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More hospital beds ‘squeezing out rehab and keeping people out of work’

Extra beds squeezed into hospitals as part of winter planning are crowding out space for rehab, pushing up length of stay and knock-on costs, and increasing the chance of readmission, NHS leaders have been warned. 

Systems and trusts were encouraged to staff thousands of additional ward beds in the run-up to last winter to try to ease emergency care pressures, and government and NHS England have since asked for many of them to be kept open through the year.

However, many of the additional beds are not in proper ward spaces, instead being located in gyms and other areas used for physiotherapy and other rehab. This followed on from some rehab areas already being lost during the pandemic, to be used for beds or storage.

NHSE has sent out a warning about the issue, following a commitment by ministers earlier this year. However, senior figures in physio and older people’s care remain concerned the spaces will not be restored without checks and enforcement, especially as acute trusts remain under pressure to increase general bed space.

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‘Over a year behind’ on key maternity target, NHSE admits

Pregnant women and new mothers are facing wide variation in access to mental health support, new figures suggest, as NHS England admits national performance on a key long-term plan goal to expand services is ‘over a year behind trajectory’.

Analysis of access rates for perinatal mental health services from NHS Digital shows the rates of women accessing support within the past 12 months range from 3.7 per cent in Humber and North Yorkshire to 15 per cent in Shropshire, Telford and Wrekin ICS.

The long-term plan target is for 66,000 women per year to be accessing specialist perinatal services, which can help with conditions such as post-partum psychosis, by March 2024. NHSE admitted in its papers that “although access is increasing, performance remains over a year behind trajectory”.

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Source: HSJ, 25 May 2023

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Young mental health patients 'at risk' in child wards

A safety investigation has warned that young people with complex mental health needs are being put at significant risk, by being placed on general children's wards in England.

The findings come from the Healthcare Safety Investigation Branch (HSIB).

BBC News recently highlighted the plight of a 16-year-old autistic girl, who spent several months in a children's ward.

Other families have since contacted the BBC describing similar situations.

The majority had faced similar difficulties getting appropriate support.

HSIB says that paediatric wards are designed to care for patients who only have physical health needs and not for those with mental health needs.

It describes the situation in 18 hospitals it visited as "challenging", and 13 were described as "not safe" for children who were suicidal or at risk of harming themselves to be on their paediatric wards.

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Source: BBC News, 25 May 2023

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Top doctor questions need for change at gender clinic

A doctor with a key role in reforming a controversial gender identity clinic for children has been recorded questioning the need for change.

Prof Gary Butler, clinical lead for the children's gender clinic in England and Wales, also appeared to accuse the author of a report, which will underpin the new service, of "nepotism".

He was recorded making the comments in a keynote speech at a major conference.

The Gender Identity Development Service (Gids), based at London's Tavistock and Portman NHS Foundation Trust, was rated as "inadequate" by inspectors, who visited in late 2020. It was earmarked for closure in July 2022.

An independent review, led by Dr Hilary Cass, also called for a "fundamentally different" model of care for children with gender dysphoria.

Prof Butler has been awarded a key role in shaping the new service, as one of several people tasked with implementing a new training programme, underpinned by Dr Cass's recommendations.

However, BBC Newsnight has learned Prof Butler has publicly questioned the need for change and described Dr Cass's recommendations as "slightly unusual".

In the 14-minute speech at the conference, he talked about current services across the UK, the legal challenges to the situation in England, and how he felt Gids has been the subject of "lies" in the media.

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Source: BBC News, 24 May 2023

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Northern Ireland: No shows to health appointments costing thousands

Patients who fail to turn up for surgical day case procedures are costing the health service thousands of pounds.

It is a problem across Northern Ireland's five health trusts.

Over a 10-month period in the South Eastern area 14,000 patients did not attend or cancelled review appointments on the day they were due to turn up.

Assistant Director of Elective Surgery at the South Eastern Trust Christine Allam said it was "frustrating".

The South Eastern trust review showed between April 2022 and January 2023, 7,755 people did not attend or cancelled new outpatient appointments on the day.

During the same period, 14,003 or 10% of patients didn't show for review appointments.

Ms Allam said the situation was "frustrating for those patients who are waiting to be seen".

"Those slots where people don't turn up are lost capacity because we haven't been given notice - and this only lengthens the waiting lists," she added.

It is a problem that all health trusts are experiencing.

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Source: BBC News, 24 May 2023

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World must prepare for disease more deadlier than Covid, WHO chief warns

The head of the World Health Organisation warned on Tuesday that governments need to prepare for a disease even deadlier than Covid-19.

Dr Tedros Adhanom Ghebreyesus, director general of WHO, told its annual health assembly in Geneva that it was time to advance negotiations on preventing the next pandemic.

He warned that nation states cannot “kick this can down the road” and that the next global disease was bound to “come knocking”.

Dr Tedros said: “If we do not make the changes that must be made, then who will? And if we do not make them now, then when?”

He added: “The threat of another variant emerging that causes new surges of disease and death remains. And the threat of another pathogen emerging with even deadlier potential remains.”

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Source: The Independent, 24 May 2023

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An exercise trial for Long Covid is being criticised by some patients

A proposed exercise trial for Long Covid is being criticised by some of the patients the government-funded researchers want to study.

The trial is part of the Researching COVID to Enhance Recovery (RECOVER) initiative, funded by the US government for $1.15 billion over four years. It aims to study Long Covid and help find treatments for the millions of people experiencing a range of long-lasting symptoms, including extreme fatigue, brain fog and shortness of breath.

The exercise study protocol has not been finalised, but it will test physical therapy at different intensity levels, tailored to the patient’s capabilities, and aim to improve endurance, said Adrian Hernandez, executive director of Duke Clinical Research Institute.

Some Long Covid advocates, however, say that any exercise trial could be potentially dangerous for long-covid patients with myalgic encephalomyelitis (ME/CFS), also known as chronic fatigue syndrome.

Studies show that people with ME/CFS don’t have the same response to physical exertion as healthy individuals, and many ME/CFS patients report a worsening of symptoms after even small amounts of activity. This crash is called post-exertional malaise.

Advocates now worry that Long Covid patients with ME/CFS could be similarly harmed if they take part in any exercise study.

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Source: Washington Post, 22 May 2023

Further reading on the hub:

Understanding Covid-19 as a vascular disease and its implications for exercise

 

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Work pressures driving nurses and midwives away

Work pressures are driving thousands of nurses and midwives a year away from the profession, the Nursing and Midwifery Council  (NMC) says.

The NMC said retention was becoming a major concern despite an overall growth in the register.

Its annual report found 27,000 professionals had left the register in the UK in the year to the end of March.

While retirement appeared to be the most common reason for leaving, health and exhaustion were cited as the next.

NMC Chief Executive Andrea Sutcliffe said: "There are clear warnings workforce pressures are driving people away.

"Many are leaving earlier than planned, because of burnout and exhaustion, lack of support from colleagues, concerns about quality of care and workload and staffing levels."

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Source: BBC News, 24 May 2023

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Approach to tackling violence raises concern among NHS England staff

There has long been an acknowledgment by ministers and NHS leaders that violence against staff by patients was an issue that needed addressing, with a strategy to tackle it announced nearly five years ago.

The health service’s 2019 long-term plan included a pilot for the use of body-worn cameras by paramedics in a bid to “de-escalate” situations. The following year the Crown Prosecution Service announced an agreement with the police and NHS England to “secure swift prosecutions” of those who assault staff, and the maximum penalty for assaulting emergency workers, including doctors and nurses, was also doubled to two years.

Despite these measures, there have been internal disagreements within NHS England about the best approach to the problem, which affected almost 15% of staff last year, according to the latest national survey of the health service workforce.

The Guardian understands that senior managers in NHS England told staff in its violence prevention and reduction (VPR) team last April that prosecutions of those who assaulted healthcare workers and dismissals of abusive staff should be a last resort. Instead, the focus should be on improving the culture of the NHS and staff wellbeing.

It is also understood that managers cautioned against using the term “zero tolerance” because they said it did not take into account that some people who abuse NHS staff might lack capacity, an apparent reference to mentally ill patients.

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Source: The Guardian, 23 May 2023

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New treatment ‘can help people stop taking opioid painkillers for chronic pain’

A new treatment could help people to stop taking addictive opioid painkillers for chronic pain, research suggests.

Data suggests there are one million people at risk from longer-term continuous opioid prescriptions, and more than 50,000 have been taking these for six months or more.

While recent NHS initiatives have managed to reduce opioid prescribing by 8%, saving an estimated 350 lives, the new research has found evidence that could help many more people stop their opioid painkiller use.

A team of researchers and doctors has developed and successfully trialled a programme designed to guide people in coming off prescription painkillers, tapering their opioid intake and learning how to manage their pain using alternative techniques with a course which combines one-to-one and group support.

According to the findings, after one year, one in five people were able to stop taking opioids without their pain increasing.

The scientists suggest the new treatment is an alternative to opioid use and has potential to give patients a better quality of life.

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Source: The Independent, 23 May 2023

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Essex GP struck off over 'sexually motivated' examination

A GP accused of trying to pull down a patient's gym shorts and of touching her genitalia has been struck off the medical register.

The Medical Practitioners Tribunal Service found Dr Kamran Ali's behaviour towards four women at a surgery in Essex amounted to misconduct.

The tribunal heard he had not practised since the allegations in 2016.

The 44-year-old, of Glendale Gardens, Leigh-on-Sea, was cleared of criminal charges following a trial in 2018.

Panel chairman William Hoskins said at the tribunal on Thursday that erasing him from the register was necessary to "protect public confidence in the medical profession".

A female patient - referred to as Patient C - reported his behaviour to police in the November.

She had complained of spots on her face, white coating on her tongue and wanted a repeat prescription for anxiety medication.

The panel heard Dr Ali began to pull down her gym shorts and examined her genitalia without wearing gloves and without obtaining consent.

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Source: BBC News, 23 May 2023

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People paying for operations up by third since Covid pandemic

The number of people paying privately for operations and treatments in the UK has risen by more than a third since the pandemic started, the latest figures from the Private Healthcare Information Network (PHIN) show.

Last year 272,000 used their own money to pay for treatments, such as knee or eye surgery - up from 199,000 in 2019.

The NHS backlog has been blamed for the trend, with some of the treatments costing more than £15,000.

But there does appear to have been a shift away from private insurance driven by the cost of living crisis.

The numbers treated through that route were just below 550,000 - more than 30,000 fewer than three years ago.

Health providers are reporting patients desperate for treatment because of NHS waits are increasingly turning to the private market.

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Source: BBC News, 24 May 2023

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Menopause: Post-hysterectomy care in NI must improve, says patient

A woman who had a hysterectomy has said she was discharged without sufficient information on its impact on her physical and mental health.

Mechelle Davis, from County Down, said it was crucial women left hospital with appropriate medication and advice.

Her operation involved removal of her womb, ovaries, fallopian tubes, and cervix.

Ms Davis was 48 when she had her operation and said she had no option but to look online for advice, something she described as "unsatisfactory".

"I had the operation in October 2022 and didn't go on HRT until the following February," she told BBC News NI.

"Every woman who is going through the menopause - including surgically induced - needs support.

In its online tool for clinicians, British Menopause Society advise that HRT plays a significant role in managing surgical menopause, especially in women under 45 - provided there are no contradictions such as personal history of hormone dependant cancer.

It also adds that "all women undergoing surgical menopause should have counselling and be provided with information about the hormonal consequences of surgery and the role of HRT, both before surgery and before leaving hospital with clear communication to the primary care team."

BBC News NI has spoken to other women who, after having a hysterectomy, were discharged without advice or a HRT prescription.

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Source: BBC News, 23 May 2023

Further reading on the hub:

World Menopause Day 2022: Raising awareness of surgical menopause

 

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Over 80% of GP practices lack crucial technology, warns NHSE lead

Only 10-15% of GP practices are using all three of the ‘modern’ patient access tools — including overhauling their approach to triage — which are at the centre of NHS England’s primary care recovery plan, its GP lead has told HSJ. 

Amanda Doyle, national director for primary care and community services, told HSJ this was its current estimate of the share of practices which already have in place all three of: digital phone systems; online messaging; and modern triage, response and care navigation.

These are cornerstones of the primary care recovery plan,published by the government and NHS England this month, which says they are prerequisites for offering “modern general practice access”.

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Source: HSJ, 23 May 2023

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Woman died on floor after waiting over five hours for ambulance in Wales

A 58-year-old woman died alone curled up in a blanket on the floor of her bedroom as she waited more than five hours for an ambulance.

Relatives of Rachel Rose Gibson believe she had a heart attack at her home in Wrexham, north Wales, only a short drive away from a hospital, but died before an ambulance reached her.

The Welsh ambulance service said that on the day Gibson died, its crews spent more than 700 hours waiting outside hospitals for patients to be admitted, which meant they could not respond quickly to people needing help.

Family members said Gibson, a grandmother of seven, called an ambulance at 4pm on 5 April as she was coughing up blood and in chronic pain. By the time an ambulance arrived at 9.30pm, she had died.

Her daughter, Nikita, 29, said: “She was lying on the floor curled up in a blanket. It haunts me to know she died alone in so much pain.

“I feel like I can’t fully grieve because I’m so angry. She only lives five minutes away from the hospital, but must have been in too much pain to get into a taxi.”

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Source: The Guardian, 22 May 2023

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35,000 cases of sexual misconduct or violence in NHS in five years

More than 35,000 incidents of sexual misconduct or sexual violence - ranging from derogatory remarks to rape - were recorded on NHS premises in England between 2017 and 2022.

Rape, sexual assault or being touched without consent accounted for more than one in five cases.

Most incidents - 58% - involved patients abusing staff.

The data was collected by the BMJ and the Guardian, and shared with BBC File on 4.

Freedom of Information requests were received from 212 NHS trusts and 37 police forces in England.

The data that came back from trusts showed at least 20% of incidents involved rape, sexual assault or inappropriate physical contact - including kissing. Other cases included sexual harassment, stalking and abusive or degrading remarks. One in five cases involved patients abusing other patients - although not all trusts provided a detailed breakdown.

Meanwhile, police recorded nearly 12,000 alleged sexual crimes on NHS premises in the same time period - including 180 cases of rape of children under 16, with four children under 16 being gang-raped.

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Source: BBC News, 23 May 2023

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Trusts ‘could be sued’ under new strike law

Ambulance chiefs have warned a controversial piece of legislation could lead to legal action against their trusts by patients denied an ambulance.

The Strikes (Minimum Service Levels) Bill, which is currently going through Parliament, would enable the health and social care secretary to set minimum levels of staffing for ambulance call centres and crews. Employers would be able to issue “work notices” compelling staff to provide cover during any strike.

But, in its response to the government consultation on how the system would work, the Association of Ambulance Chief Executives has said it does not support the legislation in its current form as it does not believe it will deliver an improvement for patients, or offer a practical means of delivering minimum service levels.

It said the proposed legislation appears to pass responsibility for the service levels to employers, which could leave them “exposed to patient liability risks to a greater extent than before”.

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Source: HSJ, 22 May 2023

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New NHS training launched as dementia rates increase among Asian and Black people

Healthcare leaders are rolling out new NHS training to help speed up dementia diagnoses among Black and Asian people following criticism about a lack of support for patients from minoritised communities, The Independent has revealed.

An awareness campaign is being launched in England to help those from ethnic minority communities receive a prompt diagnosis and get the support they need at the earliest opportunity.

The announcement follows a critical report which found that thousands of south Asian people with dementia are being failed by “outdated health services designed for white British patients”.

Dr Bola Owolabi, director of the Healthcare Inequalities Improvement programme at NHS England, said: “The pandemic put a greater spotlight on longstanding health inequalities experienced by different groups across the country.

“While there are many factors involved, the NHS is playing its part in narrowing the gap and ensuring equitable access to services through taking targeted action where needed to improve outcomes."

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Source: The Independent, 21 May 2023

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Social Beats networking platform supports people with Long Covid

Social Beats, a networking platform for those living with Long Covid, has been launched by free social community service Biocomm, allowing people to exchange health information from trusted sources, share experiences and interact with other people with Long Covid.

The goal of the platform is to help connect those living with Long Covid so that they can receive and provide emotional and social support to others in the same position.

The platform is the brainchild of BiocommAI and is sponsored by InnoMedica and Normax Biomed.

Peter Jensen, CEO and chairman of Normax, said: “Community is key for anyone dealing with an illness or long-term condition. Biocomm.net is a safe space for people affected by Long Covid – a platform designed to help people living with the condition to connect with others and to build a better life.

“We have recognised that Long Covid has impacted people in many ways and now is the time to help them by enabling them to connect, learn and share knowledge.”

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Source: Digital Health, 22 May 2023

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UK reliance on foreign nurses at critical level

Britain’s reliance on foreign nurses has reached “unsustainable” levels, the government has been warned as new analysis reveals that international recruits has accounted for two thirds of the rise in numbers since 2019.

Ministers have repeatedly promised to boost the domestic supply of health staff amid warnings that reliance on international workers leaves the NHS at the mercy of global labour markets.

Overall, a fifth of the UK’s nursing, midwifery and nursing associate workforce originally trained overseas.

The figures will reignite concerns that nations such as the Philippines, traditionally a key source for the NHS, are being increasingly targeted by countries including Germany and Canada. Senior NHS leaders fear the health service could be left in a precarious position if increased competition results in nurses choosing alternative destinations, resulting in a shortfall for the UK. The health service in England already has one post in ten vacant.

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Source: The Times, 18 May 2023

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Mental health patients forced to travel hundreds of miles for treatment despite government pledge

Some mental health patients in England are still having to travel more than 300 miles for hospital treatment two years after the government pledged to end the “completely unacceptable” practice.

The number of patients in crisis forced to move potentially hundreds of miles for NHS help is rising again after falling during the pandemic, separating them from family and support networks and potentially delaying their recuperation.

According to official data seen by the Observer, 420 so-called “out of area” treatments started in February because no local beds were available – up from 240 in February last year. The most recent NHS England records show there are 720 out of area placements deemed “inappropriate”, risking the patient’s recovery.

Dr Mayura Deshpande, an associate registrar for policy at the Royal College of Psychiatrists, said targets for eliminating the practice had been “widely missed” and called for an urgent plan for the proper funding of mental health services. “It’s completely unacceptable that some mental health patients are having to travel hundreds of miles for care at a time when they are at their most vulnerable,” she said.

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Source: The Guardian, 20 May 2023

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More than 23,000 people died in A&E in England last year, Labour estimates

About 23,000 people died in accident and emergency departments last year, according to an estimate by Labour based on Freedom of Information requests to every NHS trust in England.

Half of the trusts responded to the party’s requests and, based on that information, it calculated that just over 23,000 people had died – an increase of more than 20% on 2021, and nearly 40% on 2020.

The increase in deaths corresponds with a sharp rise in NHS waiting times, as hospitals struggle with high demand and a lack of resources after the Covid-19 pandemic.

Wes Streeting, the shadow health secretary, said: “People turning to the NHS in an emergency should know they will be seen and treated before it’s too late. The Conservatives’ failure over 13 years to properly staff or reform the NHS has a cost in lives.”

Maria Caulfield, the health minister, defended the government’s record, however, saying: “We are delivering a record number of tests, speeding up discharge from hospitals, and cutting waiting lists as we also work to halve inflation, grow the economy, reduce debt, and stop the boats.”

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Source: The Guardian, 19 May 2023

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ICB sends trust five safety warnings in six weeks

An integrated care board (ICB) has sent multiple warnings to a local trust highlighting ‘serious issues’ with the safety and quality of care provided.

East Kent Hospitals University Foundation Trust had had severe and widely reported issues in its maternity services but the five emails and letters from Kent and Medway ICB, sent across a six-week period in February and March, flagged concerns extending into other parts of the organisation. These included:

Serious incidents had “recurrent themes” and there was a “lack of evidence the trust is learning” from them. A spot audit had revealed more than one in five patients at the Queen Elizabeth The Queen Mother Hospital in Thanet had overdue modified early warning scores, which can show if a patient is deteriorating.

Further concerns about adult safeguarding “have been raised in relation to 18 allegations of abuse against people in positions of trust” despite the provider implementing a review on the issue 18 months earlier.

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Source: HSJ, 22 May 2023

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Trust execs accused of creating a ‘cult of the individual’

Regulators are probing a series of whistleblowing claims about the leadership culture of a trust which is rated ‘outstanding’ for its management, HSJ has learned.

It is understood multiple current and former staff members at Bolton Foundation Trust, including people in senior positions, have been in contact with NHS England and the Care Quality Commission in recent months.

The claims include a dramatic worsening in leadership culture at the trust, particularly around the FTSU process and people who speak up being bullied, side-lined and silenced. And investigations and meetings are stage-managed and tightly controlled by executives, with constant “sugar-coating” and positive spin on board reports, and intolerance of people who disagree.

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Source: HSJ, 22 May 2023

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Labour vows to reverse rise in suicides in England and Wales within five years

A Labour government would reverse the rise in the number of deaths from suicide as part of a health plan to replace pain and anxiety with a “hope of a renewed NHS”, Keir Starmer will pledge.

In a speech today, the Labour leader will say his plan for reforming the NHS will focus on the biggest causes of death in the UK including suicide.

He will point to coroners’ statistics showing that deaths from suicides have been rising since 2008, and reached a record high last year in England and Wales. If the party takes power Labour will reverse this rise within five years, Starmer will say.

A segment of his speech previewed by the party says: “Suicide is the biggest killer of young lives in this country. The biggest killer. That statistic should haunt us. And the rate is going up. Our mission must be and will be to get it down.”

Labour has not provided details on how it proposes to meet this pledge other than an aspiration to shift from “sickness to prevention”.

Starmer will also propose introducing new NHS targets on cutting deaths in England from heart disease and strokes by a quarter over 10 years.

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Source: The Guardian, 21 May 2023

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