infirmary,” Ms Traynor said. “She was traumatised there, particularly the second time. There was no dignity in that admission. “I think she felt like a burden. It’s really sad. I think her generation is very stoic but I think she was badly let down. “She wouldn’t survive another admission like that. “Although she was booted out, and I think it’s appalling that she was, I think she was safer at home.” Read full story Source: The Scotsman, 3 March 2025
  13. Content Article
    More information about "The challenges of navigating the healthcare system: Margaret's story"
    We hear time and time again on the hub about the lack of joined up care and communication within and across organisations. Patients and their families and carers not knowing who to contact to chase up a referral, systems not joined up, lack of communication, having to repeat the patient’s history and medications to every new healthcare professional they see because the notes haven’t been shared or clinicians "don’t have time to read them all". These issues are widespread and urgently need to be addressed if we are to prevent people falling through the gaps and suffering worse health outcomes. In this blog, *Margaret shares her and family's experiences of trying to coordinate their elderly father's upcoming surgery. Interoperability issues My father has dementia and has a complex set of health issues, as a lot of elderly people do. He has a number of comorbidities, including vascular, heart, and cognition and memory problems, that has meant coordinating his care between the care home, his GP, the local hospital and a specialist hospital has been quite complex. There have been multiple issues but there were two that stood out. The first issue was at the diagnostic stage. My father has severe vascular problems and he needed fairly urgent and necessary surgery. In order to assess whether he was suitable for surgery, given his heart condition, he needed a scan. We have had problems in the past in getting access to scans on his heart so the GP said in order to move things on quicker it would be good to get the scan done privately. As the surgery was urgent, we paid to get the scan done at a private diagnostic centre. However, when it came to getting the information from the private diagnostic centre to the tertiary hospital where he was being treated we encountered problems. The hospital couldn’t access the scans from the private hospital because they were two different systems which meant there was an interoperability issue as the two systems ‘didn’t talk to each other’. One of the suggestions I was given was that I could drive to the private diagnostic centre, which was about a 40 mile drive from my house, with a CD, and then they would download the scans onto the CD and I could then drive back to the hospital, which was about another 35 mile drive. There were multiple calls and this was really quite distressing for our family because we knew my father needed access to the scans urgently. In the end they said they’d do another scan in the hospital. Although I don't think there were any kind of safety issues with my father having another scan, it did mean that not only did it cause delays and stress for my father and the family, it was also a cost to the NHS, which could have been avoided. Communication problems between departments Then around the same time, the hospital wanted to do another scan on my father to prepare for the surgery. Again, as it was urgent, I kept ringing the hospital asking if he had his scan yet but because my father was under the vascular and cardiac departments it was often difficult to know who to speak to because one department needed information from the other and they hadn't received it. So I’d get through to one department who then told me to phone another department, or I would be put on hold by someone from admin who didn’t know the answer and would say they’d ring back but didn’t because they were very busy. As a carer/relative you don’t know what’s happening and you become worried that your loved one is lost in the system. I persisted in phoning but, coincidentally, at the same time my sister visited my father’s house to pick up some bits for him. She saw there was a letter from the hospital so she opened it and it was a letter inviting my father in to have an outpatient appointment scan in the hospital he was an inpatient in! I ended up going to PALS. The lady I spoke to was understanding, sympathetic, kind and highly efficient. But she told me this happened all the time as the radiology department doesn't have access to the hospital's IT system, so they wouldn't know my father was an inpatient and would have just invited him in in a timely way but they would have done that as if he was an outpatient. I coordinated between the different departments and we finally got the scan for my father, he had the surgery and survived. However, these delays could have compromised his health because the surgery was urgent and if he had deteriorated whilst waiting that may have killed him. As a family we were very conscious that time was of the essence and we had to push continuously. Lack of information given to families These are just two examples from a multiple of occasions where we as a family were trying to get information. My father was elderly and wouldn’t have questioned the doctor. And because of his cognition issues due to his dementia, and also because he was on high doses of pain medication, he becomes confused and we couldn’t always rely on what he told us. However, often the healthcare professionals wouldn’t tell us things, despite me being next of kin and with documented power of attorney, and told us to speak to my father. So as a carer or relative you are trying to join the dots and work within a health system that isn’t coordinated. What I want to see change On the face of it they may seem like quite small examples, but when they build up, they are significant in terms of risk. My father was a high-risk patient and if it wasn’t for our diligence and persistence he would have fallen through the cracks, to a significant detriment to his health. I didn’t want there to be avoidable harm, an investigation and ‘lessons learned.’ I want us to be working in a coordinated and proactive manner to recognise the risks and void any harm. And for that insight to be used to ensure systems and processes are improved for the benefit of other patients and families. Also, I want opportunities to share my experience, not as a formal complaint but for genuine interest in our family’s customer experience. Again, for learning and future preventative action not for blame. *The names in this blog have been changed to ensure anonymity. Are you a patient, relative or carer frustrated with navigating the healthcare system? Or is your GP practice or Trust doing something innovative to make it easier for patients? We would love to hear your stories. Please add to our community forum (you will need to register with the hub, it's free and easy to sign up) or email us at [email protected]. Related reading The challenges of navigating the healthcare system: David's story The challenges of navigating the healthcare system: Sue's story Navigating the healthcare system as a university student: My personal experience Lost in the system? NHS referrals "I love the NHS, BUT..." Preventing needless harms caused by poor communication in the NHS (DEMOS, November 2023) Robust collaborative practice must become the bedrock of modern healthcare Robbie: A homeless patient’s struggles with the system Digital-only prescription requests: An elderly woman sent round the houses Lost in the system: the need for better admin Digital-only prescription requests: An elderly woman sent round the houses
  14. Content Article
    Research led by Lancaster University has revealed that the exceptional circumstances early in the Covid-19 pandemic led to distressing experiences of death and dying in care homes. Not only did care homes suffer significantly high death rates amongst residents , but this was compounded by the impact of social distancing restrictions on family visiting and external support from palliative care teams for some care home residents dying in the early months of the pandemic. The study was led by Lancaster Professor Nancy Preston of the International Observatory on End-of-Life Care with colleagues from Newcastle University and the University of Sheffield. The research explored the impact on care homes of the early waves of the pandemic between Autumn 2020 and Summer 2021. Interviews were conducted with 16 UK care home staff , three residents , five family members and health service staff working with ten care homes , exploring their experiences of death and dying. Experiences of death and dying in care homes were particularly distressing for staff and families at this time for a number of reasons. Preparing for large scale deaths The findings suggest that care home staff found the prospect of preparing for, and managing a large number of deaths particularly difficult, with one care home manager telling researchers that “Just before lockdown we had a nurse came to the home and said to us, ‘Right you need to be prepared to hold bodies in the care home. Do you have any cold bedrooms where you can hold bodies?’ … and I think that kind of hit us.” Policing family visiting due to social distancing restrictions Care home staff also found it very distressing enforcing strict social distancing restrictions on family visits when a care home resident was dying, which often brought them into conflict with their personal and professional instincts for supporting residents and families at these times. One care home worker said: “It’s just an awful position to be in because who are we to say they can’t say their goodbyes and for how long. That’s the bit that I find difficult.” Distress surrounding deaths for all involved Social distancing regulations were clearly also very distressing for families. As well as time restrictions on visits, they also had to choose a single family member to visit, which was difficult for all involved, and could cause family conflict. The findings suggest that the impact of these factors continued to affect families some months after their bereavement, with one telling researchers: “To end his life without having anyone there with him that he knows. That is just a terrible way to go and I don’t think we’ll ever forgive that really.” Staff also found resident deaths extremely distressing, particularly witnessing the rapid decline of residents whom they had often known and worked with for months or years. They reported not being able to offer the type of end-of-life care that they would wish to, and some felt they had limited external support in managing end-of-life care. Professor Nancy Preston said: “We don’t yet know the long-term impact of this distress for care home staff and families, but planning for future crises should have clear policies for end-of-life care, including prioritising family visiting and ensuring consistent access to external support services including specialist palliative care.”
  15. Content Article
    More information about "The challenges of navigating the healthcare system: David's story"
    We hear time and time again on the hub about the lack of joined up care and communication within and across organisations. Patients and their families and carers not knowing who to contact to chase up a referral, having to travel miles for appointments, miscommunication, diagnostic errors, or having to repeat the patient’s history and medications to every new healthcare professional they see because the notes haven’t been shared or clinicians "don’t have time to read them all". These issues are widespread and urgently need to be addressed if we are to prevent people falling through the gaps and suffering worse health outcomes. In this blog, David* shares his story about his elderly sister and a mix up with an urgent referral which led to a near miss. Background My sister has cancer and she's got a diagnosis of dementia too. The cancer is very aggressive and it causes her a lot of pain. Her care team are managing her pain very well. Due to her age and frailty, chemotherapy was out of the question but she had surgery and it seemed to go well. She was having routine check ups post-op to monitor her. An urgent referral A few months later unfortunately the cancer came back and we got an urgent referral from her GP for her to see her consultant. So when within a couple of weeks we got an invite to the hospital for an appointment we assumed it was for her urgent cancer referral. When we got to the appointment, neither the consultant or her advanced nurse practitioner team, who were all familiar with her diagnosis and history, were there. Instead there was a junior doctor on his own. He asked my sister how she had been since her surgery and was she doing well. When my sister said, well no, the tumour had grown significantly and we think the cancer had come back, he went white and rushed out of the room saying he needed to speak to someone else. Communication issues He came back and said my sister would need 20 days of successive radiotherapy in the hospital (which is at least a two-hour round trip). We had many questions we wanted to ask but he wasn’t able to answer them, and I was very concerned whether this was the right course of treatment for her. There were a number of issues—I had questions about how aggressive the cancer was, whether the cancer had spread elsewhere, whether this was palliative or curative treatment, what impact this would have on my sister’s health. Radiotherapy is harsh and my sister was physically very frail. In the end, because I phoned the advanced nurse practitioner and explained what had happened and my concerns, we were invited back for another appointment, and a few days later we saw the consultant. On the advice given, my sister was told about the significant risks and unsuitability of radiotherapy because of her co-morbidities and she decided not to go ahead with the radiotherapy. This was a relief as I didn’t want her to have unnecessary treatment, especially treatment that would not address her cancer and make her remaining months painful and distressing. The consultant was wonderful, and I’ve written him a lovely letter thanking him, but there has been a big communication issue here which could have led to a different outcome altogether. A 'near miss' The issues here, as I see them, are that the urgent referral got mixed up with the routine post-op appointment, which led to a doctor in training being placed in a situation for which he was untrained and unprepared in making significant treatment decisions. The advice he received and acted upon was from an unnamed consultant who didn’t even speak with or examine my sister. There is also the fact that they didn’t have a conversation with my sister about her options and they just told her she needed the radiotherapy. This is not informed consent! If we hadn't been there with her and questioned it, would she have had that course of treatment, accepted the radiotherapy, even though it was completely unnecessary, which would have led to avoidable harm? This really is a big ‘near miss’. What would have happened if she hadn’t had anyone there to intervene and advocate for her. She has absolute confidence in the health system but, for her family trying to navigate the system, this was incredibly stressful. What happens to the patients who haven’t got a family around to support and advocate for them? We need to look at the whole care pathway and try to design it from the patient and family’s perspective. *The names in this blog have been changed to ensure anonymity. Are you a patient, relative or carer frustrated with navigating the healthcare system? Or is your GP practice or Trust doing something innovative to make it easier for patients? We would love to hear your stories. Please add to our community forum (you will need to register with the hub, it's free and easy to sign up) or email us at [email protected]. Related reading The challenges of navigating the healthcare system: Margaret's story The challenges of navigating the healthcare system: Sue's story Navigating the healthcare system as a university student: My personal experience Lost in the system? NHS referrals "I love the NHS, BUT..." Preventing needless harms caused by poor communication in the NHS (DEMOS, November 2023) Robust collaborative practice must become the bedrock of modern healthcare Robbie: A homeless patient’s struggles with the system Digital-only prescription requests: An elderly woman sent round the houses Lost in the system: the need for better admin Digital-only prescription requests: An elderly woman sent round the houses
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    The abuse and neglect of older people in care homes is widespread across England, but current causative explanations are limited and frequently fail to highlight the economic and political factors underpinning poor care. Informed by social harm and state–corporate crime perspectives, this study uses ethnographic data gathered through a nine-month period of working in an older person’s residential care home to show how neglect is embedded in working routines. Three aspects of care are interrogated to reveal the embedded nature of harm in the home; all reveal the rift between official, regulatory rules and informal working practices shaped by material constraints of the labour process. This article explores the role of regulatory regimes in actively legitimising sectors, such as the residential care industry, even in the face of routine violence, by bureaucratically ensuring the appearance of compliance with formal rules. While the harms of contemporary institutionalised care for older people have its roots in material conditions, performative compliance through regulation guarantees that these injurious outcomes are concealed. This article contends that malpractice (and harm) can be explained with reference to conjoint state–corporate relationships and practices.
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    Adult social care covers a large range of services given to the frail and disabled, from home visits to end-of-life care. The sector employs 1.6 million people in England (about the same as the NHS). There are many concerns about the sector: staff shortages, low pay, rising costs, poor conditions, patchy quality etc. But with a rapidly ageing society, the main area of worry is old-age care, and how to pay for it. The NHS Confederation estimated that in 2019/20 alone, 855,000 emergency admissions to hospital of older people could have been avoided with the right care at the right time. And as of September 2024, 13% of NHS hospital beds were occupied by people waiting for social care.
  18. News Article
    New cases of dementia in the United States are projected to double in the next three decades, a new study suggests. The study, published this week in the journal Nature Medicine, looked at more than 15,000 people and estimated the lifetime risk of dementia from ages 55 to 95. The team—including researchers from Johns Hopkins University, Mayo Clinic and New York University—projected new US dementia cases would double from more than 500,000 in 2020 to approximately one million by 2060. The authors said this increase is directly tied to the ageing of the US population. The study also showed that the risk of developing dementia after age 55 is 42%, more than double the risk seen by older studies. After age 75, the lifetime risk increases to more than 50%, according to the study. "Our study results forecast a dramatic rise in the burden from dementia in the United States over the coming decades, with one in two Americans expected to experience cognitive difficulties after age 55," Dr Josef Coresh, a study senior investigator, epidemiologist and founding director of the Optimal Aging Institute at NYU Langone, said. Read full story Source: ABC News, 14 January 2025
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  20. News Article
    An 84-year-old man with heart conditions endured an agonising three-hour wait for an ambulance while lying on his damp driveway after breaking his hip. Graham Woolston was driven to his home in Lowestoft, Suffolk, by his son Daniel Woolston last Friday before falling and injuring himself at about 22:20 GMT. Despite his age and pre-existing medical conditions, coupled with the cold weather, paramedics did not arrive at the scene until about 01:20 GMT. Neill Moloney, chief executive of East of England Ambulance Service (EEAST), said: "We would like to apologise sincerely to Mr Woolston and his family." Mr Woolston had just spent eight hours in James Paget University Hospital, Gorleston, Norfolk, after experiencing dizziness over Christmas. But after arriving home, he stumbled out of his son's car and hit the floor, shattering his hip and leaving him in excruciating pain. After calling for an ambulance Daniel, 47, and his sister, with the help of neighbours, covered him in a duvet and blankets and used an umbrella to keep him dry. Within an hour and a half of the fall, Mr Woolston started to look "a bit pale", so Daniel called the ambulance service again, but to no avail. He was, however, told to get a defibrillator kit in the event his dad went into cardiac arrest, which he interpreted as being asked to "play paramedic". Read full story Source: BBC News, 3 January 2025
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    Rachel Reeves’ Budget measures will devastate care providers, leaving vulnerable disabled and elderly people without care next year, healthcare experts are warning. The disastrous scenario could also bankrupt local authorities, care providers say. The rise in employers’ national insurance in April, together with increases in the minimum wage and national living wage, will threaten the future of care companies, according to the Homecare Association, a membership body for care providers. The association says that if care providers fold, the UK risks widespread failure of care provision, which could “leave people without care, overwhelm family carers and cripple NHS services”. Read full story Source: The Independent, 15 December 2024
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    The National Medicines Symposium 2024 session recordings are now available. Whether you missed a session or want to revisit the insightful discussions, you can now explore the key highlights from the event. Panel highlights to explore: Managing Medicines for an Ageing Population – Hear from Professor Jennifer Martin, Professor Libby Roughead and Mr Steve Waller on challenges of medication safety in an ageing population such as polypharmacy and multimorbidity and opportunities for improvement. Deprescribing in Practice – Join Professor Sarah Hilmer AM, Dr Lisa Kouladjian O’Donnell and Professor Jenny May AM as they explore practical approaches to safely deprescribe medications when the risks outweigh the benefits, ensuring patient safety. Digital Tools for Safe Medication Use – Gain insights from Professor Melissa Baysari, Mr Michael Bakker, Ms Kate Oliver and Ms Alice Nugent on how innovative digital tools can be leveraged to enhance medication management.
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    An elderly man was left unable to swallow after waiting over two days in A&E without being given regular medication, and died four weeks later. In a “shocking” case that has raised fresh concerns over the state of urgent NHS care, the 85-year-old was sent to a hospital emergency department after a routine appointment. Amid massive delays, his A&E wait went into a third day, with most of it spent on a bed in the corridor. He had Parkinson’s disease and required medicine at various intervals to control his symptoms. During his time in A&E, the man should have received 18 doses but seven were not given and three were given late, according to a report from the Health Services Safety Investigations Body (HSSIB). The report, which does not name the patient or hospital, highlights how the man was advised to go to A&E after complaining of back pain following a fall at home the day before. After 52 hours in A&E, he was finally admitted to a ward where his Parkinson’s symptoms deteriorated and he lost the ability to swallow, the HSSIB said. He died four weeks later, with the causes of death listed on the death certificate as a severe chest infection, Parkinson’s and frailty of old age. The HSSIB report highlights how the man spent most of his time in A&E on a bed in a corridor because of demand on services. Corridor care can cause problems for emergency staff because there are “limited opportunities to store medication brought from home”, the authors said. Read full story Source: The Guardian, 5 November 2024 Further reading on the hub: Professionals with Parkinson’s tackle time critical patient safety issue: a blog by Sam Freeman Carney Parkinson's UK: Time critical medication guides for health professionals Medication delays: A huge risk for inpatients with Parkinson’s A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift
  24. News Article
    A 95-year-old woman was left on a cold pavement for more than five hours waiting for an ambulance after the emergency services told a bystander trying to help her that she wasn’t a priority. Winifred Soanes fell and broke her hip on Christchurch High Street in Bournemouth on 25 November. Her husband Andrew, 92, “wouldn’t leave her side”, and several people in the area tried to help out, with local businesses offering essentials to help Winifred. Jennifer Baylis, who works at a nearby Prama charity shop, helped throughout the day. She said: “I can’t tell you how upsetting it was, she actually said, ‘I’m going to die here tonight’”. Ms Baylis said a number of people attempted to call an ambulance to help Winifred, but they were given no timeframe and told she was not a priority by the emergency services. Winifred was eventually taken to Poole Hospital for treatment and is waiting for an operation, he said. David Lovell, a bystander who was the first to call for an ambulance, said: “I can’t describe how cold it was, and as it got dark, the temperature dropped really quickly. “She was lying on the cold pavement, and we couldn’t move her because she was in huge amounts of pain”. Read full story Source: The Independent, 1 December 2024
  25. Content Article
    More information about "Sexual assaults against older people in hospitals: awareness and support are key to reducing harm (by researcher, Amanda Wynn)"
    Amanda Wynn is an independent consultant, researcher and trainer based in Cambridgeshire, specialising in older and disabled survivors of domestic abuse and sexual violence. In this blog, Amanda talks about her recent research into sexual assaults against older people by hospital staff. She shares an overview of her findings and calls for greater awareness and support. Motivated by a patient death I undertook my first research into sexual assaults against older people by hospital staff in 2021, after reading about the horrific case of an older patient who died from internal haemorrhaging due to severe vaginal injuries. A member of staff was arrested on suspicion of rape, but ultimately was not charged. I found it staggering that more people weren't aware of what happened to this lady. After placing a post saying as much on social media, I received messages indicating that this wasn't the isolated case I assumed it was. I was curious to know how often older people in hospital are being sexually assaulted by staff - people in positions of trust who should be caring for patients. So, I decided to find out for myself. The findings: increasing numbers, bias and poor support As I don't receive any funding for my research, I had to rely on freedom of information (FOI) requests to get data from NHS England trusts. I looked at the number of incidents reported to staff and recorded on the hospital’s incident system over a 5 year period, from 2016/17 to 2020/21 (financial years). My first paper highlighted at least 75 incidents of sexual assault against patients aged 60+ in NHS Hospitals in England, where the alleged perpetrator was a member of staff. I was surprised by the numbers but also at the responses to the follow-up questions I asked about support for these survivors. In the vast majority of cases, there was no referral to specialist services. Only 21% (16) of the incidents recorded were reported to police. Of these 16, all but two had ‘no further action’ taken. I don’t have the data on how the other two progressed so it is unclear whether any convictions were made. I was keen to review the data to see if anything had changed, so I undertook a similar research project in early 2024. This time, the number of reported incidents was much higher over a shorter reporting period (at least 274 incidents over three years). Once again, the number of victims being referred to Sexual Assault Referral Centres or specialist support was very low. Responses to both sets of FOI requests included anecdotal comments from professionals making worrying assumptions about the reliability of people with dementia when disclosing sexual assault. It was also interesting to note that male victims in reported incidents had a higher prevalence than male victims of sexual assault in general - potentially highlighting an increased risk of sexual assaults against older men in hospital. Limited data but a sad fundamental truth Due to lack of funding for my research, I was able to merely touch the surface and report only quantitative data. That means I am unable to determine if the increase in the number of reported incidents is due to more sexual assaults against older people happening. Or if improved reporting and data recording methods can account, either fully or partially, for the increase. However, what is clear is that older patients in hospital are at risk of sexual assault from the very people who should be assuring their well-being and safety. Opportunity for positive change to reduce harm The main aim of my research is to raise awareness of the issue among front-line professionals. Whilst this can include the potential perpetrators, most will be the people who are best placed to stop such incidents, and to ensure an appropriate response when an incident is reported. NHS England has strengthened its approach to domestic abuse and sexual violence in recent years with duties placed on staff to record and report incidents. There may still be some complacency about how genuine patient reports are though, and therefore less emphasis on support. It's also important for both health care staff and the general public to be aware that sexual assaults in hospital do happen. More awareness of the issue will hopefully lead to more survivors being able to disclose and getting the right support when they do. I would like to develop some training for health and social care staff around responding to disclosures of sexual assault and violence from older people - this will likely be in an eLearning format - but I am keen for access to the training to be free. Too much essential knowledge sits behind paywalls making it prohibitive for the target audience to access. I have the content, but if anyone can help with a platform for hosting and developing online training it would be great to hear! You can contact me at [email protected] if you would like to hear more about my research or the online training. Hopes for the future I would like all health and social care workers to be much more aware of sexual assault against older people - not just in hospitals but in care homes and the community too. Funding for services needs research and data to back it up - my research only touches the edge of the issue and it would be great if more research and eventually specialist support for older survivors of sexual violence can lead on from it. I’d just like to add that I'm really grateful to Hourglass for publishing my research to help get the word out as wide as possible. And, of course, to Patient Safety Learning for giving me the opportunity to share the findings too. Related reading Sexual violence and assault against older people in NHS hospitals in England (2024) Doctors practising despite sexual assault and rape allegations Hundreds of social care residents allegedly sexually assaulted, watchdog reveals Share your insights If you would like to comment on this article or any of the articles published on the hub, please sign up here (for free) and contribute your thoughts and insights below. If you'd like to write about a patient safety issue, experience or improvement project, please read our guide to writing a blog, or contact the editorial team at [email protected].

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