Tag: NHS

Health organisations warn of mounting patient safety crisis in Urgent and Emergency Care

Nearly two thirds of A&Es across the UK had ambulances waiting to transfer patients every day in the past week, according to a new survey from the Royal College of Emergency Medicine.

The latest RCEM survey covers the period 8 November to 14 November 2021 and was sent to Clinical Leads in Emergency Departments across the UK and received 70 responses.

The NHS mandates that ambulance handovers ought to be reliably completed within 15 minutes of arrival, but 61% of Emergency Departments in the survey were struggling to meet this standard every day.

The survey also found that over half of Emergency Departments had provided care to patients in non-designated areas such as corridors every day in the past week.

These findings come following a report by the Association of Ambulance Chief Executives (AACE) which found that 160,000 patients may be coming to harm annually as a result of ambulance handover delays.

While a separate report by the Royal College of Emergency Medicine, ‘Crowding and its Consequences’, found that at least 4,519 patients have died as a result of dangerous crowding in Emergency Departments in England in 2020-2021.

The Royal College’s survey also found:

  • 14% of respondents stated that the longest stay they had had in their Emergency Department was between 48 and 72 hours
    • 36% of respondents stated the longest stay in their Emergency Department was 24 to 48 hours
    • 39% of respondents stated the longest stay in their Emergency Department was 12 to 24 hours
  • 14% of respondents stated that there was no effective Same Day Emergency Care available in their Emergency Department
    • 50% of respondents stated that Same Day Emergency Care had limited availability, less than 12 hours a day or weekdays only in their Emergency Department
  • 71% of respondents stated that they were unable to maintain social distancing for patients in their Emergency Department in the past week

Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “These results show the serious state that our urgent and emergency care system is in.

“None of us want to have patients held in ambulances, treated in corridors, or waiting very long times to go up to a ward bed. Sadly, these findings support our stark report on crowding and the AACE’s shocking report on ambulance handovers.

“We all need to work together to solve this acute patient safety problem. We believe enacting many of the suggestions we have made in RCEM CARES: The Next Phase will help. We want patients to feel confident that their Emergency Care system is there for them, but this winter is going to be a huge challenge unless we can get flow back into the system.

“RCEM CARES: The Next Phase details our system-wide plan to tackle the current crisis and improve patient care as well as staff wellbeing. In the short-term, to promote flow and to reduce handover delays, capacity must be expanded in a safe way. Same Day Emergency Care must be made available at all Trusts and they must expand its provision, so it is available 12 hours a day, seven days a week. While maximising the service Discharge to Assess will allow patients to be discharged in a timely and supported way.

“In the long-term, we urge the government to publish a long-term workforce plan, this must include actions to retain existing staff as well as recruit new staff. Across the UK there is a shortfall of 2,000-2,500 WTE Emergency Medicine consultants, and crucially, there are also widespread shortages of Emergency Medicine nurses and both junior and supporting staff. At the same time capacity is severely depleted across the UK. The government must restore bed capacity to pre-pandemic levels, this requires an additional 7,170 beds across the UK.

“This is only the beginning of winter and of what may come. We are facing a crisis in urgent and emergency care and a crisis of patient safety. The Secretary of State in the House of Commons spoke of ‘a duty to avoid preventable harm of everyone working in health and social care’, we urge him to act on his own words and prevent avoidable harm and ensure the safety of patients.”

Managing Director of AACE Martin Flaherty OBE QAM said: “These alarming new figures from RCEM underline once again the unprecedented pressures facing the entire urgent and emergency care system.

“We now know that excessive handover delays and crowding in A&E departments are routinely harming patients, some very severely. To resolve this, we need system leaders to further toughen their resolve to deal with this problem once and for all and as a matter of priority and we await details of progress being made in this area, while underlining our commitment to work as part of the solution to this complex issue.”

Tracy Nicholls, Chief Executive of the College of Paramedics, said: “We must not forget that behind all these mounting figures are real people, both staff and patients, who are bearing the brunt of this continuing strain on services. 

“Reform must happen to alleviate the intolerable pressure and reduce the guilt many paramedics and Emergency Department staff feel about dealing with patients who are waiting outside Emergency Departments or, more worryingly, in the community.

“We support any efforts to deal with the here and now, but we commit to working with stakeholders and partners to make real change happen.”

New report reveals shocking number of deaths caused by crowding in Emergency Departments last year

A new report by the Royal College of Emergency Medicine ‘Crowding and its Consequences’ has found that at least 4,519 patients have died as a result of crowding and 12 hour stays in Emergency Departments in England in 2020-2021.

The new report investigates the extent of harm that crowding causes and applies NHSE’s own findings from the Getting It Right First Time (GIRFT) program which found that one in 67 patients staying in the Emergency Department for 12 hours come to excess harm.

The report also provides comprehensive analysis on a variety of data points:

  • Four-hour target
  • 12-hour waits
  • Decision-to-admit (DTA) waits and admissions
  • 12-hour DTA waits vs. 12-hour time-of-arrival waits
  • Time to initial assessment for ambulance arrivals
  • Time to treatment
  • Median total time patients spend in Emergency Departments
  • Ambulance handover delays
  • Bed availability
  • Length of hospital stays

Dr Adrian Boyle, Vice President (Policy) of the Royal College of Emergency Medicine, said: “To say this figure (4,519 excess deaths) is shocking is an understatement. Quite simply, crowding kills.

“For many years we have issued warnings about the harm that dangerous crowding causes, but now we can see the number of excess deaths that have occurred as a result. This will not surprise any member or fellow of the Royal College.

“October 2021 saw an unimaginable 7,059 12-hour stays from decision to admit, the highest number ever recorded, 40% higher than September 2021 which was the previous highest on record. The number of 12-hour stays has risen drastically for six months and is very likely to rise again in coming months.

“The picture is more bleak as Hospital Episodic Statistics show that 12-hour stays from time of arrival are 21 times higher than 12-hour DTA stays. We now know that at least one in 67 of these patients are coming to avoidable harm. It is appalling.

“The situation is unacceptable, unsustainable and unsafe for patients and staff. Political and health leaders must realise that if performance continues to fall this winter: more and more patients will come to avoidable harm in the Emergency Department; staff will face moral injury; and the urgent and emergency care system will be deep into the worst crisis it has faced.

“This potential trajectory is supported by the recent report by the Association of Ambulance Chief Executives that found that as many as 160,000 patients annually, may be coming to harm as a result of delayed ambulance handovers. We continue to urge the Secretary of State to meet with us to discuss patient safety and the unprecedented pressures facing the urgent and emergency care system.

“RCEM CARES: The Next Phase outlines our system-wide plan to improve patient care. In the short-term Trusts must safely expand capacity where possible. They must maximise the use of services such as Same Day Emergency Care and Discharge to Assess. Trusts must focus on promoting flow through the hospital, ensuring patients are discharged in a timely way once their treatment is complete.

“In the long-term, the government must restore bed capacity to pre-pandemic levels, across the UK an additional 7,170 beds are required. The government must ensure that social care is resourced to support patients both when leaving hospital and once they are back in the community, this would help to reduce long hospital stays and prevent successive trips to the Emergency Department.

“Lastly, as a matter of urgency the government must publish a long-term workforce plan, this must include actions to retain existing staff who are reaching burnout as well as to recruit new staff. Across the UK there is currently a shortfall of 2,000 – 2,500 WTE Emergency Medicine consultants, as well as shortages of essential Emergency Medicine nurses and junior and supporting staff.

“This is the beginning of a long winter and an extremely challenging time for the current workforce as pressures will rise and patient safety will continue to be put at risk. These pressures may currently be facing urgent and emergency care and the ambulance services, but the solutions and actions must be system-wide and joined-up.

“It is up to the government, NHS leaders, and all of us to work together to put a stop to dangerous crowding; avoidable harm; preventable deaths; ambulance handover harm; and to ensure that we keep patients safe and deliver effective urgent and emergency care.”

Pharmacies delivering swift patient care

More than 2 million consultations with NHS Pharmacy First

An innovative NHS community pharmacy service has helped see patients quickly and relieve pressure on A&E units and GP surgeries by sparing the NHS 200,000 avoidable appointments for the treatment of urinary tract and skin infections in the last year.

The NHS Pharmacy First network of more than 1,200 community pharmacies are the first port of call for minor ailments and common clinical conditions. The NHS Pharmacy First Scotland service has carried out over 2 million consultations since the launch of the service in July 2020.

The service provides free access to a consultation with an appropriately qualified member of the pharmacy team who provides advice on self-care, referral to another part of the NHS if they feel it is necessary and, if appropriate, will provide treatment. 

The community pharmacist can also treat certain conditions such as urinary tract infections, shingles and impetigo without the need for a prescription or to see a doctor. This is part of a co-ordinated series of measures to improve patient care and help reduce demand on A&E.

Pharmacists in the network have taken more than 200,000 appointments in the last year which would otherwise have gone to GP surgeries or hospital A&E departments.

Since its launch at the height of the pandemic, only 4% of patients needed to be referred on to another healthcare professional, such as a GP or hospital unit. The majority were handled by the pharmacy team, advice on self-care or with treatment.

Health Secretary Humza Yousaf said: “Community pharmacists are playing a fantastic role in ensuring that millions of people have their minor ailment needs addressed quickly, without needing to go to a GP or hospital. They are a prime example of getting the right care in the right place at the right time.

“This is particularly helpful as our NHS faces one of the most difficult winters in its history, with the NHS Pharmacy First service helping to relieve some of the current pressures faced by emergency departments. As community pharmacy staff continue to give care and advice during the busy winter period, please continue to be kind and patient.

“The Scottish Government introduced the NHS Pharmacy First service, backed by £10 million of investment. As part of the NHS Recovery Plan we will look to expand the range of common clinical conditions that can be treated by community pharmacists, avoiding unnecessary GP and out of hours appointments.

“We have also committed to establishing a community pharmacy hospital discharge and medicines reconciliation service to help speed up the process for people being discharged from hospital. New digital solutions such as ePrescribing and eDispensing will make prescribing paperless and free up capacity for healthcare professionals to see more patients, while making it easier for the public to access their medicines quickly and safely.”

NHS Pharmacy First Scotland launched on 29 July 2020, and is designed to encourage everyone to visit their community pharmacy as the first port of call for all minor illnesses and specific common clinical conditions.

Scottish health service set for gruelling winter as performance deteriorates yet again

The latest Emergency Department performance figures for Scotland published by the Scottish Government yesterday for September 2021 show a deterioration in performance for the fifth consecutive month. The data show the worst four-hour performance on record and both the highest number of 12-hour and eight-hour stays since records began.

In September 2021 there were 113,998 attendances to major Emergency Departments across Scotland, the number of attendances dropped by 3,500 patients (3%) compared to the previous month, August 2021.

Despite the slight decrease in attendances data show that four-hour performance reached a new record low, with 73.8% of patients being seen within four-hours, this is 1.5 percentage points lower than the previous month, August 2021. It is the second time in 2021 that performance has fallen below 75%.

In September 2021 1,840 patients spent 12-hours or more in a major Emergency Department, this is an increase of 31.5% compared to the previous month, August 2021. This number increased for the fifth consecutive month and is once again the highest number of 12-hour stays since records began.

Data also show that 6,413 patients spent eight hours or more in a major Emergency Department. This is an increase of 20%, equal to over 1,000 patients. The number of patients delayed by eight-hours or more increased for the fifth consecutive month and once again this is the highest number of eight-hour stays since records began.

Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “The consistent fall in performance is seriously worrying. What we are seeing: ambulance handover delays; dangerous crowding; long stays; put patient safety at risk and can lead to harm or avoidable deaths.

“Data show that for every 67 patients waiting 8-12 hours, one of them will come to avoidable harm – therefore we can estimate that in Scotland between January and August 2021 there have been 231 excess deaths directly caused by a long wait due to a crowded Emergency Department.

“These are unconscionable practices and both ambulance crews and Emergency Medicine staff are under pressure to resolve the problem – together with the College of Paramedics we laid out this guidance.

“The problem is poor flow throughout the hospital and exit block, this will not be resolved in the Emergency Department, it is a system-wide problem and requires system-wide solutions and collaboration.

“Boards must safely expand capacity where possible, provided doctors and nurses and other healthcare workers are available to staff the beds. Same-day emergency care can help to reduce unplanned hospital admissions, maximising the delivery of this service may alleviate some pressures.

“Discharge to assess, ensuring that patients can be discharged in a safe and timely way where they have the support they need to recover in the community, can help free up beds to increase flow throughout the hospital.

“Lastly, it is vital that adequate support and resources are given to social and community care so vulnerable patients do not face successive trips to the Emergency Department or hospital.

“Clear communication between Clinical Leads and senior Board management about the reality of ambulance handover delays; dangerous crowding; and long stays is also vital. Stating the threat these practices pose to patient safety and both reporting and escalating incidents as they occur should guide leadership to take swift action.

“It is a very difficult time, and we are preparing for a gruelling winter. The past five months of performance figures suggest that more deterioration is set to come. In Emergency Medicine we must continue to work towards collaborative solutions and work with other departments, specialties, and management.

“But we continue to call on the Scottish government to set out a long-term workforce plan. In Emergency Medicine (EM) in Scotland there is a vital need to both recruit new and retain existing staff, we need at least 113 EM consultants along with sufficient numbers of both junior and supporting staff and nurses.”
Today’s statistics revealed the worst weekly and monthly A&E statistics since records began.

The statistics show that only 65.6% of attendances at A&E services in NHS Lothian were seen and resulted in a subsequent admission, transfer or discharge within 4 hours for the week ending on the 24th of October. 

This is lower than the previous record low of 66.3% recorded in week ending 12th September. Furthermore, 508 patients in NHS Lothian waited more than 8 hours, with 240 not being seen for 12 hours.
  
Scottish Labour MSP Foysol Choudhury said: “A&E services in the Lothians are in crisis, with the situation rapidly deteriorating with every passing week.’’
  
“Hard-pressed frontline staff have been sounding the alarm for months, but the Health Secretary has spectacularly failed to take action. Patients in the Lothians are being put in danger thanks to the SNP’s catastrophic failure to support A&E services. 

‘’The Health Secretary is without a workable plan, so we have a health service in freefall. Action must be taken now. Our NHS deserves better’’

Scottish Government commits extra funding to tackle delayed discharge from hospitals

Humza Yousaf: “This winter is likely to be the most challenging in the history of the NHS”

The Scottish Government is investing an additional £10 million to help patients avoid a hospital stay wherever possible – and to prevent delayed discharge for inpatients.

This is part of a range of actions included in the £300 million winter package of funding to health and social care services, and outlined in the health and social care winter plan, to take the pressure off hospitals and frontline staff.

Two new programmes – Interface Care and Discharge without Delay – will support NHS Boards to explore alternatives to hospital inpatient care where appropriate, and improve the discharge process for those who do need to be admitted to hospital.

Interface Care, backed by an additional £6 million this financial year, will deliver safe, high-quality care as an alternative to hospital admission, or will support early hospital discharge. The programme will be implemented by early winter.

Discharge without Delay, supported with a further £4 million, will improve pathways through hospital settings, reducing inpatient length of stay and building bed capacity. Working with patients, families and/or carers, it will ensure patients are treated in their home where appropriate.

Health Secretary Humza Yousaf said: “This winter is likely to be the most challenging in the history of the NHS, and it’s important we take urgent action to ensure our hospitals and emergency frontline staff are not overwhelmed. That’s why these actions to improve the discharge process, and redirect patients who don’t need to be in hospital, are so important.

“I am confident that through our collective investment in people, capacity and systems to deliver the right care in the right setting, we can improve outcomes for those of us who need to use our health and social care services.”

The Scottish Government has invested more than £80 million this year to support the reduction in waiting times for people having elective procedures, which has been impacted by the pandemic. To minimise delays for those patients waiting on urgent hospital treatment within four weeks, including cancer patients, extra capacity is being provided through private hospitals over the winter period.

Discharge without Delay launches this month, with four early adopter sites to test the approach, with the aim of rolling the programme out nationally across all sites over the next 10 weeks.

The Interface Care Programme launched this month in two pathfinder sites – NHS Greater Glasgow and Clyde and NHS Tayside. Roll out across all boards is planned over the winter.

Register your defibrillator to help save lives across Scotland

The Circuit: Charities and health organisations urge people to register their defibrillators on database to help save lives  

A new campaign has been launched across Scotland to urge defibrillator owners to register their devices on a national database to help save more lives from cardiac arrests.

Leading charities and health organisations have come together calling for defibrillators to be registered on The Circuit – The national defibrillator network, which connects defibrillators to NHS ambulance services across the UK, so that in those crucial moments after a cardiac arrest they can be accessed quickly to help save lives.

  • There are around 3,200 out-of-hospital cardiac arrests every year in Scotland, but only one in ten people survive.
  • Every minute that passes without CPR or defibrillation reduces the chances of survival by up to 10 per cent in some instances, but immediate CPR and defibrillation can more than double the chances of survival.
  • It’s estimated that public-access defibrillators (PADs) are used in less than one in ten out-of-hospital cardiac arrests across the UK – often because 999 call handlers aren’t always aware that a defibrillator is available nearby because the ambulance service hasn’t been told about it. If they don’t know it is there, they can’t direct someone at the scene to retrieve it while waiting for the ambulance to arrive. 

To help save more lives, The British Heart Foundation (BHF), Resuscitation Council UK (RCUK) St John Ambulance and Association of Ambulance Chief Executives (AACE), are urging people who look after defibrillators in places such as offices, communities, shopping centres and leisure centres, as well as in public places, to register them on The Circuit.

James Jopling, Head of BHF Scotland, said: ““Every second counts when someone has a cardiac arrest and, alongside CPR, prompt use of a defibrillator is critical in giving them the best chance of survival.

“To put it simply, knowing where the nearest defibrillator is could be the difference between life and death.

“The Circuit is pioneering technology which will help emergency services direct bystanders more quickly to a defibrillator when someone collapses with a cardiac arrest. But for The Circuit to save lives, it is vital that unregistered defibrillators are put on the system. If you, or somebody you know is a defibrillator guardian, then we urge you to register your device on The Circuit. You could help save a life.”

Pauline Howie, Chief Executive of the Scottish Ambulance Service, said: “When someone calls 999 to report a cardiac arrest, the call handlers in our control rooms are trained to provide the location of the nearest registered defibrillator within 500m of the call. 

“Studies show that using a defibrillator within three minutes of collapse, along with starting CPR, can greatly increase chances of survival.  

“This swift action can make a real difference, and The Circuit is a vital tool in helping increase bystander action to help someone in cardiac arrest. Over the last five years, the Save a Life for Scotland (SALFS) partnership which includes SAS, the Scottish Government and the Scottish Fire and Rescue Service has equipped over 640,000 people with CPR skills, and the survival rate after an out-of-hospital cardiac arrest has doubled to one in ten people. 

“However, there’s more we can do, and to help save even more lives, we would urge everyone to register the defibrillators that they are responsible for on The Circuit, so that they can be easily located and accessed when needed.”  

Dr James Cant, Chief Executive Officer at Resuscitation Council UK, said: “A cardiac arrest can happen to anyone, anywhere, at any time. Not only is defibrillator use a crucial step in the Chain of Survival, the presence of defibrillators in public places can help raise awareness and stimulate people to think about what they would do in an emergency. 

“Survival depends on all links in the Chain of Survival being carried out quickly. This means early recognition and calling for help, early CPR, early defibrillation and post resuscitation care – and The Circuit plays a vital role in giving people their best chance of surviving a sudden cardiac arrest.”

While the 14 UK ambulance services have previously had their own regional databases, The Circuit will eventually replace these with a new national database that lets the ambulance services see defibrillators across the UK once it has been rolled out. This will allow them to direct people to the nearest defibrillator when somebody is having a cardiac arrest, wherever they are.

The Circuit, which is already live in 12 of the 14 ambulance service regions across the UK[1] and will become nationwide soon, could help to save thousands of lives – but it is vital that as many defibrillators as possible are registered on the database for it to work effectively. 

It’s free to register your defibrillator onto The Circuit, and you only have to do it once. You can also register multiple defibrillators if you are the guardian to more than one.

Visit TheCircuit.UK for more information or to register your defibrillator. 

Army called in to support struggling NHS

In response to the immediate pressures on the NHS because of COVID-19 and the backlog in care caused by the pandemic, military assistance has been requested for NHS Lanarkshire and NHS Borders.

Acute services in both health board areas are operating at capacity because of workforce shortages associated with the virus.   

A total of 63 military personnel will be deployed to NHS Lanarkshire – this includes three nurses, 45 military medics, 12 General Duties Troops and three drivers who will be working in acute settings.

In NHS Borders, 14 military medics, two nurses and four additional military personnel will provide assistance in acute settings. A military driver will provide transport. Two military medics will oversee operations from the army’s headquarters in Scotland.

Military support within the two health board areas is due to start on 19 October and continue initially until 10 November 2021 though this will be kept under constant review.

Health Secretary Humza Yousaf said: “The NHS is experiencing significant pressure at the moment because of COVID-19 admissions and the backlog in care built up during the pandemic and we are taking a range of steps to introduce additional capacity in order to help with the unprecedented pressures on the health and care system.

“Earlier this month we announced a record winter package funding of £300 million to support a range of measures to maximise capacity in our hospitals and primary care, reduce delayed discharges, improve pay for social care staff, and ensure those in the community who need support receive effective and responsive care.  

“In the NHS Borders and NHS Lanarkshire areas, staff shortages because of COVID-19 are affecting bed capacity and temporary military assistance has been requested to support the boards at this time.

“With increasing levels of social mixing and close social contact it is expected that this winter COVID-19 will circulate alongside respiratory viruses, such as flu, adding to the winter pressures usually faced by the NHS.

“This military support will allow both boards to support existing staff to reduce waiting times, enhance care and provide a better experience for our patients.     

“As always I would like to thank all those involved in our healthcare systems for their continuing hard work and dedication over this particularly busy time.” 

RCM warn of midwife exodus as maternity staffing crisis grows

Midwives are being driven out of the NHS by understaffing and fears they can’t deliver safe care to women in the current system, according to a new survey of its members by the Royal College of Midwives (RCM).  

The College is warning of a ‘midwife exodus’ as it publishes the results of its annual member experiences of work survey. Over half of midwives surveyed said they were considering leaving their job as a midwife with 57% saying they would leave the NHS in the next year. 

Of those midwives who either have left or were considering leaving, more than eight out of 10 were concerned about staffing levels and two-thirds were not satisfied with the quality of care they are currently able to deliver.  

Alarmingly, the highest level of dissatisfaction among those surveyed came from midwives who had only worked for five years or less in the NHS. This will have a significantly detrimental impact on workforce planning and, says the RCM, the ability of maternity services across the country to provide acceptable levels of safe, quality care. 

The RCM’s General Secretary and Chief Executive, Gill Walton, said: “Every midwife and maternity support worker goes to work to provide safe, quality care. That so many feel that understaffing means they are unable to do so is deeply worrying.

“What these numbers suggest is a midwife exodus, which will leave already-struggling services on their knees. Quite rightly, there is a strong focus on improving maternity safety, but there is a risk that the Government is ignoring the essential ingredient to that: having the right staff, in the right place.  

“Investment and programmes to improve safety in maternity services hang in the balance here, because without adequate numbers of staff with are fighting a losing battle. Every safety report cites understaffing as an issue that is comprising the delivery of safe care, but when are the Government going to take note?

“We are calling on the Government to listen to those best advised and work with us to improve retention and recruitment. All NHS organisations must urgently review their maternity staffing levels using a recognised workforce planning tool to ensure staffing reflects the workload.” 

A report published by NHS Digital in July revealed the number of NHS midwives working in England in May had fallen by almost 300 in just two months. This is the fastest fall for these two months for any of the years listed in the NHS report, which goes back to 20 years say the RCM.  

Burnout among midwives and all maternity staff is higher than ever, particularly after COVID-19 which saw an increase in sickness absence adding to a pre-existing shortage of 2,000 midwives in England alone.

Last week leaked results of an NHS national staff survey showed a sharp drop in those who believe their health and wellbeing is being supported by their employer. This is echoed in the RCM survey, with over half of respondents saying that they did not feel valued by their employer.

Almost all (92%) of midwives and maternity support workers (MSW) said that they did not feel their work was valued by the current Government.

 

Gill added: “Not a day goes by that we don’t hear of a maternity service having to close temporarily, suspend services or divert women to other maternity units just because there simply aren’t enough midwives. This can’t continue because we know it compromises safety and means women don’t always get the safe positive pregnancy and birth experience that they should.  

“It’s also having a shocking impact on maternity staff themselves. A shortage of midwives has undoubtedly worsened rates of physical and mental burnout among our members. Morale among staff is low and has been worsened by the recent pay award in England.  

“Sadly, this survey shows that many midwives and MSWs have had enough. They are feeling very fragile and are simply at breaking point. Enormous demands are being made on midwives and the services they work for, yet investment in these services from the Government remains inadequate to provide the safe, high-quality care that women deserve.

“We have previously advised the Government on what can be done to begin to address this situation which hasn’t happened overnight. Prior to the pandemic the RCM has voiced concerns and solutions to the recruitment and retention issues faced by UK maternity services, and we are happy to do that again, but we are now sadly at crisis point.

“That is today we are again calling on the Government and NHS Employers to take action immediate to keep midwives in midwifery before it’s too late.” 

Additional £5.4 billion for NHS COVID-19 response in England over next six months

Includes £1 billion to help tackle COVID-19 backlogs, delivering routine surgery and treatments for patients

The NHS will receive an extra £5.4 billion over the next six months to support its response to COVID-19 and help tackle waiting lists, the Prime Minister and Health and Social Care Secretary Sajid Javid have announced.

The funding will immediately go towards supporting the NHS to manage the immediate pressures of the pandemic. This includes an extra £1 billion to help tackle the COVID-19 backlog, £2.8 billion to cover related costs such as enhanced infection control measures to keep staff and patients safe from the virus and £478 million to continue the hospital discharge programme, freeing up beds.

The additional £5.4 billion brings the government’s total investment to health services for COVID-19 so far this year to over £34 billion, with £2 billion in total for the NHS to tackle the elective backlog.

Prime Minister Boris Johnson said: “The NHS was there for us during the pandemic – but treating Covid patients has created huge backlogs.

“This funding will go straight to the frontline, to provide more patients with the treatments they need but aren’t getting quickly enough.

“We will continue to make sure our NHS has what it needs to bust the Covid backlogs and help the health service build back better from the worst pandemic in a century.”

Health and Social Care Secretary Sajid Javid said: “The NHS has been phenomenal as it has faced one of the biggest challenges in its history.

“Today’s additional £5.4 billion funding over the next 6 months is critical to ensuring the health service has what it needs to manage the ongoing pandemic and helping to tackle waiting lists.

“We know waiting lists will get worse before they get better as people come forward for help, and I want to reassure you the NHS is open, and we are doing what we can to support the NHS to deliver routine operations and treatment to patients across the country.”

Amanda Pritchard, NHS chief executive, said: “This funding provides welcome certainty for the NHS, which has pulled out all the stops to restore services, while caring for thousands of seriously ill Covid patients requiring hospital treatment during the toughest summer on record.

“This additional investment will enable the NHS to deliver more checks, scans and procedures as well as helping to deal with the ongoing costs and pressures of the pandemic as the NHS heads in to winter.”

The UK Government has been clear that the NHS will ‘get what it needs’ to recover its usual services and deliver quality care to patients.

The waiting list for routine operations and treatments such as hip replacements and eye cataract surgery could potentially increase to as high as 13 million. While today’s extra £1 billion funding will go some way to help reduce this number, waiting lists will rise before they improve as more people who didn’t seek care over the pandemic come forward.

£478 million of this new funding has been dedicated to continue the hospital discharge programme so staff can ensure patients leave hospital as quickly and as safely as possible, with the right community or at-home support.

This will free up thousands of extra beds and staff time to help the NHS recover services. The government has also invested £500 million in capital funding for extra theatre capacity and productivity-boosting technology, to increase the number of surgeries able to take place.

This funding is for England only. The devolved administrations will receive up to £1 billion in Barnett consequentials in 2021-22. The final amount will be confirmed and allocated at Supplementary Estimates 2021-22.

On top of this funding, the NHS recently launched a £160 million initiative to tackle waiting lists. This is looking to accelerate the recovery of routine treatments and operations by trialling new ways of working, including a high-volume cataract service, one stop testing facilities where people can get tests done quickly and efficiently, to speed up the time to treatment, greater access to specialist advice for GPs and pop-up clinics so patients can be seen and discharged closer to home.

The UK government is ‘committed to delivering the greatest hospital building programme in a generation with 40 new hospitals by 2030’, backed by an initial £3.7 billion.

Yesterday’s announcement is in addition to the £3 billion announced at Spending Review 2020 to support the NHS.

First Minister Nicola Sturgeon is expected to announce a further £2.5 billion increase in NHS spending in Scotland when she lays out her Programme for Government later today.

“Shocking”: Ambulance handover delays are threatening patient safety, experts warn

A new snapshot survey by the Royal College of Emergency Medicine has found that in August 2021 half of respondents stated that their Emergency Department had been forced to hold patients outside in ambulances every day, compared to just over a quarter in October 2020 and less than one-fifth in March 2020.

The survey, sent out to Emergency Department Clinical Leads across the UK, also found that half of respondents described how their Emergency Department had been forced to provide care for patients in corridors every day, while nearly three-quarters said their department was unable to maintain social distancing every day.

One-third said that the longest patient stay they had had in their Emergency Department was between 24 and 48 hours, with seven per cent reporting the longest stay to be more than 48 hours.

Dr Ian Higginson, Vice President of the Royal College of Emergency Medicine, said: “It is shocking to see the extent of the challenges faced by Emergency Departments across the UK.

“Holding ambulances, corridor care, long stays – these are all unconscionable practices that cause harm to patients. But the scale of the pressures right now leaves doctors and nurses no options.

“We are doing all we can to maintain flow, maximise infection prevention control measures, and maintain social distancing. Our priority is to keep patients safe, and ensure we deliver effective care quickly and efficiently, but it is extremely difficult right now.

“The data is stark, and this is August. Our members are really worried about what may come in autumn and winter. We have a duty to our patients and staff. Currently there is extremely high demand – for a number of reasons – but demand is not the whole picture.

“Demand presents a challenge because of the limitations of hospital space, workforce shortages, difficulties arranging quick ambulance handovers, smooth care and safe discharge of patients from wards, and a lack of services and alternatives to admission, particularly in the evenings and at weekends.

“The health service entered the pandemic short of staff, with less beds, and underprepared. Throughout the pandemic these shortages have been felt, but with demand higher than ever before, and with a workforce that is burned out, these shortages are felt more acutely than ever.”

Commenting on the increase in ambulance handover delays, Tracy Nicholls, Chief Executive of the College of Paramedics, said: “The College of Paramedics’ members also speak passionately about the potential for harm to those patients who, as a consequence of these lengthy ambulance handover delays, can wait an unacceptably long time for help. It is deeply concerning.

“Like the Royal College of Emergency Medicine, we recognise that all partners are working exceptionally hard to manage this situation and current demand. The reality is, however, that unless effective actions are taken now to ease the system pressures, more and more patients will face these delays as we head into another difficult winter, and both paramedics and ambulance clinicians across the UK will face the brunt of any further increase in demand.

“We urge NHS leadership to take action now to mitigate this risk wherever possible and protect both patients and our collective workforce from the inevitable pressure that we face if nothing is done.”

The survey also found that over 80% of respondents had little or no confidence in their organisation’s ability to safely and effectively manage the current or predicted combination of pressures as we head into winter.

Dr Higginson continued: “The final response that found an overwhelming lack of confidence signals something deeply troubling.

“The College has consistently warned of the upcoming winter and ongoing pressures. It is time we saw leadership and an equivalent response. There must be a comprehensive plan for the current demand and upcoming winter that include short- and long-term solutions to tackle these serious challenges.

“If ambulance services and Emergency Departments cannot cope with ongoing pressures, then it is patients and the workforce looking after them who will suffer. The winter could lead the health service into a serious crisis. Patients and staff must have assurance that they, their Emergency Department and their hospital will get what they need to manage.”