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  1. Content Article
    Key findings Introducing access and waiting time standards for mental health services was an important step towards parity of esteem with physical health services. Overall, the number of people treated by NHS mental health services has increased, but some access targets are not being met. The NHS has achieved its waiting times standards, which aim to get people into treatment quickly, for talking therapy services and early intervention in psychosis services, but not yet for eating disorders services for children and young people. NHS mental health services are under continued and increasing pressure and many people using services are reporting poor experiences. NHS England’s ambitious plan for community-based mental health services is still at an early stage. The impact of initiatives to reduce inequalities in mental health is not yet clear. Although the NHS mental health workforce has increased, staff shortages remain the major constraint to improving and expanding services. The share of funding for mental health services has increased slowly, reflecting the pace set by NHSE’s targets Improvements to mental health data and information are taking longer than planned in many areas. DHSC and NHSE have not defined what achieving full parity of esteem between mental and physical health services would mean. Plans for service expansion up to 2023-24 still leave a sizeable gap between the number of people with mental health conditions and how many people the NHS can treat. The national programme, led by NHSE, has maintained a consistent focus on expanding services. Increased demand and disruption following the pandemic mean it is likely to take longer for the NHS to close treatment gaps.
  2. Content Article
    NHS services are under extreme pressure. Recent testimonies from healthcare professionals, patients and journalists have highlighted the scale of these problems, which go significantly beyond the usual increase in pressure over the winter period. One key area of concern is a lack of hospital bed capacity, which as noted by the Nuffield Trust, is an important indicator of wider pressure on the system: "Hospitals cannot operate at 100% occupancy, as spare bed capacity is needed to accommodate variations in demand and ensure that patients can flow through the system. Demand for hospital beds peaks at different times of the day, week and year. There must be enough beds to accommodate these peaks. A lack of available beds can have widespread consequences in a health system.”[1] An absence of spare bed capacity can significantly impact a hospitals ability to provide safe and timely care. This also has consequences for other parts of the system, such as increased ambulance waiting times because of handover delays. There are multiple causes of these capacity issues: Longer-term structural challenges – such as the number of hospital beds relative to the population and workforce shortages.[2] Medium-term issues – for example the impact of delayed discharges. Short-term problems – such as increases in admissions of patients with seasonal illnesses. In this blog we will consider two specific issues stemming from this lack of hospital bed capacity and consider their impact on patient safety: Increasing cases of patients being cared for in hospital corridors and non-clinical areas, commonly referred to as ‘corridor care’. Current proposals to reduce the number of patients waiting to be discharged. Increasing cases of ‘corridor care’ ‘Corridor care’ can be broadly defined as care being provided to patients in corridors, non-clinical areas or unsuitable clinical areas because of a lack of hospital bed capacity. In recent years this has become an increasing occurrence as pressures and demands on the NHS mount, particularly during the winter months. In February 2020, the Royal College of Nursing (RCN) highlighted its concerns about this becoming normalised, publishing a survey of its members that found that over 90% of respondents said that ‘corridor nursing’ was being used at their Trust.[3] [4] In March 2020, the Royal College of Emergency Medicine (RCEM) also raised this issue as part of a broader campaign around improving emergency care, highlighting the need to significantly increase the number of hospital beds in the NHS.[5] However, during the height of the Covid-19 pandemic, infection control and social distancing rules restricted the use of ‘corridor care’ in hospitals.[6] When providing guidance for emergency care after the initial Covid period, the RCEM reiterated the threats to patient and staff safety from crowding in emergency departments and emphasised the need to avoid a return to corridor care becoming the norm.[7] However, in recent months we have seen growing concerns about a significant increase in care being provided in corridors and non-clinical settings.[8] [9] [10] [11] [12] Patient safety risks Corridor care raises significant patient safety concerns. It can present problems providing appropriate care, as these unsuitable spaces can make it difficult to administer specific treatments, such as intravenous medication, or the ability to access oxygen, medication and lifesaving treatment in an emergency. It also makes it more difficult to monitor patients, which can result in delays in providing further treatment if their condition begins to deteriorate. The constraints on space that working in these conditions impose may mean that relatives are not able to be accommodated, reducing their ability to support patients whose condition may not otherwise be closely monitored. This lack of space can also result in physical hazards, with the potential for escape routes becoming blocked in emergencies.[13] Corridor care also has particularly negative impact on patient dignity and confidentiality: “Our overflow corridor never has fewer than 20 patients on it; people who are too unwell to sit in the waiting room. The corridor is made up of trolleys of patients lined up, top to toe, along a wall. It’s busy, it’s noisy and there’s no dignity there. Patients stuck there are being toileted behind staff holding up sheets on the corridor.”[14] Working in these conditions has a significant impact on healthcare professionals too, who know that they are not able to provide the best care possible to their patients. This can affect their mental health and wellbeing creating the risk of moral injuries: the distress experienced when circumstances clash with one’s moral or ethical code.[15] “Tonight I’ve come close to tears whilst apologising to patients for the standards of care we are able to provide. In my 22 years of being an A&E doctor I’ve never seen things so bad. It’s the same everywhere.”[16] Preventing avoidable harm Patient Safety Learning believes that corridor care should be avoided whenever possible. It is vital that this is not normalised. However, in the current circumstances, in some cases this is clearly unavoidable. In these situations, it is important that: Risk assessments are carried out for service redesign and for individual patients, with mitigating actions being taken to maintain the safest care possible. Trusts have clear guidance and apply learning from examples of good practice that prioritise patient safety. Trusts have plans in place to ensure the introduction of corridor care is only a temporary measure. Staff and patients report any incidents of unsafe care so that action can be taken swiftly to address harm or near misses. There is close oversight by Trust leadership, including the Board, to ensure that patient safety safeguards are in place if corridor care is needed and that this is minimised and not normalised. We also believe more research is needed to fully understand the consequences of corridor care in terms of patient outcomes as well as patient safety. There needs to be more research undertaken to evaluate the impact of this. Reducing the number of patients waiting to be discharged Having considered the patient safety impact of corridor care because of lack of hospital capacity, we now turn to current proposals aimed at increasing capacity by reducing the number of patients waiting to be discharged. Hospital discharges can be complex. To enable a safe and timely transfer of care, they require good co-ordination between hospital and community staff to arrange clinical assessments and to ensure the home or community setting has the appropriate equipment and care plans. A delayed discharges refers to a patient who no longer meets the clinical criteria to reside in hospitals and, therefore, should be discharged to non-acute settings. The Department of Health and Social Care has recently stated that there are around 13,000 patients meeting this description.[17] These patients may end up spending a significant amount of time waiting to be discharged for a range of different reasons: Lack of available places in care and nursing homes. Delays putting in place specialist support, such as home care or short-term rehabilitation, required following discharge. The need to ensure specific criteria for a safe discharge are met for patients who need to access ongoing mental health services and support. The need to ensure that complex needs are met prior to discharge, for example in some cases concerning patients with a learning disability, where these processes may involve a range of different professionals and specialist assessments. Reducing the number of delayed discharges is not a new policy idea, but in recent weeks it has received increased attention as this has been identified as a key measure to increase hospital bed capacity resulting in several new proposals aimed at achieving this. Patient safety risks Any measures aimed at increasing the speed of hospital discharges must have at their heart considerations of how this will impact on the safety of patients and the need to prevent avoidable harm. Below we consider some of the proposals that have recently been made in relation to this and their potential impact on patient safety. 1. Discharging patients without care packages The Welsh Government has recently issued new guidance to Health Boards to discharge patients who are well enough to leave even if they do not have a package of care in place.[18] A package of care is intended to meet a patient’s ongoing care needs, which may relate to healthcare, personal care or care home costs, following discharge. Without this in place, there is a significantly increased risk of avoidable harm, particularly for patients returning to their own homes. Not having in place required adaptations, equipment or access to rehabilitation could result in patients struggling to support themselves, increasing the risk of avoidable harm and re-admission to hospital. Commenting on this proposal, Dr Amanda Young, Director of Nursing Programmes at the Queen’s Nursing Institute, also highlighted concerns that: “… patients being discharged from hospital without appropriate care packages, or inadequate support or reablement, results in poorer outcomes in the short and longer term. Discharges may occur late in the evening with no advance warning to community services, in order to free up hospital beds. Vulnerable people may arrive to cold homes, alone, with community services unaware this has happened until the following day or even the day after.”[19] This also opens up the potential for inconsistent decision-making, transferring significant risk to individual healthcare professionals who may be under significant organisational pressures to make discharge decisions that they don’t believe are safe. 2. Funding additional care home beds The Department of Health and Social Care has announced £200 million in funding to buy thousands of extra beds in care homes and other settings to help discharge more patients who are fit to leave hospital and free up hospital beds.[17] The Scottish Government has also announced a similar package, stating it will provide £8 million in funding for additional care home beds.[20] While these announcements have been welcomed in some places, there are concerns about the ability of the social care system to fulfil this, with a key problem being staff shortages. In England alone it is estimated that there are 165,000 vacant posts in social care.[21] Serious concerns have been raised about how appropriate care can be provided where additional beds may be available but staff are not.[22] [23] In many cases this could lead to this additional bed capacity not being utilised, due to lack of staffing, or is utilised despite under-staffing, increasing the potential risk of avoidable harm. Considering this new funding in the context of these workforce shortages, Martin Green, Chief Executive of Care England, said: “… there has been little consultation with the social care sector on how this can be achieved. Yet again, the Government has talked to the NHS and pretty much nobody else, and this is why their policies never work.”[24] There is also a question about whether patients subject to these accelerated discharge processes will receive the appropriate support they need. Integrated Care Boards will be tasked with using this new national funding for hospital discharges to purchase bedded step down capacity plus associated clinical support for patients.[25] However, concerns have been raised about the potential for rushed placements stemming from this, without appropriate access to rehabilitation and enhanced healthcare, which may increase the risk of patient harm.26] The British Geriatrics Society has noted that this could disproportionately impact older patients: “When older people leave hospital in poor health, they need rehabilitation and support to recover. Without it, their health deteriorates further – already on average 15% of older people being discharged from hospital are readmitted within 28 days. With each admission their level of frailty and care needs increase, generating even more demand for health and social care at home or in a care home.”[27] There have also been practical concerns raised questioning whether this funding can be effectively distributed, and extra beds provided quickly enough, to reduce the current pressures. There are further concerns too around how this is being targeted, with the provision of funding being “decided on a ’weighted population basis‘, rather than adjusted to reflect the current share of delayed discharge patients”.[28] [29] Preventing avoidable harm Patient Safety Learning believes that decisions on the introduction of new measures aimed at accelerating hospital discharges and freeing up hospital bed capacity must have patient safety considerations at their core. Whether they involve discharging patients at an earlier stage without care packages, or increased funding to move patients into care homes, all elements of these changes must be considered through a lens maintaining the safety of patients. This includes ensuring: Patients return home, or move to a care setting, with the correct medications and medical devices. Appropriate handover of information for patients is provided when moving from hospital directly into care settings. Appropriate equipment/adaptations being in place for patients returning home. Patients and their responsible carers have access to timely clinical advice if there is deterioration in the patient’s health, and guidance on the signs and symptoms that may indicate this. Patients and their families are decision makers in their own care and have access to information and advice to enable this. Concluding comments The shortage of hospital bed capacity has a wide range of consequences across the healthcare system with implications for patient safety. Here we have focused on the need to ensure that in two specific areas – managing the increase in cases of corridor care and reducing the numbers of patients waiting to be discharged – patient safety is being placed at the heart of decision-making processes around both. In addition to the areas we have identified, ensuring this happens also requires patient safety leadership at a national level. While far from a desirable state of affairs, corridor care is taking place in parts of the NHS and will continue to do so for the foreseeable period, meaning its impact on patient safety must be understood and mitigated where possible. We believe there needs to be recognition of this from NHS England and the Department of Health and Social Care, along with a proactive effort to share and disseminate knowledge and good practice in this area to prevent avoidable harm to patients. We also believe it is important that there is both a recognition and inclusion of patient perspectives and experience of these issues. This particularly applies to hospital discharge processes, which too often are either discussed as purely a capacity problem or worse disparagingly an issue caused by ‘bed-blockers’.[30] [31] It is vital that we hear and listen to the patients and family members voices on changes aimed at accelerating discharge processes. We need to recognise that these situations involve individuals with specific ongoing healthcare needs who, as well as the safe provision of care, deserve dignity and respect. Share your views and experiences We would welcome your views on the patient safety concerns raised in this blog: Are you a healthcare professional who has experience of delivering corridor care and would like to share your story? Are you a patient or family member who has experience of corridor care or a delayed discharge process? Do you work in social care and have experience of, or concerns about, accelerated discharge processes from hospitals? You can share your views and experiences with us directly by emailing content@pslhub.org or by commenting below (register here for free to activate your membership). References Nuffield Trust, Hospital bed occupancy: We analyse how NHS hospital bed occupancy has changed over time, 29 June 2022. Nuffield Trust, Hospitals at capacity: Understanding delays in patient discharge, 3 October 2022. RCN, ‘Corridor care’ in hospitals becoming the new norm warns RCN, 26 February 2020. RCN, Corridor Care: Survey Results, 26 February 2020. RCEM, RCEM launches new campaign to end corridor care as data shows more than 100,000 patients waiting over 12 hours in A&Es this winter, 3 March 2020. Health and Social Care Select Committee, Delivering core NHS and care services during the pandemic and beyond, 1 October 2020. RCEM, Covid19: Resetting Emergency Department Care, Last Accessed 11 January 2023. Birmingham Live, ‘Worst I’ve ever seen it’: Doctor speaks out about horrors of patients in corridors as NHS crisis deepens, 3 January 2023. Health Service Journal, Trust that banned corridor care ‘reluctantly’ brings it back, 4 January 2023. iNews, Striking paramedics tell of patients having seizures in hospital corridors and relentless 16-hour shifts, 11 January 2023. BBC News, NHS A&E crisis: Staff making ‘difficult decisions in unprecedented times’, 7 January 2023. This is Local London, BHRUT boss apologises to patients ‘care for in corridors’, 11 January 2023. Health Service Journal, NHSE issues fire risk warning over ‘corridor care’, 29 November 2022. The Guardian, It’s beyond dreadful. We’re now running A&E out in the corridor and wating room, 12 January 2023. Health Education England and NHS England, Understanding moral injury a short film, 15 January 2021. The Guardian, ‘It feels terminal’: NHS staff in despair over working at breaking point, 4 January 2023. Department of Health and Social Care, Up to £250 million to speed up hospital discharge, 9 January 2023. Wales Online, Doctors claim hospital discharge guidance could see patients die, 6 January 2022. Nursing in Practice, Welsh hospital patients to be discharged to community with care package in place, 6 January 2023. Scottish Government, Additional Winter support for NHS, 10 January 2023. Skills for Care, The state of the adult social care sector and workforce in England, October 2022. The Times, Fears over plans to move patients into care homes, 10 January 2023. The Independent, Staffing ‘crisis’ means £200m extra care beds plan won’t work, health bosses warn, 10 January 2023. Community Care, Care home discharge plan risks inappropriate placements and neglects the causes of crisis – sector, 9 January 2023. NHS England, Hospital discharge fund guidance, 13 January 2023. The Health Foundation, Hospital discharge funding: why the frosty reception to new money?, 13 January 2023. British Geriatrics Society, Protecting the rights of older people to health and social care, 10 January 2023. Health Service Journal, New discharge fund risks being ‘political theatre’, warn NHS leaders, 9 January 2023. Health Service Journal, Revealed: How much is each ICS getting from the £200m discharge fund, 13 January 2023. Daily Mail, Hospitals are discharging bed-blockers into hotels to free up space on wards, 5 January 2023. iNews, NHS discharges patients into hotels to ease bed blocking and A&E crisis, 4 January 2023.
  3. News Article
    The independent data watchdog has called for greater clarity from NHS England on how it will ensure there are “as strong… if not stronger” safeguards on health and care data following its takeover of NHS Digital. NHS Digital – whose role included controlling access to large amounts of NHS data – became part of NHS England on 1 February, and its teams and functions are due to merge in coming months. In an interview with HSJ, national data guardian Nicola Byrne said the merger creates “an inherent tension in having one organisation be both data custodian and the organisation seeking to access the data”, although it “makes sense in terms of streamlining and efficiencies”. Concerns have been raised about the merger’s information governance implications by campaign group medConfidential, the British Medical Association and politicians. These include that there would be less transparency over the handling of data, and that NHSE would be “marking its own homework” as both controller of, and a major user of, data. Read full story (paywalled) Source: HSJ, 8 February 2023
  4. News Article
    NHS waiting lists are unlikely to fall in 2023, and the backlog is unlikely to be significantly tackled until mid-2024 despite being one of Rishi Sunak’s priorities for this year, research suggests. The NHS has struggled to increase the number of people it is treating from its waiting lists each month due to ongoing pressures from Covid-19, although there have been signs of improvement in the past month, analysis from the Institute for Fiscal Studies (IFS) has found. Max Warner, an IFS economist and one of the report’s authors, said that although the NHS had made “real progress” to reduce the number of patients waiting a very long time for care, efforts to increase overall treatment volumes had “so far been considerably less successful”. The NHS Providers’ chief executive, Julian Hartley, urged the government to introduce a fully funded workforce plan and to talk to unions about pay for this financial year as strikes were causing huge disruption to services, and risked undoing hard-won progress made on care backlogs. “Mounting pressures on acute, ambulance, mental health and community services, such as chronic workforce shortages, could hamper efforts to cut the backlog further if left unchecked,” he said. Read full story Source: The Guardian, 8 February 2023
  5. Content Article
    Key points The 2022 Autumn Statement saw the Chancellor promise an extra £3.3bn for the NHS and £1.4bn for capital investment in 2023/24 and 2024/25. In cash terms, spending in 2024/25 will be almost £14bn higher than in 2022/23. Much of this additional spending will be needed to meet inflation. After accounting for inflation, real-terms funding in 2024/25 will be £6bn higher than in 2022/23. This means that in real terms, core day-to-day spending on the NHS will rise by 2% a year by 2024/25, while capital spending will grow by just 0.2%. Overall, the Department of Health and Social Care’s funding settlement will increase by 1.2% a year in real terms over the next 2 years. This is higher than planned at the last Spending Review but far below the 3.6% long-term average growth rate. The NHS continues to face rising cost pressures that will erode the spending power of this settlement, with pay being the most significant. Health service inflationary pressures may be higher than the government estimates through the central GDP deflator forecast. The different methods used to estimate inflation for the whole economy show that the buying power of this settlement is uncertain. The unknown outcome of future pay negotiations and volatility in the cost of other key inputs add further uncertainty around the actual cost pressures the health care sector will face.
  6. News Article
    East Kent Hospital University Foundation Trust has been criticised for failures in services by the Care Quality Commission, after an unannounced inspection last month, years after major problems began to come to light. The Care Quality Commission has highlighted: Issues with processes for fetal monitoring and escalation at the William Harvey Hospital, Ashford. There had been “incidents highlighting fetal heart monitoring” problems in September and October, and the trust’s measures to improve processes were not “embedded and understood by the clinical team”; Slow maternity triage, due to staffing problems, and infection control problems at the William Harvey. The trust is reviewing how issues with infection prevention and control and cleanliness were not identified or escalated; and Fire safety issues at the Queen Elizabeth, the Queen Mother Hospital, in Thanet with problems linked to fire doors and an easily accessible secondary fire escape route. Three years ago issues with reading and acting on fetal monitoring were highlighted at the inquest into baby Harry Richford, whose poor care by the trust led to an independent inquiry into widespread failings in its maternity services, led by Bill Kirkup. Read full story (paywalled) Source: HSJ, 6 February 2023
  7. News Article
    Nurses could refuse to carry out any further strikes alongside other health workers because of fears over patient safety, The Independent has learnt. A mass walkout billed as the largest strike in NHS history is due to take place on Monday as tens of thousands of nurses, paramedics and 999 call handlers walk out in a bid to force ministers to the negotiating table. But the coordinated strikes could be a one-off if nurses feel that the decision to take part in direct action compromises patient safety, The Independent has been told. One union source said walkouts are not carried out on a “come what may” basis, and that the unions would have to assess whether striking together was “helpful” or not. Unions have been escalating their industrial action in recent weeks in an attempt to secure higher pay rises. Any de-escalation in tactics will be seen as a blow to their campaign and a boost to Rishi Sunak’s hopes of riding out the wave of protests. With patient safety the priority, sources insisted there are strong local controls that will pull nurses from picket lines if they think there is an issue. Read full story Source: The Independent, 5 February 2023
  8. News Article
    “Frustration with the system was why I went off in the end,” said Conor Calby, 26, a paramedic and Unison rep in southwest England, who was recently off work for a month with burnout. “I felt like I couldn’t do my job and was letting patients down. After a difficult few years it was challenging.” While he usually manages to keep a distinct divide between work and home life, burnout eroded that line. He also lost his sleep pattern and appetite. The final straw came when what should have been a 15-minute call resulted in three hours on the phone trying to persuade the services that were supposed to help a suicidal patient to come out. “I was on a knife edge. That was due to the system being broken. That’s the trigger.” Doctors and nurses are struggling under the strain too. After her third time with burnout - the last resulting in her taking six months off work – Amy Attwater, an A&E doctor, considered leaving the profession altogether. Attwater, 36, said in the Covid crisis, during which a colleague killed himself, she started having suicidal thoughts and doubting her own abilities. She twice reported that she was being bullied but said no action was taken. “The only thing I was left with was to take time off work. I ended up having therapy, seeing a psychiatrist and being on two antidepressants,” said Attwater, the Midlands-based committee member for Doctors’ Association UK. Read full story Source: The Guardian, 5 February 2023
  9. News Article
    Deadlock over NHS pay is putting patients in danger and risks hardening the position of unions, 10 chief nurses have warned. Unions have warned that the government is making no moves towards resolving the strikes, with one general secretary accusing the government of lying about the state of negotiations. In a joint statement shared with the Guardian, chief nurses from 10 leading hospitals known as the Shelford group highlighted their concern that patients’ health could suffer as a direct result of the increasing disruption the stoppages are causing. Tens of thousands of nurses and ambulance workers in England will stage what will be the biggest strike in the NHS’s 75-year history on Monday. In a plea to the government and health unions, but especially ministers, the 10 Shelford group chief nurses stress that they want both sides to end their standoff as a matter of urgency “because of the impact on the patients and communities we serve. “Industrial action means appointments cancelled, diagnostics delayed [and] operations postponed. The longer industrial action lasts, the greater the potential for positions to harden, waits for patients to grow, and risks of harm to accumulate.” This week will see just one day – Wednesday – when there are no NHS strikes. Nurses will strike again on Tuesday, physiotherapists will stage their second walkout on Thursday and ambulance personnel will stage a further stoppage on Friday. Read full story Source: The Guardian, 5 February 2023
  10. News Article
    Commissioners have begun a ‘serious incident review’ across their integrated care system after early indications showed patients may have suffered harm due to long waits for cancer treatment. The review has been launched by Somerset Integrated Care Board into dermatology services after an initial review found five of 50 patients had seen their skin lesions increase in size since being referred to hospital by their GPs. ICB board papers stated “potential patient harm has been identified” for those patients, who were on the two-week wait pathway to be seen by a specialist following a referral by their GP. Read full story (paywalled) Source: HSJ, 3 February 2023
  11. News Article
    More than 500,000 people in the UK will be diagnosed with cancer every year by 2040, according to analysis by Cancer Research UK. In a new report, researchers project that if current trends continue, cancer cases will rise by one-third from 384,000 a year diagnosed now to 506,000 in 2040, taking the number of new cases every year to more than half a million for the first time. While mortality rates are projected to fall for many cancer types, the absolute numbers of deaths are predicted to increase by almost a quarter to 208,000. In total, it estimates that between 2023 and 2040, there could be 8.4m new cases and 3.5 million people could have died from cancer. Cancer Research UK’s chief clinician, Charles Swanton, said: “By the end of the next decade, if left unaided, the NHS risks being overwhelmed by the sheer volume of new cancer diagnoses. It takes 15 years to train an oncologist, pathologist, radiologist or surgeon. The government must start planning now to give patients the support they will so desperately need.” Read full story Source: The Guardian, 3 February 2023
  12. News Article
    The CEO of a troubled trust has said evidence is emerging of ‘massively reduced’ length of stay in a new hospital criticised for being too small. Emergency staff have raised concerns about a lack of space and bed capacity at the new Royal Liverpool Hospital, which opened in October, as services have come under severe pressure this winter. The new building, on a next-door site to the old hospital, has fewer beds, although more have opened elsewhere in the city. In an interview with HSJ, Liverpool University Hospitals Foundation Trust chief executive officer James Sumner acknowledged aspects of the new building have created difficulties, including in relation to accident and emergency configuration and capacity, but added the move’s benefits are beginning to be seen. He said a new care model and single rooms throughout the whole hospital are helping to reduce length of stay, as well as eliminating bed closures due to infection outbreaks. He said: “We’ve got really good evidence of massively reduced length of stay in this new building, [with] about 70 fewer people every day waiting over seven, 14 and 21 days in hospital. Read full story (paywalled) Source: HSJ, 1 February 2023
  13. News Article
    A major hospital in the UK has declared a critical incident, warning it is facing “immense pressures” on its services. Wigan’s Royal Albert Edward Infirmary urged people to avoid its A&E unless suffering a “life or limb-threatening emergency”. Wrightington, Wigan and Leigh (WWL) Teaching Hospitals NHS Foundation Trust warned that “unprecedented attendances” meant the emergency department was “full”. It said it is working with partners to discharge patients who are ready to leave hospital. The trust, which previously declared a critical incident in December, said the safety of its patients is the “top priority”. By declaring a critical incident, hospitals are able to take action so that safe services are maintained despite increasing pressures. Read full story Source: The Independent, 1 February 2023
  14. News Article
    Donna Ockenden, who is leading an independent review examining how dozens of babies died or were injured at the Nottingham University Hospitals (NUH) trust, is due to meet with chief executive of NUH, Anthony May, and other members of the NUH executive team. Speaking ahead of the meeting, she said: "The commitment I want to give to the women and families of Nottingham is that real learning, real improvement in maternity safety will happen throughout the life of this review. "It won't be a case of waiting until the end and then presenting the trust with a huge amount of learning that they then have to start putting in place. "Today's meeting with the trust is at executive level. Along with colleagues from NHS England, I'll be meeting with the chief executive and some of his colleagues to talk about how we will ensure that learning reaches the trust on a regular basis and in a timely way so families can be assured that the maternity improvement plan is including learning from our review." Read full story Source: BBC News, 2 February 2023
  15. News Article
    NHS England has effectively admitted the backlog of cancer long-waiters will still be higher in March 2024 than before covid hit, in a document seen by HSJ. The consultation document, detailing trajectories for reducing numbers waiting 62 days or more from referral, shows the expected national total in March 2024 is 18,755. NHS England previously committed to reducing this to pre-pandemic levels (14,226) by March 2022, then delayed the target until March this year. There are now significant backlogs in diagnostics, with particular challenges in endoscopy and breast screening. NHS Providers director of policy and strategy Miriam Deakin said: “Cancer is a key priority for trusts. They understand the risk to patients who have to wait. “The pandemic left people waiting longer than NHS trusts wanted for diagnosis or to start treatment, with some people not coming forward, but now urgent referrals for suspected cancer are far higher than pre-pandemic. Read full story (paywalled) Source: HSJ, 1 February 2023
  16. News Article
    Thousands of ambulance staff across five services in England - London, Yorkshire, the South West, North East and North West - will walk out on Friday 10 February, Unison says. It means strikes over pay will now be happening across the NHS every day next week, apart from Wednesday. Life-threatening 999 calls will be attended to but others may not be. Downing Street says the continuing industrial action will concern the public. The NHS's biggest day of industrial action is set to happen on 6 February, when many nurses and ambulance crews across England and Wales will be on strike. Unison says the government must stop "pretending the strikes will simply go away" and act decisively to end the dispute by improving pay. The union warned that unless the government had a "major rethink" over NHS pay, and got involved in "actual talks" with unions, it would announce strike dates running into March. The government says the above-inflation pay rises requested are unaffordable. Read full story Source: BBC News, 31 January 2023
  17. News Article
    All three acute trusts in an integrated care system are failing to meet national requirements to tackle health inequalities after being overwhelmed by emergency and elective care pressures. A report by Devon Integrated Care Board found progress on addressing variation in poor health outcomes had “slipped due to capacity issues.” Both Royal Devon University Healthcare Foundation Trust and Torbay and South Devon FT were rated “red” for a lack of headway. All trusts were told by NHSE in 2021 to undertake a range of actions as part of work to reduce health inequalities during 2022-23. These included publishing analyses of waiting times disaggregated by ethnicity and deprivation, using the waiting list data to identify disparities between different patient groups, and measuring access, experience and outcomes for patients from a deprived community or an ethnic minority background. Sarah Sweeney, interim chief executive of National Voices, which represents health and care charities and patients, said she was “really concerned to see that some ICSs are not making as much progress on reducing health inequalities as expected and hoped”. “These inequalities are completely unjust and preventable,” she said. Read full story (paywalled) Source: HSJ, 30 January 2023
  18. News Article
    Trusts are getting better at coping with industrial action and are still on track to hit the national target of eliminating the backlog of 78-week waiters, an NHS England director has told staff. Paul Doyle, NHS England’s programme director for elective recovery, said: “We continue to make really good progress [on elective recovery]… we are very much in the end game now of meeting the 78-week ambition for the end of March.” There have been concerns about the impact of recent strike action on eliminating the 78-week backlog, but Mr Doyle praised managers’ handling of the strikes and said administrative staff were doing an “incredible job”. He added: “Most organisations affected have got better and better as time has gone on about making sure that there are as few cancellations as possible and that cancellations are rebooked quickly or that clinical time is put to good use such as doing virtual outpatient appointments or doing validation of waiting list.” Read full story (paywalled) Source: HSJ, 30 January 2023
  19. News Article
    More than half a million patients a year will be treated in “hospitals at home” in an attempt to relieve pressure on A&E departments. Under the plans, elderly and frail patients who fall will be treated by video link, with ministers saying that a fifth of emergency admissions could be avoided with the right care. Health officials said the “virtual wards” would be backed up by £14 billion in extra spending on health and care services over the next two years, as the NHS tackles record backlogs, with seven million people on waiting lists. Rishi Sunak said the Urgent & Emergency Care Recovery Plan showed that the NHS was one of his “top priorities”. Read full story (paywalled) Source: The Telegraph, 29 January 2023
  20. Content Article
    Key recommendations The Delivering the future hospital report identifies six requirements that are key to improving patient care: Ensure patients and carers are at the centre of healthcare design and delivery. Provide local support for teams to improve patient care in a financially constrained and politically exposed healthcare system. Develop a collaborative learning structure to enable healthcare teams to successfully implement improvement projects. Collect and analyse data to support ongoing improvements to patient care. Develop future clinical leaders. Partnership working between the RCP and local teams is an effective model for improving aspects of patient care. The Future Hospital Programme has demonstrated that a patient-centred approach to improving services can help deliver better care for patients by more motivated, engaged staff.
  21. News Article
    The NHS faces an alarming mass exodus of doctors and dental professionals, health chiefs have said, as a report reveals 4 in 10 are likely to quit over “intolerable” pressures. Intense workloads, rapidly soaring demand for urgent and emergency healthcare and the record high backlog of operations are causing burnout and exhaustion and straining relationships between medics and patients, according to the report by the Medical Defence Union (MDU), which provides legal support to about 200,000 doctors, dental professionals and other healthcare workers in the UK. In an MDU survey of more than 800 doctors and dental professionals across the UK, conducted within the last month and seen by the Guardian, 40% agreed or strongly agreed they were likely to resign or retire within the next five years as a direct result of “workplace pressures”. Medical leaders called the report “deeply concerning”. There are already 133,000 NHS vacancies in England alone. NHS chiefs said it laid bare the impact of the crisis in the health service on staff, and MPs said it should serve as a “wake-up call” to ministers on the urgent need to take action to persuade thousands of NHS staff heading for the exit door to stay. Read full story Source: The Guardian, 29 January 2023
  22. News Article
    Thousands of extra hospital beds and hundreds of ambulances will be rolled out in England this year in a bid to tackle the long emergency care delays. The 5,000 new beds will boost capacity by 5%, while the ambulance fleet will increase by 10% with 800 new vehicles. Details of the £1bn investment will be set out later in a joint government and NHS England two-year blueprint. Questions have also been raised about how the extra resources will be staffed - 1 in 10 posts in the NHS is vacant. The government believes the measures, which will be introduced from April, will help the NHS to start getting closer to its waiting time targets. It has set goals that by March 2024: 76% of A&E patients will be dealt with in four hours. Currently fewer than 70% are. The official target is 95% An average response time of 30 minutes for emergency calls such as heart attacks and strokes. In December patients waited over 90. The official target is 18. Prime Minister Rishi Sunak said cutting NHS waiting times was one of his five main priorities. Read full story Source: BBC News, 30 January 2023