Tag: NHS

“There can be no denying it; the Emergency Care system is failing”

RCEM launches campaign to resuscitate Emergency Care as polling reveals the public’s lack of confidence in UK government’s policies to tackle the crisis

The Royal College of Emergency Medicine has outlined five priorities for UK governments to tackle the crisis in Emergency Care, after polling carried out by Ipsos on behalf of the College found 59% of respondents expressed a lack of confidence that the UK Government have the right policies to tackle long patient waiting times in A&E departments in hospitals.

The campaign launches amid the worst Emergency Care crisis on record, as reflected in A&E performance figures across all four-nations.

Five Priorities for UK Governments to #ResuscitateEmergencyCare lays out what UK governments must focus on to tackle the crisis, improve patient care, retain staff, and prevent harm.

The five priorities are:

  • Eradicate overcrowding and corridor care for patients
  • Provide the UK with the Emergency Medicine workforce it needs to deliver safe care
  • Ensure our NHS can provide equitable care to emergency patients
  • Focus on evidence-based interventions to tackle overcrowding
  • Introduce meaningful and transparent metrics to facilitate performance and better outcomes for patients.

More patients than ever before across the UK are facing long and dangerous waits. It has been widely reported that crowding, corridor care and long waiting times for patients in Emergency Departments are associated with patient harm and patient deaths.

The public are acutely aware of the issues and pressures in A&E departments, with an Ipsos poll, commissioned by the College, showing that:

Nearly half of those polled by Ipsos expressed that they did not feel confident they would be treated in an appropriate area if they personally had a medical emergency in the next week that required them to attend their local A&E.

Meanwhile, two-thirds did not feel confident that a hospital bed would be available if they personally had a medical emergency in the next week and needed to be admitted to hospital.

Dr Adrian Boyle, President of the Royal College of Emergency Medicine, said: “There can be no denying it; the Emergency Care system is failing and not functioning as it should.

“We can argue about numbers and calculations of excess deaths or we can work together and take the urgent and necessary action to prevent any further harm or deaths occurring. Patients and staff are rightly concerned, they deserve to see honesty and meaningful action from our political and health leaders. This is our plan to tackle the crisis.

“The roots of the problem lie in the lack of adequate capacity in hospitals, lack of staff, and lack of social care in the community. Since 2010, more than 29,000 beds have been removed from the system despite the increasing complexity of population healthcare needs.

“While for many years, social care has faced devastating cuts, meaning patients medically ready to leave hospital do not have the support they need to leave – so they reside in hospital for longer than they should preventing others from being admitted.

“The inability to discharge patients and the inability to admit patients is causing severe exit block – our hospitals are completely gridlocked, meaning Emergency Departments are becoming dangerously crowded and patients are facing extremely long waits.

“These delays and crowding impact heavily on the existing workforce, which has been stretched to its limit for too long. There are significant shortfalls of staff in Emergency Medicine; Emergency Departments across the UK are not safely staffed and the public recognise that.”

Polling shows that just 18% of respondents surveyed agreed their local A&E had enough staff to care for them in a timely way while just 23% expressed agreement that their local A&E had enough staff to care for patients in a safe way.

Dr Boyle said: “Clinicians are doing all they can and what they can to bridge the gap between an under-resourced system and the quality of care patients require, but it’s plain as day to anyone that we have too few staff.

“We are in a dire place right now, but it is fixable. We know what needs to be done to tackle the crisis and improve patient care, but this requires sustained and continued cross-party political willingness and investment to engage with the issue and tackle it root and branch.

“Our campaign to resuscitate Emergency Care shows the way forward for governments, with five key priorities to address. The first priority must be on improving flow through our hospitals to end corridor care and overcrowding.

“UK governments must open more staffed beds, where safely possible, and run hospitals at no more than 85% bed occupancy. In tandem with this, UK governments have been right to invest in community and social care but this can no longer be short-term; we need sustained expansion, resource and funding for social care to ensure patients are discharged safely and promptly when their medical care is complete.

“There must also be recognition of the impact of the crisis on the workforce, they do excellent work, but they cannot continue to flirt with burnout or this will lead to burn away. UK governments must urgently work to retain our highly-skilled frontline clinicians – but they must feel supported, listened to and valued.

“Lastly, performance is at an all-time low and metrics are currently documenting a failing service. Together with the expansion of capacity and resourcing of social care, we must see a renewed effort to improve performance and meet the four-hour waiting time target in Emergency Departments.

“We cannot afford to be in a performance vacuum any longer, metrics must have meaning and drive improvement and better patient care. In England, this must start with monthly publication of 12-hour waits from the time a patient arrives – as it is in the rest of the UK – rather than the misleading and dishonest current metric which measures 12-hours from the time a decision to admit a patient is made.”

Action to cut delayed discharge

National exercise to re-assess hospital patients who are clinically safe to be discharged

Patients who no longer need to be in hospital are to be reassessed as soon as possible to get them the right care in the right place at the right time.

Before the end of the month each health board area will identify patients who are clinically safe to be discharged without further delay and can safely move home or to another setting such as an interim placement in a care home.

Staying in hospital is not the best option for those who are clinically fit for discharge. Being in hospital for longer than needed is not in the best interests of the individual, particularly for older patients, reducing their ability to look after themselves and return home.

This approach is based on good practice already adopted by several health boards. Patients will only be discharged if it is deemed safe, and clinical risk assessments will take into account the capacity of social care and social work and the potential impact on families or carers of patients.

This is the latest step in efforts to free up capacity in hospitals and help get the NHS through the toughest winter in its history. It builds on last week’s £8 million commitment to provide an extra 300 interim care home beds to get patients discharged quicker.

Health Secretary Humza Yousaf said: “First and foremost, we know hospital is not a good place to be for people who are medically fit to leave, because it can lead to them becoming weaker or less independent. That’s why it’s so important they can move home, or to a homely setting, as soon as possible.

“We believe this will also help to alleviate pressure on our NHS by freeing up beds and improving the flow of patients through hospitals. It is also, crucially, in the best interest of the people concerned.

“If we can reduce delayed discharge there is more chance that beds will be available for people who need them. We hope that these reviews will also contribute to reducing some of the pressures our hospitals are facing.”

Additional Winter support for NHS

Scotland’s health and social care crisis discussed by resilience committee

First Minister Nicola Sturgeon chaired a further meeting of the Scottish Government’s resilience committee (SGoRR) yesterday to discuss the ongoing pressures on the health and social care system.

The group met on Friday morning and assessed issues including the latest situation with respiratory infections, pressures throughout the system, and ongoing work to reduce rates of delayed discharge.

The SGoRR meeting was also attended by Deputy First Minister John Swinney, Health Secretary Humza Yousaf, other Cabinet ministers, the Chief Medical Officer and key partners from across the system including senior representatives from NHS boards, COSLA, Integration Joint Boards, NHS24 and the Scottish Ambulance Service.

Earlier this week, Health Secretary Humza Yousaf announced a number of additional measures to address demands on the system, including £8 million to procure around 300 additional care home beds, and NHS24’s plans to take forward recruitment of around 200 new starts before the end of March.

The First Minister’s handling of the health crisis was criticised by opposition parties at Question Time this week and Conservative leader Douglas Ross also called for the sacking of Health Secretary Humzah Yousaf.

The First Minister said: “It is clear that pressure on the NHS and social care system continues to be very high, and that we need to maintain our emphasis on doing everything we can to help the service through the remainder of the winter.

“The measures set out by the Health Secretary earlier in the week will help to address some of the main issues – easing delayed discharge by purchasing additional care beds for those who are fit to leave hospital, and ensuring adequate resource is in place for NHS24.

“The focus of today’s meeting was to ensure that we keep pushing ahead with every possible step to support our tremendous health and social care staff, and ensure the people of Scotland continue to get the care and treatment they need. I would like to thank every single person working in the NHS and care system for the tremendous contribution they are making.”

Additional Winter support for NHS

Measures to help NHS deal with extreme pressure

Funding of at least £8 million for additional care home beds and efforts to boost NHS 24 capacity are among the measures outlined by Health Secretary Humza Yousaf to help the NHS and social care deal with ongoing extreme winter pressure.

Health and Social Care Partnerships will share £8 million to procure around 300 additional care home beds to help alleviate pressures caused by delayed discharge. The funding will allow boards to pay 25% over and above the National Care Home rate for beds. This is in addition to around 600 interim care beds already in operation across the country.

NHS 24 is taking forward plans to recruit around 200 new starts before the end of March. In the run up to Christmas NHS 24 had already recruited over 40 whole time equivalent call operators, call handlers and clinical supervisors.

Guidance has been issued to all Boards making it clear they can take necessary steps to protect critical and life-saving care.

Mr Yousaf said: “This is the most challenging winter the NHS in Scotland has ever faced and the immediate pressure will continue for the coming weeks. My thanks to all health and social care staff for their incredible efforts during these exceptionally challenging times.

“We are ensuring all possible actions are being taken to support services, and the additional measures I have outlined today will help relieve some of the extreme pressure Health Boards are facing. We know one of the most significant issues our NHS is facing is delayed discharge, that is why I have announced further support to buy additional capacity in the care sector.

“NHS 24 has a vital role in referring people to appropriate urgent care services outside of hospitals and plans to increase staff numbers over the course of winter,  will help the service deal with increases in demand.

“Emergency care will always be there for those who need it, but for many people, the best advice and support might be available on the NHS Inform website or the NHS 24 App, or by calling NHS 24, so I would encourage people to make use of these services as many are already doing.”

Responding to the Scottish Government NHS briefing on Monday, Dr Iain Kennedy, Chair of BMA Scotland said: “”Scotland’s NHS is not just being pushed to the limit, in many places it is well past that.

“Bed occupancy of 95% across our hospitals is just not sustainable in terms of providing the safe and effective care that patients need on a daily basis either in A&E or across all wards. And we know demand is far exceeding capacity at GP surgeries too and has been for some time.

“In that context, the very fact that the First Minister and Health Secretary provided today’s briefing should emphasise the seriousness and urgency of the situation. Our members provided us with first hand testimony from all across the health service just before Christmas, and the picture that painted was really harrowing. Services and staff are on their knees.

“In terms of the short term actions that the Government indicated today, we have long emphasised the need to focus on ensuring people who are able to leave hospital, can do so – freeing up desperately needed capacity and therefore ensuring those who need to can be admitted from A&E more quickly and safely. So the focus on this is welcome, but we will need to see the details and extent of the proposals to make any judgement on the immediate impact it may have. Extra interim care beds – while something which could help as part of the overall plan – will also deliver nothing unless there are people there to staff them, which we know is a huge issue in social care.

“More fundamentally, many doctors remain to be convinced that the Scottish Government’s practical response matches up to the huge scale of the problems the NHS is facing. In particular, staffing shortages will only get worse as more staff burn out and dread going to work, unless there is a more comprehensive and urgent package of investment in staffing to support and retain them in our NHS for good.

“Longer term, these pressures are the culmination of the warnings the BMA and many others have delivered for some time, that Scotland’s NHS isn’t sustainable within the resources – both staffing and financial – we are willing to provide it with.

“We have to get serious about this and have a proper long term discussion about the future of our health service rather than just struggle to survive from crisis to crisis as the NHS and its staff endure the kind of perpetual pressures which in the past were reserved for the worst of winter.

“We absolutely agree with the assessment of the First Minister that there are no easy solutions, so the sooner we truly get to grips with the big picture issues, the sooner we can get away from having to implement short term measures in the desperate hope of bolstering collapsing services and begin actually start talking about an NHS fit for the future. That’s why a national conversation on the NHS in Scotland is required without delay.”

Opposition should be targeting Government not GPs, says BMA

Responding to shadow health secretary Wes Streeting’s comments on reform of the existing GP system, Dr Kieran Sharrock, BMA England GP committee acting chair said: “There’s no doubt that the situation in general practice – for both patients and staff alike – has never been under more pressure. GPs share the frustration of patients as demand outstrips capacity, and worry that they’re unable to provide the safe high-quality care that they want to.

“But as Mr Streeting himself alludes to, when supported properly, general practice is value for money and improves health outcomes, meaning people don’t need to go on to receive expensive hospital care. We agree with Mr Streeting that the GP contract needs to be revamped, to enable the most efficient, cost-effective part of the NHS to thrive.

“This shouldn’t be about reinventing the wheel though, when we know people value the continuity of care that their GP practice should be able to provide through the partnership model. We’re not at all averse to change and, in England, the BMA’s GP committee is already looking ahead to what contract will replace the current five-year framework that ends in 2024.

“We’ve already seen changes in recent years with a wider variety of health professionals working with GP practices and more direct referrals to people like physiotherapists that both benefits patients and reduces the burden on GPs. 

“But what cannot be escaped is the spiralling workforce shortage that we have, which has been made worse by a lack of political support and continuous attacks on the profession. Instead of blaming family doctors and their representatives for problems with the health service – the opposition should clearly be setting its sights on the Government that has overseen a haemorrhaging of GPs over the last decade.

“This is not about ‘vested interests’. We represent our members and also want the best for patients. The two co-exist.

“We have offered to sit down and discuss this with Mr Streeting, to ensure that he understands the pressures on the frontline and how these can realistically be alleviated for the benefit of both staff and patients.”

Choudhury: Urgent action needed to tackle housing crisis

“Housing concerns make up over a quarter of my casework – the Scottish Government urgently needs to start prioritising housing for Scotland”

Over the past year, housing issues have made up a significant amount of my casework – currently, approximately 25% of casework is concerned with housing issues (writes Labour Lothian list MSP FOYSUL CHOUDHURY).

Most housing issues that constituents are writing to me about relate to the lack of suitable council accommodation, with many having to live in temporary accommodation.

Recently, a coroner reported that the tragic death of two-year-old Awaab Ishak was a direct result of the black mould in the flat he lived in and constituents have, understandably, been concerned about black mould in their properties. 

The Tory Government has inflicted chaos on the country this year, with a staggering display of financial mismanagement. However, funding for local authorities in Scotland is set by the Scottish government, and it is SNP-inflicted austerity that has left Scotland’s local services under threat.

There has been a cut of more than a quarter to the house building budget. This is a disgraceful dereliction of the duty of this Government to solve our ongoing housing crisis and will lead to less homes being built for those families stuck in temporary accommodation, people sleeping on the streets, or languishing on social housing waiting lists for year after year.

Rapid rehousing transition plans and homelessness prevention are flat, meaning that there will be no more support available for local authorities to deal with the continuing crisis of homelessness, made worse by the supply of new homes being cut off.

NHS waiting times, health issues (including delayed discharge), continue to be a major problem in Lothian, with approximately 11% of my casework being related to these issues.

In Scotland, the length of time that people are having to wait for hospital procedures, outpatient appointments and diagnostic tests has shot up to 776,341 – equivalent to 1 in 7 Scots. Figures have revealed that at the end of September 2022, 2,114 people referred for an outpatient appointment and 7,612 patients waiting for a day case, or inpatient procedure had already been waiting for over two years.

These shocking figures have been reflected by the high number of constituents who have contacted me about the length of time that they are having to wait for appointments, hospital procedures, or the length of time they have had to wait in A&E.

For example, some in Lothian are being told that they may have to wait approximately 70 weeks for some eye laser treatments and over 110 weeks for some exploratory gynaecological operations.

The stress and anxiety caused by such long waits can lead to other mental and physical problems or exacerbate conditions that are already present. Constituents have also contacted me about delayed discharge from hospital due to the lack of social care available, or places in care homes.

Despite the SNP promises to end delayed discharge back in 2015, this practice has soared and in October 2022, an average of 1,898 bed days were lost every day – the worst figure on record.

I will continue to press the Scottish Government on these and other important issues, like the cost of living crisis, and will continue to make representations on behalf of my Lothian constituents as we head into the new year.

Stopping “haemorrhaging” of crucial NHS staff must be an urgent priority, says BMA Scotland

‘Sticking our heads in the sand – or using the NHS as a political football to exchange snappy soundbites – will not cut it anymore‘

The number one “quick fix” priority for Scotland’s NHS as we move into 2023 must be the retention of our invaluable healthcare professionals, the chair of BMA Scotland said today (Wednesday, Dec 28th).

Dr Iain Kennedy said any plan for further recruitment, investment in the systems and aspirations of improvement will “fall flat on its face” unless there is a laser like focus on keeping the experienced staff our NHS already has.

Dr Kennedy, who was speaking as he delivered his annual festive message for doctors, added that the need for an open discussion on the NHS is now greater than ever.

His renewed call for a national conversation on the future of the health service comes as BMA Scotland shares more than 100 testimonies from doctors about what working in the NHS is like at the moment and their concerns for what the future holds.

Comments included:

  • “There have been a number of critical incidents in the last six months involving unsafe staffing levels. The acuity of the workload has increased. Patients are generally getting sicker and more complex, but we have less resources or time to care for them. It’s hard to keep them safe. I wouldn’t want to be an inpatient at the moment, and hope everyone in my family remains well for the foreseeable.”
  • “It feels unsafe – because it is. It’s not safe for patients, and it’s not safe for staff either. I have gone from being a passionate committed GP to being a shadow of my former working self. I want to leave the profession and I am devastated by this.”
  • “Things are very bad. Chemotherapy can only be delivered four weeks after seeing a consultant because of a chemotherapy nurse shortage. Radiotherapy preparation scans can only be done two weeks after seeing a consultant because of lack of radiotherapy staff/physicists – and it’s another two or more weeks before radiotherapy can actually be delivered.”

Dr Kennedy said: “The NHS is haemorrhaging crucial staff – staff who we urgently need now more than ever before – and the government must step up to stop it. They can talk as much as they want about recruitment of staff, of investment in the system or of plans for improvement, but every single one will fall flat on its face unless there is a laser like focus on keeping the staff we have.

“That is why the retention of healthcare professionals – keeping them in the service – needs to be the number one priority in terms of the quick fixes to help us just make it through this winter with the NHS in Scotland somehow intact.

“I desperately want to be optimistic and forward looking, to set out some hope for the future – for the medical profession that I am so proud to be a part of, and the Scottish health service that I am equally proud to work in.

“But it’s not easy to find that indication of a brighter future – especially after reading the, frankly, harrowing comments from some of my NHS colleagues about what they are experiencing day in, day out. No one working in the health service would give me any credibility if I gave an upbeat description of the way our NHS will, or can, get better and how the working conditions of those caring for the people of Scotland will miraculously improve.

“All the statistics tell us that it’s a desperate state of affairs. Things are as bad, or worse, than they have ever been. Winter is a meaningless term now – this entire year has been winter.

“But looking beyond the statistics, looking at the people behind the statistics, the picture being painted is even more grim and concerning. The experiences my colleagues have shared speak louder than anything I could say, and anything any official stats could imply.

“We face crises across workload, workforce, working conditions, pay and pensions – all of these are hitting efforts to retain doctors, which we are already short of across both primary and secondary care. Hospitals have too many vacancies – indeed the current vacancy rate for consultants alone is 14.32% – and GP practices are falling over, with the Scottish Government not even close to being on target to deliver their promised 800 additional GPs by 2027.

“In the face of everything else pay and pensions are – incredibly – fairly quick fix issues. The government can make a decision to improve pay for NHS workers. And the UK Government can finally once and for all sort out the pension taxation issues that penalise senior doctors across primary and secondary care and force them to cut hours or face massive and unexpected bills.

“These two things will make a difference in staff retention – junior doctors will feel more valued and be more likely to stay in the NHS instead of looking to move abroad where they will be paid more and have a better work life balance.

“Senior doctors will be less likely to reduce their hours and more likely to work waiting list initiatives if they know they won’t receive a huge tax bill for doing so. We are beyond crisis point now – urgent action is needed to save our NHS and that simply must focus on investing in the workforce.

“Looking beyond that, of course we need to finally get a proper long-term workforce plan in place. But even more fundamentally we need, as a whole society, to grasp the nettle, face up to hard truths that have been brushed under the carpet for too long, and have a proper grown up, depoliticised national conversation about the future of the NHS in Scotland.

“Sticking our heads in the sand – or using the NHS as a political football to exchange snappy soundbites – will not cut it anymore.

“It’s clear we need to reflect on what we ask of our NHS and the levels of funding we, as a country, are prepared to provide to meet those asks, and to ensure the health service stays true to its founding principles and remains free at the point of delivery. The current approach of pushing insufficient resources harder and harder, then blaming staff when standards fall has failed and is failing patients every single day. I know doctors across Scotland are suffering moral injury as a result.

“Let’s stop putting healthcare workers in the impossible and insidious position of having to constantly be apologising and being the bearer of bad news.

“We need politicians on all sides to be brave and act – by bringing us together and finally actually properly talking about a plan for a future NHS we can all confidently get behind. And a better NHS will be better not just for Scotland’s doctors, but for the many people who rely on it for care.”

Nearly 50% of 999 calls being managed outwith Emergency Departments

The Scottish Ambulance Service is managing nearly 50% of the 999 calls it receives without the need to take patients to Emergency Departments across Scotland

The Scottish Ambulance Service is managing nearly 50% of the 999 calls it receives without the need to take patients to Emergency Departments across Scotland.

Latest figures for the Scottish Ambulance Service (SAS) in October 2022 show that the proportion of patients being cared for out with Emergency Departments was 49.1%. 

This was made up of 24.9% of patients who were managed at the point of call and a further 24.2% whose care was managed by SAS clinicians on scene.

These results have been  achieved through a range of initiatives, including working closely with partners to increase the range of alternative clinical pathways in communities which support the Service to deliver care closer to home, accessing  Health Board Flow Navigation Centres, expanding our Mental Health pathway access, and utilising highly-trained staff in remote clinical consultation and assessment.

The Service’s central Pathway Navigation Hub also continues to increase the volume of calls it manages, connecting patients with services and communicating pathway information to SAS clinicians.

The figures are released as the Service launches its Integrated Clinical Hub, co-ordinated through the SAS Ambulance Control Centres in the west, north and east of Scotland.

Health secretary Humza Yousaf visited the Service’s East ACC base n South Queensferry yesterday to meet SAS Chief Executive Pauline Howie and Chair Tom Steele, along with key staff involved in the Integrated Clinical Hub. The Health Secretary also thanked staff for their dedication over the past year.

Using a multi-disciplinary network of skilled clinical staff across Scotland, the Hub gives SAS the ability to provide a detailed consultation for patients whose initial 999 triage has ruled out time-critical illness. The hub will operate 24 hours a day, to ensure patients receive the best possible response to their need when they dial 999.

SAS Chief Executive Pauline Howie said: “The number of patients being cared for out with hospital Emergency Departments remains substantial and as we head into a challenging winter period, it’s vital we work together with our health board and community colleagues to find ways of delivering the right care for individuals and easing pressure on Emergency Departments.

“We are focussed on continuing to develop our clinical care model to support more patients in communities where it is safe to do so and to ensure patients get the right care, at the right time.

“The clinical decision-making roles within our Integrated Clinical Hub all have a role to play in understanding patients’ need at point of call, and that they receive the most appropriate care and support to ensure there is a positive impact across the whole system.

“If the patient’s symptoms are not immediately life-threatening, they can then benefit from a clinical assessment with a senior experienced clinician to agree how help can be best provided. Frontline emergency clinicians can also be supported by more senior clinical staff via telephone and video, aiming to enable the patient to access the most appropriate pathway or care provision to address their need. This can help reduce pressure within Scotland’s Emergency Departments.

“To help our staff, we also would like to remind people that if you need urgent care, but it’s not life-threatening, you can call NHS 24 on 111, day or night, or your GP during opening hours.”

Health Secretary Humza Yousaf said: ““We are facing a challenging winter ahead for the NHS and it’s initiatives such as the integrated clinical hub that can help ensure patients receive appropriate care at home or in the community and alleviate pressures on our already busy A&E departments.

“There are a range of pathways of care and not every call to 999 needs an ambulance or a trip to A&E as demonstrated by stats out today.  Experienced clinical staff are on hand to triage calls and get patients the right care at the right place.

“Once again, I would like to thank Scottish Ambulance Service staff for their tremendous work and dedication.”

Innovative health technology helping patients

More than 5,000 procedures performed

An innovative new procedure which speeds up cancer diagnosis has now benefitted more than 5,000 patients.

The cytosponge diagnostic service, introduced during the pandemic, means patients can access cancer checks closer to home, helping to reduce the strain on health services.  

Using cytosponge means that patients can get scope results by simply swallowing a small pill with a thread attached rather than using traditional scope methods and sedation. After swallowing the pill, it expands into a tiny sponge which is pulled back up the oesophagus, collecting cells on the way which are then examined for abnormalities. Cytosponge helps to identify important conditions such as Barrett’s oesophagus which is a known risk factor for oesophageal cancer. 

The procedure, which is supported by NHS Golden Jubilee’s Centre for Sustainable Delivery (CfSD), has now been used 5,036 times (to 3 November 2022) across Scotland.

Health Secretary Humza Yousaf said: “The cytosponge is an excellent example of an innovative technology that allows people to access services quicker, and closer to home. It is helping to deliver better outcomes for patients, while also easing pressures at our hospitals. That’s why I am pleased to see it being used so widely.

“Cytosponge offers a simpler alternative to endoscopy procedures and takes only around 15 minutes. It is a much simpler and more patient-friendly test than endoscopy that enables faster diagnosis of patients at risk of pre or early cancer, without the need for them to undergo a more invasive procedure.

“Using this new technology means we can help tackle the waiting lists for endoscopy procedures that have arisen during the pandemic.”

Professor Jann Gardner, Chief Executive of NHS Golden Jubilee, said: “In these challenging times, it is vital that we improve patient experience with faster diagnostic imaging, facilitating targeted treatments and improving long term outcomes. This cutting-edge technology has helped NHS Scotland advance cancer diagnosis and provide direct benefit to over 5,000 patients.  

“Cytosponge provides a better, more comfortable experience for patients, and we look forward to ensuring that even more people are treated this way as we continue to help meet the diagnostic demand resulting from the pandemic.” 

Unlike endoscopy procedures, where clinicians use a long, thin, flexible tube with a light and camera at one end to inspect organs inside the body, cytosponge is a non-Aerosol Generating Procedure (AGP) and can be performed outside of traditional hospital environments, such as community health centres or general outpatient clinics.

RCEM: Emergency care ‘in dire crisis’

Devolved governments call for more cash for NHS pay

The UK Government has been urged to increase the amount of funding available for NHS pay.

Ahead of the Autumn statement, Scottish Health Secretary Humza Yousaf and Welsh Health Minister Eluned Morgan have written to UK Health Secretary Steve Barclay to ask for additional funding to help avert strike action this winter in the NHS.

The letter reads:

“We wanted to write to you in advance of the Chancellor’s Autumn Statement on 17th November to once again make the case for additional funding for our hardworking NHS staff.

“In recent weeks the Deputy First Minister of Scotland and the Welsh Government Minister for Finance and Local Government have written to His Majesty’s Treasury to make clear the need for additional funding for public services.

“The Royal College of Nursing have announced a sweeping legal mandate for industrial action across the UK. In Scotland, they have joined several other unions representing NHS staff in gaining a legal mandate for industrial action with ballots expected to confirm a mandate in the rest of the UK.

“The risk to the NHS of industrial action this winter is profound, and we all need to do all we can to avert industrial action in any form. The NHS across the UK continues to feel the effects of the pandemic as it recovers and remobilises, and any action is likely to have catastrophic effects in all parts of the UK.    

“We are experiencing a cost of living crisis and the anger of NHS staff is entirely understandable. Sky rocketing inflation combined with high interest rates, a direct result of the havoc caused by the UK Government’s mini-budget, means that we are simply unable to come close to matching the expectations of NHS staff across the country. While the support provided by the UK Government on areas such as support for energy bills is welcome, it has not gone nearly far enough.

“Media reports suggest that the Chancellor is considering reimposing austerity on the people of the UK again, for which there is no mandate, through extensive spending cuts. That would be a disaster for our public services, including the NHS, at a time when they need more investment, not less.

“We would therefore implore you to work with us to make the case to the Chancellor in advance of his Autumn Statement for increased funding for the NHS and the devolved governments as a whole, primarily to pay our hard working NHS staff a fair pay rise in the face of the cost of living crisis this winter, and avoid what could be catastrophic industrial action in the NHS.”

Responding to the latest Emergency Department performance figures published by NHS England for October 2022, Dr Adrian Boyle, President of the Royal College of Emergency Medicine, said: “The crisis in Emergency Care is dire. October saw nearly 44,000 patients face a 12-hour DTA wait – we know 12-hour waits measured from decision-to-admit are just the tip of the iceberg and hides the reality.

“We know far more patients wait for 12-hours measured from their time of arrival. NHS England and the Department of Health and Social Care will still not commit to publishing this data, despite it being collected by all Trusts. We believe this is a barrier to tackling the root of the crisis.

“We know excessively long waits and dangerous crowding are associated with patient harm and increased risk of mortality. Scientific studies have shown that there is one death for every 67 patients waiting between eight and 12-hours from their time of arrival in the Emergency Department.

“The ONS continue to report worryingly high excess mortality figures and we believe that dangerous crowding, long delays, and the crisis in urgent and emergency care are contributing to a significant proportion of these excess deaths.

“We are increasingly concerned about the winter and the health system’s ability to cope. We are already at 94.3% bed occupancy for all general and acute beds and each month patients face the longest waits on record. The system is failing in its core function – the quick and effective delivery of emergency care.

“We need meaningful action now – sticking plasters like setting up tents or handover units will do nothing to resolve these long-waits and may actually cause more harm to patients. We know we need to be able to admit patients, we know ambulances need to handover patients quickly, we agree that it is vital that ambulances must return to Urgent and Emergency calls in the community – but to achieve this we must tackle the issue of poor flow in our hospitals.

“Many patients in hospital no longer meet the criteria to reside, they are occupying beds to which we could be admitting patients. Around 13,000 people are in hospital unable to be discharged. We urgently need an effective social care workforce to help with the discharge of these patients, so we can admit patients, receive patient handovers promptly, and get ambulances back out to the community.

“It is crucial that those in power understand that this is not a demand issue, attendances are not causing crowding and long waits. Crowding and long waits are a consequence of the inability to move patients through the hospital, a consequence of patients who are unable to be discharged because of severe cuts to social care.

“If you can’t discharge patients, beds are indefinitely occupied and the whole system is blocked. The government must get a grip of the social care crisis to fix flow.”

Commenting on the news that the RCN have voted in favour of strike action, Dr Adrian Boyle said: “In Emergency Medicine there is a retention crisis, particularly amongst our nursing colleagues.

“Emergency Medicine nurses are a critical part of the workforce – EM is a team sport. We know and understand that many EM staff, including nurses, are burned out, exhausted and overwhelmed.

“They are skilled, competent professionals who deliver excellent care for our patients. It is vital that our nursing colleagues feel valued and appreciated.”

The latest Emergency Department performance figures published by NHS England for October 2022 for show:

  • There were 1,399,916 attendances at major Emergency Departments
    • This represents a 7.5% increase compared with September 2022, and a 1.7% increase compared with pre-pandemic levels (October 2019)
    • There were 2,000,493 attendances at all Emergency Care facilities
  • 43,792 patients were delayed for 12-hours or more from decision to admit to admission
    • This is the highest number of 12-hour waits on record
    • It is 520% higher than the same month last year, October 2021, and it is 5932% higher than October 2019
    • There have now been 255,334 12-hour DTA stays recorded so far in 2022 – three times as many as were recorded in the 137 months prior to 2022
  • Four-hour performance at major Emergency Departments was 54.8%, this is the worst four-hour performance on record
    • This is a 7.1 percentage point decrease from October 2021, and a 19.7 percentage point decrease compared with October 2019
  • Type 1 admissions stood at 366,964 (a daily average of 11,838)
  • 26.2% of type 1 attendances were admitted, this is a one percentage point decrease from September 2022
  • 150,922patients spent more than four hours in an Emergency Department from decision to admit to admission (also referred to as ‘trolley waits’)
    • This is the highest figure on record and is a 14.5% increase from September 2022
  • Delays to admission stood at 29.8%, this is the highest on record and a 2.8 percentage point decrease from September 2022

The latest beds data for October 2022 show:

  • Last month there were 97,350 general and acute beds available, an increase of 0.71% from September. The occupancy rate was 94.3%, 0.7 percentage points higher than September, the highest monthly figure on record
  • The occupancy rate for adult general and acute beds was 95.6%, also the highest figure on record.

The latest Hospital Episodic Statistics published by NHS Digital for September 2022 show:

  • Patients leaving the department before being seen stood at 5.2%. This is a decrease of 0.2 percentage points from August 2022, but a decrease of 0.7 percentage points from September 2021. 
  • Unplanned reattendance rate was 8.5%. This is 0.4 percentage points lower than September 2022, but 0.3 percentage points higher than September 2021.  
  • Median time in department for admitted patients was 404 minutes. This is an increase of 29% compared with September 2021 (314 minutes). For all patients, the median wait was 192 minutes.