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.
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 the letter to NHS trusts, the regulator says: “Given the level of risk facing the system, it is clear that having sufficient bed capacity going into Christmas is critical, and we know most organisations will already have this in hand as part of local planning arrangements.
“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
Sharp rise in 'trolley waits' for hospital beds in England (The Guardian: 7 December 2016)
There has been a sharp rise in “trolley waits” – the length of time people wait for a hospital bed in England after being admitted in an emergency, figures show.
Data analysed by the BBC shows 473,453 patients waited more than four hours between October 2015 and September 2016 – almost a fivefold increase since 2010-11.
The figure represents 11% of the 4.2 million patients admitted over the period. More than 1,400 patients faced delays of more than 12 hours.
In 2010-11, there were 97,559 trolley waits – although NHS England said a small fraction of the rise could be attributed to a change in the way the waits were measured last December.
While the waits are known as trolley waits, the figures include patients waiting in side-rooms, seats in the A&E department and spare cubicles before being admitted to a ward.
The BBC also reported that three-quarters of hospitals in England are reporting bed shortages. Bed occupancy is not meant to exceed 85%, to give staff time to clean beds, keep infections low and ensure patients who need beds can be found them quickly....read more
Sick children moved as NHS intensive care units run out of beds (The Guardian: 3 December 2016)
Seriously sick children are having to be transported long distances to receive intensive care this weekend because of a lack of beds in major cities.
In England, 85% of beds available in paediatric intensive care units were full on Friday night. But some units in cities including London and Leicester have been forced to declare themselves as “at capacity”. Planned operations are, in some cases, being delayed to prepare for any possible emergencies, as the system shows signs of serious strain as winter starts to bite.
The director of communications at NHS England, Simon Enright, tweeted: “It is true that the NHS is very busy at the moment – record demand.”
It has long been feared that this winter would expose the frailties of the health service. Last month, the cross-party health select committee, chaired by Tory MP Sarah Wollaston reported widespread concerns among medics at the beginning of December because they had already been struggling to deal with the level of demand.
As part of the NHS’s contingency preparations, every hospital trust was ordered to draw up plans to cope, with new “A&E delivery boards” to be set up. Thousands of non-emergency operations and appointments in the run-up to Christmas have been cancelled to enable doctors to concentrate on discharging patients who can safely be sent home, in an effort to free up beds. Official figures show 6,000 more A&E attendances daily compared with six years ago.
Yet last week it emerged that ambulance response times were declining in England, Scotland and Northern Ireland, and last night senior doctors said the problems in paediatrics were a sign of systemic problems....read more
NHS transformation plans may be used as cover for cuts, says BMA (The Guardian: 21 November 2016)
Controversial plans put forward as a way of improving the health service in England and ensuring its sustainability risk being used as a cover for cuts and running down the NHS, the head of the British Medical Association (BMA) has said.
The doctors’ union says the 44 regional sustainability and transformation plans (STPs) amount to £22bn in cuts by 2020-21 to balance the books, which will have a severe impact on patient care.
Guardian analysis of the plans that have been published has found that thousands of hospital beds are set to disappear, pregnant women will face long trips to give birth and a string of A&E units will be downgraded or closed.
Dr Mark Porter, the BMA council chair, said: “Improving patient care must be the number one priority for these plans. Given the scale of the savings required in each area, there is a real risk that these transformation plans will be used as a cover for delivering cuts, starving services of resource and patients of vital care.”
NHS England is expected to find £22bn in efficiency savings by 2020-21 but its finance directors and independent experts have suggested the target is unattainable, as the health service struggles with unprecedented demand and understaffing....read more
A&E, cancer and maternity units to close in major NHS overhaul (The Guardian: 18 November 2016)
Thousands of hospital beds are set to disappear, pregnant women will face long trips to give birth and a string of A&E units will be downgraded or even closed altogether as part of controversial NHS plans to reorganise healthcare in England.
A Guardian analysis of the 24 NHS regional plans that have now been published – more than half the total of 44 – has found that health service chiefs plan to push through an unprecedented centralisation of key hospital services across England.
Opposition to the plans is growing among campaign groups, councillors and a growing number of MPs, including Conservatives, in areas where major changes are planned amid fears that patients will be unable to access urgent care quickly enough.
Dozens of England’s 163 acute hospitals look likely to have services, including cancer, trauma and stroke care, removed as a result of the plans, which are at the heart of the new funding package for the NHS. The thinking behind the changes is that some NHS services can be rationalised and managed more efficiently, helping improve patient care, tackling understaffing and helping the NHS save £22bn by 2020 as part of the wider financial settlement agreed for the current parliament.....read more
NHS bosses 'trying to keep cuts secret' (BBC: 14 November 2016)
NHS chiefs are trying to keep plans to cut hospital services in England secret, an investigation has found.
Full details of 44 reviews of services around the country - which involve closing some A&Es or, in one case, a whole hospital - are yet to emerge.
That is because NHS England told local managers to keep the plans "out of the public domain" and avoid requests for information, the King's Fund suggested.
Managers were even told how to reject freedom of information requests.
The King's Fund report did not include any details of cuts, but from the leaks and plans that have been published so far a partial picture is emerging of what is involved.
- Plans in south west London to close one of five hospitals - St George's, Kingston, Croydon, St Helier or Epsom
- The North Tees proposal to centralise specialist services, including A&E, on two sites. It would lead to services being downgraded at one of the three major hospitals in the area
- In Devon bosses are looking at whether to close some A&E, maternity and stroke services at hospitals across the county so they can be centralised at bigger sites
- In Merseyside there has been talk of merging four hospitals - the Royal Liverpool, Broadgreen, Aintree and Liverpool Women's - to plug a £1bn shortfall, according to leaked documents
- Plans in Birmingham and Solihull involve reorganising maternity services with fears this could result in fewer units
- Bosses at North Central London have talked about a consolidation of services on fewer sites, leading to fears that the Whittington Hospital could lose its A&E
All eyes on Horton General Hospital as maternity unit changes begin in Banbury (BanburyCake: 3 October 2016)
ALL eyes will be on the Horton General Hospital this week as its maternity service closes its doors to all but low-risk expectant mothers from across Oxfordshire.
The temporary move, brought about by chronic under-staffing at the Banbury unit, is aimed at ensuring patient safety, but poses risks of its own.
Last week campaigners were left bitterly disappointed as Oxfordshire County Council's health overview and scrutiny committee decided not to refer the matter to the Secretary of State, voting five to three that enough evidence for the move had been provided by Oxford University Hospitals NHS Foundation Trust....read more
NHS facing 'pockets of meltdown' this winter (The Guardian: 11 September 2016)
The NHS will experience “pockets of meltdown” this winter as the service comes under increasing pressure, a leading doctor has warned. Dr Mark Holland, president of the Society for Acute Medicine, said the resilience of medical units was being “put to the test like never before”.
It comes a day after the chief executive of NHS Providers, Chris Hopson, said the government would fail to achieve its aim of a seven-day NHS without more cash.
Writing in the Observer, he warned that hospitals are cutting services and the NHS risked “slowly deteriorating” as it did in the 1990s.
Holland echoed the warnings about a service under pressure, saying those parts of the NHS where performance was already weak would find the winter months particularly difficult.
He also pointed to the “national emergency” of medically fit patients not being discharged home from hospital. This is partly due to inadequate social care in the community.
He said the current concern was “that hospitals where performance is already weak will find it very difficult to cope during the winter and that will lead to pockets of meltdown”.
He added: “At the core of the issues facing the NHS is the rapidly increasing number of delayed discharges. The figures are spiralling and are fast becoming disastrous....read more
NHS chiefs warn that hospitals in England are on the brink of collapse (The Observer: 11 September 2016)
The body that represents hospitals across England has issued a startling warning that the NHS is close to breaking point because of its escalating cash crisis.
Years of underfunding have left the service facing such “impossible” demands that without urgent extra investment in November’s autumn statement it will have to cut staff, bring in charges or introduce “draconian rationing” of treatment – all options that will provoke public disquiet, it says.
In an unprecedentedly bleak assessment of the NHS’s own health, NHS Providers, which speaks for hospital trust chairs and chief executives, tells ministers that widespread breaches of performance targets, chronic understaffing and huge overspends by hospitals mean that it is heading back to the visible decline it last experienced in the 1990s.
“Taken together this means the NHS is increasingly failing to do the job it wants to do and the public needs it to do, through no fault of its own,” Chris Hopson, the chief executive of NHS Providers, writes in the Observer....read more
NHS 'in perpetual winter of Narnia' as waiting list reaches record 3.9m (The Guardian: 8 September 2016)
The NHS is missing so many of its key performance targets that it has entered “the perpetual winter of Narnia”, a medical leader has said, after figures revealed the highest ever number of patients on waiting lists.
Claire Marx, president of the Royal College of Surgeons, criticised the NHS’s failure to give patients planned care in hospital within the required 18 weeks, such as surgery for cataract removals, hernia repairs and hip and knee replacements.
The number of people in England who are awaiting such treatments has climbed to almost 3.9 million.
Hospitals are meant to treat 92% of patients on the “referral-to-treatment” (RTT) waiting list within 18 weeks, according to guarantees in the NHS constitution. However, they did so in just 91.3% of cases in July, NHS-wide performance data released on Thursday shows. It was the service’s worst RTT performance in more than five years.
Hospitals met the 92% target in nine categories of RTT patients, including those requiring treatment for eye problems (92.7%), cardiac care (92.7%) and gynaecological problems (92.3%). However, it missed the target in 10 other categories. It treated barely four of of five (81.7%) of all those awaiting neurosurgery within 18 weeks, 86.9% of those needing plastic surgery and 88.9% of trauma and orthopaedic patients....read more
Demand for NHS care is dangerously high, says thinktank (The Guardian: 8 September 2016)
Demand for NHS care has reached record levels, with unprecedented numbers of patients being treated in A&E units, a new report reveals.
But that has left hospitals dangerously full and growing numbers of patients who need to be admitted are having to wait longer than they should because no bed is available, according to health thinktank the King’s Fund.
A total of 5,873,998 patients sought help in all types of A&E units in April, May and June – the largest number ever to do so in any three-month period – leading the Royal College of Nursing (RCN) to warn that the NHS had become “a pressure cooker” and was buckling under the weight of demand.
An unusually high number of patients were admitted to hospital during the same period, in a sign that the NHS is dealing with growing numbers of people who are so unwell they need inpatient care. In all just over 1 million of those who attended A&E ended up being admitted, one of the largest numbers on record.
Overall there were an extra 54,000 A&E attendances a month and 14,200 extra emergency hospital admissions a month in the first quarter of 2016-17 than in the same period the year before.
Experts said that the record high, revealed in official NHS statistics analysed by the King’s Fund, was surprising because it occurred in a period when hospitals used not to be especially busy....read more
The NHS secret is out. And local communities won't like it (The Guardian: 26 August 2016)
When Simon Stevens became NHS England’s chief executive in April 2014 he disavowed his predecessor David Nicholson’s radical centralisation of specialist hospital treatment into far fewer places.
Stevens also went further, using his first interview in the post to pledge to maintain local hospitals. Every NHS leader, and every MP, knows how attached the great British public is to the bricks and mortar of their local NHS. The last thing Stevens wanted was to face opposition by campaign groups, councillors and MPs to a particular A&E or maternity unit being downgraded or closed, and certainly not a wave of such protests in many parts of England simultaneously battling to save much-loved local services.
Yet that is the growing risk he now faces as a result of the 44 regional sustainability and transformation plans (STPs). The disclosure of controversial changes planned in north-west London, Leicestershire and the West Midlands – including entire hospitals being downgraded or closed – could easily result in England-wide protests.
Number of NHS mental health nurses has fallen by 15% under Tories (The Guardian: 1 November 2016)
The number of mental health nurses working in the NHS has dropped by almost a sixth since the Conservatives came to power in 2010, figures show.
The revelation has sparked fresh doubt that government pledges to improve mental health services are being matched by progress at the NHS frontline.
Philip Dunne, the health minister, has admitted in a written parliamentary answer that while there were 45,384 mental health nurses working in England in 2010, there were just 38,774 in July this year. That fall of 6,610 nurses represents the loss of about 1,000 such specialists a year, or almost 15% of the entire workforce providing that sort of vital care to patients over the last six and a half years.
“This is a very worrying downward trend that shows no sign of turning around, despite all the government’s pronouncements and pledges about equality for mental health care compared to physical health care,” said Labour MP Luciana Berger, the ex-shadow health minister who obtained the answer.
The loss of so many posts meant that patients are at risk of receiving lesser-quality care than before and their recovery is being jeopardised by having less contact time with nurses, who were likely to be busier than ever, Berger warned.
The Royal College of Nursing claimed the figures proved that patients were being let down and ministerial pledges of recent years were not being delivered....read more
Iconic specialist hospital discovers 7,000 patients missed off waiting list (HSJ: 24 February 2016)
An internationally renowned children’s hospital had to send patients to other providers after discovering its waiting list was four times bigger than it thought, HSJ can reveal.
Great Ormond Street Hospital for Children Foundation Trust saw its waiting list grow from 2,000 to more than 9,000 after it realised it had not properly recorded the waiting time information for thousands of patients.
The waiting list problems affected outpatient, surgical and diagnostic units
The London based trust was criticised by the Care Quality Commission last month and the full size of the waiting list backlog was revealed in the trust’s January board papers...read more
Hospital on black alert as patients face diversions and long waits in A&E (The Argus: 25 February 2016)
Why David Cameron is completely wrong about 11,000 weekend NHS deaths (The Independent: 25 February 2016)
NHS hospitals 'putting profit before public service' by expanding private work amid falling standards (The Independent: 20 February 2016)
Elderly hospital patients given eviction warnings (The Telegraph: 17 February 2016)
Spike in mental health patient deaths shows NHS 'struggling to cope' (The Guardian: 26 January 2016)
More heart patients die as Hunt gives 999 dispatchers longer to send ambulance (Evening Standard: 12 January 2016)
NHS will struggle to cope this winter, new analysis finds (Nuffield Trust: 10 December 2015)
Hundreds of operations cancelled despite doctors' strike being called off (The Guardian: 1 December 2015)
South Tyneside NHS Trust 'requires improvement' inspectors say (BBC Tyne & Wear: 1 December 2015)
NHS pressure increases as A&E waiting times INCREASE with 12 per cent waiting over four hours (The Mirror: 28 November 2015)
NHS trusts' overspend hits £1.6bn (BBC: 20 November 2015
The worrying truth about mental health services (HSJ: 12 November 2015)
Trust closes beds as chair warns it is 'becoming unviable clinically' (HSJ: 29 October 2015)
Half of all services now failing as UK care sector crisis deepens (The Guardian: 26 September 2015)
Royal college warning over staffing 'pressure' on maternity wards (HSJ: 24 September 2015)
What Addenbrooke's tells us about state of NHS. (BBC News: 22 September 2015)
Jeremy Hunt’s hit squad is a danger to our national health. (The Guardian: 22 September 2015)