Tag: public health

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.”

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Monkeypox: What we know so far

The UK Health Security Agency (UKHSA) has published its first technical briefing on the ongoing monkeypox outbreak. The briefing shares UKHSA analysis with other public health investigators and academic partners.

This first publication includes updated epidemiological data, with evidence from anonymised detailed interviews with patients which are helping us to understand transmission and to determine how to target interventions.

Of the cases interviewed, 81% were known to be London residents and 99% were male. The median age of confirmed cases in the UK was 38 years old.

152 cases participated in more detailed questionnaires. In this data, 151 of the 152 men interviewed identified as gay, bisexual, or men who have sex with men, or reported same sex contact. Recent foreign travel, within 21 days prior to symptom onset, was reported by 75 cases, with 59 of these reporting travel within Europe.

We also share preliminary assessment of the genomic differences between the outbreak virus and previous monkeypox viruses. In any emerging infection outbreak we assess the virus or bacteria for any changes. We will be working to investigate the significance of the mutations identified so far to determine if they will have any impact on the virus’ behaviour

Dr Meera Chand, Director of Clinical and Emerging Infections, UKHSA said: “We are working, both in the UK and together with global partners, to progress the investigations that we need to help us better understand the virus, its transmission and the best use of mitigations such as vaccines and treatments. We use the new data rapidly to inform the public health response and we continue to work to reduce transmission. 

“We are grateful to all those who have come forward for testing and the patients who continue to help us understand the outbreak through participating in studies and investigations.”

UKHSA has identified a number of aspects of this outbreak which require further investigation. We will release the results of our ongoing investigations in subsequent technical briefings – these will be published regularly.

Monkeypox: latest figures

The UK Health Security Agency (UKHSA) has detected 15 additional cases of monkeypox in England and 3 in Scotland.

This brings the total number confirmed in England to 214 as of 2 June.

There are currently 8 confirmed cases in Scotland, 2 in Northern Ireland and 1 in Wales, taking the UK total to 225.

Anyone can get monkeypox. Currently most cases have been in men who are gay, bisexual or have sex with men, so it’s particularly important to be aware of the symptoms if you’re in these groups.

Contact a sexual health clinic if you have a rash with blisters and you’ve been either:

  • in close contact, including sexual contact, with someone who has or might have monkeypox (even if they’ve not been tested yet) in the past 3 weeks
  • to West or Central Africa in the past 3 weeks

Ten years of success for Scotland’s Family Nurse Partnerships

More than 10,000 young mothers and their children have been helped by a decade-long programme since it began as a pilot in NHS Lothian.

An analysis report on the Family Nurse Partnership shows positive results for mothers and babies in areas such as breastfeeding rates and stopping smoking, with most children meeting all their milestones, and 95% receiving all their immunisations.

The Family Nurse Partnership supports young, first-time mothers to prepare for motherhood and throughout the first two years of their child’s life.

Women’s Health Minister Maree Todd met mothers and staff who have taken part. She said: “Over 10,000 young women have now received support through this programme since it started, which is a fantastic milestone.

“Family nurses help mothers to think about the future, what kind of parent they want to be and their goals and aspirations for other areas of their lives like education and employment.

“Earlier this year we committed to expanding the programme to all young first time mothers aged 21 and under by the end of 2024. Where possible, we will also target first time mothers under the age of 25 who are care experienced or from the most deprived communities. This expansion will mean we can support up to an additional 500 families per year by 2025.”

Val Alexander, service manager of the Family Nurse Partnership, who has been with the programme since it began, said: “We are so proud of the Family Nurse Partnership and everything our clients have achieved. 

“The Family Nurse Partnership programme works to support young, first-time mothers to prepare for motherhood and continues that support for them and their child through the first two years.

“FNP was first delivered in NHS Lothian and to see it extended across Scotland to reach thousands more families is something very special for all of us.

“This 10-year analysis of the delivery of the service across Scotland will help us to see how far we have come and map out our goals and ambitions for the future of the programme and young families.”

Scotland to modernise breast screening services

A major review of Scotland’s breast screening programme which makes 17 recommendations to strengthen and improve it has been published.  

The report recommends ways to make the breast screening programme more accessible, resilient and sustainable, to drive improvements and build upon successful delivery of services.

These include developing a single programme-wide workforce plan that focuses on role development and redesign, training capacity, leadership for major developments which will help to automate aspects of activity, and benchmarked staffing levels.

It also recommends digital initiatives, including exploring the potential for adoption of Artificial Intelligence in breast screening mammography.

A new Breast Screening Modernisation Programme Board, chaired by Dr Marzi Davies, will take forward the recommendations from the report as well as considering additional ways to modernise the service.

Separate to the modernisation work, the Scottish Breast Screening Programme will see those aged 71 years and over being able to opt to self-refer for appointments once again from autumn 2022, in a phased way which won’t impact on the main screening programme.

Public Health Minister Maree Todd said: “I welcome this report and I am very grateful for the work that went into it while our NHS faced immense pressures in responding to the pandemic.

“We accept all of the recommendations, many of which are already being progressed, such as reinstating self-referral services for those aged 71 years and over, and others that will require careful consideration and planning. 

“It sets out a number of key learning points and opportunities for improving how we do things, and while it was commissioned pre-COVID-19, it’s important to note that the breast screening programme is still recovering from the impacts of the pandemic.

“Among our immediate priorities is ensuring that there is sufficient capacity for women aged between 50-70, the recommended screening population, to be invited for screening every three years.   

“I’m pleased Dr Davies has agreed to chair the breast screening modernisation programme to drive forward key ambitions.”

Breast Screening Modernisation Programme chair Dr Marzi Davies said: “The publication of this review and the establishment of the Breast Screening Modernisation Board represent an exciting opportunity to ensure resilience and deliver a sustainable, more person-centred breast screening programme in Scotland.

“I’m privileged to have been asked to lead this work, which will drive improvements in a number of areas and build upon an already high-quality and effective service.”

Scottish Breast Screening Programme: major review  

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Monkeypox: First case in Scotland

Monkeypox has been confirmed in an individual in Scotland. The individual is receiving care and treatment appropriate to their condition and contact tracing is underway.

Monkeypox is a viral infection usually found in West and Central Africa. The West African strain that has been recently detected in the UK is generally a mild self-limiting illness, spread by very close contact with someone already infected and with symptoms of monkeypox. Most people recover within a few weeks.

Public Health Scotland (PHS) is working with the UK Health Security Agency (UKHSA), Public Health Wales and Northern Ireland HSC Health Protection Agency to monitor and respond to potential and confirmed cases of monkeypox in the UK.

As of Friday 20 May, the UKHSA has identified 20 cases in England but more are expected.

Dr Nick Phin, Director of Public Health Science and Medical Director, PHS explains: “Public Health Scotland is aware of an individual in Scotland who is confirmed to have monkeypox. The affected individual is being managed and treated in line with nationally agreed protocols and guidance.

“We have well established and robust infection control procedures for dealing with such cases of infectious disease and these will be strictly followed.

“We are working with NHS Boards and wider partners in Scotland and the UK to investigate the source of this infection. Close contacts of the case are being identified and provided with health information and advice. This may include the offer of vaccination.

“The overall risk to the general public is low.

“Anyone with an unusual blister-like rash or small number of blister-like sores on any part of their body, including their genital area, should avoid close contact with others and seek medical advice if they have any concerns.”

Symptoms

Initial symptoms of monkey pox include fever or high temperature, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion.

A blister-like rash or small number of blister-like sores can develop, often beginning on the face, then spreading to other parts of the body, including the genital area.

The rash changes and goes through different stages, before finally forming a scab, which typically falls off over the course of a couple of weeks. Individuals are infectious from the point symptoms start until all the scabs fall off. During this time close contact with others must be avoided.

UKHSA identifies thirty-six more cases of monkeypox in England

The UK Health Security Agency (UKHSA) has detected 36 additional cases of monkeypox in England.

The latest cases bring the total number of monkeypox cases confirmed in England since 7 May to 56.

The virus does not usually spread easily between people, but it can be passed on through close person-to-person contact or contact with items used by a person who has monkeypox, such as clothes, bedding or utensils. Monkeypox is usually a self-limiting illness and most people recover within a few weeks.

While the current outbreak is significant and concerning, the risk to the UK population remains low.

Anyone with unusual rashes or lesions on any part of their body, especially their genitalia, should immediately contact NHS 111 or their local sexual health service.

A notable proportion of cases detected have been in gay and bisexual men, so UKHSA continues to urge this community to be alert to monkeypox symptoms.

People should notify clinics ahead of their visit and can be assured their call or discussion will be treated sensitively and confidentially.

Dr Susan Hopkins, Chief Medical Adviser, UKHSA, said: Alongside reports of further cases being identified in other countries globally, we continue to identify additional cases in the UK. Thank you to everyone who has come forward for testing already and supported our contact tracing efforts – you are helping us limit the spread of this infection in the UK.

“Because the virus spreads through close contact, we are urging everyone to be aware of any unusual rashes or lesions and to contact a sexual health service if they have any symptoms.

“A notable proportion of recent cases in the UK and Europe have been found in gay and bisexual men so we are particularly encouraging these men to be alert to the symptoms.”

UKHSA health protection teams are contacting people considered to be high-risk contacts of confirmed cases and are advising those who have been risk assessed and remain well to isolate at home for up to 21 days.

In addition, UKHSA has purchased supplies of a safe smallpox vaccine (called Imvanex) and this is being offered to identified close contacts of someone diagnosed with monkeypox to reduce the risk of symptomatic infection and severe illness.

We continue to engage with partners across the sector to ensure people are aware of the signs and symptoms and what action to take.

The vaccination of high-risk contacts of cases is underway. As of 10am on 23 May 2022, over 1,000 doses of Imvanex have been issued, or are in the process of being issued, to NHS Trusts. There remain over 3,500 doses of Imvanex in the UK.

Annual health checks for people with learning disabilities

Health boards are to share £2 million to deliver annual health checks for all people with learning disabilities.

The new service will help to address health inequalities and ensure that people in this group are able to have any health issues identified and treated as quickly as possible.  

Health checks will be delivered in the local community.

Mental Wellbeing Minister Kevin Stewart said: “Unfortunately we know that people with learning disabilities can experience poorer health than the rest of the population.

“Evidence suggests that people in this group are twice as likely to die from preventable illness. This is clearly unacceptable and I hope these annual checks will help to address this and begin to reduce this health inequality.

“Health issues like respiratory disorders, diabetes and thyroid problems can become serious if picked up too late. But if they are detected and treated early there’s a much better chance of a positive outcome and a good quality of life. That is where these annual health checks will be so valuable.”

 Eddie McConnell, Chief Executive of Down’s Syndrome Scotland, said: “This is a really significant moment in the lives of people with learning disabilities and their families. 

“The rollout of the annual health checks across Scotland has the potential to be a game-changer in improving the health outcomes for this community who deserve equal access to good health.  It is no exaggeration to say that a well-implemented annual health check could save lives.”

Community Learning Disability Nurse, Sharon Bandeen, who has an adult son with Down’s Syndrome, said: “The new health checks are a welcome additional layer of good health practice for people with learning disabilities in Scotland. 

“It is so important that everyone living with a learning disability has equal access to the health checks, no matter where they live in Scotland.”

COVID-19 variants identified in the UK

Omicron BA.4 and BA.5 designated as variant of concern by UKHSA

The UK Health Security Agency (UKHSA) has elevated the classification of the COVID-19 variants Omicron BA.4 and Omicron BA.5 to variants of concern (VOCs) on the basis of observed growth.

As of 17 May, 115 cases of BA.4 and 80 cases of BA.5 have been confirmed in England and the latest UKHSA variant technical briefing was published yesterday.

Whilst Omicron BA.4 and BA.5 are in the early stages of growth in the UK, analysis of the available data suggests that they are likely to have a growth advantage over the currently-dominant Omicron BA.2 variant.

There can be several reasons for growth advantage, but in the case of BA.4 and BA.5, laboratory data suggests a degree of immune escape which is likely to contribute.

Dr Meera Chand, Director of Clinical and Emerging Infections at UKHSA, “said: The reclassification of these variants as variants of concern reflects emerging evidence on the growth of BA.4 and BA.5 internationally and in the UK.

“Whilst the impact of these variants is uncertain, the variant classification system aims to identify potential risk as early as possible.

“UKHSA is undertaking further detailed studies. Data and analysis will be released in due course through our regular surveillance reporting.”

UK Covid Alert Level has moved from level 4 to level 3

“Based on advice from UKHSA, we the UK Chief Medical Officers and NHS England Medical Director have recommended to ministers that COVID Alert Level should move from level 4 to level 3.

“The current BA.2 driven Omicron wave is subsiding. Direct COVID-19 healthcare pressures continue to decrease in all nations and ONS community positivity estimates continue to decrease.

“We would like to thank healthcare staff for their remarkable efforts during a challenging time. Whilst it is reasonable to expect the number of cases to increase due to BA.4, BA.5 or BA2.12.1, it is unlikely in the immediate future to lead to significant direct COVID pressures. This will continue to be kept under review.”

Chief Medical Officer for England, Professor Chris Whitty

Chief Medical Officer for Northern Ireland, Dr Michael McBride

Chief Medical Officer for Scotland, Dr Gregor Smith

Chief Medical Officer for Wales, Dr Frank Atherton

NHS England National Medical Director, Professor Stephen Powis

FIRST MINISTER TESTS POSITIVE FOR COVID-19

First minister Nicola Sturgeon has tested positive for Covid

In a social media post last night, the first minister wrote: “Unfortunately I’ve tested positive for Covid this evening after experiencing mild symptoms.

“In line with Scottish government guidance, I’ll work from home over next few days, and hopefully be back out and about later next week.”

The First Minister attended a number of engagements in Washington DC this week and held a meeting with Sinn Fein’s Michelle O’Neill in Bute House yesterday.

£3 million awarded to long COVID projects

Projects to improve the care and support available for people with long COVID are to benefit from an initial tranche of £3 million of Scottish Government funding.

Following a thorough planning process undertaken by health boards to determine the key priorities, the first allocations of the long COVID Support Fund across 2022 will provide £3 million for boards to introduce care co-ordinator roles, extra resource to support a patient-centred assessment, including a multi-disciplinary assessment service, and additional capacity for community rehabilitation to support people with issues affecting their day-to-day quality of life.

Support for people with long COVID is already available across a full range of NHS services. However, this additional investment has been informed by patient experience and expert views brought together by the long COVID Strategic Network set up by the Scottish Government – drawing on priorities identified by people affected by long COVID and recommendations from clinicians.

As well as the awards to boards, NHS National Services Scotland (NSS) has also been awarded £370,000 to support a national programme of improvement work led by the National Strategic Network – this includes £200,000 to provide digital tools to support the care of people with long COVID. The network will also provide an analysis of the specific needs of children and young people living with long COVID in Scotland .

Health Secretary Humza Yousaf, who announced the allocation during a Scottish Parliament debate, said: “We have already supported thousands of people struggling with long COVID through a wide range of measures but the investment announced today has been shaped by priorities highlighted by people with long COVID themselves.

“We’ve engaged directly with NHS Boards, alongside clinical experts and those with lived experience, to identify the support that they need. This will help ensure the investment through our £10 million long COVID support fund will make the biggest different to people living with long COVID.

“Given the range of symptoms which can be involved, we know there’s no ‘one-size fits all’ response and our approach is to support people with long COVID to access care and support in a setting that is appropriate and as close to their home as practicable.

“It’s for each board to explore what is the best service they can provide, this can include a Long COVID Clinic if they believe that is the best model to adopt – and today’s funding will help boards to bolster existing provision for those with long COVID.

“However, just because a service doesn’t say ‘long COVID’ on the plaque when you walk through the door, it doesn’t mean that these services cannot provide, or are not providing, a long COVID  service. There is not a specific treatment being provided within long COVID clinics elsewhere that is not already available to those accessing NHS Scotland services.”

NHS Highland Associate AHP Director, Linda Currie said: “The funding allocation is welcomed. Self-management will be offered and we will recruit Occupational Therapy and Physiotherapy to support holistic interventions like fatigue management, vocational rehab, goal planning and dysfunctional breathing. This funding will support coordination of care across the relevant clinical teams and our partners.”

Two more cases of monkeypox

The UK Health Security Agency (UKHSA) has detected 2 additional cases of monkeypox, one in London and one in the South East of England.

The latest cases bring the total number of monkeypox cases confirmed in England since 6 May to nine, with recent cases predominantly in gay, bisexual or men who have sex with men (MSM).

The 2 latest cases have no travel links to a country where monkeypox is endemic, so it is possible they acquired the infection through community transmission.

The virus spreads through close contact and UKHSA is advising individuals, particularly those who are gay, bisexual or MSM, to be alert to any unusual rashes or lesions on any part of their body, especially their genitalia, and to contact a sexual health service if they have concerns.

Monkeypox has not previously been described as a sexually transmitted infection, though it can be passed on by direct contact during sex. It can also be passed on through other close contact with a person who has monkeypox or contact with clothing or linens used by a person who has monkeypox.

The 2 new cases do not have known connections with previous confirmed cases announced on 16, 14 and 7 May.

UKHSA is working closely with the NHS and other stakeholders to urgently investigate where and how recent confirmed monkeypox cases were acquired, including how they may be linked to each other.

The virus does not usually spread easily between people. The risk to the UK population remains low.

Anyone with concerns that they could be infected with monkeypox is advised to contact NHS 111 or a sexual health clinic. People should notify clinics ahead of their visit. We can assure them their call or discussion will be treated sensitively and confidentially.

Monkeypox is a viral infection usually associated with travel to West Africa. It is usually a mild self-limiting illness, spread by very close contact with someone with monkeypox and most people recover within a few weeks.

Dr Susan Hopkins, Chief Medical Adviser, UKHSA, said: “These latest cases, together with reports of cases in countries across Europe, confirms our initial concerns that there could be spread of monkeypox within our communities.

“UKHSA has quickly identified cases so far and we continue to rapidly investigate the source of these infections and raise awareness among healthcare professionals.

“We are particularly urging men who are gay and bisexual to be aware of any unusual rashes or lesions and to contact a sexual health service without delay if they have concerns. Please contact clinics ahead of your visit.

“We are contacting any identified close contacts of the cases to provide health information and advice.

“Clinicians should be alert to individuals presenting with rashes without a clear alternative diagnosis and should contact specialist services for advice.”

Symptoms

Initial symptoms of monkeypox include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion. A rash can develop, often beginning on the face, then spreading to other parts of the body including the genitals.

The rash changes and goes through different stages, and can look like chickenpox or syphilis, before finally forming a scab, which later falls off.