The Crisis in Accident and Emergency.

It's been quiet on this blog for a while - we've reached the stage where the crisis in the NHS has gone beyond problems that can be fixed - the lack of investment, cutbacks and failure to train enough staff has left sections of the service unable to cope with the basic needs of the population.

This Christmas we saw two elderly people die while left on trolleys in corridors because there weren't enough staff to admit them to a ward.

A unattended vulnerable patient died after taking his blood transfusion devise and stand into a toilet, fell over and strangled himself.

This BBC article publishes a leaked document which sets out the crisis in Accident and Emergency;


Leak shows full extent of NHS winter crisis
By Dr Faye Kirkland and Nick Triggle
BBC News
10th January 2017

Record numbers of patients are facing long waits in A&Es as documents leaked to the BBC show the full extent of the winter crisis in the NHS in England.

Nearly a quarter of patients waited longer than four hours in A&E last week, with just one hospital hitting its target.

And huge numbers also faced long waits for a bed when A&E staff admitted them into hospital as emergency cases.

There were more than 18,000 "trolley waits" of four hours or more last week.

That suggests about one in five patients admitted for further treatment endured one of these long waits on trolleys and in hospital corridors - twice the rate normally seen.

Some 485 of them were for more than 12 hours - treble the number seen during the whole of January last year.

The figures come from a document compiled by NHS Improvement, one of the regulators in England, and show that this winter is proving to be the most difficult for more than a decade.

Since the start of December, hospitals have seen only 82.3% of patients who attended A&E within the four-hour target.
That is the worst performance since the target was introduced in 2004.

Chris Hopson, of NHS Providers, which represents hospitals, said what was being seen was not "ordinary winter pressures".
"Trusts are really struggling," he added.

The leaked document also showed:

Performance started deteriorating markedly in the first week of the new year with 22% of patients waiting longer than four hours to be seen in A&E.

In one hospital - Weston Area - that reached 44%
 
Just one trust hit the target of seeing 95% of patients within four hours with only nine within 5% of hitting the mark
 
Dangerously high levels of bed occupancy were reported with 94.7% of beds full
 
- well above the "safe" threshold of 85%

It comes after the British Red Cross said over the weekend the NHS was facing a "humanitarian crisis" this winter.

Ministers have denied this is the case, with Health Secretary Jeremy Hunt saying on Monday the health service was coping well given the increasing demands.

But he did suggest the four-hour target may have to be relaxed - it has not been met since July 2015.

He said there were growing numbers of patients attending A&E units with minor conditions and suggested in order to "protect" the four-hour guarantee in the future it may need to be applied only to those with urgent needs.

Dr Kathy McLean, of NHS Improvement, said the data given to the BBC had yet to be verified and was meant for "internal" purposes so the true figure could be lower.

But she accepted that the NHS was facing "exceptionally high" levels of demand.

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Neil Harris
(a don't stop till you drop production)
Home: helpmesortoutthenhs.blogspot.com
Contact me: neilwithp-romisestokeep@gmail.com

The Tories NHS crisis.

This 'Guardian' article neatly sets out the crisis that has developed in the NHS over the last couple of years of Tory rule;


NHS 'in perpetual winter of Narnia' as waiting list reaches record 3.9m

Waiting time targets missed, bed blocking at record levels, and medical leaders say system is close to breaking down

 

Denis Campbell  Health policy editor

Thursday 8 September 2016

The Guardian

 

The NHS is missing so many of its key performance targets that it has entered “the perpetual winter of Narnia”, a medical leader has said, after figures revealed the highest ever number of patients on waiting lists.
Claire Marx, president of the Royal College of Surgeons, criticised the NHS’s failure to give patients planned care in hospital within the required 18 weeks, such as surgery for cataract removals, hernia repairs and hip and knee replacements.

The number of people in England who are awaiting such treatments has climbed to almost 3.9 million.

Demand for NHS care is dangerously high, says thinktank

Over three-month period to June nearly 6m people visited A&E, creating ‘huge strain’ on the health service, experts say

           

Hospitals are meant to treat 92% of patients on the “referral-to-treatment” (RTT) waiting list within 18 weeks, according to guarantees in the NHS constitution. However, they did so in just 91.3% of cases in July, NHS-wide performance data released on Thursday shows. It was the service’s worst RTT performance in more than five years.

Hospitals met the 92% target in nine categories of RTT patients, including those requiring treatment for eye problems (92.7%), cardiac care (92.7%) and gynaecological problems (92.3%). However, it missed the target in 10 other categories. It treated barely four of of five (81.7%) of all those awaiting neurosurgery within 18 weeks, 86.9% of those needing plastic surgery and 88.9% of trauma and orthopaedic patients.

“It feels as if the NHS has stepped through the wardrobe and into the perpetual winter of Narnia,” Marx said. “We cannot forget that behind these statistics are potentially very ill and anxious patients who are being made to wait far too long for treatment. This is the true impact of the serious financial pressure we’ve seen the NHS come under in recent months.”

The NHS also missed targets covering A&E, ambulance response times, diagnostic tests, two forms of cancer treatment and rapid first treatment for those experiencing psychosis for the first time.

Dr Mark Holland, president of the Society for Acute Medicine, said: “This data reflects a system which is close to breaking down.”

Bed blocking has reached record levels. In July a total of 184,188 bed days were lost to delayed discharges – when patients are fit to leave but social care support is not in place – up sharply from 147,376 in the same month last year, and the highest number since records began in August 2010.

At midnight on the last Thursday in July, 6,364 patients who were fit to leave were still in their beds, up from the previous record of 6,105 patients the month before.

“For every 100 people who come to A&E, around 30 are admitted and, of these, 20 come under acute medicine. That number is increasing and our front-of-house workforce is depleted”, Holland said.

“However, performance is most significantly hampered due to our inability to discharge people at the backdoor of our hospitals. Failure to get people home is, in my view, a national emergency.”

Medical leaders want ministers to urgently pledge more money for the NHS to tackle its growing problems.

 

 

Marx said: “The forthcoming autumn statement offers an opportunity for the government to provide more money for the NHS and social care, and to agree to a cross-party commission to review how we can make the NHS sustainable for the long-term. Without a serious look at what the NHS needs in funding, we will remain in a state of constant winter.”

NHS England said that despite missing so many targets, its performance was still very good by international standards.
“As the NHS responds to ever increasing care needs, hospitals are continuing to look after more than nine out of 10 A&E patients within four hours, and more than nine in 10 patients are waiting less than 18 weeks for their routine operations,” said Matthew Swindells, its national director of operations and information.

“While this is probably the best performance of any western nation, these figures underline the pressures facing the NHS, and the obvious risks to patient care posed by weeks of further drawn-out industrial action. 

Neil Harris
(a don't stop till you drop production)
Home: helpmesortouthenhs.blogspot.com
Contact me; neilwithpromisestokeep@gmail.com

How privatisation costs us money.

Here's how saving money by using the private sector ended up costing the NHS nearly £9 million pounds;

University Hospitals NHS Foundation Trust

Millions of pounds of taxpayers' money was wasted on an NHS outsourcing contract, investigators have found.
Under the £726m deal, UnitingCare was meant to provide care for older and mentally ill people in Cambridgeshire.
But the consortium claimed the contract was not financially viable and pulled out of the deal in December.
A joint statement from the two organisations in the consortium said the National Audit Office's (NAO) findings provided "clarity".
Cambridgeshire and Peterborough Clinical Commissioning Group had been been in charge of care for older and mentally ill people but put these services out to contract because it was trying to save money.

The UnitingCare Partnership's business case estimated net savings of £178m to the local health economy by 2020.

'Astonishing array of errors'

But the NAO's investigation into the contract - which ended just eight months after it started - has criticised the planning and the lack of data setting out the true cost of the service.
The report found the consortium had not taken account of VAT costs and underestimated both the changeover and running costs of delivering the service in drawing up its bid for the contract.

The report also found negotiations between the CCG and the UnitingCare were continuing when the contract started.
As a result, one month into the contract UnitingCare asked for £34m in extra funding which triggered fresh negotiations.

The report said: "The wasted cost to the NHS of the contract set-up and bidder costs was £8.9m."
Amyas Morse, head of the National Audit Office, said: "This contract was innovative and ambitious but ultimately an unsuccessful venture, which failed for financial reasons which could, and should, have been foreseen.

"Limited oversight and a lack of commercial expertise led to problems that quickly became insurmountable."

Meg Hillier, chairman of the Public Accounts Committee, said the report "details an astonishing array of errors" in implementing service changes.

"Despite drafting in specialist expertise from the private sector and the NHS, the assumptions underlying the contract's cost structure were not tested.

"Instead, the contract - which was not remotely ready - was rushed through without due regard for protecting taxpayers' money."

A joint statement from the two organisations behind Uniting Care, the Cambridgeshire and Peterborough NHS Foundation Trust and Cambridge University Hospitals NHS Foundation Trust, said: "We believe that the report is balanced and provides clarity on the reasons why the contract ended."

The CCG is yet to comment.

That came from a BBC news article.

Neil Harris
(a don't stop till you drop production)
Home: helpmesortoutthenhs.blogspot.com
Contact me: neilwithpromisestokeep@gmail.com

Deaths in mental health Units? Just don't count them and they'll go away.

This story from the Telegraph actually comes from some excellent Labour party research, or it would be if the Government was doing the research.

I would urge you to take a look at my other Blog which has highlighted failings at The Abraham Cowley Unit which is a Mental Health Unit based on St. Peter's Site but run by a different trust. I've recorded stories of a series of unacceptable deaths which have occurred at the Unit and these are to be found on the 'Pages' section at the right hand side of the Blog;

helpmesortoutstpeters.blogspot.com


It's very distressing to hear that these statistics are not being collected centrally because if you don't know the extent of the problem you are never going to try and do anything about it.

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Daily  Telegraph
News

Government accused of failing mentally ill people by not collecting data
Laura Hughes,  Political Correspondent 
1 April 2016  

The Government has been accused of failing mentally ill people after it was revealed they have failed to collect basic data about death, suicides and waiting times.

Luciana Berger, the shadow mental health minister, has called on Ministers to address "appalling" levels of negligence after more than 50 freedom of information requests from Labour were dismissed with the response that the data
is “not collected centrally”.

Labour have said the lack of information is preventing the NHS from treating mental health with the same importance as physical health.

On each day this month Labour will release examples of areas in which the Department of Health said it did not collect information on a national scale.

Speaking before the campaign launch, Ms Berger said the government was unable to provide data for the number of children who have died in inpatient care, or the number of people referred to consultant-led mental health services who were seen within the 18 week target time.

The Labour MP said: “The Prime Minister promised to improve transparency and accountability in mental health, yet his Government is not even collecting basic data.

"It is absolutely appalling that Ministers have no idea how many new mums have taken their own lives because of mental health problems, how many people diagnosed with mental illness go to prison, or how many children have died in NHS mental health units.
 
"How can ministers claim to be focussing on mental health when they don’t have an accurate picture of what is actually happening on the ground? 

“If Ministers couldn’t answer such basic questions on physical health there would be outrage. These findings cast further doubt over the Tory Government’s ability to deliver what they have promised and make mental health the real priority it deserves to be.”

Norman Lamb MP, the former Lib Dem mental health minister, told the Guardian he found working in Whitehall had felt like “operating in fog”.
In a speech last month David Cameron said the NHS was leading a “revolution in mental health treatment in Britain.”
 
His comments have been echoed by the Health Secretary Jeremy Hunt, who has spoken about the “transparency revolution” going on in Britain's health service.

The minister for mental health, Alistair Burt, said: “I have been working on this issue for some time and agree that there is further to go on mental health data as part of making the NHS the safest healthcare system in the world.

"We have made big improvements, publishing more statistics than ever before – such as recovery rates and waiting times for psychological therapies.

“We have brought in the first ever waiting times for mental health, setting the NHS challenging targets to drive improvements, and increased mental health funding to £11.7bn.

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Neil Harris
(a don't stop till you drop production)
Home: helpmesortoutthenhs.blogspot.com
Contact me: neilwithpromisestokeep@gmail.com

The '111' emergency service fails again.

For the last few years I've highlighted the catastrophe of the closure of the highly effective 'NHS Direct' phone line created by the 2002 Labour government.

The Conservative Liberal alliance closed it down and replaced it with the 111 service which is staffed by people who have no medical qualification.

There have been many examples of failure to spot serious conditions - this is just the latest. This inquest report makes it clear once again that 111 needs Nurses and Doctors available for patients; 


William Mead's 'fate was sealed' after NHS 111 call handlers failed to identify his deadly illness, says mother

The report called into question the NHS non-emergency helpline’s ability to identify deadly illnesses
Kate Ng  
The Independent

The mother of a one-year-old baby who died of sepsis said his "fate was sealed" after NHS 111 call handlers failed to identify his deadly illness. Melissa Mead, mother of William Mead, told BBC Radio 4: “When I dialled 111… we were told William’s condition was non-urgent and didn’t require any emergency treatment, and that we would get a call-back within six hours.

“But when the doctor called back after three hours, I think William’s fate was sealed. He died within 12 hours of that phone call. We found him just after 8 in the morning… he had been passed away for a little while [already].”

Her interview follows an NHS England report into William’s death in 2014, which found there were 16 missed chances to save his life.
The report, seen by the Daily Mail and the BBC, said he might still be alive today if NHS 111 call handlers had realised he was in a life-threatening situation.

The NHS 111 non-emergency helpline’s ability to identify deadly illnesses in children and babies has been called into question.
NHS 111 call handlers are not medically trained. The report suggested that if a doctor had taken the call instead of 111 staff, they would have most likely recognised the need for "urgent medical attention".

The report detailed the opportunities missed to save William’s life.

Out of 16 missed chances, the five main windows were:
 
William’s GP had not recorded all the relevant information in his notes
 
The severity of William’s symptoms had not been recognised
 
Inadequate advice was given to William’s parents about what to do if his condition worsened
 
The out-of-hours GP service had no access to the baby’s primary care records

 
The pathway tool used by NHS 111 call handlers was not sensitive enough to pick up “red-flag” warnings of sepsis

It also included failure by GPs, who saw William six times in the months prior to his death, to spot pneumonia which could have prevented his circumstances.

The report said: “Had any of these different courses of action been taken, William could probably have survived.”

Recommendations made by the report included training call advisors to spot when there is a need to probe further into the condition of the patient, and when to escalate cases.

It also called for better recognition of the signs and symptoms of septicaemia by GPs.

The report is the result of a year-long campaign by William’s parents, Paul and Melissa, to find out what really happened to cause their son’s death.

Director of nursing with NHS England in the south west, Lindsey Scott, told the BBC: “One of the significant learning points for us is how difficult it is for both professionals and parents to diagnose septicaemia.

“Everyone involved in this report is determined to make sure lessons are learned from William’s death, so other families don’t have to do through the same trauma.

“None of this detracts from our profound regret at the loss of William. For that loss, on behalf of all NHS organisations involved, I would like to apologise publicly to Mr and Mrs Mead,” she told BBC.

Neil Harris
(a don't stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com
Contact me: neilwithpromisestokeep@gmail.com

Latest figures for NHS payrises.

This Daily Telegraph article has researched the current state of pay rises for NHS Chief Executives against a background of staff pay rises limited to 1% and a forthcoming dispute with junior doctors;

Daily Telegraph

By Laura Donnelly, Health Editor

02 Jan 2016

       

NHS hospital chief executives have been handed pay rises of up to £35,000, with the highest annual earnings reaching a record £340,000, a Daily Telegraph investigation has found.

Despite government pledges that the most senior NHS managers would have their pay frozen, 40 per cent of trusts increased executives’ wages by at least £5,000 during 2014-15.

Some managers’ earnings rose by almost a quarter, the findings from more than 200 NHS trust boards show. Patients’ groups accused the NHS of “scandalous excesses” at a time when the health service is facing the greatest financial crisis in its history.

The head of the Royal College of Nursing said it was “immensely demoralising” to find that some executives had been awarded rises larger than a full year’s salary for the average nurse.
The highest individual increase of £35,000 went to Sir Andrew Morris, at Frimley Health NHS Foundation Trust in Surrey, taking his earnings to £215,000. The 19 per cent rise followed a takeover of another nearby NHS trust. The finance director, Martin Sykes, also received a 19 per cent, or £25,000, increase in his earnings taking them to £155,000. Nicola Ranger, the director of nursing, enjoyed a 23 per cent boost, taking her earnings to £135,000.
Simon Barber, chief executive of 5 Boroughs Partnership trust in the North West, was paid £200,000 during 2014-15 – a rise of £25,000 thanks to a pay bonus. David Sloman, chief executive of the Royal Free London Foundation Trust received a £20,000 rise, taking his earnings to £240,000. And Lewisham and Greenwich trust in south-east London awarded £20,000 pay rises to its chief executive, Tim Higgingson, whose salary rose to £195,000, and to its director of nursing, Claire Champion, boosting her earnings to £150,000.

In total, 40 per cent of boards made at least one pay rise of between £5,000 and £15,000.

At least 10 senior managers received rises of at least £20,000, according to the analysis by the Telegraph.
 
Because trust boards do not publish precise pay figures, the lowest point of published ranges was used for all calculations, leaving a £5,000 margin.

The highest overall package went to Dr Tracey Batten, the chief executive of Imperial College Healthcare, who was paid £290,000 plus a £50,000 relocation payment to move from Australia.
 
Several of those with the highest earnings left the NHS in recent months. The second highest earner overall was Peter Morris, the chief executive of Barts Health trust, on £275,000 until he resigned in February amid a growing financial crisis. The trust is now facing a deficit of £135 million, the largest any trust has ever had.
 
Another of the highest earners, Dr Keith McNichol, who came from Australia to run Addenbrooke’s Hospital, resigned in September — just before a damning inspection report saw the trust plunged into special measures. A salary of at least £260,000 made him the fourth best paid chief executive.
 
Tim Smart, who earned £255,000 a year as chief executive of Kings College Hospital Foundation Trust, announced his retirement in April, just after an inspection which later saw the trust rated as “requiring improvement”.

Katherine Murphy, the chief executive of the Patients Association, said she was concerned that the NHS had developed a culture of “rewards for failure” with many of the highest salaries paid to chief executives who had left as serious problems emerged.
In March 2014, the Treasury promised most public sector workers a rise of one per cent in 2014-15, but said the most senior managers would see pay frozen, amid efforts to put the nation’s finances on a sustainable footing.
 
The NHS is facing the worst financial crisis in its history, with three quarters of trusts forecasting deficits, which are expected to reach £2.2  billion across the service by March.
The vast majority of overspending has been fuelled by a reliance on agency doctors and nurses, some on rates of more than £3,500 a day. Hospitals are also struggling to cope with rising demand from an ageing population.
 
Janet Davies, chief executive of the Royal College of Nursing, said: “Nursing staff have been repeatedly told that there isn’t enough money to improve their pay, even after years of pay restraint. To learn that many senior NHS staff are enjoying pay rises and bonuses while nurses struggle to make ends meet is immensely demoralising.”

The trusts with the most highly paid chief executives defended the sums paid, saying they were among the largest trusts in the country, with rates in line with those for similar roles in other NHS organisations.
 
A spokesman for Frimley Health said: “Recent salary adjustments in executive pay at Frimley Health were a reflection of the added responsibility associated with the acquisition of Heatherwood and Wexham Park Hospitals NHS Foundation Trust. These were independently assessed by the Hay Group and set by a committee of non-executive directors.”

When Frimley Park took over Heatherwood and Wexham Park Hospitals the trust doubled in terms of staff, infrastructure, and patient numbers.
 
The 5 Boroughs Partnership NHS Foundation Trust said its chief executive had received a 1 per cent pay increase, plus a performance-related bonus which recognised that the trust had achieved quality and financial targets.
 
A spokesman for the Royal Free said it became one of the largest trusts in the country after taking over Barnet and Chase Farm hospitals in July 2014.
It said pay was agreed by a committee of non-executive directors based on value for money.
 
Lewisham and Greenwich trust said salaries were reviewed after a hospital merger, with the director of nursing taking on added responsibility as deputy executive.

Neil Harris
(a don't stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com
Contact me: neilwithpromisestokeep@gmail.com

 

The Parliamentary Ombudsman condemns the NHS failure to investigate deaths properly.

This Guardian article highlights a report by The Parliamentary Ombudsman. However I would point out that my own complaint to her was dealt with very unsatisfactorily.

The Patients Association has recommended against complaining to The Ombudsman due to the ineffectiveness of her organisation.

  
The Guardian

Denis Campbell Health policy editor

Tuesday 8 December 2015

 

Three out of four investigations by hospitals into complaints that patients suffered avoidable injury or death fail to identify serious failings in care, leaving distraught families in the dark, the NHS ombudsman has warned.

Inquiries by hospital staff are so often inadequate that many complainants seeking to understand what went wrong are met with “a wall of silence from the NHS”, according to Dame Julie Mellor.
Mellor, the parliamentary and health service ombudsman, has demanded an urgent overhaul of how hospitals examine serious complaints made against them, in which mistakes allegedly led to patients being harmed or even killed.

Frontline staff in the NHS and public services shouldn’t fear complaints            

Organisations should welcome complaints as it shows they are open to feedback. But people need to feel their concerns are acted upon.

             

Her review of the quality of internal hospital investigations uncovered a series of major weaknesses. In 73% of cases in which she found evidence of clear failings, the NHS hospitals trust concerned had concluded that no failings occurred.
“Parents and families are being met with a wall of silence from the NHS when they seek answers as to why their loved one died or was harmed,” said Mellor.
“Our review found that NHS investigations into complaints about avoidable death and harm are simply not good enough. They are not consistent, reliable or transparent, which means that too many people are being forced to bring their complaint to us to get it resolved.”

In just over half (52%) of the cases she examined, the investigation had been led by a doctor who was not independent of the events complained about.

For example, when a baby girl was left with brain damage after a blood transfusion went wrong, the hospital appointed a close colleague of the paediatrician at the centre of the complaint to investigate. The girl’s family had to wait three years before learning what mistakes had been made.

Hospitals also failed to categorise 20 out of 28 cases of avoidable harm examined as serious incidents, which meant they were not properly investigated.

NHS investigations into care complaints 'appalling'

More than a third of investigations into deaths or avoidable harm at hospitals found to be inadequate in ombusdsman’s review 

           

Mellor said hospitals’ inquiries into serious injuries or deaths too often fail to gather enough evidence, are inconsistent in how they look for proof of errors, and do not look closely enough at material to see what went wrong and why.

Almost a fifth (19%) of inquiries did not gather important evidence such as the patient’s medical records, statements and interviews, Mellor found.

In investigations that found there had been failings, more than a third (36%) failed to get to the bottom of why they had occurred, even though 91% of complaints managers said they were confident they could find out what happened.

Hospital bosses admitted that too many investigations are substandard.
“We know we don’t always get this right and it’s crucial that we learn and improve every time,” said Rob Webster, the NHS Confederation chief executive.
“The Care Quality Commission, ombudsman and others are highlighting major inconsistencies and shortcomings in the handling of complaints and those problems cannot be allowed to continue. So we urgently need to learn from what is working and fix what doesn’t, to ensure patients have complete confidence in the National Health Service.”

Anna Bradley, the chair of Healthwatch England, a patient group, said: “Hundreds of thousands of incidents of poor care go unreported every year across the NHS precisely because people fear they either won’t be taken seriously or that nothing will change as a result.”

 

Peter Walsh, the chief executive of the patient safety charity Action Against Medical Accidents, said the new independent patient safety investigation service, set up by Jeremy Hunt to promote airline-level safety in the NHS, should improve investigations.
“The ombudsman’s findings are doubly worrying, as they were only reviewing cases where there had already been a complaint under the NHS complaints procedure. If this is how the NHS investigates when there is a formal complaint, one has to wonder how it investigates when it is left entirely to its own devices,” said Walsh.
“Unfortunately, in our experience it is not uncommon for NHS bodies to carry out investigations without even informing the patient or family affected by an incident.”

Neil Harris
(a don't stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com
Contact me: neilwithpromisestokeep@gmail.com