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News ArticleA cancer patient has told Sky News it's "terrifying" for her health that junior doctors are striking again from Thursday. The NHS is expecting "major disruption" during the five-day strike as medics in England walk out over pay amid a yellow health alert heatwave and ongoing disruption to some services because of a ransomware cyber attack earlier this month. Major hospitals Guys' and St Thomas' and King's in London are still running at reduced capacity after the incident. Cancer survivor Donia Youssef has annual colonoscopies but her last was cancelled because of previous industrial action by junior doctors. Donia, from Grays in Essex, said: "It's a worry as a mum with two young children and I was on the list. It got cancelled. First time because of the strikes. And after that I didn't hear from them. So I kept pushing. Nothing. It was just more delays. I was just kept waiting. "[They said]: 'There's a backlog. We'll get back to you. There's a backlog, they're getting through. We'll let you know if there's any cancellations.'" "It's like months later. Nothing. So eventually, because the symptoms are getting worse, I decided to pay." Donia was so scared of her health worsening she paid for private treatment, a cost she could barely afford. And now, as a cancer survivor, every time there's a fresh round of strikes she is filled with dread. "I get scared. I can't get [treatment] on the private and a lot of it's really expensive. So, yeah, it's terrifying. So you're constantly aware," she said. Read full story Source: Sky News, 27 June 2024
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News ArticleA patient in a West Midlands A&E was forced to urinate while lying in a corridor as another was left crying in agony for hours in an undercover report highlighting the NHS’ emergency care crisis. A Channel 4 Dispatches programme has exposed the “suffering and indignity faced by patients on a daily basis” after an undercover reporter secretly filmed himself working as a trainee healthcare assistant inside the emergency department of the Royal Shrewsbury Hospital for two months. The footage, which aired on Monday night, shows one patient waiting 30 hours in a “fit to sit” area while a suspected stroke sufferer was there for 24 hours, the broadcaster said. In one clip, an elderly man was forced to urinate in a trolley on the corridor in full view of staff and other patients, while in another a woman is left crying in agony for hours. Nurses are also seen discussing how one of their patients was forced to wait a staggering 46 hours for care and at one point the footage shows large pools of blood on the floor. Experts have said while the scenes were “shocking” and “harrowing” they were not unique to the Royal Shrewsbury Hospital and are occurring in hospitals across England. Read full story Source: The Independent, 25 June 2024
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News Article
Trusts plead for national help with surge in long waiters
Patient Safety Learning posted a news article in News
The number of children waiting more than a year for community services has risen by a third in two months – mostly driven by referrals for neurological disorders – causing trusts to plead for national intervention. NHS England figures show the number of children’s community waits of more than 52 weeks grew from 27,429 in February to 35,922 in April (31 per cent). Data collection changed in February, which resulted in an increase in that month, but, even discounting this, the total appears to have roughly doubled in the year to April. Along with a rise in the overall waiting list for community health services, it has been overwhelmingly driven by a large rise in referrals to children’s “community paediatrics” services, mostly for neurological disorders such as autism and ADHD. Several trusts have declared they are effectively unable to deal with demand locally and called for national intervention and regional coordination to help. Read full story (paywalled) Source: HSJ, 25 June 2024 -
News Article
Nearly 19,000 NHS patients left waiting for three days in A&E over 12 months
Patient Safety Learning posted a news article in News
Almost 19,000 NHS patients were left waiting in A&E for three days over a 12-month period, an investigation has revealed. Between April 2023 and March 2024, nearly 400,000 people were left waiting more than 24 hours across A&E departments, a 5% rise on the previous year. Channel 4’s Dispatches programme also found that 54,000 people had to wait more than two days, a freedom of information request to NHS England found. The investigation exposed “suffering and indignity faced by patients on a daily basis”, after an undercover reporter secretly filmed himself working as a trainee healthcare assistant inside the emergency department of the Royal Shrewsbury hospital for two months. The “harrowing” scenes from the hospital’s A&E department came as an analyst from a thinktank said people were dying in emergency care in England “who don’t need to be dying”. Footage shows one patient waiting for 30 hours in a “fit to sit” area while a suspected stroke sufferer was there for 24 hours, the broadcaster said. Dr Adrian Boyle, president of the Royal College of Emergency Medicine, said: “I don’t think this is unique to this hospital by any stretch of the imagination. The things we’ve seen here today are clearly not just confined to winter. It was a year-round crisis in emergency care. “Spending two days in an emergency department is worse than spending two days in an airport lounge. These are people who are sitting in uncomfortable seats where the lights never go off. There’s constant noise, there’s constant stress. There’s no end in sight.” Read full story Source: The Guardian, 24 June 2024 -
News Article
NHS in summer crisis of emergency care waits, doctors say
Patient Safety Learning posted a news article in News
The NHS is engulfed in a summer crisis, senior doctors have said, amid severe ambulance delays, corridors crowded with trolleys and patients facing 25-hour waits in A&E units. The Royal College of Emergency Medicine (RCEM) sounded the alarm over the “national scandal” of long waits for emergency care that it said were leading to “entirely preventable” deaths at a time of the year when there should be some respite from the traditional pressure experienced over winter. Elderly people in particular were facing the brunt of the impact, with many forced to endure horrific long waits for a bed once a decision had been taken to admit them to hospital, the college said. A snapshot survey by the RCEM of emergency department chiefs from across the UK, conducted between Monday and Wednesday this week, exposed the extent of the summer crisis in hospitals. Nine in 10 (91%) of 63 A&E bosses admitted NHS patients were “coming into harm” on their wards due to the quality of care that could be delivered under current conditions. Eighty-seven per cent said they had patients being treated in corridors and 68% said they had patients waiting in ambulances outside their A&E. One emergency department leader revealed that one of their patients this week waited more than 19 hours for a hospital bed to become available once a decision was made to admit them after they had already waited six hours to be seen. Overall, the patient ended up waiting 25 hours in A&E. Read full story Source: The Guardian, 20 June 2024 Related reading on the hub: A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift Reflections on a clinical shift: "After 20 years of nursing, this is one of the worst shifts I have ever completed" -
Content Article
Age UK: It’s a struggle to be seen (May 2024)
Patient Safety Learning posted an article in Older people
Results of Age UK’s research into the experience of people aged 50 and over accessing health and social care services. This research into older people’s experiences of health and care services has revealed the extent of the challenges they face in accessing and receiving them. These challenges are confronted at a time in their lives when people are likely to be most reliant on such services to keep them well, independent, connected and safe. People from across the age spectrum, from 50 to over 100 years old, told Age UK about difficulties in accessing primary care services, including GPs and dentists. Health problems that could have been quickly and easily resolved have worsened through long waits for appointments and treatment. In some cases, older people have given up seeking treatment and care as they had lost hope of being able to see a clinician at all. For those of working age the problems in accessing appointments, referrals and treatment have had an impact on their ability to maintain good health, to remain in work and to care for others. Lack of access to support for carers has led to deteriorations in their physical and mental health. -
News Article
Millions of over-50s in the UK fear they can't access healthcare
Patient Safety Learning posted a news article in News
Millions of people over the age of 50 in the UK have concerns about struggling to access healthcare, according to new analysis by Age UK. It comes as one elderly and disabled patient admitted he cannot afford to wait on hold to his GP practice for an appointment for long due to rising phone bill costs. A new report by Age UK – It’s a Struggle to be Seen – analysed the results of a representative poll, conducted for the charity by Kantar, of 2,621 UK adults over 50, as well as its own online survey which attracted more than 17,000 responses. The report claims less than half (48%) of people over 50 are confident their medical issue would be solved by NHS services. Some 49% – which Age UK equates to 12.6 million people – were concerned about their ability to access their GP, while 42% were worried about access to hospital appointments. The same proportion expressed concerns about access to emergency departments, the charity said. Caroline Abrahams, charity director at Age UK, said: “Sadly, for some older people, healthcare delayed means healthcare denied, because they do not have time on their side. “Our new analysis highlights just how many are being subjected to distress and, in some cases, enduring pain, because of their difficulties in accessing the GP services that they need.” Read full story Source: Medscape. 17 June 2024 -
News Article
More sick kids go private as others face NHS waits
Patient Safety Learning posted a news article in News
The number of children receiving treatment in private hospitals across the UK rose by almost a quarter last year to more than 46,000, according to new data seen by the BBC. In each case, families either paid for treatment or used medical insurance - rather than being referred by the NHS. The record figures from private healthcare providers come as England's NHS trusts tell File on 4 that children have become the “forgotten generation” in the race to reduce health service backlogs. The Department of Health says NHS staff are “working tirelessly” to cut waiting lists. But the Royal College of Surgeons of England told us children were lagging behind adults and spending years waiting for NHS surgery - with potentially life-long consequences for their health and development. The BBC has spoken to a number of families whose children’s conditions have deteriorated during long waits. They include 16-year-old Georgina Smith from Hertfordshire, who is waiting for open-heart surgery to repair a valve on her right side which doesn’t close properly. It can cause her blood to flow the wrong way, making it harder for her heart to work. Georgina is one of 601 children waiting for heart surgery in England - 139 have been waiting more than six months. She suffers chest pains, extreme fatigue and fainting episodes and has been forced to miss a lot of school. Georgina says she feels like her operation will never happen. “It’s like a cloud over my head, it’s always just this waiting and waiting and waiting,” she says. Read full story Source: BBC News, 18 June 2024 -
News Article
Sussex NHS trust apologises for cancer treatment delays before man’s death
Patient Safety Learning posted a news article in News
A troubled NHS trust has apologised to the family of a man who died after a series of delays led to him waiting four times longer for an operation than a national cancer target. Before he died in November 2022, Ken Valder, 66, complained of “delays after delay” to his treatment for oesophageal cancer. University Hospitals Sussex – the focus of a separate police investigation into allegations of surgical negligence and cover-ups over dozens of deaths between 2015 and 2021 – admitted that errors, failures and disagreements between surgeons contributed to delays to Valder’s treatment. They also accepted that the case highlighted patient safety concerns that prompted the hospital regulator in 2022 to suspend upper gastrointestinal cancer services at the trust, which includes the Royal Sussex County hospital in Brighton. An independent review of the case also found that Valder’s care was “suboptimal” and that if he had received surgery earlier it “might have led to a better oncological outcome”. Read full story Source: The Guardian, 17 June 2024 -
News Article
Deadly cancer treatment delays now ‘routine’ in NHS, say damning reports
Patient Safety Learning posted a news article in News
Hundreds of thousands of people are being forced to wait months to start essential cancer treatment, with deadly delays now “routine” and even children struck by the disease denied vital support, according to a series of damning reports. Health chiefs, charities and doctors have sounded the alarm over the state of cancer care in the UK as three separate studies painted a shocking picture of long waits and NHS staff being severely hampered by a worsening workforce crisis and a chronic lack of equipment. The first report, by Cancer Research UK, found that 382,000 cancer patients in England were not treated on time since 2015. The charity investigated how many patients had begun treatment 62 days or longer after being urgently referred for suspected cancer. The national NHS target – under which at least 85% of people should start treatment within 62 days – was last met in December 2015. The second report, by the Royal College of Radiologists (RCR), said delays in cancer care had become routine, with nearly half of UK cancer centres experiencing weekly delays in starting treatment. The RCR also warned of a “staggering” 30% shortfall in clinical radiologists and a 15% shortfall in clinical oncologists – figures it projects will get worse in the next few years. The third paper, from four children’s cancer charities – Young Lives vs Cancer, Teenage Cancer Trust, Ellen MacArthur Cancer Trust, and Children’s Cancer and Leukaemia Group – said young patients were being failed by a lack of support after diagnosis. Naser Turabi, the charity’s director of evidence, said the crisis was causing widespread treatment delays that “negatively impact” patients. “One study has estimated that a four-week delay to cancer surgery led to a 6-8% increased risk of dying, and delays can also reduce the treatment options that are available. There are also the psychological effects – with waiting causing major stress and anxiety for cancer patients and their loved ones.” Read full story Source: The Guardian, 13 June 2024 -
Content ArticleCancer Research UK has published a manifesto that sets out the measures and commitments the next government can make to help prevent 20,000 cancer deaths every year by 2040.
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Content Article
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Ambulances lined up outside hospital Emergency Departments (EDs) are a vivid, and politically embarrassing, indication of inadequate capacity in the NHS. Media reports of diktats demanding that hospital CEOs meet performance targets suggest a desire for action, but are the local solutions being implemented to ease the pressure in the best interest of patient safety? The use of ‘safety cases’ in healthcare has received some interest in recent years but the conclusion drawn by, for example, Leberati and her colleagues,[1] was that while they have some potential value they are "fraught with challenge, highlighting the limitations of efforts to transfer safety management practices to healthcare from other sectors". A survey of the literature suggests that there is a danger of conflating ‘safety cases’ with ‘safety management’ or ‘quality’ systems. Part of the problem might be that safety cases are more a concept rather than a methodology: there is no script to follow. In this blog, Norman MacLeod discusses whether the the current crisis in hospital capacity can be explored through the safety case lens.- Posted
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News Article
Surge in patients sent hundreds of miles for care
Patient-Safety-Learning posted a news article in News
The number of people sent out of their home area for a mental health bed – in some cases hundreds of miles away – has increased to a five-year high, despite national ambitions to eliminate the practice. A 2021 date to stop “inappropriate out of area placements” was initially set by government and NHS England in 2016 but, despite initial reductions, the target was missed, with hundreds of patients still affected each month. Demand and bed pressures in the wake of covid appeared to make it more difficult and numbers have been rising. Analysis of the latest NHS Digital data this month shows 825 active inappropriate placements in February 2024 following a steady rise from December 2023, when there were 700 (see chart). The year on year increase from February last year is 15 per cent, but there has been a 46 per cent rise since a low of 565 just 14 months previously, in December 2022. Being sent out of area can disrupt the patient’s care, make it less likely patients will be visited, harder for them to return home and to community support, and is also often very expensive as places are bought at short notice from independent providers. NHSE acknowledged pressures on OAPs in 2024-25 planning guidance but asked systems to “work towards” eliminating them, saying they are “detrimental to patient safety, experience and outcomes.” National mental health director Claire Murdoch last month told HSJ they represented “poor care at relatively high costs.” Read full story (paywalled) Source: HSJ, 23 May 2024 -
Content Article
Blog: Waiting for what? (May 2024)
Patient-Safety-Learning posted an article in Patient engagement
Patients’ waits do not begin when the NHS clock starts—on referral to a consultant. They begin when the person decides their symptoms merit professional attention. In this blog, Sue Brown, CEO of the Arthritis and Musculoskeletal Alliance (ARMA) looks at the patient’s experience of waiting and how it differs from the NHS understanding. She argues that if the NHS is to deal with waiting lists well, it needs to understand what waiting means to patients. -
News Article
NHSE targeting 50% cut to waiting list
Patient-Safety-Learning posted a news article in News
NHS England is floating proposals to cut the elective waiting list by nearly 50 per cent to under 4 million over the next five years. HSJ understands this scenario is being discussed among system leaders as they brace themselves for the next government, whoever wins the general election, demanding a radical reduction in the waiting list. The list stood at 7.5 million as of the last official figures. The figure of just under 4 million is in part being targeted because this is the level NHS bosses estimate the list would need to be reduced to if the service is to return to meeting the standard that 92 per cent of patients referred are treated within 18 weeks, which has not been met since February 2016. Waiting list expert Rob Findlay estimated the required level would need to be closer to 3.5 million if the 92 per cent target is to be met. He told HSJ the list “would need to shrink to around 3.6 million before the statutory 18-week target became achievable again”. HSJ understands NHSE’s leadership believes a target of under 4 million could be credible—albeit likely dependent on targeted extra capacity, technology, resolution of strikes and on which other targets are set, especially around emergency waiting times. Progress could be accelerated by, for example, major outpatient reform to remove many appointments deemed unnecessary and use of technology to overhaul some pathways, officials believe. These could have a similar impact to the likes of faecal immunochemical testing, known as FIT, which is said to be playing a big role in reducing the cancer backlog. Read full story (paywalled) Source: HSJ, 26 April 2024 -
News Article
How Covid is pushing up waiting lists for cancer treatment
Patient-Safety-Learning posted a news article in News
New figures have quantified what the pandemic has meant for cancer waiting lists—and the impact is stark. Official data show that 15,971 cancer patients in the UK have had to wait more than 124 days, or four months, after diagnosis for their treatment to start since 2020 as the pandemic sends waiting lists soaring. The statistics show that the number of untreated patients has more than doubled since Covid began, with one patient waiting for more than two years, according to data released following a freedom of information request from the Liberal Democrats. This is despite an NHS target for patients to receive cancer treatments within two months of an urgent referral. Last year, 6,334 patients waited more than 124 days, compared to 2,922 in 2022, the figures show. Data was received from 69 out of 137 acute health trusts in the UK, meaning the true number of people waiting long periods for treatment is likely to be much higher. Over 1,100 cancer patients last year were left waiting more than six months to receive treatment, triple the NHS target time. Liberal Democrat Leader, Ed Davey, said: “Every single one of these figures is a tragedy. Long delays for treatment can have a devastating impact on cancer patients and their families, and in certain cases can even cost lives." Read full story Source: inews, 22 April 2024 -
News Article
Jammed 999 lines and not enough ambulances to go round
Patient Safety Learning posted a news article in News
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 -
Content ArticleThis French cohort study in JAMA Internal Medicine aimed to find out whether spending a night in the emergency department (ED) associated with increased in-hospital mortality and morbidity among older patients. The results showed that older patients who spent a night in the ED showed a higher in-hospital mortality rate and increased risk of adverse events compared with patients admitted to a ward before midnight. This finding was particularly notable among patients with limited autonomy.
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News Article
Why Mondays are the deadliest day to go to A&E
Patient Safety Learning posted a news article in News
The number of people dying needlessly in A&E soars on a Monday as hospitals are stretched to the limit and failing to discharge patients at the weekend, new data shows. Figures uncovered by The Independent show an average of 126 patients died every Monday between 2020-2023 – 25% higher than any other day. On a Saturday, the average number of deaths drops as low as 90. Waiting times are also shown to spike massively at the start of the week, with an average of 9,300 patients spending more than 12 hours waiting on a Monday – up to 2,000 more than any other day. Medical experts said the rise in A&E waits can be attributed to people staying away from hospitals during weekends and patients not being discharged from medical care, causing a bottleneck in an already buckling system. The stark statistics also directly contradict repeated government efforts to make the NHS a seven-day service. Multiple coroners have warned the government and health leaders about delays to patients’ treatment and diagnosis due to variations in staffing and access to specialists – particularly over the weekend. Adrian Boyle, president of the Royal College of Emergency Medicine, said the NHS England data clearly signposted an “increased risk” at the start of the week. Another expert said the sharp rise in deaths on Mondays showed an A&E “running constantly in the red zone”. Read full story Source: The Independent, 8 April 2024 -
Content ArticleAbout 40,000 patient pathways have disappeared. But on the plus side, a new and better data series has begun. The referral-to-treatment (RTT) waiting list data has now changed in two important ways. First, about 40,000 patient pathways in community services are now excluded from the RTT data collections, and this accounted for all of the apparent reduction in list size in the latest (February) official RTT data. Second, NHS England has started regular publication of the more detailed and timely (though – for now – less complete and accurate) Waiting List Minimum Data set. This HSJ article looks at those changes in more detail.
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News Article
NHS waiting lists: Rishi Sunak fails on key pledge as 7.5m people languish
Patient-Safety-Learning posted a news article in News
Rishi Sunak has failed to deliver on his key promise to cut NHS waits, the health secretary has admitted, as new figures show that the overall waiting list now stands at 7.5 million. An extra 300,000 patients are waiting for hospital care compared with January last year, when the prime minister pledged that, under his government, “NHS waiting lists will fall and people will get the care they need more quickly” . Victoria Atkins, the health secretary, admitted that Sunak had failed to deliver on his promise but argued: “I don’t think anyone could have thought that it was an easy promise to make and it was going to be easy to achieve.” Read full story (paywalled) Source: The Times, 11 April 2024 -
News ArticleIn the next few days, once the data has been collected, the Government will come out and say that, thanks to its policies, the situation in A&E is improving. Despite estimates released recently by the Royal College of Emergency Medicine that soaring waits for A&E beds led to more than 250 needless deaths a week in England alone last year, the Government will point to declining numbers of patients who breached the four-hour target this March. The four-hour target means we're meant to see and either discharge or admit patients within four hours of their arriving in A&E. But it's a sham, writes Professor Rob Galloway in the Daily Mail. Because, for the past month, the four-hour data has been manipulated, the result of two policies introduced earlier in the month by the Government. Read full story Source: Daily Mail, 3 April 2024
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News Article
The ICSs ‘diverting’ the most GP referrals through controversial model
Patient Safety Learning posted a news article in News
There is huge regional variation in the rate at which health systems are preventing patients joining the elective waiting list through “advice and guidance” to GPs, according to analysis by HSJ. Some systems – including Northamptonshire – have managed to ramp up these “diverts” to such an extent that they now report around one A&G case to every 3.5 cases cleared from the waiting list through treatment or seeing a consultant. This contrasts with others, such as Lancashire and South Cumbria, which only reports one A&G case for every 16 cleared from the waiting list. Advice and guidance involves GPs consulting specialists before making direct referrals and around half the time this results in a referral being avoided. The model is set to be a cornerstone of NHS England’s new outpatient transformation strategy, which is due imminently. Victoria Tzortziou-Brown, vice chair of the Royal College of GPs, said the analysis “confirms reports we’ve heard from our members – that there is too much regional variation in the use of the ‘advice and guidance’”. She added: “Some GPs report that when advice and guidance is properly resourced and well implemented, it can be a helpful tool for improving communications with their colleagues in secondary care. “[But] it is clear that more time, funding and capacity needs to be dedicated to allow clinicians to communicate efficiently and effectively whilst respecting professionalism.” Read full story (paywalled) Source: HSJ, 9 April 2024 Related reading on the hub: Rejected outpatient referrals are putting patients at risk and increasing workload pressure on GPs -
Content ArticleNHS England’s response to claims of excess deaths due to long A&E waits leaves a lot to be desired, writes Steve Black for the HSJ. The Royal College of Emergency Medicine (RCEM) claim that more than 250 A&E patients are dying each week because they waited more than 12 hours to be admitted. If long waits in A&E are killing an extra 250-400 people every week, it is the biggest performance problem in the NHS. NHSE should urgently ask their analysts to rework this analysis with current data to test (or refute) the validity of the claim. The first step to solving a huge problem is admitting the scale of the problem, not denying it exists. This analysis features a refinement of the RCEM estimate that includes estimated mortality from waits between four and 12 hours. This increases the estimate to 400 extra deaths per week compared to the RCEM number of 250.
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News Article
Urology inquiry: Waiting lists greatest source of harm
Patient Safety Learning posted a news article in News
A former consultant at the Southern Health Trust has told an inquiry into urology services that waiting lists are the "greatest source of patient harm". The inquiry was established in 2021 and is examining the trust's handling of urology services prior to May 2020. Aidan O'Brien became a consultant urologist in Craigavon Area Hospital in July 1992. His work is at the centre of the inquiry. Giving evidence on Monday, he said waiting list figures highlighted what "myself and my colleagues [have said] for decades" and described it as a "grossly inadequate service". "If you look at four-and-a-half years for urgent surgery, it is appalling," he told the inquiry. "I don't have a magic solution to the current situation, which is dire." Read full story Source: BBC News, 8 April 2024
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