Tag: NHS

“We are seeing the sharp demise of the health service”

30,000 patients wait more than 12 hours in A&Es in England in July

Responding to the latest Emergency Department performance figures published by NHS England for July 2022, Vice President of the Royal College of Emergency Medicine, Dr Adrian Boyle said: “These performance figures are worse than we could have ever expected for a summer month.

“There were nearly 30,000 12-hour waits (measured from decision to admit to admission) in July 2022, that is more than 3.5 times the total number of 12-hour waits for the whole of 2019.

“This is only the Tip of the Iceberg as the true number of 12-hour waits, measured from time of arrival, is much higher. We urgently need transparency for the scale of the crisis, only then will everyone recognise the reality of the situation and begin to take critical action. We urge NHS England to commit to publishing this data (which is already collected by all Trusts) monthly with immediate effect.

“The crisis is escalating quickly, and health workers are seriously concerned about the quality of care being provided, especially as we exit summer and head into winter. The system is struggling to perform its central function: to deliver care safely and effectively.

“This is a whole-system problem and requires a whole-system approach. There must be total focus on promoting flow throughout the hospital and priority around our ability to provide an NHS that helps patients in an emergency.

“We must ensure patients are discharged in a timely way, so beds are freed and patients in A&Es are able to move through the system and be treated. Flow and discharge rely heavily on an effective social care service that has sufficient workforce – the government must get to grips with this.

“Across the UK we urgently need 13,000 beds to drive meaningful improvement: in Emergency Medicine in England there is a shortfall of 2,000-2,500 Consultants as well as widespread shortages of nurses, trainees, SAS doctors and junior and supporting staff.

“The social care workforce must also be bolstered, which can be achieved by giving these core workers a fair wage that respects and recognises the value of their role. Retention of all health and social care workers is vital, staff are burned out and exhausted, and some are considering their careers.

“We are seeing the sharp demise of the health service and we are seeing little to no political will to act on or acknowledge the crisis – neither of the leadership candidates seem to recognise the scale of the crisis at hand.

“Winter is looming, which will bring a wave of flu and covid and increased footfall in Emergency Departments, with the data as dire as it is today and the scale of patient harm already occurring, we dread to think how much worse things could get for patients.

In winter four-hour performance typically decreases while the number of 12-hour waits significantly increases. We may reach a point where only half of patients are seen or treated within four-hours and see an even higher number of 12-hour waits.”

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

  • There were 1,385,080 attendances at major Emergency Departments
    • There were 2,163,779 total attendances at all Emergency Care facilities
  • 29,317 patients were delayed for 12 hours or more from decision to admit to admission, this is just over 3.5 times higher than the total number of 12-hour waits over the whole of 2019
    • This is the highest number of 12-hour waits on record
    • This is a one third increase compared to the previous month, June 2022, or an increase of over 7,000 12-hour waits
    • There have now been 150,014 12-hour waits (from decision to admit to admission) so far this year
  • Four-hour performance at major Emergency Departments was 57.0%, this is the worst four-hour performance on record
    • More than 2 in 5 patients were delayed by four-hours or more
  • Type 1 admissions stood at 358,284 (a daily average of 11,575
  • 136,221patients spent more than four hours in an Emergency Department from decision to admit to admission (also referred to as ‘trolley waits’)

Persistent understaffing of NHS a serious risk to patient safety, warns Westminster committee

‘We now face the greatest workforce crisis in history in the NHS and in social care’

The NHS and social care face the greatest workforce crisis in their history, compounded by the absence of a credible government strategy to tackle the situation, say MPs in a new Health and Social Care Committee report.

In the NHS, persistent understaffing poses a serious risk to staff and patient safety in routine and emergency care.

The Workforce: recruitment, training and retention report outlines the scale of the workforce crisis: new research suggests the NHS in England is short of 12,000 hospital doctors and more than 50,000 nurses and midwives; evidence on workforce projections say an extra 475,000 jobs will be needed in health and an extra 490,000 jobs in social care by the early part of the next decade; hospital waiting lists reached a record high of nearly 6.5 million in April.

The report finds the Government to have shown a marked reluctance to act decisively. The refusal to do proper workforce planning risked plans to tackle the Covid backlog – a key target for the NHS.

The number of full-time equivalent GPs fell by more than 700 over three years to March 2022, despite a pledge to deliver 6,000 more. Appearing before the inquiry, the then Secretary of State Sajid Javid admitted he was not on track to deliver them. The report describes a situation where NHS pension arrangements force senior doctors to reduce working hours as a “national scandal” and calls for swift action to remedy.

Maternity services are flagged as being under serious pressure with more than 500 midwives leaving in a single year. A year ago the Committee’s maternity safety inquiry concluded almost 2,000 more midwives were needed and almost 500 more obstetricians. The Secretary of State failed to give a deadline by when a shortfall in midwife numbers would be addressed.

Pay is a crucial factor in recruitment and retention in social care. Government analysis estimated more than 17,000 jobs in care paid below the minimum wage.

A separate report by the Committee’s panel of independent experts (Expert Panel) published today rates the government’s progress overall to meet key commitments it has made on workforce as “inadequate”.

Health and Social Care Committee Chair Rt Hon Jeremy Hunt said: “Persistent understaffing in the NHS poses a serious risk to staff and patient safety, a situation compounded by the absence of a long term plan by the government to tackle it.

“We now face the greatest workforce crisis in history in the NHS and in social care with still no idea of the number of additional doctors, nurses and other professionals we actually need. NHS professionals know there is no silver bullet to solve this problem but we should at least be giving them comfort that a plan is in place.

“This must be a top priority for the new Prime Minister.”

George Cross for our NHS

Her Majesty The Queen has presented the George Cross to the NHS for 74 years of dedicated service.

The award for heroism was accepted by representatives of the NHS from Scotland, England, Wales and Northern Ireland in an audience at Windsor Castle.

It is only the third time in the award’s 82 year history that the honour has been presented to an organisation and follows the efforts of health and social care workers across the country during the COVID-19 pandemic.

Accepting the award on behalf of the health service in Scotland was NHS Scotland Chief Executive Caroline Lamb, and Eleanor Grant, a palliative care nurse specialist at University Hospital in Wishaw who was named Nurse of the Year at the Scottish Health Awards 2021.

Ms Lamb said: “We wouldn’t be where we are today without our health services. NHS and social care staff have cared for all of us on the frontline of the pandemic.

“Thanks to their dedication and duty our NHS has saved countless lives and the George Cross is a symbol of the country’s gratitude. I know that the rest of Scotland will join me in paying tribute and giving thanks for everything the NHS and wider social care has done for us not only during the pandemic, but since its formation in 1948.

“The NHS is only the third entity to receive the George Cross and I am truly honoured. This award goes beyond the commitment and personal sacrifices staff have made over the past two-and-a-half years. It reflects the wider admiration and gratitude we all have for the NHS.

“I’d like to take this opportunity to thank everyone working across the health and social care sector for everything they have done, and continue to do, to care for us all.”

Ms Grant has been a nurse for 35 years, working in St Andrew’s Hospice before re-joining the NHS to provide hospital patients with palliative and end-of-life care.

Ms Grant said: “I’m absolutely thrilled to accept this award on behalf of my colleagues across health and social care In Scotland. It’s an honour and a privilege.

“For me, COVID-19 has changed how I work. When patients were unable to have loved ones with them in their final moments, it was for me to be there. We all pulled together in the toughest of times and did what we had to do.

“The George Cross is sometimes awarded to individuals involved in the military and it feels quite fitting for this recognition to be given to the NHS as the early days of the pandemic did feel like a battle.”

National Care Service Bill published

“This is the most ambitious reform of public services since the creation of the NHS” – Humza Yousaf

Legislation to establish a National Care Service for Scotland (NCS) will ensure the best possible outcomes for people accessing care and support and end the ‘postcode lottery’ of care, says the Scottish Government.

The National Care Service Bill will make Scottish Ministers accountable for adult social care in Scotland – a change strongly supported by those responding to the recent consultation on the plans.

The Bill provides the foundation for the NCS, and enables the fine detail of the new  service to be co-designed with people who have direct experience of social care services.

Plans have also been published to explain how that collaboration will work.

The aims are to:

  • support people in their own homes or among family, friends and community wherever possible, with seamless transitions between services;
  • create a charter of rights and responsibilities for social care, with a robust complaints and redress process;
  • introduce rights to breaks for unpaid carers
  • introduce visiting rights for residents living in adult care homes, giving legal force to Anne’s Law
  • ensure fair employment practices and national pay bargaining for the social care workforce;
  • focus on prevention and early intervention before people’s needs escalate;
  • create a new National Social Work Agency to promote training and development, provide national leadership and set and monitor standards in social work.

On a visit to Aberdeen-based charity VSA, which supports people with a wide range of social care needs, Cabinet Secretary for Health and Social Care Humza Yousaf said: “This is the most ambitious reform of public services since the creation of the NHS.

“People have told us they want a National Care Service, accountable to Scottish Ministers, with services designed and delivered locally. That’s exactly what we are going to deliver.

“The design of the NCS will have human rights embedded throughout, and the actual shape and detail of how the NCS works will be designed with those who have direct experience of accessing and providing social care.

“We are going to end the postcode lottery of care in Scotland. Through the National Care Service we’re going to ensure everyone has access to consistently high-quality care and support so they can live a full life. This is our ambitious goal and while it will not be easy to achieve it is vital that we do.”

Social Care Minister Kevin Stewart said: “One of the key benefits of a National Care Service will be to ensure our social care and social work workforce are valued, and that unpaid carers get the recognition they deserve.

“When this Bill passes we will be able to have the new National Care Service established by the end of this parliament. In the interim we will continue to take steps to improve outcomes for people accessing care – working with key partners, including local government, and investing in the people who deliver community health and social care and support.”

Chief Operating Officer of VSA Aberdeen John Booth, said: “We welcome the announcement that the National Care Service Bill has been published. With this being the biggest reform since the creation of the NHS we will now take the time to properly review the bill to understand the opportunities and challenges that lie ahead.

“We look forward to working with the Scottish Government to co-design the NCS to ensure the voices and needs of the vulnerable people who rely on our vital services are heard.”

Local government umbrella body COSLA has issued a statement:

A massive restructuring project, limited resources, local government opposition … Now, what could possibly go wrong?

National Care Service (Scotland) Bill

Tip of the Iceberg: New report exposes real number of A&E waits

Over 1,000 patients faced a 12-hour wait in A&E every day in 2021

A new report by The Royal College of Emergency Medicine ‘Tip of the Iceberg: 12-Hour Stays in the Emergency Department’ reveals that on average 1,047 patients waited 12-hours or more from their time of arrival every day in a major Emergency Department in 2021 in England, equalling a total of 381,991 patients experiencing these 12-hour waits in 2021.

There is a total of 124 NHS Trusts in England. The College received responses from 74 NHS Trusts that were contacted. The figures above are only representative of 60% of NHS Trusts in England. The true total figure of 12-hour waits from time of arrival in major Emergency Departments in England in 2021 will be even higher.

These figures show the deep crisis facing the NHS and the Urgent and Emergency Care system. The alarming number of 12-hour waits are an indicator of the serious and dangerous levels of crowding occurring in Emergency Departments.

Crowding is unsafe, inhumane, and undignified for patients, our previous report Crowding and its Consequencesfound that patients can come to associated harm and even death.

The NHS in England currently measures 12-hour waits from decision to admit (DTA). The Decision to Admit is the decision to admit a patient to a hospital bed made by a clinician. Measuring from decision to admit is a gross underrepresentation of the reality of patient waits, as many patients will have already waited for a long period in a busy Emergency Department before this decision is made.

12-hour DTA waits have been increasing substantially, so much so that in the first four months of 2022 alone (January – April 2022) there were a total of 79,610 12-hour DTA waits; nearly as many as the cumulative total of the 11 years since data collection began (82,746 12-hour DTA waits between August 2010 – December 2021). It is evident that while the pandemic has contributed to the current situation somewhat, long waiting times have clearly been rising for over a decade.

Our recent report Beds in the NHS found that 25,000 staffed beds have been lost since 2010/11 and this has contributed to the steady increase in long waiting times in Emergency Departments since 2010/11 as detailed in Tip of the Iceberg.

Commenting on the FOI findings, Dr Adrian Boyle, Vice President of The Royal College of Emergency Medicine, said: “These figures are staggering and show the critical state of the Urgent and Emergency Care system.

“They also make clear that measuring 12-hour waits from decision to admit masks the reality facing patients and staff. Clearly, it is misleading to measure 12-hour waits in this way, and it is detrimental to staff efforts to improve A&E waiting times.

“NHS England have previously promised to make 12-hour data measured from time of arrival in the Emergency Department public and publish it alongside monthly NHS performance figures. We are still waiting for them to fulfil their promise.

“We recently wrote to Amanda Pritchard, Chief Executive of NHS England, about this, questioning why the data has not yet been published and when it will be. We have not received a response. Until it is published the NHS cannot hope to drive meaningful change and improvement in Emergency Care. Publishing this data will bring about greater accountability, and help all stakeholders understand the extent of crowding, long stays, and corridor care.

“NHS England must publish 12-hour data from time of arrival as a matter of urgency, this is the first step towards meaningfully tackling this crisis. At present, we fear that the full scale of this crisis is either being ignored or inadvertently misunderstood by the government.

“To truly tackle the problem, you must understand the scale of the task at hand. This data should facilitate better understanding of the challenges facing Urgent and Emergency Care and the wider health system and allow us to take the steps towards tackling it.

“In the short-term, the government must set out a meaningful plan for social care that includes recruitment and investment in the social care workforce and paying a wage that values and reflects significance of their role.

“In the medium-term, the government must finally commit to publishing a fully funded long-term workforce plan that recruits new staff into the health service and includes measures to retain existing staff who are burned out and questioning their careers. Then will it be possible to open the 13,000 staffed beds required to drive meaningful improvement within the health service.

“The health service is failing, and failure to act will take it deeper into crisis and inevitably lead to another ‘worst winter on record’ and further patient harm. The government can talk about phantom new hospitals all it likes, but political unwillingness to tackle the deepest health crisis in NHS history costs; the cost is both deteriorating patient health and patient lives, and an undervalued workforce struggling to deliver.”

Tip-of-the-Iceberg-12-Hour-Stays-in-the-Emergency-DepartmentDownload

Diagnostic test waiting times: cancer patients waiting too long, says charity

Cancer Research UK’s has responded to the latest diagnostic test waiting times statistics published by Public Health Scotland. Eight tests are considered in the report, including several that are relevant to the diagnosis of cancer. 

These latest figures show that more than 155,000 patients in Scotland were waiting for a key diagnostic test at the end of March 2022. This is a 10% increase compared with the previous quarter and a 74% increase compared with pre-pandemic levels. 

The report also tells us that, of those people waiting, 50% had been waiting more than six weeks for their test at the end of March 2022.

This is similar to the proportion waiting at the end of the previous quarter and more than three times the proportion pre-pandemic, which was 16% at the end of March 2019. The figures also show around 5,400 (3.5%) patients waiting for a test had been waiting over a year, with almost all of these patients waiting for an endoscopy test. 

The Scottish Government standard that no one should be waiting more than six weeks for a diagnostic test hasn’t been met since June 2010. 

David Ferguson, public affairs manager for Cancer Research UK in Scotland, said: “It is unacceptable that people in Scotland are waiting too long for a test to determine whether they have cancer. Early diagnosis followed by swift access to the most effective treatment can save lives.  

“Despite the best efforts of NHS staff, the delays are due to Scotland’s chronic staff shortages in the areas key to diagnosing and treating cancer. These shortages have hampered progress for years – well before the pandemic.

“The Scottish Government must set out long-term, properly funded plans to address workforce shortages and improve cancer services so patients get the care they need and deserve.”

Emergency Care ‘remains in extreme crisis’

More than one third of patients facing long waits in Scotland, as Emergency Care remains in severe crisis.
Responding to the latest weekly Emergency Department performance figures in Scotland Dr John Thomson, Vice President of The Royal College of Emergency Medicine Scotland, said: “We are continuing to see severely poor performance in the Emergency Care system. Staff are becoming more and more burnt out; the appalling crisis in Emergency Care is seriously distressing.

“The public are extremely worried about these long waiting times, and rightly so, because patients are coming to harm. Staff continue doing all they can to deliver care and keep patients safe, but it is incredibly challenging.

“It is a desperate situation, a result of widespread shortages of staff and beds throughout the system and a crisis in social care. Despite exiting winter and entering spring, the situation remains dire; we have never faced a crisis worse than this. The intense workload is breaking staff, and the distressing circumstances are breaking their morale.

“Patients continue to face seriously long waits, and we continue to state that this crisis is worse than ever, and that patients are coming to harm. The government cannot let this deteriorate further, staff and patients urgently need meaningful action now to tackle the desperate situation in Emergency Care and address the widespread staff shortages, the bed shortages, and the social care crisis.”

The latest weekly Emergency Department performance figures for Scotland show:

There were 22,774 attendances at Emergency Departments

Four-hour performance was 66.2%, the lowest ever on record-

7,705 patients waited more than four-hours in an Emergency Department

More than 3 in ten patients were waiting for more than four hours in an Emergency Department

2,373 patients waited more than eight-hours in an Emergency Department

Nearly one in six patients were waiting for more than eight-hours in an Emergency Department

944 patients waited more than 12-hours in an Emergency Department

One in twenty-five patients were waiting more than 12-hours in an Emergency Department

UK to donate fleet of ambulances to Ukraine

A fleet of NHS ambulances will provide urgent care for those injured by Russian attacks in Ukraine following a donation from the UK.

  • UK NHS trusts donating around 20 ambulances to the Government of Ukraine
  • donations will help replace Ukrainian ambulances lost to Russian bombardments and provide urgent care to injured
  • Ukraine’s health services stretched as Russian attacks hit civilian shelters and hospitals

The donation of around 20 NHS ambulances will help bring vital lifesaving care to Ukrainians remaining in towns and cities under attack from Russian bombardments.

This donation will help replace those Ukrainian ambulances lost to Russian attacks, bolstering the existing fleet’s resilience as the barbaric war goes on.

It is estimated more than 12 million people are currently in need of humanitarian assistance across Ukraine.

The conflict has stretched Ukraine’s health services, with Russia’s indiscriminate attacks targeting civilian shelters and even hospitals.

South Central Ambulance Service NHS Foundation Trust (SCAS) is leading the way, donating four of its ambulances, with further donations from NHS trusts across the country soon to follow.

The first ambulances will arrive in Ukraine this week, destined for Lviv in the west of the country, where they will be transported on to those areas most in need.

Foreign Secretary Liz Truss said: “We have sadly seen day after day the horrific impacts of Putin’s cruel war on the people of Ukraine, including evidence of appalling acts by Russian troops in towns such as Irpin and Bucha.

“The UK has been among the biggest aid donors, providing food, medicines and generators to help those affected. These world class NHS ambulances will now help bring lifesaving care directly to those injured in the conflict.”

Health and Social Care Secretary, Sajid Javid, said: “The UK government has stood shoulder to shoulder with Ukraine and provided them with the lifesaving medical equipment they need.

“The invasion has damaged key medical infrastructure and the generous donation of four ambulances by South Central Ambulance Service will ensure people in Ukraine can receive urgent care. It marks the first of many ambulances the UK government and the NHS is donating to Ukraine in the coming days.”

Paul Kempster, SCAS Chief Operating Officer said: “Ambulance Trusts around the country have been rallying to provide ambulances and we in SCAS are immensely humbled to also be able to support those in need in Ukraine.

“We hope that this small gesture goes some way to helping provide immediate frontline healthcare support to the many people who desperately need it.”

This latest funding and donation comes in addition to the nearly £400 million (£394 million) already pledged by the UK for the conflict in Ukraine, including £220 million of humanitarian aid.

To date, the UK has donated more than 5 million items of medical supplies to Ukraine to help the country cope with the medical emergency caused by the Russian invasion. 

Royal College: Urgent and Emergency Care ‘in dire crisis’

RCEM urges action to address failing A & E system

The latest monthly Emergency Department (Major EDs) performance figures for Scotland for February 2022 show:

  • There were 95,692 attendances
  • Four-hour performance was 71.7%, 1.9% lower than the previous month, January 2022, and the second lowest on record
  • 27,087 patients were delayed by four hours or more, this is means more than one in four patients were delayed by four hours or more
  • 6,248 patients were delayed by eight hours or more
  • 2,230 patients were delayed by 12 hours or more, this represents the highest proportion of attendances experiencing 12 hour waits since records began

Dr John Thomson, Vice President of the Royal College of Emergency Medicine Scotland, said: “The crisis in Urgent and Emergency Care is dire. The health system in Scotland is ceasing to function as it should. Patients are at risk of severe harm and staff are facing stress, distress, burnout and moral injury on a daily basis.

“This is unsustainable and dangerous. The first step to tackling this crisis is opening 1,000 beds that are desperately needed across the system and recruiting senior decision makers in Emergency Medicine. In addition, the crisis in social care, which is resulting in the most vulnerable patients residing in hospital for extremely long periods of time before being discharged means that the system is unable to cope.

“This patient safety crisis must be a priority for the Scottish Government, and they must take meaningful action now before more patients come to severe harm.”

SARCS: Rape and sexual assault support service launched

Improving healthcare choices and support

A marketing campaign has been launched to ensure people know about a dedicated national NHS service that offers choices in healthcare, forensic examination and support after a rape or sexual assault.

The national service, which is to be implemented across all health boards, will allow those aged 16 and over to self-refer for a forensic health examination at a Sexual Assault Response Coordination Service (SARCS), whether or not they wish to report to the police.

Funding of £11.7 million has been invested by the Scottish Government alongside the unanimous passing of Forensic Medical Services Act 2021 by Parliament. This money has gone towards creating healthcare facilities for examinations across all health boards, to recruit more specialist staff and set up a single point of contact for self-referral through NHS 24.

The campaign which will run across digital channels and outdoor advertising sites encourages people who have experienced a sexual crime to visit the NHS Inform website for information to help them decide the best next step for them.

Chief Medical Officer, Professor Sir Gregor Smith said: “It is very important that everyone knows about this service and while I hope that people will never need to use it, for those that do, knowing where to turn for support and information is a vital part of giving them back control.

“This legislation marks an important step in ensuring that those who have experienced a sexual assault have access to healthcare and support, even if they don’t feel ready to report it to the police.

“The campaign will be running over the next few months to raise awareness of the Sexual Assault Response Coordination Service (SARCS), to help improve the experience of those who have suffered a sexual crime.”

Jennifer Wilson, Nurse Director for NHS Ayrshire & Arran added: “Improving healthcare services for victims of sexual offences is a priority for NHS Ayrshire & Arran.

“We are committed to the Taskforce vision of consistent, person-centred, trauma-informed healthcare and forensic medical services and access to recovery, for anyone who has experienced rape or sexual assault in Scotland.

“With the launch of the FMS Act and the National Self-Referral Service we can now offer local services to victims of sexual assault who require a Forensic Medical Examination (FME) and who do not wish to, or are not yet ready to report this to the Police.

“This is a vital part of improving services for victims of sexual assault and making sure that timely healthcare support, including a forensic medical examination, is available to victims of rape and sexual assault in a way that is sensitive, compassionate and reduces the risk of any re-traumatisation.”

Sandy Brindley, Chief Executive of Rape Crisis Scotland said: “This is a huge step forward in improving responses to rape in Scotland. Immediately following rape or sexual assault can be a really difficult time to make a decision about whether to report what has happened to the police, but there are time limits involved in being able to capture forensic evidence.

“Self-referral means that if someone doesn’t feel ready to make the decision about reporting they can ensure all the evidence is captured and make the decision when they are ready.”