A and E waiting times.

These are the latest national Accident and Emergency waiting times  taken from an article in The Independent today;

First missed targets of the winter heighten fears that casualty wards will struggle with seasonal workload

                                                      

 Charlie Cooper  

 Health Reporter

 Friday 13 December 2013

 

Casualty wards in England have missed their waiting times

targets for the first time this winter, heightening fears that accident and

emergency units may struggle to cope with the seasonal spike in hospital

admissions.

 

Nationwide, 94.8 per cent of patients at all A&Es, minor injury units and urgent care centres were still admitted or treated within four hours in the first week of December, but this was just below government targets of 95 per cent.

 

At major casualty wards, the figure was even lower – 92.2 per cent. The last time so many patients had to wait longer than four hours was in April.

 

Overall, 3,678 patients waited for between four and 12 hours. Five patients had to wait for more than 12 hours to be treated or admitted.

 

Although the number of people attending A&E is in fact highest in spring and summer, emergency admissions to hospital through all routes, including GP and social care referrals, peak in the winter months as seasonal illnesses take their toll, particularly among older patients.

 

This increases bed occupancy on hospital wards, which in turn makes it more difficult for emergency doctors to admit patients from A&E, driving up waiting times for those arriving at A&E for treatment.

 

Health chiefs said it had been the busiest week of the year so far with 415,400 A&E attendances and 105,800 emergency admissions.

 

Two thirds of NHS trusts with a major A&E unit missed the four hour target. Nationally, major A&E units have not the target since July.

 

Dame Barbara Hakin, chief operating officer for NHS England said that while it was “disappointing” patients were waiting longer than they should, A&Es were seeing “many more patients than ever before”.

 

“Every year we see a dip in the figures for December, with week-on-week variations, which is why we fully assess how local systems are coping with winter pressures over a longer period,” she said.

 

“We knew this winter would be difficult but it is important to stress the NHS continues to deliver a good service, with 94.8% of people going to hospital for urgent care this week treated, admitted or discharged within four hours. This is thanks to the hard work and dedication of our frontline staff.”

 

A Department of Health spokesperson said: "There hasn't been an entire December in the past five years where the NHS has not missed its A&E target. But last week, the NHS saw more people in A&E than in the same period in any previous December, and saw more patients — almost 400,000 - within four hours in that period.

Neil Harris

(a don’t stop till you drop production)

Home: helpmesortoutstpeters.blogspot.com

Urgent help needed.

Your urgent help is needed – hidden as a minor clause in an Act of Parliament which is currently being debated, is a provision that will make it easy for the Health Secretary to shut down hospitals, effectively bypassing local people and their protests.

I would be grateful if any readers who would like to make their voice heard would sign this electronic petition organised by 38 degrees;

https://secure.38degrees.org.uk/hospital-closure-clause

With thanks

Neil Harris

(a don’t stop till you drop production)

Don't miss out.

A

You know you may be missing out.

I started this Blog about 6 months ago but I started Blogging last year after my local hospital sent me home with a dislocated fractured ankle which the consultant had thought was a sprain.

I started helpmesortoutstpeters.blogspot.com

To reform Accident and Emergency department, increase the number of consultants to 10 and generaly make things better. I never realised how hard it would be.

Because I’m ill, I also used the Blog to have fun and to show what you can do even when you’re old and ill.

I started to worry about the page counts (it was a campaign, after all) because whenever I did serious things, I’d lose (nearly) all my readers. I would always make it up again but as I got more ill it became harder to get the energy together to campaign.

So, unusually for me, I came up with a compromise; I kept on having a laugh but I started this Blog which I nicknamed ‘my seriously boring Blog’.  And I put on it all the serious and boring stuff that is actually so important.

The thing is, over on the other side there’s a party going on – why not take a look.

Don’t miss out.

K

Neil Harris

(a don’t stop till you drop production)

Home: helpmesortoutthenhs.blogSpot.com

Drips - dying from ignorance.

This is obviously significant in itself.

Then again, one or two ignorant or disinterested staff could be regularly killing many and no one would be any the wiser. Which may be one explanation for variations in mortality rates where there aren't obvious explanations.

 

Thousands of patients dying from incorrect use of IV drips, warns Nice

 

National Institute for Health and Care Excellence says one in three patients die within days of surgery from too much fluid

Haroon Siddique   

 

 

The Guardian, Tuesday 10 December 2013

 

Patients' lives are being put at risk by an "astonishing" lack of knowledge surrounding the correct administration of intravenous (IV) drips in hospitals in England and Wales, experts have warned.

 

The National Institute for Health and Care Excellence (Nice) has issued guidelines for medical practitioners on their use amid fears that tens of thousands of patients are suffering complications each year because most doctors do not know how to prescribe them properly.

 

There is a risk of pneumonia or heart failure if a patient is given too much fluid, or kidney failure if they are given too little.

 

Dr Mike Stroud, a gastroenterologist who chaired the group that developed the guidelines, said: "We are very confident that it has not been done well in the past and it needs to be done better … Doctors and other medical professionals are not well educated in terms of what a patient needs and that's astonishing really … It is as important or more important than anything else in terms of making hospitals safer places."

 

Stroud said that IV drips were probably the second most commonly used therapy in acute hospitals, and yet surveys suggested nine out of 10 doctors do not know the correct dosage and timing. He attributed the lack of knowledge to it not being a specialism. "This has fallen through the cracks because it's no one's baby," he said.

 

Experts say it is difficult to pinpoint the consequences of mistakes, because most patients on a drip are also receiving other treatments. But Stroud estimates that tens of thousands of people are experiencing complications.

 

In 1999, the National Confidential Enquiry into Patient Outcome and Death said one in five patients on IV fluids and electrolytes suffered complications owing to inappropriate administration. In 2011, the same organisation found that a fifth of hospital patients who received too little fluid before surgery and a third who received excessive fluid died within 30 days of having their procedure.

 

The Nice guidelines say that hospitals should identify an IV fluids champion to be responsible for training, clinical governance and auditing, and monitoring patient outcomes, with incidents of fluid mismanagement reported.

 

Dr Jerry Nolan, a consultant in anaesthesia and intensive-care medicine who was part of the Nice guidance group, said the costs of implementing the guidelines, including training staff, would be more than offset by the reduction in complications. "We know that some elements of the undergraduate curriculum will include the physiology of fluids but it appears that there is some disconnect between what they learn at medical school and a lack of practical application when they become doctors," he said.

 

"I think it is really important that healthcare professionals understand that fluids are effectively drugs, and just as is the case with any drug, the dose of fluid therapy is very important and that is something that is often being forgotten."

 

Katherine Murphy, chief executive of the Patients Association, said: "It's disgraceful that staff are allowed to go through their professional life without having the right training and support. The trust boards need to listen to this and treat it as a high priority. It's all very well Nice coming up with the guidelines, but they need to be put into practice."

 

In June, the use of starch drips in UK hospitals was suspended because the Medicines and Healthcare Products Regulatory Agency said that "their benefits no longer outweigh the risks" after it was found that the drips were linked to hundreds of unnecessary deaths.

Neil Harris

(a don’t stop till you drop production)

Home: helpmesortoutstpeters.blogspot.com

Ambulance waiting times.

This Daily Telegraph article is based on BBC News research into ambulance waiting times – hanging around outside Accident and Emergency when they should be handing over their patients and driving off to the next job.

There are two results from this – ambulances aren’t available while they wait and so when there are emergencies ambulances from much further away have to be called in. Delay with emergencies costs lives.

Secondly, this waiting time postpones the A and E ‘4 hour clock’ from running, so 30 minutes stuck outside is quite useful.

There are a whole list of other ruses hospitals are using to ‘bend time’– a ‘triage’ room where patients are held before they are booked in and a ‘ward’ (another room) where patients are sent to get them out of A and E and stop the clock running.

Accident and Emergency departments are often too busy to admit patients with some made to wait outside in ambulances for up to six hours, an investigation reveals

NHS guidance recommends that patients should wait in ambulances for no longer than 15 minutes and delays of more than 30 minutes in England can lead to fines.

By News agencies

 09 Dec 2013

Some patients are being forced to wait in ambulances outside hospitals for hours because accident and emergency departments are too busy to take them, according to research.

In one case, a patient in Wales was made to wait more than six hours before being admitted, while another in England was delayed for more than five hours, the BBC found.

 

NHS guidance recommends that patients should wait in ambulances for no longer than 15 minutes and delays of more than 30 minutes in England can lead to fines.

Paramedics are only allowed to hand patients over to hospitals when staff there can take charge of them.

The figures were released to the BBC under the Freedom of Information Act after it asked all UK ambulance services for their longest waits for the 12 weeks from August to October.

 

The longest delay, of a patient waiting for six hours and 22 minutes, occurred in Wales. Each weekly maximum wait there for the period was more than three hours.

In the east of England one patient was forced to wait five hours and 51 minutes, while Scotland had the best record, with none of the weekly maximum waits longer than two hours.

Northern Ireland and the Isle of Wight failed to provide data, the BBC said.

Dr Clifford Mann, president of the College of Emergency Medicine, said the figures were ''alarming''.

He told the BBC: ''There's always going to be a small number of patients whose transfer is delayed, but not to the extent of these figures - which are approaching three, four - sometimes six hours.

''And remember, these figures relate to the three months up until October. They don't include the really pressured time of the winter and so it's unlikely these figures are going to improve - and that must be a cause for concern.''

 

Barbara Hakin, deputy chief executive of NHS England, said there were 4,476 delays of more than 30 minutes in handing patients on from ambulances last week, down by nearly 1,000 on the same week in 2012.

But she conceded that ambulance services were under pressure.

She said: ''NHS England recognises it is essential ambulances are back on the road as soon as possible after taking patients to A&E, though we know it is sometimes in the best interests of patients' safety that they remain in the ambulance after they have arrived at the hospital.''

Ms Hakin said NHS England has allocated an extra £14 million for extra staff and equipment over the winter months.

Neil Harris

(a don’t stop till you drop production)

Home: helpmesortout the nhs.blogspot.com

Eight days a week.

This is an interesting article, based on another analysis by the Dr Foster organisation, taken from the Belfast Telegraph, which seems to be the only paper to have read this particular press release:

People who need to recover in hospital at the weekend fare worse than those who have an operation earlier in the week

 

08 December 2013

Belfast Telegraph.

People having a routine operation on a Friday are 24% more likely to die than if they had one earlier in the week, according to a major report. The study, by statistics firm Dr Foster, showed that people who need to recover in hospital at the weekend fare worse than those who have an operation earlier in the week.

 

Patients admitted at the weekend are also 3.9% more likely to be readmitted in an emergency and, overall, have a 20% higher chance of dying on weekends.

 

The findings come as NHS medical director Professor Sir Bruce Keogh prepares to publish his report on seven-day working in the NHS.

 

Several high-profile studies in recent years have shown that patients admitted to hospital on weekends and bank holidays have poorer outcomes and are more likely to die than those admitted on weekdays.

 

One problem repeatedly highlighted is the lack of senior staff working on NHS wards at weekends.

 

Today's report said that, while weekend care appears to be improving, there are still variations and a lack of access to diagnostic tests.

 

The number of emergency MRI scans carried out on weekends is 42% lower than during the week, while emergency endoscopies also drop 40%.

 

Overall, the study says patients are less likely to receive treatment on weekends and are less likely to have an emergency operation within a day or two of being admitted.

 

People who have suffered a broken hip or fracture also have to wait longer for it to be repaired than somebody admitted during the week.

 

A poll of more than 5,500 doctors for doctors.net.uk, included in the study, showed that 68% of doctors believe patients admitted on weekends receive poorer care.

 

This includes 66% of consultants, 76% of middle-grade doctors and 74% of junior doctors.

 

Eight NHS trusts in today's report have higher death rates at the weekend than weekdays. These include Colchester Hospital University NHS Foundation Trust and United Lincolnshire Hospitals NHS Trust.

 

Seven trusts, including East Kent Hospitals University NHS Foundation Trust and University Hospital of North Staffordshire NHS Trust, have patients admitted at the weekend who are more likely to return to hospital after being discharged.

 

 

Five trusts, including Bradford Teaching Hospitals NHS Foundation Trust, have longer waiting times for patients needing hip repairs over the weekend.

 

Eight trusts that have been found to have very low death rates for both weekdays and weekends include North West London Hospitals NHS Trust and Guy's and St Thomas' NHS Foundation Trust.

 

Six have low re-admission rates for weekdays and weekends, and nine have records of a quick repair of broken hips on both weekdays and weekends.

 

Dr Foster director of research Roger Taylor said: "We have now looked at many different aspects of quality of care. Every indicator we look at shows that patients who come to hospitals on weekends get worse care and worse outcomes.

 

"We are pleased that the NHS has made addressing this issue a priority and there is evidence that these efforts are already starting to yield benefits for patients with shorter waits for operations at weekends and, in some cases, lower mortality rates."

Neil Harris

(a don’t stop till you drop production)

Home: helpmesortoutstpeters.blogspot.com

16 Hospital Trusts to worry about.

The excellent Dr Foster organisation, which analyses statistics to highlight problems in the NHS (although this is all paid for by the fees NHS Trusts pay them) has produced another revealing report.

This is from the Daily Telegraph, but as you can see its actually an agency report.

Some of the Trusts highlighted have been highlighted by me, especially in my ‘never happen event’ articles, hospitals scoring badly on the mistakes that are avoidable and should never happen.

The lessons are to look at many indicators – as many as possible and take notice of the warning signs.

Who knows one day far in the future, it will all be about emulating the best. For now all we can do is spotlight the stragglers.

It’s a start.

NHS trusts with 'significantly higher' than expected death rates

 

Sixteen NHS trusts in England have higher than expected death rates, with some seeing deaths among people with low-risk conditions who would normally survive.

By News agencies

 

9:00AM GMT 06 Dec 2013

Sixteen NHS trusts in England have higher than expected death rates, while some score poorly on at least two indicators relating to patient death, according to a major report.

 

The guide, from health statistics firm Dr Foster, showed 16 hospital trusts had higher than expected death rates among patients in hospital, down from 20 the previous year.

 

 

But analysis showed 13 hospital trusts scored poorly on at least two out of four main indicators relating to patient death.

The indicators included a standard measure of in-hospital deaths, deaths within 30 days of the patient leaving hospital, deaths after surgery and deaths among people with low-risk conditions who would normally survive.

 

 

Of these 13 trusts, five were investigated earlier in the year by NHS medical director Sir Bruce Keogh over concerns about their standards of care.

They were Blackpool, Medway, North Cumbria, Northern Lincolnshire and Goole, and United Lincolnshire hospital trusts. In today's analysis, Blackpool had higher than expected death rates across three out of the four indicators.

Overall, today's report showed that 28 trusts had lower than expected in-hospital death rates. Furthermore, more trusts scored low on two or more of the death rate indicators than scored highly.

 

Using all key measures, the data also showed that 10 hospital trusts have one or more hospital sites with a death rate higher than the overall trust level.

The number of people who died in hospital in England and Wales in 2012/13 was also higher than in the previous year but lower than 2010/11.

Some 237,100 patients died in hospital in 2012/13, 4,400 more than in 2011/12 but 5,300 fewer than 2010/11.

Dr Foster director of research Roger Taylor said: "These findings reveal overall that while the number of people who are dying in hospital has risen slightly since last year it is still a much more improved picture than in the 10 years previous.

 

'This year, following the inquiry in Mid Staffordshire, the NHS has renewed its efforts to tackle avoidable mortality resulting from failures in healthcare.

 

"Hospital level mortality indicators can provide vital insights into where problems are worst.

"They also help us to monitor the extent to which outcomes for patients are improving. We are pleased that there are fewer hospitals with outlying high mortality rates this year compared to last."

Dr Foster awarded four "trust of the year" awards for good performance.

One went to Guy's and St Thomas' NHS Foundation Trust in London, which scored lower than expected on all death rate measures and also had the best performance of any trust in England.

 

In the north, Salford Royal NHS Foundation Trust had lower than expected death rates across two indicators, as did West Suffolk NHS Foundation Trust.

In the south, Frimley Park Hospital NHS Foundation Trust in Surrey had lower than expected death rates across three indicators.

The full list of trusts with hospital death rates that were "significantly

higher" than expected:

 

Blackpool Teaching Hospitals NHS Foundation Trust

 

Burton Hospitals NHS Foundation Trust

 

George Eliot Hospital NHS Trust

 

Heart of England NHS Foundation Trust

 

Medway NHS Foundation Trust

 

Mid Cheshire Hospitals NHS Foundation Trust

 

North Cumbria University Hospitals NHS Trust

 

North Tees and Hartlepool NHS Foundation Trust

 

Northern Lincolnshire and Goole Hospitals NHS Foundation Trust

 

Northumbria Healthcare NHS Foundation Trust

 

Salisbury NHS Foundation Trust

 

Sherwood Forest Hospitals NHS Foundation Trust

 

South Tees Hospitals NHS Foundation Trust

 

United Lincolnshire Hospitals NHS Trust

 

University Hospitals Birmingham NHS Foundation Trust

 

West Hertfordshire Hospitals NHS Trust.

Neil Harris

(a don’t stop till you drop production)

Home: helpmesortoutstthenhs.blogspot.com