NHS England treats too many patients as an emergency, watchdog warns (The Guardian, 2 March 2018)

Hospitals in England are admitting so many patients as medical emergencies that the NHS’s finances and ability to function are under threat, Whitehall’s spending watchdog has warned.

But one in four of the growing number of mainly older people who end up in inpatient care should not be in hospital in the first place, according to the National Audit Office (NAO).

The ageing population and other unexplained factors mean hospitals are now treating 5.8 million patients as emergency admissions every year, 24% more than a decade ago, the NAO found. Together they cost the health service £13.7bn, almost a 10th of its budget, and account for 33.59m bed days.

Its hard-hitting report, published on Friday, praises NHS England’s handling of the extra numbers but also criticises its failure to put in place enough services outside of hospitals to keep patients healthier.

The watchdog believes this lack of provision underpins its finding that 24% of emergency admissions are avoidable, implying that £3.43bn a year of NHS funds may be being wasted on people who, with better care, would not have ended up falling ill.

The NAO said: “The impact on hospitals of rising emergency admissions poses a serious challenge to both the service and financial position of the NHS.”

It acknowledged that hospitals have done well to reduce the overall impact of rising emergency admissions in recent years, in particular by reducing patients’ length of stay and treating more patients as day cases.

But it warned: “[The health service] cannot know if its approach is achieving enduring results until it understands whether reported increases in readmissions are a sign that some people admitted as an emergency are being discharged too soon.

“The NHS also still has too many avoidable admissions and too much unexplained variation. A lot of effort is being made and progress can be seen in some areas, but the challenge of managing emergency admissions is far from being under control.” ...read more


Fifth of prescribed antibiotics are unnecessary, study finds (The Guardian, 27 February 2018)

GPs are fuelling the growing threat of antimicrobial resistance by wrongly giving antibiotics to one in five patients who has a cough or sore throat, a government-funded study has found.

Family doctors are displaying “substantial inappropriate antibiotic prescribing” when dealing with patients who have an infection, according to research published by Public Health England (PHE), the government’s public health advisers.

Of the 32.5m antibiotics GPs in England prescribe every year “at least” 20% – 6.3m – are unnecessary, a panel of experts has concluded.

They said only 10% of patients with an acute cough should be given antibiotics, but 41% received the drugs, theydiscovered when they examined GP records.

Senior doctors and Jeremy Hunt, the health and social care secretary, seized on the overprescription to urge GPs to do more to thwart the growing ineffectiveness of some antibiotics, which leads to about 25,000 deaths a year in Europe.

The findings of the study – the first to quantify the number of antibiotics issued inappropriately in primary care – has led to renewed pressure on GPs to prescribe fewer. GPs record no clinical reason for issuing the antibiotics in a third of all prescriptions, they discovered.

Most antibiotic prescriptions are issued for respiratory and urinary infections, the experts found, but GPs are giving out far too many for conditions for which they are not justified, they say in a series of five articles in the Journal of Antimicrobial Chemotherapy. ...read more


Exclusive: Vanguards dent emergency admissions but not bed days (HSJ, 26 February 2018)

NHS England’s national performance dashboard for the programme shows that, over the measurement period, there was a larger reduction in the rate of hospital bed days in non-vanguard areas than in the nine primary and acute care systems.

Across the 14 multispeciality community providers there was a slightly larger reduction than in the non-vanguard population.

However, the dashboard report shows that vanguards saw substantially lower growth in the rate of emergency admissions over the same period than the rest of England.

Bed days and emergency admissions are the “efficiency” metrics included in the new care models dashboard.

The vanguard dashboard report seen by HSJ compares the rate of emergency admissions and bed days in the 12 months to September 2017, to that in the 2014-15 financial year. It also reveals figures for all the vanguard sites. ...read more


A 'staggering increase' in cancelled operations (The Independent, 25 February 2018)

Patients are facing delays to life-saving treatment amid warnings over a “staggering increase” in cancellations of urgent surgery.

Nearly 1,000 urgent operations have been cut so far this winter for patients with life-threatening illnesses due to pressures on hospital resources, such as beds or staff, according to new analysis of NHS figures.

The total represents a 40 per cent increase in cancellations since 2013-14, when 707 operations were cut, and a surge of 31 per cent since 2010-11 when there were 755 cancellations. ...read more


Ambulances stuck at A&E 'unable to respond quickly to 999 calls' (The Guardian, 18 February 2018)

Patients who have a stroke or heart attack are at risk of harm because so many ambulances are stuck at A&E units that they cannot respond quickly enough to 999 calls, an NHS boss has said.

Wayne Bartlett-Syree, the director of strategy and sustainability at the East of England ambulance service, said the huge number of delays ambulance crews have faced this winter in handing over patients to hard-pressed staff of overcrowded A&E units was to blame. ...read more


Patients 'dying in hospital corridors' (BBC News: 11 January 2018)

Patients are dying in hospital corridors as safety is compromised by "intolerable" conditions, doctors say.

The warning has been issued in a letter to the prime minister signed by 68 senior A&E doctors, spelling out the danger patients are facing this winter.

It comes as reports have emerged of people being left for hours on trolleys in corridors and stuck in ambulances....read more 


'Desperate times' for overcrowded hospitals, senior doctor warns (The Guardian: 1 January 2018)

Pressures on the NHS have “escalated rapidly” over the festive period, with hospitals experiencing significant bed shortages, a leading doctor has warned.

Dr Nick Scriven, president of the Society for Acute Medicine (SAM), said many hospitals reported more than 99% capacity in the week before Christmas.

He said services are being placed under significant strain as they enter the new year and called for non-urgent operations to be postponed until at least the end of January.

Doctors have described corridors overflowing with patients and used social media in a bid to find extra staff to cope with demand....read more


Call for more hospital beds to cope with winter breathing difficulties (The Guardian: 11 December 2017)

need to provide more beds in the winter months to deal with the rising numbers of adults and children who struggle to breathe, according to a report that warns this is a major cause of the crisis in accident and emergency departments.

The report from the British Lung Foundation says more and more people are ending up in an already hard-pressed A&Es because of the increase in breathing problems caused by air pollution, an ageing population and the long-term effects of heavy smoking.

In the last seven years, lung disease admissions to hospitals in England and Wales have risen at over three times the rate of all other conditions, says the report. They are at their worst in the winter, often complicated by seasonal flu....read more


NHS trust boss resigns in protest over underfunding of health services (The Guardian: 10 December 2017)

The boss of one of the NHS’s biggest trusts has resigned in protest at what he claims is such serious government underfunding that hospitals cannot perform their key role properly.

Bob Kerslake, who was the head of the civil service until 2015, is quitting as the chairman of the board at King’s College hospital in London, after a long-running dispute with the NHS watchdog over its finances. Ministers are in denial about the reality of how much extra money the NHS requires, he says.

In an article for the Guardian, Lord Kerslake, a highly respected crossbench peer and former permanent secretary at the Department for Communities and Local Government, explains that he is stepping down because hospitals are being asked to agree to meet unrealistically demanding savings targets....read more


NHS bosses sound alarm over hospitals already running at 99% capacity (The Guardian: 7 December 2017)

Hospitals are already as much as 99% full as the NHS braces itself for the winter – far over the 85% limit experts say must be maintained to protect patient safety.

Hospital trust chief executives have disclosed that they are running at close to 100% bed occupancy even before the expected bad weather and major flu outbreak this winter have arrived.

NHS bosses speaking on condition of anonymity also voiced fears that patients could be harmed and staff left unable to cope with the seasonal surge in demand for care because their hospitals could run out of spare beds.

“We’re lucky to get below 99% bed occupancy rates,” said the chief executive of one trust. “We plan for winter all year round, but there’s an underlying lack of beds and resources. There is a daily battle [over where to care for patients who need to be admitted] due to the lack of beds.”

The chief executive admitted to being worried about a chronic lack of beds risking patients’ health. “In terms of extreme pressure, we do worry. We worry about getting people into beds quickly enough.” ...read more

Rule changes could put mental health trusts in ‘impossible position leading sector figures warn. (National Health Executive: 6 December 2017)                            

Changes to the rules governing the detention of mental health patients in police cells could put trusts in an “impossible position” if there are not enough resources to improve access to hospital care, leading sector figures have warned.

The changes, which come in on 11 December, will mean under-18s who are detained under section 136 of the Mental Health Act can no longer be held in police cells, while adults can only be held in them in strictly-defined circumstances. Police are also expected to consult a healthcare professional, if practical, before detaining anyone.

The 72 hour limit on holding someone under section 136 in any place of safety will be reduced to 24, with the possibility of extension for 12 hours. This will mean patients will need to be assessed and potentially moved to more appropriate accommodation much quicker than currently.

Sean Duggan, chief executive of the Mental Health Network, welcomed the changes but said trusts would be left “in an impossible position” if the right mental health professionals and inpatient beds were not available. “The government must ensure there are adequate resources for local areas to apply the new regulations,” he said...see more


Private health firm gives GPs operation price list for impatient patients (The Guardian: 5 December 2017)

A private healthcare company has sent letters to hundreds of GPs setting out a price list of operations they could offer their patients to beat NHS delays and restrictions.

Care UK, which runs nine centres offering treatment on the NHS, said it intended to use spare theatre time to provide “self pay” procedures ranging from earwax removal to hip replacements.

The company said it was trialling the scheme at two treatment centres in the west of England but insisted core work at the sites would remain NHS referrals.

The move has, however, alarmed some GPs and health campaigners who fear it is another example of creeping privatisation in the NHS....read more


Maternity services suspended in South Tyneside due to safety concerns. (National Health Executive: 4 December 2017)

Bosses at South Tyneside District Hospital have halted baby delivery services following concerns being raised about safety.

The hospital, run by South Tyneside NHS FT, have already suspended its special care baby unit (SCBU) last Thursday due to extreme staffing pressures, a decision which was thought to have had a knock-on effect.

Although a number of low-risk deliveries were completed over the weekend, trust leaders have decided to suspend all deliveries from today following advice from maternity experts in other parts of the region.

There were a total of 165 women booked for deliveries in the maternity unit and the trust says they will all be personally contacted to ensure safe alternative arrangements can be made.

Dr Shahid Wahid, medical director at South Tyneside NHS FT said closing services was a “very difficult decision” but thanked other colleagues in the region for their support...see more


Unreported chest x-ray causes two patient deaths. (HSJ: 1 December 2017)

Two patients died and a third suffered “significant harm” after x-rays went unreported by radiologists resulting in missed opportunities to diagnose lung cancer.

The incidents were among the “unacceptable” failures at Portsmouth Hospitals Trust, which had built up a backlog of more than 26,000 unreported images of chest x-rays by March 2017.

The Care Quality Commission, which carried out an unannounced inspection following a tip-off from a member of the public, has told the trust to take urgent action and has begun reviewing radiology reporting across the NHS.

Its report into Queen Alexandra Hospital in Cosham found three incidents where patients’ lung cancers were missed.

One patient’s x-ray, taken in 2014, was examined by a junior doctor who found no abnormality. A year later, the patient was referred for an x-ray again by their GP and this time a radiologist reported suspected lung cancer, which they felt was evident from the first x-ray.

Another patient was x-rayed in late 2015 but the medical notes showed no formal review by the referrer so it is unclear if the lung cancer was spotted – or if the x-ray was reviewed. Ten months later the patient was x-rayed again and found to have advanced spread of lung cancer.

Both patients died because of the illness, the trust confirmed to HSJ...see more


Landmark study links Tory austerity to 120,000 deaths (The Independent: 16 November 2017)

The Conservatives have been accused of “economic murder” for austerity policies which a new study suggests have caused 120,000 deaths.

The paper found that there were 45,000 more deaths in the first four years of Tory-led efficiencies than would have been expected if funding had stayed at pre-election levels.

On this trajectory that could rise to nearly 200,000 excess deaths by the end of 2020, even with the extra funding that has been earmarked for public sector services this year.

Real terms funding for health and social care fell under the Conservative-led Coalition Government in 2010, and the researchers conclude this “may have produced” the substantial increase in deaths....read more


NHS straining at the seams year before 70th birthday, finds regulator (The Guardian: 10 October 2017)

The NHS is in danger of a sharp decline in its services around its 70th birthday next year, with the risk of the quality of care becoming precarious, the health service’s regulator has warned.

The Care Quality Commission said staff shortages, rising demand and increasing numbers of patients with preventable illnesses meant services were straining at the seams.

An increase in the number of older people who are frail, many with dementia and have multiple long-term conditions, was placing unprecedented pressure on the system, it added.

Examples of pressure in the system include the fact 2.5 million people spent longer than four hours in A&E in 2016-17, up from 1.8 million the previous year. Hospital bed occupancy reached record levels of 91.4% this year.

Behan said the NHS was in need of modernisation and it had been created almost 70 years ago when the big issues were diseases such as TB and polio.

“Today, the NHS and social care are dealing with obesity, diabetes, coronary heart disease, cancers, dementia. All of which are driven less by those diseases of the middle of the last century and more by lifestyle choices.”

He continued: “We are living longer but are not living healthier so I think what we are signalling is that the system now and into the future has got to deal with those increased numbers of older people who are going to have more than one condition.”....read more 


NHS warns of ‘dangerous’ beds shortage this winter (The Guardian: 3 September 2017)

Patients could die this winter because the NHS is alarmingly unprepared to deal with the surge of people who fall ill during the cold weather, hospital bosses warn today.

NHS Providers, which represents hospital trusts in England, fears lives could be lost because patients are being forced to spend long periods waiting in ambulances outside A&E, or on trolleys.

Hospitals are so “dangerously short” of beds that they may be unable to cope with the coming winter, Chris Hopson, the organisation’s chief executive, told the Observer. They will struggle even more than last winter – when chaotic scenes led the Red Cross to call the situation “a humanitarian crisis” – because a £1bn government initiative intended to free 2,000-3,000 beds by September has failed, he added. 

That scheme aimed to reduce the proportion of beds occupied by patients who are fit to be discharged but cannot leave – called “delayed transfers of care” – to 3.5% of all beds by this month. It was 5.6% of beds at the end of 2016 and still 5.2% at the end of June, NHS figures show....read more


Grantham A&E unit's night closure policy to remain (7 August 2017)

A decision to close a hospital accident and emergency unit overnight has been backed by the government.

United Lincolnshire Hospitals NHS Trust (ULHT) closed Grantham Hospital's unit a year ago because a lack of doctors.

In February, Lincolnshire County Council asked Health Secretary Jeremy Hunt to review the decision.

Mr Hunt then called for the Independent Reconfiguration Panel (IRP) review and backed its view the unit should not reopen until it had "sufficient staff".

The county council's Conservative leader Martin Hill described Mr Hunt's decision as a "disappointing result".

"The fear that this 'temporary closure' would be anything but temporary, has proved to be entirely founded", said Mr Hill.

"It is unacceptable that Grantham district has had a substantial change to hospital services for over a year without proper consultation or planning."

ULHT employs about 17 doctors across its three sites in Lincoln, Boston and Grantham, and needs a minimum of 21 to keep all of them open for 24 hours.

The trust's actions led to protests from a campaign group opposed to the closure of the unit from 18:30 to 09:00.... read more


Hospital stops children surgery in a bid to improve services (3 August 2017)

Children's surgery will move out of The Royal Orthopaedic Hospital to others "better placed" to provide the specialist care, says the trust which runs the hospital.

The board of The Royal Orthopaedic Hospital NHS Foundation Trust said the Birmingham hospital will cease providing paediatric surgery by 1 January next year but adds that patients currently awaiting surgery will see "no immediate changes".

The decision follows a report by the Care Quality Commission earlier this year which said the hospital "required improvement" within several areas, including it's services within intensive and critical care.

The Trust has undertaken a significant amount of work and investment to meet these recommendations, and progress has continued to be made. However, recent external reviews over the last few weeks have reiterated that paediatric inpatient surgery would be better delivered in a hospital setting with access to extensive centralised care facilities at all times.

The Royal Orthopaedic Hospital Statement

.... read more


Lack of mental health support leaving children stuck in hospital – thinktank (The Guardian: 26 July 2017)

Children with serious mental health problems are becoming trapped in NHS psychiatric units, unable to leave because care is unavailable outside hospitals, a thinktank has said.

NHS figures show that between October 2015 and September 2016 children and young people in England spent almost 9,000 days in hospital after being declared fit to be discharged. Some end up stuck in units for several months.

NHS England did not tell the Education Policy Institute how many patients were involved in the 9,000 days, despite being asked this in a freedom of information request. But the thinktank said data showed the problem was growing.

The total number of what the EPI termed “wasted days” was 42% higher between December 2016 and February 2017 than in the same period in 2015-16. In January alone this year, under-18s spent 804 delayed days in mental health inpatient units, compared to 553 the previous January.

Delayed discharges of such patients can occur because their home area cannot provide the specialist support they need to ensure they remain safe.

Sarah Brennan, chief executive of the charity Young Minds, said: “Far too many young people are being left in limbo in mental health hospitals because the right support isn’t available in their community. In some cases they may have to wait weeks or even months before they are discharged.”... read more


Sick patients dying ‘unnecessarily’ in NHS because of poor care (15 July 2017)

Some of the sickest patients that hospitals treat are dying unnecessarily because they receive poor care, blighted by shortages of staff and equipment, a new NHS inquiry has revealed.

A death rate of one in three among inpatients who need emergency help with breathing is already high by international standards, and is getting worse.

The analysis by the National Confidential Enquiry into Patient Outcome and Death of NHS services for the 50,000 patients a year who receive emergency oxygen treatment uncovered a series of major flaws in the care they received. It described its findings as “shocking”.

The growing numbers of patients who receive non-invasive intervention (NIV) – oxygen through a face mask – usually have chronic obstructive pulmonary disease, pneumonia or other conditions which mean they cannot breathe unaided. Despite their lives being at risk, the vast majority receive sub-standard care, according to an in-depth examination of 353 patients during February and March.

“The care of these patients was rated as less than good in four out of five cases. The mortality rate was high: more than one in three patients died,” the inquiry found. “Supervision of care and patient monitoring were commonly inadequate. Case selection for NIV was often inappropriate and treatment was frequently delayed due to a combination of service organisation and a failure to recognise that NIV was needed.” In addition, investigators found from examining case notes that “the quality of medical care provided was often poor. This poor care included both non-ventilator treatment and ventilation management, which were frequently inappropriate”.... read more

‘Quality of care’ complaints rise in two thirds of mental health trusts. (National Health Executive: 9 May 2017)                         

Almost two-thirds (60%) of England’s mental health trusts recorded a higher number of complaints in 2015-16, compared to five years ago, a freedom of information (FoI) investigation by NHE can reveal.

NHE asked mental health trusts how many complaints related to ‘quality of care’ they had received every year between 2011 and 2016, with 38 of 55 trusts in England responding to the FoI.

Of the respondents, 23 recorded more complaints last year than in 2011-12. Nine trusts had complaints go down in 2015-16 compared to five years previously, and six trusts were unable to give figures for 2011-12...read more

Children's hospital units forced to close to new patients due to staff shortages (The Guardian: 27 April 2017)
Hospital units that treat children and very sick babies are having to shut their doors temporarily to new patients because they are “dangerously” short of specialist staff, a new report reveals.

Widespread shortages of paediatric doctors and nurses also means that the care children receive is being put at risk, according to the Royal College of Paediatrics and Child Health.

A chronic lack of staff is forcing doctors to take potentially life or death decisions about which patients to treat quickly, one paediatrician said. “Last night we only had one registrar instead of two. We had an emergency in A&E and [the] labour ward at the same time and she had to make a snap decision which to go to. It’s being forced to dice with death,” said the medic, who asked to remain anonymous.

Another paediatrician said: “It’s becoming normal to do the work of two or three so corners are constantly being cut and kids don’t get the time and attention they deserve.” Read more


Continued STP hospital closures risk A&Es reaching ‘danger point’ (NHS England 24 April 2017)

The performance in North West London A&E departments has suffered considerably following the closure of two emergency departments in the area, sparking concern about the effect that 24 potential closures across STPs in England could have on national performance and patient safety.

In the ‘Can we afford to close any more A&E departments?’ report released today by the Centre for Health and the Public Interest (CHPI), it was revealed that following the closure of the A&E departments, performance in North West London hospitals has seen a considerable drop, with performance against the 95% four hour waiting time target falling to as low as 60% in some hospitals.

The research found that before the closure of Central Middlesex A&E and Hammersmith A&E, the performance of Type 1 A&E departments across North West London hospitals met the four-hour target between 78% and 95% of the time during the winter months....Read more


NHS staff ask 'least bad' patients to sleep in corridors amid hospital demand crisis (The Telegraph: 28 February 2017)
Patients are being asked to volunteer to sleep in corridors in order to free up spaces on overrun NHS wards, a new report reveals.

An anonymous survey of front-line doctors found staff are deliberately approaching the “least bad” patient in their ward to ask them to give up their bed.

The report on NHS performance in December and January by the Royal College of Physicians also reveals concerns that “panicking” managers desperate to get new patients into recently vacated beds are sidelining proper infection controls.

Patients groups said the document showed that quality hospital care has now become “a lottery” and that, despite a relatively mild winter, the NHS is “on course for catastrophe”.

Approximately 60,000 patients visited A&E a day in England in the last week of December, and early data indicates that a quarter had to wait for more than four hours to be seen, with many having to wait for up to 12 hours...Read More

Hospitals could join prisons in cycle of 'crisis, cash, repeat', says report (The Guardian: 28 February 2017)
Better financial planning and reforms needed to avoid ‘disastrous combination of failing public services and breached spending controls’

Hospitals could join prisons and social care in a cycle of “crisis, cash, repeat” unless they receive better financial planning and reforms, a Whitehall report has warned.

Without improvements, public services are doomed to fail or breach spending controls, the report by the Institute for Government and the Chartered Institute of Public Finance and Accountancy (Cipfa) said.

The government’s austerity programme of delivering good services while cutting spending “ran out of steam” in 2015, according to an analysis of official figures. Both organisations are urging the chancellor to ensure any measures in the budget have sound evidence behind them.

The findings come as Philip Hammond comes under pressure to use an unexpected rise in tax receipts to aid public services in his first full budget next week.

Julian McCrae, the Institute for Government’s deputy director, said that unlike others, this report was not calling for more money but instead better organisation to shore up the public sector.

“As we’ve seen with prisons, social care and now potentially hospitals, the government risks getting into a cycle of crisis, cash, repeat,” he said. “This report is a call for better financial planning and reforms that are robust enough to survive public scrutiny."...Read More


Hospitals feel the strain all year (The Argus: 21 February 2017)
 The impact of cuts in health and social care is becoming extremely dangerous for patients with crucial hospital space being taken up by those ready to leave, campaigners have warned.

On one day last week more than 160 people were stranded on hospital wards despite being ready to be discharged.

The delays were caused by there not being enough beds in the community or support in their own homes had not been arranged.

Last Thursday Brighton and Sussex University Hospitals had 58 delayed discharges...Read More 
British Medical Association: 'NHS at breaking point' as shortage of beds compounds situation (ITV News: 20 February 2017)

The NHS is at "breaking point" with a decline in the number of hospital beds compounding the situation, according to the British Medical Association.

A reduction in bed numbers has led to delays in admissions and cancelled operations, the BMA claimed.

In a report, based on official statistics, almost three-quarters of NHS trusts were found to have a bed occupancy rate of over 95% on at least one day in the first week of January this year.

The BMA also reported that in November 2016, 14.8% of patients spent more than four hours waiting for a hospital bed, having been seen in an A&E department.

Its findings have been described by Labour as a "wake-up call which Theresa May must not ignore".

The Liberal Democrats, meanwhile, warned that the situation in the NHS was becoming "intolerable"...Read More

NHS Health Check: A&E waits for January 'worst ever' (BBC News: 9 February 2017)

Record numbers of patients spent more than four hours in accident and emergency units in England in January, figures leaked to the BBC suggest.

During a difficult winter for the NHS, January appears to be the worst performing month in the past 13 years.

The figures also suggest record numbers of people waited longer than 12 hours for a hospital bed once seen in A&E.

The BMA said the prime minister could no longer "bury her head in the sand" over increasing pressure in the NHS.

And it accused the government of failing to grasp the seriousness of the situation.

But a spokesman from the Department of Health said the vast majority of patients were seen and treated quickly, and busy periods in hospitals were supported by an extra £400 million of funding....read more
NHS Health Check: Nine in 10 hospitals ‘overcrowded’ this winter (BBC News: 6 February 2017)

The number of patients on hospital wards in England has been at unsafe levels at nine out of 10 NHS trusts this winter, BBC analysis shows.

To minimise the risk of infections and delays in getting treatment, hospitals are meant to have no more than 85% of beds occupied.

But the analysis showed 137 out of 152 hospital trusts have been above that level since the start of December.

NHS bosses said hospitals had major problems discharging frail patients.

One experienced hospital boss described some of the weeks this winter as the “worst” he had seen in his career...Read More


One in six A&E departments at risk of closure or downgrade (The Guardian: 6 February 2017)

One in six A&E departments face being closed or downgraded in the next four years, according to an analysis of NHS proposals.

About 33 casualty departments in hospitals in 23 areas of the UK are facing either complete closure or being replaced with minor injuries units.

The plans are part of efforts to plug a £22bn hole in the health service budget by 2021. Health officials insist the changes will come alongside efforts to modernise services and increase specialist urgent care.

In seven cases, proposals have been drawn up, some of which have been issued for local consultation. According to research by the Health Service Journal (HSJ), 26 more hospitals are now considering plans to close or downgrade services but no final decision has been made.

The seven hospitals for which there are public proposals to downgrade or close emergency departments include Sandwell and West Birmingham hospitals trust’s City hospital and Sandwell district general hospital, which are due to be replaced by a new department at the Midland Metropolitan hospital that is scheduled to open in 2018.

The remaining 26 hospitals may have their A&Es downgraded or closed but, equally, they could be kept or upgraded. Decisions are expected to be made between either Shrewsbury or Telford, Bedford or Milton Keynes and Darlington memorial hospital or the University hospital of north Tees.

In total, about 24 of the 33 hospitals under discussion are likely to lose full A&E services, the HSJ said.

Hospitals across UK cancelling 'urgent' cancer operations as NHS winter crisis worsens (The Independent: 15 January 2017)

Hospitals across the UK are cancelling "urgent" cancer operations as the NHS winter crisis worsens.

Some patients have reportedly been told with just a day's notice that their surgery has been postponed, with a leading surgeon saying it was "extremely worrying" that hospitals had resorted to the decisions.

Cancer operations have previously held a protected status but the demand for beds and lack of social care capacity has encroached on that.

Clare Marx, president of the Royal College of Surgeons, told The Observer: "Feedback from our members suggests that since the start of January, a large number of hospitals across the UK are now cancelling cancer surgery. This will be extremely worrying to patients and their families.

"It is heartbreaking for a surgeon to have to explain to a patient who has cancer that their operation has had to be cancelled as there are no beds available. It is increasingly clear that no part of the system and no patient is immune from the pressure the NHS is experiencing."...read more


Thousands forced to wait outside swamped hospitals as cold spell hits (The Telegraph: 3 January 2017)

Heaving A&E departments are forcing thousands of patients to wait for hours in ambulances outside hospitals as freezing conditions hit the UK.

Health chiefs were forced to apologise yesterday after spiraling waiting times in one hospital caused a queue of 20 ambulances unable to offload patients.

In London alone, the winter crisis means more than 6,000 patients each week are being left in the back of emergency vehicles because A&E departments are too busy to admit them, new figures reveal.

The turnaround issues means an unfortunate delay for our patientsSouth Central Ambulance Service

The crisis in hospitals means that ambulance services are then unable to respond to subsequent 999 calls.

Last night Britain’s most senior emergency medicine doctor said departments across the country were “buckling under pressure” with staff “working at the very limits of their abilities”...Read More


NHS could face its worst January as it struggles with festive backlog, warns doctor (The Guardian: 2 January 2017)

The NHS is facing “potentially the worst January” ever as it struggles to deal with the backlog of patients occupying beds over Christmas, a leading doctor has warned.

Dr Mark Holland, president of the Society for Acute Medicine (SAM), said hospitals had already seen large numbers of elderly patients over the festive period and that the health service was on the brink of a major crisis.

Holland, who is based in Manchester, said hospitals were operating under a “false sense of security” as elective procedures dipped during the Christmas period with those beds becoming available for emergency patients.

Once routine operations start up regularly this week, hospitals must make these allocated beds available again. A bout of flu, the winter vomiting virus, or even a cold snap, could prove the tipping point, he warned....Read More


Jeremy Hunt accused of compromising weekday hospital care (The Guardian: 2 January 2017)

The health secretary, Jeremy Hunt, has been accused of compromising the care patients receive during the week by not taking forward his pledge to hire more junior doctors to help deliver a seven-day NHS.

The Liberal Democrats’ health spokesman, Norman Lamb, said that with juniors now having to work more at weekends, already under-staffed hospitals had fewer medics on duty on weekdays.

He said Hunt had done little to make good on the hiring pledge he made in parliament during the year-long dispute over junior doctors’ contracts.

“My fear is that unless you can guarantee that there will be more junior doctors employed, imposing a change which involves more hours being worked at weekends will inevitably reduce the numbers of hours worked during weekdays when the pressure is at its greatest,” Lamb said. “This could result in real safety concerns.”

In a letter to Lamb, Hunt failed to provide any detail of how many more junior medics would be trained and employed this year or any other year before the end of this parliament in 2020.

He has previously acknowledged the potential for too few doctors being on duty between Monday and Friday as a result of the new contract he imposed in October on all 54,000 junior doctors working in the NHS in England.

Hunt told Lamb that it was up to hospital trusts to expand their junior doctor workforce, raising doubt that his previous assurance would be acted on.

Nor did the letter provide any detail on how many extra trainee medics would join the NHS this year, despite Hunt having told Lamb in the House of Commons on 5 September that he would give him a number.....Read More


Hospitals ordered to divert patients from overstretched A&Es (The Telegraph: 18 December 2016)

Hospitals have been ordered to divert thousands of patients from Accident & Emergency units in an unprecedented step to help stave off a winter crisis.

GPs and nurses will be sent to the front doors of casualty units to turn away less serious cases, in a bid to tackle record demand and overcrowding as Christmas approaches.

At least 14 hospitals have already set up such schemes, which are supposed to ensure that the sickest patients get priority treatment, in the face of mounting strain. NHS England has now ordered dozens more struggling hospitals to set up such services in a matter of days.

The requirement is for every single acute provider to have streaming/co-located services during peak hours in the first instanceNHS England board papers, 15 December

Hospitals have already been ordered to stop carrying out the majority of operations for at least a month, in a bid to reduce dangerously high levels of bed occupancy. They were given a deadline of Monday December 19 to reduce occupancy from 95 per cent to a recommended safe limit of 85 per cent.

The new measure, revealed in papers to the board of NHS England, is an attempt to reduce numbers coming through the front door of A&E, amid warnings of “unprecedented demand” for services.

The paper, discussed by NHS England’s board on Thursday, warns that health officials have found "significant gaps" in health service plans for winter....read more


Hospitals in England told to put operations on hold to free up beds (The Guardian: 16 December 2016)

Hospitals in England have been advised to halt elective surgery over Christmas to ensure enough beds are free for patients who need emergency treatment at the end of the year.

In a sign of the intense pressures on NHS resources over the winter months, the regulator NHS Improvement said all hospitals should make more beds available between now and mid-January.

Jim Mackey, the chief executive of NHS Improvement, said the focus needed to be on emergency patients at what he called a critical time for the health service. Many hospitals take steps to wind down the number of operations they perform over the Christmas period, but a letter obtained by the Health Service Journal states that operations may need to be postponed “beyond any current plans”.

“In preparing for managing winter pressures, it is recommended that all providers pace their elective work by introducing elective breaks where trusts cease most in-patient elective activity and focus on treating emergence activity and non-admitted patients.”...read more


Archive of earlier stories here

More on quality: 






Trends in reported problems





Examples of problems (by provider)

Childrens surgery halted 


Care UK
Fails to process 6000 X-ray records


Six patients feared sight loss


Harmoni (Care UK)
Out-of-hours service alleged "unsafe"


Celia Collet tells of her poor care


Not enough staff and "fiddled" figures
NHS lab failings


Breast implant scandal


Clinic put patients at risk
Understaffing at Kings Health Centre



Share your examples about the impact of NHS changes - in a community d/base


Recent reports:

The A&E Winter Crisis: lessons from last year

Nuffield Trust report on the reasons for the A&E crisis in winter 2014/2015

Mental Health Under Pressure

Report into the state of NHS mental health services by Helen Gilburt of The King's Fund, November 2015

The State of Healthcare and adult social care in England 2014/2015

The Care Quality Commission's annual report

Quarterly survey of NHS financial directors by The King's Fund - February 2013 report

‘Making it better? Assuring high-quality care in the NHS

NHS Confederation discussion paper on the quality of care in NHS following the Francis report - February 2013

Care Quality Commisson State of Care report 2011/12

Annual survey by the Care Quality Commission

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