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Found 48 results
  1. News Article
    Waiting lists for treatment in 2019 were at record levels, with the proportion of patients waiting less than 18 weeks for treatment at its lowest level in a decade. Cancer waiting times were the worst on record, with 73% of trusts not meeting the 62-day cancer target. Waiting for diagnostic tests was at the highest level since 2008: 4.2% of patients were waiting over six weeks against a target of less than 1%. On 17 March 2020, NHS England and NHS Improvement asked trusts to postpone all non-urgent elective operations to free up as much inpatient and critical care capacity as possible. At this point, there were 4.43 million people on waiting lists for consultant-led elective treatment. It is imperative that we open a national debate on what the NHS can deliver in a resource-constrained environment. To translate into action, this must involve patients, clinicians, system and regional leaders, the public and politicians. Such a debate is long overdue: current methods for prioritising elective care, such as referral to treatment or the 62-day cancer standard, are no longer fit for purpose. Read full story (paywalled) Source: HSJ, 14 July 2020
  2. News Article
    A former senior NHS official plans to sue the organisation after he had to pay a private hospital £20,000 for potentially life-saving cancer surgery because NHS care was suspended due to COVID-19. Rob McMahon, 68, decided to seek private treatment after Worcestershire Acute Hospitals NHS trust told him that he would have to wait much longer than usual for a biopsy. He was diagnosed with prostate cancer after an MRI scan on 19 March, four days before the lockdown began. McMahon was due to see a consultant urologist on 27 March but that was changed to a telephone consultation and then did not take place for almost two weeks. “At that appointment, the consultant said: ‘Don’t worry, these things are slow-growing. You’ll have a biopsy but not for two or three months.’ I thought, ‘that’s a long time’, so decided to see another consultant privately for a second opinion.” A PET-CT scan confirmed that he had a large tumour on both lobes of the prostate and a biopsy showed the cancer was at risk of breaking out of the prostate capsule and spreading into his body. He then paid to undergo a radical prostatectomy at a private Spire hospital. “This is care that I should have had on the NHS, not something that I should have had to pay for myself. I had an aggressive cancer. I needed urgent treatment – there was no time to waste,”, he said. “With the pandemic, he added, “it was almost like a veil came down over the NHS. He worked for the NHS for 17 years as a manager in hospitals in London, Birmingham and Redditch, Worcestershire, and was the chief executive of an NHS primary care trust in Leicester.” Mary Smith of Novum Law, McMahon’s solicitors, said: “Unfortunately, Rob’s story is one of many we are hearing about from cancer patients who have been seriously affected by the disruption to oncology services as a result of COVID-19." Read full story Source: The Guardian, 11 July 2020
  3. News Article
    A quarter of people who sought help for mental health problems during lockdown were unable to access NHS services, a new survey shows. A survey by the mental health charity Mind found that 25% of respondents who contacted primary care services could not get support. More than a fifth (22%) of adults with no previous experience of poor mental health now say that their mental health has deteriorated, according to the survey. Many people who were previously well will develop mental health problems as a “direct consequence of the pandemic and all that follows”, according to Mind. Two out of three (65%) adults aged 25 and over and three-quarters of young people aged 13-24 with an existing mental health problem reported worse mental health during the lockdown. Mind predicts that prolonged worsening of wellbeing and “continued inadequate access” to NHS mental health services will lead to a marked increase in people experiencing longer-term mental health problems. Read full story Source: The Independent, 30 June 2020
  4. Content Article
    The charities have put together a 12-point plan across the two phases of the pandemic that NHS England are planning for, restoration (phase II) and recovery (phase III). Across all of these recommendations close monitoring and adequate action is needed to ensure inequalities are addressed. In addition, they have set out plans to get the significant transformation agenda for June 2020 cancer services back on track, as simply restoring to pre-COVID-19 levels and models of service is not sufficient to deliver the improved outcomes that patients in this country expect and deserve. Keeping baseline services running. Covid-protected environments. Diagnosis and referrals. Personalised care. Clinical trials. Supporting the vulnerable. Preventing cancer. Workforce. Screening programmes. Guidance. Innovation. Long-term ambitions.
  5. Content Article
    The outpatient appointment Attending an outpatient appointment, in my experience, is daunting at the best of times. First, there is the appointment date. Often you have had to wait an exceptionally long time for this appointment (providing the referral letter hasn’t been lost). The date and time are chosen by the Trust. There are some Trusts and specialities that will allow you to choose a time and place, but more often than not you are not able to choose and changing the date and time can prove tricky. There are many reasons for a patient not to turn up for an appointment. These reasons and how to mitigate them are looked at by Trusts. The 'Did not attend' (DNA) rate is looked at by Trusts. DNAs have an enormous impact on the healthcare system in terms of increasing both costs and waiting times. Trusts often want to reduce these to: reduce costs improve clinic or service efficiency enable more effective booking of slots reduce mismatch between demand and capacity increase productivity. Then there is getting there. Getting time off work or college, making childcare arrangements, getting transport… finding parking! Before patients even get to the appointment, they have often been up a while planning this trip. Imagine what this must be like for a patient with learning disabilities. This poses even more planning. What medication might we meed to take with us? Are there changing facilities for adults? Can we get access? Is there space to wait? Will anyone understand me? How long will we be there for? Do they have all my information? Services need to be designed with patients' needs at the forefront: the ability to change appointment dates, the location in where the appointment is held, parking facilities, length of appointment, type of appointment, is a virtual appointment or telephone appointment more appropriate? If you have a learning disability, you may have a family member or carer with you. If you have transitioned out of children’s services you will be seeing someone new, in a new environment. You may not have had the time to discuss the fine nuances to your care that is really important to you. You have now left the comfort bubble of paediatrics where you and your family had built up trust with the previous consultant and care team, and you are now having to build up new relationships. What is in place for you to feel comfortable? Has anyone asked what would help? The consultation Reasonable adjustments such as a double-length consultation is a great way of ensuring people with learning disabilities have enough time to process information and are given time to answer questions. Extra time is only one of many reasonable adjustments that can be made. An example... I would like to reflect on a recent time when I cared for a patient with autism and I didn’t have all the information to enable me to plan care for them at this particular time. This patient had spinal surgery and spent a very brief period on the intensive care unit. As part of my role as a critical care outreach nurse, I see patients who have been in the intensive care unit to check that they are doing well, that ongoing plans of care are in place and that they understand what has happened to them. I read that this patient had autism, but I had no other information. I was unaware of how the autism affected her, if she needed a carer, what she likes, dislikes, how to approach conversations or anything that was important to her. There is a health passport that can be used to aid exactly this information, this is filled out by the patient with their family or carer. Unfortunately, I could not locate the passport. I read the medical notes and went in armed with my usual questions and proforma that we use for all patients. Usual visits like this last from around 10 minutes (for a quick check) to an hour if they are a complex long stay. With the operation that this patient had, I was expecting to be with the patient for around 20 minutes. After introducing myself to the patient, it was clear that the proforma I was going to use wasn’t going to work. Tick boxes and quick fire questions were not the right way of going about this consultation. This patient was scared. More scared than a patient without autism. Their usual routine was gone, they were unable to ask as many questions as they normally would as the nurses and doctors were busy, their surroundings were different, the food was different, new medications, new faces everyday – there was no consistency. The ward round had just happened, the patient had a good plan in place and was due to go home the following day. Normally, this would mean that my visit would be a quick one as the clinical needs of the patient are less complex. This visit took me 90 minutes. Not only did I not have the care passport to hand, due to the coronavirus pandemic I had a face mask on. I felt completely ill-equipped for this consultation. I knew I was missing vital pieces of information which would help me communicate with this patent more effectively. So much of our communication is from facial expressions. A smile for reassurance makes a huge difference. I now have yet another barrier to overcome to communicate with my patient in a way that they can understand and feel comfortable. This particular patient asked many questions. This I had not factored into my day. I have a list of 12 patients to see, in between answering calls from staff on wards who have unwell patients for me to review. It’s too late to abandon the consultation or leave it for a less busy time. I’m at the patient’s bedside and I’m already committed to giving this patient my full attention. After we spent around 20 minutes discussing why I had to wear a mask, what the mask was made of, how many I had to wear in a day, why patients were not wearing masks, we then got onto the subject of food. Where the food is made, how does it get here, who heats it up? Then it came to the other patients in the bay. She knew all of them by name and proceeded to tell me the goings on that happened during the night. I’m clearly not going to get my proforma completed here. This is because my proforma is not important to my patient. "What matters to you?" During my Darzi Fellowship I had the opportunity to visit the Royal Free. Here I met an amazing physiotherapist called Karen Turner. She introduced me to asking the question ‘What matters to you?’ Simple – but so very effective and empowering for your patient to be asked this. The food, my mask and the people around her were of greatest importance to my patient at this time – not what she thought of her stay or if she wanted me to go through the intensive care unit steps booklet; these were important for me to know, these were questions that gave the Trust insight of what is important to them. It dawned on me that we had designed our follow-up service to suit us and not involved families or the patient. I feel a quality improvement project coming on! Reasonable adjustments take planning, as clinicians we need to know about them. We need to factor them into our work. The NHS has just enough capacity to run if all patients followed the NHS pathways, if all patients grasped everything and followed all instructions, took their medications on time, turned up for their appointments – there wouldn’t be a problem. It takes me back to the clip from the BBC programme ‘Yes Minister’ of the fully functioning hospital with no patients and that services run very well without patients! Currently systems within the NHS are designed around the building, the staff within it and the targets that are set out by NHS England and the Department of Health and Social Care. If we started designing care and access around patient need and ask them what would make it easier – what helps? what matters to you? – what would healthcare look like? During this time of uncertainty and change, I see exciting opportunities to take stock and see what’s working and what isn’t – and lets start involving patients at every stage. Call to action What are you doing to ensure reasonable adjustments are made for people with learning disabilities where you work? What more needs to be done to ensure that people with learning disabilities feel part of the conversation and play an active role in their care? Are you a patient, carer or relative? What has your experience been like? Have you any experiences in designing services with patients? Perhaps you are a patient and have been a part of the process. Add your comments below, start a conversation in the Community area or contact us. We'd love to hear your thoughts and experiences.
  6. Content Article
    It has now been over 70 days since lockdown. Yes, the restrictions are easing – and this is great news for people who have been isolated for so long, it is great for the economy – but we are waiting for the second wave. My last blog spoke about how we are going to get back to ‘normal work’ and my anxieties about how we were going to do this. Slowly, we have been trying to get back to some kind of normal, but it feels confusing, slow and uncertain. None of us can see the ‘end’. None of us knows what the ‘end’ will look like, when it will happen or will even know when it happens. Remembering the early days of lockdown, the streets were empty, the roads were quiet, there were huge queues for food, and everyone seemed scared. It was a little like the post-apocalyptic film '28 Days Later'. We have all had our highs and lows: the NHS clap every Thursday, rainbows in windows, connecting with family, being furloughed, has meant some people have enjoyed lockdown. The flip side is that for some it has been a living nightmare: money worries, domestic violence, child abuse, operations cancelled and bereavements. Unlike the film that lasts 113 minutes, has a set plot that it follows and ends up with them being rescued, we are still stuck 70 days plus in and there seems no hope of a rescue. Real life does not offer us closure, does not always have a happy ending and, unlike dramas on the BBC, life is not always fair. I’m not even sure we are in the middle, which makes me feel even more helpless. I have been nursing for over 20 years. I have loved working with patients; I have even loved working in the institution that is the NHS. The politics, the hierarchy, the culture, yes, it's difficult work trying to negotiate around obstacles and blockers, but we do it and, weirdly enough, enjoy it. But this pandemic is different. In all honesty, I can’t do this anymore. Work was hard enough, but now it’s even harder. Knowing how to care for patients safely in the right area, wearing PPE all day, not being able to communicate properly through the masks, and having procedure and policy changing weekly, sometimes daily, is wearing. I feel like a new starter every day, especially after days off. I’m tired of it and can’t see an end. Due to this lack of enthusiasm, I feel I am failing at giving the care I want to, failing to give patients the care they deserve. This feeling is horrible. What kind of a nurse are you if you have ‘run out of care’? I know this is burnout. I didn’t want it to be. But it is. In January, I didn’t feel like this. This burnout has been because of the pandemic. I am interested to find out why now? I can’t be burnt out from a few months of difficult working conditions, can I? While looking into this and trying to make sense of my feeling, I came across Kanter’s Law. Rosabeth Kanter is a Harvard Business School Professor and according to her “in the middle, everything looks like a failure". Everyone feels motivated by the beginnings and obviously we love happy endings, but it is in the middle where the hard work happens. She states that in the middle, we all have doubts. This feeling is principally produced because important changes are not developed the way we would like it to, lineal and smooth. The changes that remain usually involve two steps forward and one step back. This is evident when we are trying to get back to ‘business as usual’ but new cases of the virus are detected and we can’t proceed as we thought. In addition, it’s easy to feel that when we are in the middle we are very far away from the expectations we had made. Unexpected events take place as well as deviations. What it had been estimated in regard to the need of resources appear to not be enough. It is then when despondency appears. We can’t plan, we can’t mitigate risks effectively, which often leads us into failure. This is why it’s important to fully understand that failure is a necessary part of change, because there will be periods of confusion in which the temptation to abandon will be great. I’m at the abandon bit! This work is difficult. I am not in the position where I can make big changes in my Trust. I must trust that others are making good decisions and they will support us if things don’t go as expected. Call to action I can’t be the only person feeling this now. What are Trusts doing to guide staff through uncertainty, prevent burnout and inform staff of plans for the future?
  7. News Article
    In many ways it is wrong to talk about the NHS restarting non-coronavirus care. A lot of it never stopped — births, for instance, cannot be delayed because of a pandemic. However, exactly what that care looks like is likely to be very different from what came before. There are more video and telephone consultations and staff treat patients from behind masks and visors. That is likely to be the case for some time, experts have told The Times. Read full story (paywalled) Source: The Times, 6 June 2020
  8. 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
  9. Content Article
    These guides include: Surgical patients Othopaedics Critical care Endocrinology Trauma Acute General medical Burns Cancer ED Paediatrics NIV Rheumatology Management of COVID positive patients Cardiothoracics plastics Max Fax Vascular Spinal Surgery Radiology Cardiology Muscular Skeletal Haematology Maternity TB.
  10. News Article
    St Bartholomew’s Hospital is to be the emergency electives centre for the London region as part of a major reorganisation to cope with the coronavirus outbreak. Senior sources told HSJ the London tertiary hospital, which is run by Barts Health Trust, will be a “clean” site providing emergency elective care as part of the capital’s covid-19 plan. It is understood the specialist Royal Brompton and Harefield Foundation Trust will also be taking some emergency cardiac patients. The news follows NHS England chief executive Sir Simon Stevens telling MPs on Tuesday that all systems were working out how best to optimise resources and some hospitals could be used to exclusively treat coronavirus patients in the coming months. Read full story (paywalled) Source: HSJ, 18 March 2020
  11. News Article
    NHS patients could be denied lifesaving care during a severe coronavirus outbreak in Britain if intensive care units are struggling to cope, senior doctors have warned. Under a so-called “three wise men” protocol, three senior consultants in each hospital would be forced to make decisions on rationing care such as ventilators and beds, in the event hospitals were overwhelmed with patients. The medics spoke out amid frustration over what one said was the government’s “dishonest spin” that the health service was well prepared for a major pandemic outbreak. The doctors, from hospitals across England, said the health service’s existing critical care capacity was already overstretched and “would crumble” under the demands of a pandemic surge in patients who may all need ventilation to help them breathe. Those denied intensive care beds could be those suffering with coronavirus or other seriously ill patients, with priority given to those most likely to survive and recover. Doctors said this would lead to “tough decisions” needing to be made about the wholesale cancellation of operations to free-up beds. Read full story Source: Independent, 28 February 2020
  12. News Article
    Prisoners in Britain frequently have hospital appointments cancelled and receive less healthcare than the general public, a new study has found. As many as 4 in 10 hospital appointments made for a prisoner were cancelled or missed in 2017–18, with missed appointments costing the NHS £2 million. The in-depth analysis of prison healthcare by the Nuffield Trust think tank examined 110,000 hospital records from 112 prisons in England. It revealed 56 prisoners gave birth during their prison stay, with six prisoners giving birth either in prison or on their way to hospital. The Nuffield Trust said its findings raised concerns about how prisoners are able to access hospital care after a cut in the number of frontline prison staff and a rising prison population. Lead author Dr Miranda Davies, a senior fellow at the Nuffield Trust, said: “The punishment of being in prison should not extend to curbing people’s rights to healthcare. Yet our analysis suggests that prisoners are missing out on potentially vital treatment and are experiencing many more cancelled appointments than non-prisoners.” Read full story Source: The Independent, 26 February 2020
  13. Content Article
    Key findings Prisoners use hospital services far less and miss more hospital appointments compared with the general population. There is a noticeable drop in emergency admissions to hospital from the prison population in December. This is something that is not seen in the general population. Prisoners have particular health needs related to violence, drug use and self-harm. Injury and poisoning were the most common reason for prisoners being admitted to hospital. Hospital data reveals potential lapses of care within prisons for certain groups of prisoners, particularly pregnant women and prisoners with diabetes.
  14. News Article
    NHS leaders have urged Boris Johnson’s government to build 100 new hospitals and give the service an extra £7bn a year for new facilities and equipment. They want the Prime Minister to commit to far more than the 40 new hospitals over the next decade that the Conservatives pledged during the general election. So many hospitals, clinics and mental health units are dilapidated after years of underinvestment in the NHS’s capital budget that a spending splurge on new buildings is needed, bosses say. Too many facilities are cramped and growing numbers are unsafe for patients and staff, they claim. Johnson has promised £2.7bn to rebuild six existing hospitals and pledged to build 40 in total and upgrade 20 others, although has been criticised for a lack of detail on the latter two pledges. The call has come from NHS Providers, which represents the bosses of the 240 NHS trusts in England that provide acute, mental health, ambulance and community-based services. Read full story Source: The Guardian, 3 February 2020
  15. News Article
    Heart attack, stroke and burns victims are among the seriously ill and injured patients waiting over an hour for an ambulance to arrive in England and Wales, a BBC investigation shows. The delays for these 999 calls - meant to be reached in 18 minutes on average - put lives at risk, experts say. The problems affect one in 16 "emergency" cases in England - with significant delays reported in Wales. NHS bosses blamed rising demand and delays handing over patients at A&E. Rachel Power, Chief Executive of the Patients Association, said patients were being "let down badly at their moment of greatest need" and getting a quick response could be "a matter of life or death". She said the delays were "undoubtedly" related to the sustained underfunding of the NHS. Read full story Source: BBC News, 29 January 2020
  16. News Article
    England’s poorest people get worse NHS care than its wealthiest citizens, including longer waiting for A&E treatment and worse experience of GP services, a new study has shown. Those from the most deprived areas have fewer hip replacements and are admitted to hospital with bed sores more often than people from the least deprived areas. With regard to emergency care, 14.3% of the most deprived had to wait more than the supposed maximum of four hours to be dealt with in A&E in 2017-18, compared with 12.8% of the wealthiest. Similarly, just 64% of the former had a good experience making a GP appointment, compared with 72% of those from the richest areas. Research by the Nuffield Trust and Health Foundation thinktanks found that the poorest people were less likely to recover from mental ill-health after receiving psychological therapy and be readmitted to hospital as a medical emergency soon after undergoing treatment. The findings sparked concern because they show that poorer people’s health risks being compounded by poorer access to NHS care. Read full story Source: The Guardian, 23 January 2020
  17. News Article
    Dozens of hospital trusts have failed to act on alerts warning that patients could be harmed on its wards, The Independent newspaper has revealed. Almost 50 NHS hospitals have missed key deadlines to make changes to keep patients safe – and now could face legal action. One hospital, Birmingham Women’s and Children’s Foundation Trust, has an alert that is more than five years past its deadline date and has still not been resolved. Now the Care Quality Commission (CQC) has warned it will be inspecting hospitals for their compliance with safety alerts and could take action against hospitals ignoring the deadlines. National bodies issue safety alerts to hospitals after patient deaths and serious incidents where a solution has been identified and action needs to be taken. Despite the system operating for almost 20 years, the NHS continues to see patient deaths and injuries from known and avoidable mistakes. NHS national director for safety Aidan Fowler has reorganised the system to send out fewer and simpler alerts with clear actions hospitals need to take, overseen by a new national committee. Last year the CQC made a recommendation to streamline and standardise safety alerts after it investigated why lessons were not being learnt. Professor Ted Baker, Chief Inspector of hospitals, said: “CQC fully supports the recent introduction of the new national patient safety alerts and we have committed to looking closely at how NHS trusts are implementing these safety alerts as part of our monitoring and inspection activity.” He stressed: “Failure to take the actions required under these alerts could lead to CQC taking regulatory action.” Read full story Source: The Independent, 30 December 2019
  18. News Article
    An 88-year-old woman with a broken neck died after being transferred three times between two hospitals in the space of just 48 hours, The Independent has reveal. The death of Jean Waghorn, who died after contracting pneumonia in hospital, sparked criticism from a coroner who said the NHS trust had ignored earlier warnings over moving patients between hospitals. Senior coroner Veronica Deeley had issued two official alerts to Brighton and Sussex Hospitals Trust last year after the deaths of frail elderly patients who were wrongly shuttled between hospitals. But despite this, in June this year Ms Waghorn, who broke her neck after falling at home, was repeatedly transferred between the Princess Royal Hospital in Sussex and Brighton’s Royal Sussex County Hospital. She caught pneumonia and died two days later. The hospital, which is rated good by the CQC, has now apologised and said it has learned lessons from the case. A spokesperson said it did take action following the previous warnings and added that work was ongoing to ensure the changes were consistently applied. Read full story Source: The Independent, 17 December 2019
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