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Found 326 results
  1. News Article
    Tens of thousands of patients are still suffering harm from delays in ambulance handovers to emergency departments despite a concerted effort to tackle the problem, figures seen by HSJ indicate. The data shows more hours have been lost to handover delays lasting more than 15 minutes in most of the first five months of 2024 compared to the same period in 2023. In May, more hours were lost than in May 2022 and May 2023. The Association of Ambulance Chief Executives told HSJ the problem remained severe and the government needed to act to improve it. AACE managing director Anna Parry said it had consistently warned about the ongoing risk of handover delays. She said: “This is why one of our key requests of the new government has been that they proactively support the ambulance sector’s aim to ensure patients universally receive high-quality, timely care and no longer experience unacceptable delays in response or handover of care, for example, at hospital emergency departments. “This problem is not intractable. We have demonstrated that in areas where there is a strong leadership focus and true system-wide support, handovers can be managed effectively, despite the significant pressures and constraints our health and social care system is under. However, it remains vital that we see more demonstrations of excellent leadership to get to that point across the country.” Read full story (paywalled) Source: HSJ, 10 July 2024
  2. News Article
    Long waiting times at hospitals in the north-west of England are putting patient's lives at risk by holding up ambulance crews, a coroner has warned. It comes after the death of Bobilya Mulonge, who called 999 with breathing problems on 24 November 2022. She waited 72 minutes for an ambulance - four times longer than North West Ambulance Service's (NWAS) 18-minute target for her category of emergency call - which "probably contributed to her death", coroner Lauren Costello said. A NWAS spokesman said the service was "very sorry" an ambulance was unable to attend sooner and the service had made "significant" improvements since. A report by Ms Costello has been sent to the health secretary and NWAS and urges the region's health authorities to take action to prevent further deaths. She said evidence about ambulance delays revealed during the inquest had given rise to her concerns. "In my opinion there is a risk that future deaths could occur unless action is taken," she wrote. Dale Ollier, north-west regional organiser for Unison, which represents some ambulance staff, said backlogs in moving patients out of hospitals was having a "knock-on effect" at A&E, leading to a "bottleneck crisis". “We have patients that could be safely discharged but there isn’t anywhere to discharge them to because of the lack of capacity in social care." Ambulances were working "flat out", he added, but delays had lead to an "unbearable demand" on crews who were sometimes "tied up for several hours" waiting at hospitals. Read full story Source: BBC News, 20 June 2024
  3. Content Article
    On 24 May 2023 an investigation was commenced into the death of Bobilya Mulonge then aged 62 years. The investigation concluded at the end of the inquest on 19 April 2024. The conclusion of the inquest was a narrative conclusion that Mrs Mulonge died as a result of congestive cardiac failure against a background of hypertensive heart disease. Ambulance response times probably contributed to her death.     The medical cause of death being:   1 (a) Congestive Cardiac Failure (b) Hypertensive Heart Disease   II) Chronic Kidney disease and Type II diabetes mellitus.
  4. Content Article
    Ambulance handover delays arise when emergency departments become overcrowded as patients waiting prolonged periods for admission occupy clinical cubicles designed to facilitate the assessment and treatment of emergency arrivals. In response, many organisations become reliant on temporarily lodging acutely unwell patients awaiting admission in undesignated areas for care such as corridors, to provide additional space. This results in a significant risk of avoidable harm, indignity and psychological trauma for patients and has a negative effect on the well-being of healthcare professionals, since unacceptable standards of care become normalised.
  5. News Article
    More and more UK hospitals are leaving patients in corridors due to a lack of bed space. NHS bosses say so-called corridor care is freeing up ambulances and saving lives, but BBC Newsnight has spoken to patients who say the growing practice is humiliating and degrading. Gregory Knowles counted 13 other patients alongside him on a corridor at the Norfolk and Norwich University Hospital (NNUH) in March. Complications after an operation put him back in hospital and on to a ward but at 04:00 one morning he was moved. The 68-year-old was wheeled in his bed to reception. "I was waking up with people around me. It was horrendous," he told the BBC. "I had no screens and no facilities for water or for really getting changed. My possessions were on the bottom of the bed. My daughter and partner were as horrified as I was," he said. His partner Alicia Goulty described how staff had been too rushed to attend to him. "One day when we got there his catheter had leaked in the bed when he was on the corridor. He was wet with no covers or any screens and I had to take him to the bathroom to get him cleaned". Ms Goulty said her partner's medication had been missed. "We had to ask for water for him. We had to ask sometimes for his meals because he got forgotten." Read full story Source: BBC News, 15 May 2024 You can read a nurse's first-hand account of a corridor care shift in this blog on the hub: A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift
  6. News Article
    Patients needing urgent treatment for life-threatening illness such as strokes or heart attacks waited more than 24 hours for an ambulance response, new figures show. New data shows the crisis facing NHS ambulance services resulted in every region missing vital NHS targets to respond to some of the most critically unwell patients last year. Despite improvements compared to 2022, figures obtained by the Liberal Democrat party show ambulance services continued to struggle with response times to category two patients, which may include those who have suffered a stroke or heart attack and should receive a response within 18 minutes. In two cases patients needing this level of response, in Warrington and Staffordshire, waited more than 25 hours for an ambulance. Sir Julian Hartley, chief executive at NHS Providers, which represents all NHS trusts, called for “urgent” investment and warned that “rising demand, limited resources and vast staff shortages are piling pressure on an already-stretched service, further driving up ambulance waiting times.” He said NHS hospital and ambulance leaders are working to reduce delays and responses at a time “when demand has never been higher.” Read full story Source: The Independent, 23 April 2024
  7. News Article
    This is a sick country, getting sicker. NHS waits will take years to clear, if at all. While people wait, they get sicker. When more and more people slip into absolute poverty – a fifth of people now – they get even sicker. More sicken as they age, and that peak has not yet been reached. Every part of the NHS feels at the sharp end, coping mostly because, amazingly, they just do, even with no end in sight to the stress. NHS data released last week on people waiting more than 18 weeks with serious heart problems suggests some will probably die before they get treatment. When waiting patients have heart attacks and strokes they call an ambulance – so there’s been an astonishing 7% rise in those category 1 calls. At an ambulance dispatch centre in Kent, Polly Toynbee listens in to calls like this at the South East Coast Ambulance Service dispatch centre in Gillingham, north Kent, covering Surrey, Sussex and Kent. She sat with D, a seasoned and sympathetic emergency medical adviser, call handler and life-and-death decider. Read full story Source: The Guardian, 17 April 2024
  8. News Article
    A gran was left lying outside in the cold facing a seven hour wait for an ambulance following a fall before finally being rescued — by firefighters. Betsy Hulme, 83, was left in agony with a broken hip when she tumbled in her back garden in Leek, Staffordshire. Son Steve, 60, a former ambulance technician, dialled 999 only to be told it would be several hours until paramedics could get to them due to long handover delays. After a further three hours of Betsy waiting on cold concrete slabs while soaked in rain water, desperate Steve decided to drive to a nearby fire station to ask for help. Fire crews then came to rescue to lift gran-of-four Betsy into her son's car who took her to hospital where she remains after undergoing a hip repair operation. Dad-of-two Steve, of Leek, has now branded emergency response times as “absolutely disgusting”. He said: "It’s opened my eyes if I’m honest. It’s absolutely disgusting. I’m so grateful and thankful to the fire service - but it really isn’t their job. I can't remember in my time working as an ambulance technician going to someone and saying, 'I’m sorry it’s taken us twelve hours to get here'." “It was never anywhere near those ridiculous times when I worked there until 2000 and something has gone drastically wrong since. I can't speak highly enough of the boys and girls who work in the NHS, it's the people above them. Its systemic change that's needed." Read full story Source: Wales Online, 4 April 2024
  9. Content Article
    Read the Royal College of Emergency Medicine's general election manifesto. A one page summary is below and the full manifesto can be found at the link at the bottom of the page.
  10. News Article
    A new private ambulance service will offer faster travel to A&E for those caught out by half-day waits for NHS ambulances, The Independent can reveal, in a sign of a growing “two-tier” health service. MET Medical ambulance service will begin by charging £99 for a call-out, and could serve thousands of people a week, its chief executive Dave Hawkins has said. Mr Hawkins, who is a paramedic himself, said he launched the service after seeing his elderly relatives wait too long for NHS ambulance services following falls. It comes as waiting times for ambulance service reached a crisis point in the last year, with frail and vulnerable people waiting hours for an ambulance. Ambulance response times hit record highs over 2022-23, with people who should have an ambulance within 20 minutes waiting an hour and 30 minutes in December 2023. According to estimates from the Association of Ambulance Chief Executives, 34,000 patients were likely to have suffered harm due to these delays – this hit a high of more than 60,000 in December 2022. MET Medical will still have to wait to deliver patients if they are seen as a priority, but it said its patients are likely to be lower priority and can be dropped at A&E without waiting for a handover. Mr Hawkins said vulnerable patients waiting for an ambulance can wait up to 12 hours. “It’s that moment when you’re out of options, it’s really a horrible place to be, particularly if it’s a loved one … It is a shame, like we’ve seen from the stats and everything, that the health service is failing us." Read full story Source: The Independent, 3 April 2024
  11. News Article
    An ambulance trust is having to protect its staff from the effects of fumes – including potential cancer risk – as they are spending so long in their vehicles outside hospitals. South Western Ambulance Service Foundation Trust (SWASFT) has carried out a risk assessment of the impact of diesel engine emissions after following concerns from staff, many of whom are spending hours waiting to handover on each shift. The region has faced the worst handover delays to emergency departments in recent years. Ambulance engines normally have to be kept on while waiting, to keep essential equipment running, and sometimes for warmth. But with queues of a dozen or more ambulances at times, staff and patients can be exposed to substantial emissions for long periods. The trust’s risk assessment – which has been seen by HSJ – warns exposure to diesel emissions is associated with eye and upper respiratory tract irritation, while prolonged exposure can lead to coughing, increased sputum production and breathlessness. There is also “epidemiological evidence which indicates that sustained occupational exposure to diesel engine exhaust emissions may result in an increase in the risk of lung cancer”. It gives a risk rating of 20 – one of the highest possible – which, under the trust’s policies, indicates “activities must not proceed” until mitigations are in place. Read full story (paywalled) Source: HSJ, 27 March 2024
  12. Content Article
    This report, produced in collaboration with the Association of Ambulance Chief Executives and the NHS Confederation, highlights the pivotal role ambulance trusts play in delivering urgent and emergency care and sets out a long-term vision for an enhanced role they could take in co-designing this care. It sets out the case for change and includes several case studies that demonstrate the benefits of ambulance services taking this broader approach.
  13. Content Article
    Medication errors in ambulatory care settings present unique patient safety challenges. This systematic review explored the prevalence of medication errors in outpatient and ambulatory care settings. Findings indicate that prescribing errors (e.g., dosing errors) are the most common type of medication error and are often attributed to latent factors, such as knowledge gaps.
  14. News Article
    Ambulance chiefs have warned that patients are coming to harm, paramedics are being assaulted and control room staff reporting a “high stakes game of chicken” with police during the implementation of a controversial new national care model. The Association of Ambulance Chief Executives say in a newly published letter they believe the “spirit” of national agreement on how to implement the Right Care, Right Person model is not being followed by police, raising “significant safety concerns”. The membership body set out multiple concerns about the rollout of the model, under which the police refuse to attend mental health calls unless there is a risk to life or of serious harm. In the letter to Commons health and social care committee chair Steve Brine, AACE chair Daren Mochrie says timescales for introducing it were often “set by the police rather than “agreed” following meaningful engagement with partners”, meaning demand was shifting before health systems had built capacity. They also flag a lack of NHS funding to meet the new asks. Mr Mochrie, also CEO of North West Ambulance Service Trust, described a “grey area” relating to what he called “concern for welfare” calls, which meet neither the police nor attendance services’ threshold for attendance. “To date this is the single biggest feedback theme we have heard from ambulance services, with some control room staff describing feeling like they’re in a ‘high-stakes game of chicken’ where the police have refused to attend and told the caller to hang up, redial 999 and ask for an ambulance,” he wrote. Read full story (paywalled) Source: HSJ, 20 February 2024
  15. Content Article
    In this open letter to Steve Brine, Chair of the Health and Social Committee, The Association of Ambulance Chief Executives say they believe the “spirit” of national agreement on how to implement the Right Care, Right Person model is not being followed by police, raising “significant safety concerns”. It outlines key concerns, including the timescales for implementation, the consistency of application and failure by the police to attend when required.
  16. News Article
    Ambulance trusts have often prioritised capacity and response times over dealing with cases of misconduct, a review of culture in the sector for NHS England has found. The review says ambulance trusts need to “establish clear standards and procedures to address misconduct”. The work was carried out by Siobhan Melia, who is Sussex Community Healthcare Trust CEO, and was seconded to be South East Coast Ambulance Service Foundation Trust interim chief from summer 2022 to spring last year. Her report says bullying and harassment – including sexual harassment – are “deeply rooted” in ambulance trusts, and made worse by organisational and psychological barriers, with inconsistencies in holding offenders to account and a failure to tackle repeat offenders. She says “cultural assessments” of three trusts by NHSE had found “competing pressures often lead to poor behaviours, with capacity prioritisation overshadowing misconduct management”, adding: “Staff shortages and limited opportunities for development mean that any work beyond direct clinical care is seen as a luxury or is rushed. “Despite this, there is a clear link between positive organisational culture and improved patient outcomes. However, trusts often focus on meeting response time standards for urgent calls, whilst sidelining training, professional development, and research.” Read full story (paywalled) Source: HSJ, 15 February 2024
  17. Content Article
    This is an independent review commissioned by NHS England, chaired by Siobhan Melia, Chief Executive, Sussex Community NHS Foundation Trust, to support the improvement of the culture within the ambulance service. The review considers the prevailing culture within ambulance trusts in England. It considers the core factors impacting cultural norms and offers actionable recommendations for improvement. Based on insights from key stakeholders, this review has identified six key recommendations to improve the culture in ambulance trusts.
  18. News Article
    The first time she was groped at work, Freya says she was 24 years old, a newly qualified paramedic, and was cleaning out the cupboards of the ambulance station crew room. "He came behind me without me realising. I was cleaning away, and he put his hands around my body and grabbed my breasts," said Freya, which is not her real name. "Then he said, 'Well, I won't bother doing that again'. "People just laughed, some didn't even look up from the TV. Like it was nothing, completely normal." Her story mirrors that of other current and former paramedics who, in several interviews with Sky News, painted a picture of widespread sexual harassment and a toxic culture of misogyny. The head of the College of Paramedics, Tracy Nicholls, said: "Problems exist in every [NHS] trust, across all four countries in the United Kingdom." NHS England told Sky News that any form of sexual misconduct was "completely unacceptable" and every trust had committed to an action plan to improve sexual safety. Laura - not her real name - is currently a paramedic for a different ambulance service. She describes sexual harassment as "incessant" in the profession. She says students and new recruits are routinely referred to as "fresh meat", subjected to sexual comments, questions and jokes - even in front of patients - and are continually sexualised by some male colleagues. "It's exhausting," she said. "You come to work wanting to help your patients but every day you're dealing with inappropriate behaviour and sexual comments." Read full story Source: Sky News, 8 February 2024
  19. News Article
    Reductions in the number of long ambulance delays have come at a “huge cost” as hospitals are having to take in more emergency patients than they have space for, NHS England’s urgent care director has said. Sarah-Jane Marsh told NHS England’s board meeting on Thursday that emergency departments and hospital wards are now taking more “risk” by taking extra patients in a bid to get ambulances back on the road quicker. This year, many fewer hours have been lost to ambulance delays, although the total number of delays of more than 60 minutes is approaching the same as last winter. Emergency department waits in November and December were better than last year, although still much worse than pre-covid and a long way below targets. But Ms Marsh said the improvement was a result of hospitals agreeing to take more patients into EDs and acute wards, even when they did not have space or staff to properly care for them. She said: “It’s come at a huge cost. Some of the things we have achieved are because we have moved pressures around in the system. “We have moved risk out of people’s houses and from the back of ambulances, and in some cases we’ve moved that into emergency departments [and] wards, that have had to take the pressure of taking additional patients. “Next year one of our learnings is that we need to have a really big focus on what is happening inside our hospitals [so] we decongest some very crowded areas.” Read full story (paywalled) Source: HSJ, 1 February 2024
  20. Content Article
    Expecting paramedics to wade through shared care records is unsafe and inefficient. In an emergency, access to essential information has to be easy and fast, writes Claire Jones from NHS England South West. Whilst ambulance services may need access to the entire longitudinal record, it is imperative that in those first vital minutes of an emergency they have the most pertinent and relevant data at their fingertips. In such cases, information sharing can be a matter of life or death. We should make it as easy as possible for emergency care providers to access and view relevant information about the person in their care.
  21. News Article
    Paramedics are "watching their patients die in the back of ambulances because they can't get them into A&E", according to the health union, Unison. It was commenting on data showing 2,750 hours were lost by ambulance crews waiting to hand over patients at Hull Royal Infirmary in October 2023. One crew was stuck outside A&E for 10 hours and 27 minutes. Hull University Teaching Hospitals said it was "confident" a new urgent treatment centre on the hospital site would "improve overall waiting times" and lost ambulance hours had "reduced notably" this month. The figures, obtained by the BBC through a freedom of information request, showed on 9 October 2023 ambulance crews lost 144 hours and 18 minutes, the equivalent to one crew being out of action for six full days and nights. Megan Ollerhead, Unison's ambulance lead in Yorkshire, said paramedics were "literally watching their patients die in the back of these ambulances because they can't get into A and E." "I talk to a lot of the people who receive the 999 calls in the control rooms and they're just listening to people begging for ambulances and they know there are none to send." Read full story Source: BBC News, 26 January 2024
  22. Content Article
    On the 9 December 2022, Dennis John William King suffered sudden chest pain which extended down his arm. His wife called 999 and spoke with an ambulance service call handler. Following triage of the call, the response to Mr King's call was graded as a Category 3 (a potentially urgent condition which is not life threatening with a target response of 120 minutes). This call was subsequently re-graded following review in the call centre to a Category 2 (a potentially serious condition requiring rapid assessment, urgent on scene intervention or transport to hospital, with a response within 40 minutes and a target of 18 minutes).   Upon hearing that the waiting time for an ambulance could be as long as six hour, Mr and Mrs King decided to make their own way to the West Suffolk Hospital. The ambulance service were advised and the response stood down.   Within 40 minutes of arrival Mr King had been diagnosed as suffering an ST segment elevation myocardial infarction (STEMI). Treating clinicians assessed his condition as necessitating an urgent transfer to the Royal Papworth and for the angioplasty procedure to be conducted forthwith. The ambulance call centre was contacted by the hospital emergency department with a request for an urgent transfer to the Royal Papworth. Emergency department staff were advised that there would be a 5 hour delay for an ambulance to attend. The call from the hospital emergency department to the ambulance service was graded by the ambulance call handler as a category 2 response. When the response timing was challenged the emergency department matron was advised that the hospital was a place of safety. The ambulance call handler assessment did not seem to take into account the clinical assessment of accident and emergency department staff who, in consultation with the regional cardiac intervention hospital, had determined Mr King's further treatment at the regional cardiac centre was a matter of urgency. An ambulance subsequently arrived at West Suffolk Hospital Accident and Emergency Department and transferred Mr King to the Royal Papworth Hospital where he underwent treatment for what was identified as an occluded left anterior descending artery. About 1 hour after the procedure, Mr King's condition deteriorated and he suffered a left ventricular wall rupture, a recognised complication of either the myocardial infarction he had suffered or the surgical procedure to correct the occluded artery, or both. He received emergency surgery to repair the rupture by way of a patch which was successful. However, his condition deteriorated and he died on the 13 December 2022. The medical cause of death was confirmed as: 1a Multi Organ Failure 1b Post myocardial infarction left ventricular free wall rupture (operated on).
  23. News Article
    The availability of ambulances to transfer patients to specialist units is a "matter of concern", a coroner has warned. Darren Stewart, area coroner for Suffolk, made the comments in a Prevention of Future Deaths report. It followed the death of 84-year-old Dennis King, who waited three hours to be transferred from West Suffolk Hospital to Royal Papworth in 2022. Mr King had made his own way to the West Suffolk Hospital's accident and emergency department in December 2022, after being told an ambulance could take six hours to arrive at his home due to high demand in the area, the report said. His call had been graded as category two, which should have led to a response within 40 minutes - or a target of 18 minutes. After tests at West Suffolk Hospital showed Mr King had suffered a STEMI heart attack, emergency clinicians liaised with experts from the regional heart unit and decided he needed an urgent transfer to Royal Papworth in Cambridgeshire. The report said a matron at West Suffolk told ambulance call handlers they needed an urgent transfer - but because Mr King was classed as being in a "place of safety", control room staff said the delay would be "several hours". Mr Stewart said: "the availability of ambulances to carry out transfers in a timely manner, in urgent cases" was "a matter of concern". In the report, Mr Stewart said the circumstances of the case "raised concerns about the NHS approach to centralising care in regional centres" if the means to deliver it were "inadequate". Read full story Source: BBC News, 23 January 2024
  24. News Article
    Patients have suffered cardiac arrests while waiting in A&E departments or in ambulances queueing outside because Scottish hospitals are overwhelmed, doctors have warned. At least three cases in which patients’ hearts stopped beating while they were waiting for care have been reported to the Royal College of Emergency Medicine in Scotland. Some of the incidents, the college said, may have been preventable. One frontline doctor told The Times that a patient with heart problems had died waiting in a queue of ambulances outside an emergency department. Staff could not take the patient inside because there was no capacity. JP Loughrey, vice-president of the college and an A&E consultant in the west of Scotland, said that people who should be in resuscitation rooms with a team of experts and equipment to monitor their vital signs were instead lying in ambulances outside hospital buildings. He also said that tensions were growing between frontline staff and NHS managers in large hospitals because doctors and nurses, who were already struggling to cope, were under increasing demands to work harder to process more patients. Read full story Source: The Times, 19 January 2024
  25. Content Article
    Patients treated and transported by Helicopter Emergency Medical Services (HEMS) are prone to both flight and medical hazards, but incident reporting differs substantially between flight organisations and healthcare, and the extent of patient safety incidents is still unclear. This study in the Journal of Patient Safety is based on in-depth interviews with eight experienced Norwegian HEMS physicians from four different bases from February to July 2020. The study aimed to explore the physicians’ experience with incident reporting and their perceived areas of risk in HEMS. The authors concluded that sparse, informal and fragmented incident reporting provides a poor overview of patient safety risks in HEMS. A focus on organisational factors and system responsibility is needed to further improve patient safety in HEMS, alongside research on environmental and contextual factors.
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