Tag: NHS

New doctors take their oath after a final year like no other

Becoming a doctor takes years of dedication, studying and on-the-wards training. But for this year’s cohort of 293 newly qualified doctors, currently enjoying their virtual graduation events, their final years as students were massively impacted by the coronavirus pandemic.

Some 56 of the students were based at the Glasgow Royal Infirmary.

Dr Diva Abdullah enjoyed a virtual graduation on Friday with her classmates from the University of Glasgow. It followed a separate ceremony where the newly qualified doctors recently took the Hippocratic oath from a lecture theatre. The 24-year-old from Brunei has been in Scotland for 3 years and working at hospitals across the country as part of her training.

“When the pandemic hit we were still 4th year students and all of a sudden we had to cancel our placements and there was a lot of uncertainty for everyone. We were out of the hospital for four-and-a-half months and into online learning.”

When the students were allowed back in clinical settings, they worked hard to catch up on the more practical elements of their studies.

Diva was posted to Glasgow Royal Infirmary’s Emergency Department, just as the second wave of COVID took hold.

She added: “We saw a lot of COVID patients coming in. I was in the department one day and there were about eight acute patients there presenting with shortness of breath, and that was quite a lot. However, I felt incredibly supported by the team and we worked hard to help people.”

One of the hardest things for Diva arriving in Glasgow was trying to understand the accent. “I was in a GP’s practice and I volunteered to take notes and I had no idea what was going on – but it quickly got better,” she added.

Diva is now moving to Aberdeen to do her foundation year as a newly qualified doctor. Eventually, she hopes to specialise in paediatrics, working in a children’s hospital. “I just want to help people, I like being able to make a difference to someone’s life,” she said.

Consultant Orthopaedic Surgeon and Hospital Sub Dean at Glasgow Royal Infirmary, Miss Jane Madeley, said: They were part way through their penultimate year of training when COVID-19 impacted training.

“In comparison to last year’s graduates, who had completed enough of the course by March 2020 to be able to move forward and graduate, this year’s final year students were midway thought the clinical stage of training which consists of different placements in the hospital and GP setting where they learn the principles of medicine and surgery as well as other specialties.

“They were initially withdrawn from the hospitals in March 2020 and teaching moved on-line, whilst planning for them to be able to return was undertaken.

“This must have been a very difficult period, with the stress of uncertainty, isolation from peers that the lock-down enforced, and some returning overseas, with others remaining in Glasgow but unable to see family and friends.”

Jane thanked the staff at GRI for their support for the student and added: “We are extremely proud of all they have achieved and wish them every success in the future.

“We are sure a group able to flourish during this testing period will achieve amazing things moving forwards and we look forward to welcoming them as colleagues.”

Diva has enjoyed being a part of the NHS throughout a year like no other. She concluded: “Teamwork is what makes the NHS work, it feels like a small family where everyone is looking out for each other and their patients. That’s what is so important.”

Emergency! Key staff shortages are increasing the pressure on struggling ED workforce

Census by RCEM Scotland shows a shortage of key senior decision-making clinicians and a workforce below adequate staffing levels

A census of the Emergency Medicine workforce in Scotland by the Royal College of Emergency has found shortages of key senior decision-makers, and a workforce that is below adequate staffing levels to deliver the best and most effective care to patients.

When asked for immediate staffing needs, Emergency Departments across Scotland reported they needed an increase of:

  • 25% in consultants
  • 45% in Advanced Clinical Practitioners/Advanced Nursing Practitioners/Physician Associates
  • 16% in Emergency Nurse Practitioners
  • 22% in Higher Specialist Trainees/Non-consultant Senior Decision-Makers
  • 21% in Junior Doctors

RCEM analysis shows that to resolve the shortages of senior decision-makers and to achieve adequate staffing and aspirational staffing levels by 2026 the current workforce in Scotland needs a total of 405 more health care staff broken down as:

  • 113 more consultants
  • 74 more Higher Specialist Trainees/Non-consultant Senior Decision-Makers
  • 38 more Advanced Clinical Practitioners/Advanced Nursing Practitioners/Physician Associates
  • 180 more Junior Doctors

RCEM’s Scotland workforce census consisted of a 64-question survey and was sent to Emergency Department Clinical Leads across Scotland.

Responses were received from 24 Emergency Departments, including all 20 consultant-led Emergency Departments, one Minor Injury Unit, and three Remote and Rural Hospitals.

Commenting on RCEM’s Scotland workforce census, Dr John Thomson, Vice President (Scotland) of the Royal College of Emergency Medicine, said: “The census clearly shows that the Emergency Medicine workforce in Scotland is not adequately staffed to deliver the highest quality patient care.

“This has led to an increase in intense pressures on the existing workforce and is very likely to be a contributing factor to the continued deterioration in performance.

“We have always been proud of Scotland’s performance in Emergency Medicine, ensuring quick and effective care that outperformed the rest of the United Kingdom. But, even before the pandemic, the increase in demand put severe pressure on staff, and departments began to struggle to meet the four-hour access standard, but more seriously began to struggle to deliver appropriate treatment to patients, resulting in more delays and longer stays.

“The pandemic certainly exacerbated these issues and now there are some major challenges that face Emergency Medicine in Scotland. Emergency Medicine can be relentless; a service delivered 24 hours a day, seven days a week, will always take its toll, and the pandemic has highlighted the severe burnout that Emergency Medicine staff, especially face.

“Departments must be staffed with a workforce trained and qualified in Emergency Medicine. Shortages in senior decision-making staff groups can lead to Emergency Departments over-depending on junior staff. The census shows that we need considerable expansion of funded consultant and senior decision-maker posts in order to prioritise patient safety and quality of care.

“We managed to survive the first two waves of pandemic with an insufficient workforce, but now these existing staff are facing burnout and exhaustion – with some clinicians reporting they are planning on retiring early. This census clearly shows that we must act and address these problems without delay.

“The Scottish Government must work with the specialty to devise an adequate workforce plan for the emergency care system, taking into account population needs and rising demand on the service. Plans must ensure sustainable and fulfilling careers for all staff, allowing for the delivery of quick, safe, and effective care for patients.

“Without a sufficient workforce plan that addresses the findings of the census, it is likely that there will be continued deterioration in Emergency Department performance and rates of burnout will continue to increase amongst Emergency Medicine staff.”

NHS Covid-19 funding increased

An additional £380 million is being allocated to Health Boards to help with costs arising from the pandemic.

This comes on top of the £1.7 billion already provided to Health Boards and Health and Social Care Partnerships last year. Further financial support will be made available as necessary over the course of this year.

This additional funding includes ongoing support for the vaccination programme, the Test and Protect system, and personal protective equipment (PPE) for health and care workers.

Health Secretary Humza Yousaf said: “Although we are hopefully emerging from this pandemic, coronavirus continues to add significant pressures to our health and care services.

“We will continue to assess the impact of COVID-19 and provide Health and Care services with the support they require. The remobilisation of the NHS is among our top priorities. We will publish a national recovery plan within the first 100 days of this government.

“The £380 million includes £90.3 million for Test and Protect, a further £76.8 million for the COVID and extended flu vaccination programmes, and £85.5 million allocated to National Services Scotland for PPE costs. The rest of the funding will cover costs including additional staffing to support hospital scale-up, equipment, maintenance and IT.”

The 2021-22 Scottish Budget takes total health portfolio funding in excess of £16 billion – an increase of over £800 million (5.3%) – with a further £1.08 billion of funding to address pressures related to COVID-19. 

Royal College of Emergency Medicine: Winter crisis looming?

16,000 additional beds may be needed for the NHS to cope this winter

The NHS urgently needs a rapid increase in bed numbers if it is to meet potential demand this winter according to new analysis from the Royal College of Emergency Medicine.

The College’s new briefing document ‘RCEM Explains: Hospital Beds’ looks at how bed numbers have declined in the past decade, the impact of covid, and the potential number of beds needed this winter, based on previous levels of demand.

The briefing uses the ratio of emergency admissions to beds to model the numbers of beds that will likely be needed, based on the levels of demand seen each winter prior to the pandemic.

In the last five years in England this figure has fluctuated between 11.07 admissions per bed (winter 2015/16) and 12.50 (winter 2018/19). Excluding the most recent winters (both of which saw demand and capacity fall due to the pandemic), there was an average of 11.77 admissions per bed.

If the NHS is to achieve a similar ratio this winter, and there are a similar number of admissions as in the winter of 2017/18, the NHS will need just over 7,500 additional beds. If demand is similar to 2018/19, then this figure rises to 15,788 extra beds.

President of the Royal College of Emergency Medicine, Dr Katherine Henderson said: “We are currently seeing record levels of attendances at Emergency Departments and if this continues into winter – an extremely likely situation – the NHS will have too few beds to be able to cope.

“The consequences of having too few beds could be dire. If we do not have the capacity to admit patients into hospitals, then A&E waiting times will go up, patients will end up being treated in corridors – a very real threat to their safety before the pandemic, but now with the added risk of hospital acquired infection – and the elective backlog will grow further as beds earmarked for surgeries will be used for emergency patients.”

The briefing also makes clear the relationship between high bed occupancy and an increased rate of cancelled elective operations.

Dr Henderson said: “Too few beds means higher rates of occupancy, which in itself puts patient safety at risk, but it is clear that this has a huge knock-on effect on elective care. Lack of beds is one of the top reasons for cancellation of surgeries and if we do not address the shortage now, before winter, the elective recovery will fail.

“We know that access to services is an issue throughout the NHS at the moment with resources short all-round, but Emergency Departments act as the safety net for the NHS – if they cannot function properly the entire system stalls – so it is vital that the new Secretary of State does all he can to enable the NHS to expand hospital capacity. 

“The safe restoration of bed capacity to pre-pandemic levels is no easy fix though – as we’ve seen with the Nightingale initiative, capacity cannot be expanded if we do not have enough doctors, nurses, and clinicians.

“The capacity and staffing issues we face now have been over a decade in the making. Social care is still unfixed. Waiting lists are growing. Structural reconfiguration is in progress. Covid is less of an immediate threat but is unlikely to disappear. The Secretary of State has much to do, but he must start by making the beds.”

RCEM launches public appeal to support A&E staff facing stress and burnout

The Royal College of Emergency Medicine is launching a public appeal  to support the mental health and wellbeing of A&E staff after data show that many have struggled with burnout, distress, and other psychological conditions resulting from the stress of the pandemic, further to the continued pressures of their day-to-day work in Emergency Departments.

The NHS entered the pandemic underfunded, under-resourced and understaffed. This meant the severe demands of the ensuing pandemic were faced by the existing but understaffed workforce.

The shortage of health care workers has meant these existing staff have been continually pushed to their limits and beyond. And throughout the pandemic these health care workers have been physically, mentally, and emotionally challenged. Staff have been working with little or no respite in challenging conditions while facing ever increasing pressures.

The Health and Social Care Committee report “Workforce burnout and resilience in the NHS and social care” cites data from NHS Providers that show 92% of trusts raised “concerns about staff wellbeing, stress and burnout following the pandemic”.

A study published in January 2021 found that nearly half of frontline doctors, including those working in Emergency Medicine, suffered psychological distress during the first wave of the pandemic with others suffering from trauma, PTSD and other psychological conditions.

A study from 2019 found that working as an emergency physician is one of the most fatiguing and stress-inducing professions, a result of regularly working shifts longer than 12-hours, struggling to find work-life balance, and burnout. This was recorded prior to the pandemic, during which the pressures on Emergency Medicine staff significantly increased.

Dr John Heyworth, Consultant in Emergency Medicine in Southampton and Chair of RCEM Fundraising, said: “We know that many Emergency Medicine staff are exhausted and facing burnout.

“After 15 months of this pandemic, with waves of Covid causing intense pressures on our overstretched emergency departments, and now a return to high pre-pandemic levels of hospital activity, added to the stress of the threat of a further wave of covid – this is not surprising. But it is deeply worrying.

“We must do all we can to protect and support our frontline Emergency Department staff. Their hard work and dedication throughout this extremely challenging time has been incredible. As ever, they have been on the frontline throughout the pandemic risking their personal health and dedicating themselves to the care of others.

“The public have shown their remarkable support and respect for the health service. And now, we want to appeal to them to support our A&E staff who work 24/7 in Emergency Departments, ready to treat anyone who seeks care.

“When we know that our Emergency Medicine workforce is struggling with exhaustion, burnout, stress and other psychological conditions then we must take action, and they deserve our support.

“RCEM’s Public Mental Health and Wellbeing Appeal aims to raise money to develop and expand the support services offered to A&E staff who may be struggling with mental health conditions including PTSD, stress, burnout and exhaustion.

“The support offered will be guided and dictated by what A&E staff need most so that we can help them in the best way possible.

“RCEM’s goal is to ensure the services and support provided have a positive and lasting impact on the mental health and wellbeing of our frontline A&E workers.”

RCEM Appeal:

 https://www.rcem.ac.uk/RCEM/Get_Involved/Wellbeing_Appeal.aspx

Donate here:

http://www.rcem.ac.uk/RCEM/Get_Involved/Sign_in_for_donations.aspx?f=SPRW

“No-brainer”: £5 million to remobilise NHS dentists

£5 million to help meet safety standards and see more patients

Additional funding of up to £5 million is available to NHS dentists to help remobilise services as Scotland recovers from the coronavirus pandemic.

This new funding will help NHS dental practices to purchase, renew or upgrade ventilation equipment as improved ventilation in surgeries can substantially reduce the time between seeing patients, and offer dental teams the opportunity to see more patients safely.

Health Secretary Humza Yousaf said: “The remobilisation of the NHS is one of our number one priorities and the Scottish Government remains committed to ensuring that NHS dental services emerge from this pandemic well-placed to care for the oral health of the population.

“This new funding is an important step in ensuring the continued remobilisation of NHS dental services and to ensure more patients can be seen safely. We will also continue to fund free PPE for the dental sector and, from July, we will increase it by up to 50 per cent.

“We are continuing to work with the sector to provide much-needed support to fully remobilise dental services.”

Funding will be available throughout this financial year, and will be distributed by NHS boards to those practices meeting the scheme’s conditions. Claims can be made for the period 1 April 2020 to 31 March 2022. Further details of the scheme and how to apply will be provided to the dental sector by separate circular issued by the office of the Chief Dental Officer.

The British Dental Association Scotland has welcomed confirmation the Scottish Government will allocate £5 million to help practices invest in ventilation equipment to increase patient volumes while meeting COVID restrictions.   

The BDA first made the bid for financial support to improve ventilation to the Scottish Government in November. England is now the only UK nation not to have committed any capital funding for ventilation to help restore services.   

Chief Dental Officer Tom Ferris has confirmed funds can be used to purchase, renew or upgrade ventilation systems, and practices can claim retrospectively for the period 1 April 2020 – 31 March 2022.

 The BDA is awaiting details of the conditions applied to the scheme, but has expressed concern that it may not cover those practices who have already installed portable units or air cleaners (such as HEPA filters) when they were unable to improve ventilation by other means in the short term, following guidance from the Scottish Dental Clinical Effectiveness Programme (SDCEP).

Many in this position are based in sites unsuitable for major works, such as premises owned by health boards, in densely packed city centres with adjoining residential and commercial units, or in listed properties.

To meet strict guidelines on COVID transmission, dentists have had to leave surgeries fallow between most common procedures. Investment in ventilation ensures practices can reduce these gaps and increase patient throughput.    

Restrictions have left practices operating at a fraction of their former capacity. Data from Public Health Scotland has shown a dramatic reduction in NHS dentistry delivered, which has hit those in most deprived communities the hardest. Between April and November 2020, the number of courses of treatment delivered was 83% lower than during the same period in 2019.  

This week Scotland’s CDO joined colleagues from the other three UK nations to commit to reviewing current restrictions. [1] While the review may reduce the need for a fallow time longer-term, the BDA has stressed this investment is required to ‘future proof’ services in the advent of any future pandemic, to secure an immediate boost in access, and will prove cost-neutral through increased patient charge revenues.   

David McColl, chair of the British Dental Association’s Scottish Dental Practice Committee said: “This is a no-brainer from the Scottish Government. Investment in ventilation can future proof Scotland’s dental services, boost patient numbers, and pay for itself.

“We must avoid half measures. Many dentists have had no option but to buy portable systems to get patients back through their doors. Ministers must ensure they do not lose out.  

“For our patients’ sake, this needs to mark a turning point when it comes to providing ongoing support to practices. Access to services has fallen off a cliff. A signature policy on free dentistry for all will be a promise that can’t be kept unless we see real commitment from ministers.”  

Letters: The Coming Attack

Dear Editor

At the end of the war in 1945 the population, including the armed forces, were exhausted, many having also lived through the 1930s of unemployment and poor living conditions. The population were determined to change things after six years of war.

The main thing to tackle was the formation if a National Health Service. In 1948 this would tackle the poor state of the nation and provide an example of how the nation could be organised for the people.

Now, more than seventy years on, the foresight of setting up the NHS has been experienced and it is paying off, particularly in the circumstances of the Covid 19 epidemic.

Millions of people have expressed their gratitude for the NHS, for it’s originators and for all the people who work within it.

But now, a danger looms over our NHS. The Conservatives, who voted AGAINST the formation of the NHS, feel they are able to start ‘reorganising’ the service to allow the private sector a controlling role in it.

This infiltration is the first step by the Tories in a plan to kill off the NHS as a service for all.

TONY DELAHOY

Generosity has increased since lockdown began, research reveals

I think we can all agree the last 12 months have been challenging in so many ways, for people and businesses alike. But one of the most heart-warming parts since the first lockdown was announced has been seeing how many people have pulled together to help those in need.

New research by thortful.com has shown that people are now looking to give back. thortful analysed Google Trends data since the start of the first lockdown and found that there has been a huge increase in terms like ‘care packages for friends’ and ‘care package ideas’ seeing a 3350% and 250% increase in the last 12 months.

Businesses are also looking to show their appreciation to loyal customers who have continued to support them during these uncertain times, with the search term ‘thank you business cards’ seeing a 400% increase in the last 12 months.

Interestingly, search terms like ‘thank you for your order cards’ and ‘thank you for your purchase cards’ are two breakout queries, indicating this is a growing trend and that businesses want to give back to their customer base.

People’s willingness to give back was also seen during the Mother’s Day period when people donated to thortful’s NHS Charities Together campaign, which raised £130,126.50 for NHS Charities. Thanks to their customers, they were able to smash their target of raising £110,000. .

thortful became the official card company sponsor of the NHS Charities Together during the Mother’s Day period (15th February – 14th March), and pledged £110,000 to NHS Charities Together.

During this period, 5p for every Mother’s Day card sold and £5 from every Rainbow bouquet bought was donated by thortful directly to NHSCT. thortful smashed their target on 15th March 2021 with the total figure now at £130,126.50.

Commenting on the initiative, a thortful spokesperson explained: “It’s great to see how generous and altruistic people have been during this time.

“We are so grateful to all our wonderful customers for helping us raise this huge amount of money. We wanted to show our support and gratitude for all of the NHS staff who have worked tirelessly during the pandemic.”

For the full thank you card range, go to: https://www.thortful.com/cards/thank-you

Invest in Scottish maternity to tackle deprivation, says RCM in message to next government

Tackling Scotland’s social deprivation and inequalities by investing in maternity services and staff must be at the heart of the next government’s policy. That’s the message from the Royal College of Midwives (RCM) in a Blueprint for maternity services published this week.

In five areas for action, it also calls for an end to Scotland’s midwife shortage, saying some areas of the country struggle to attract enough midwives. 

The pandemic has also exposed starkly existing inequalities hitting vulnerable women and those from Black, Asian and minority ethnic communities.  Maternity and other areas of healthcare have a key role to play in efforts to address these inequalities, says the RCM 

The RCM’s five areas for action for the next Scottish Government are: 

  • tackling social deprivation; 
  • delivering the best maternity care for all the people of Scotland; 
  • supporting NHS staff to recover from the pandemic; 
  • ensuring Scotland has birthplaces that are fit for the future; and 
  • ending Scotland’s midwife shortage for good. 

Pulling no punches, the Blueprint says the pandemic ‘has been brutal’ on maternity and other NHS staff, who have worked throughout to ensure safe and high-quality care for women. This has hit their mental and physical health and they must be given the time and support to recover from it. 

Jon Skewes, Executive Director for External Relations at the RCM, said: “There has been a monumental effort from midwives, maternity support workers, and maternity care assistants through the pandemic. It is time to step-up and really invest in them, in their pay and in their working conditions.

“Right now, we have a demoralised and exhausted workforce and women falling through the cracks and not getting the care they deserve. Staff are also often working in old, poorly designed buildings that are simply not fit for purpose. The pandemic has exposed the extent and the impact on care of this crumbling infrastructure.” 

Additional training places for student midwives are also needed in more of Scotland’s universities. When they qualify new midwives generally stay within the regions they trained in leaving the chances of recruiting staff stacked against other areas without midwifery courses.  

Jon Skewes added: “Tackling deprivation goes way beyond maternity and the wider NHS. Fixing it must be done through multiple channels including social care, education, and others.

“Maternity is a very good place to start improving the health of the nation, reduce inequalities and indeed, save lives that should not be lost. This has been a really tough year for the NHS and the people using it as it creaked under the weight of pandemic demands.

“It has also been a remarkable year because of how its staff and the service responded. Now is the time to invest to make it fit for the future.” 

Scottish Government pledges more say for communities in health and social care services

The public will have a greater say in how major decisions around health and social care services are delivered in Scotland.

New guidance will ensure NHS Boards, Integration Joint Boards and local authorities uphold their legal duty to consult and engage with local communities about major planning decisions.

This will guarantee people with real experience of using local services will be able to shape decision making at a local and national level, from building or rebuilding hospitals, to transferring health and social care services into the community.

This ‘forward thinking’ approach will ensure lessons are learned from the Coronavirus (COVID-19) pandemic by giving people with lived experience a say in the future of NHS Scotland and the reshaping of Adult Social Care. It will also help ensure services are effective, safe, value-for-money and meet individuals’ needs.

Health Secretary Jeane Freeman said: “Community engagement and participation is vital as we look to reform health and social care services, ensuring they are fit to meet the needs of the public as we deal with the long term impact of the pandemic.

“This guidance will help ensure people have a greater say in decisions which affect the care they receive.

“Our collective response to the pandemic has shown the strength of our public services and how we can come together to address challenges. Since the start of the pandemic we have been delivering services differently and have engaged with communities to ensure they are involved in decisions that affect them. This guidance captures that learning and seeks to ensure we all benefit from it.  

“The Scottish Government will continue to listen to the views of people who use health and social care services and actively involve them in re-shaping how we deliver care as we re-mobilise beyond the pandemic.”

COSLA Health and Social Care Spokesperson Cllr Stuart Currie said: “Planning with people promotes real collaboration between NHS Boards, Integration Joint Boards and Local Authorities.

“It sets out the responsibilities each organisation has to community engagement when services are being planned, or changes to services are being planned, and it supports them to involve people meaningfully.

“Fundamentally, good engagement means that services are developed which are effective, safe and value-for-money. And there is no doubt that greater participation brings better outcomes for communities all round.

“So, we encourage people in communities across Scotland to read this guidance and find out what they should expect when it comes to engagement about care planning. Ultimately, it is their experience that will be the real measure of what impact it is making.”

Care services – planning with people: guidance – gov.scot (www.gov.scot)