Tag Archives: Accident and emergency

A&Es given safe nurse staffing rules

A&E units in England are being given strict guidelines on how many staff they need on duty to provide safe care.
The draft guidance from the National Institute for Health and Care Excellence recommends one nurse for every four cubicles.
But it said for major trauma or cardiac arrest patients, there needed to be two nurses for each patient.
And it said numbers needed to be kept above what average demands were to cope with the unpredictable nature of A&Es.
Currently it is up to local hospitals to decide their staffing levels – and unions argue there are not enough on wards.
The guidance, which will now be consulted on, also calls for senior nurses to look out for red flags that may show something is wrong, such as patients falling or leaving the department without being seen.
Prof Mark Baker, from NICE, said: “Nursing staff are often among the first to see patients and we know the care they provide is essential for successful treatment of every patient.
“Ensuring there are enough available nursing staff with the right skills helps to make sure people in need of immediate medical help will get safe care whatever time of day or night.”
NICE said it had not yet gathered data on how many hospitals were failing to reach this standard.
However, evidence collected by the Royal College of Nursing shows vacancy rates for junior nurses were hovering between 10% and 20%.
Senior nurse numbers were also short too, the union said.
RCN general secretary Peter Carter said: “For years now, many A&E departments have been understaffed or staffed with temporary or less experienced nursing staff.
“Safe care cannot be delivered without safe nurse staffing levels.”
The recommendations have been published in the middle of one of the most difficult winters for the NHS for a generation – although they were being planned well before winter started.
A&E units missed their waiting time target for the last three months of 2014 with just 92.6% of patients seen in four hours – below the 95% target.
It was the worst quarterly performance since the target was introduced a decade ago.
A Department of Health spokeswoman said there were now more nurses in the NHS than when the current government came to power.
“This NICE guidance will give the NHS evidence to make sure it has the right number of staff, improving patient care,” she added.
Source BBC News

David Cameron’s Accident and Emergency ‘spin’ to be scrutinised by non-partisan UK stats watchdog

The Prime Minister told MPs this week that Accident and Emergency waiting times had gone down under the Coalition Government.

However, the House of Commons Library challenged the reliability of his statement, pointing out that typical waits had remained unchanged, while total time spent in Accident and Emergency had actually risen for patients with the most serious conditions.

The claim, along with a similar statement made in June by the Health Secretary Jeremy Hunt, will now be investigated by UKSA, the stats watchdog whose chairman Sir Andrew Dilnot last year criticised Work and Pensions Secretary Iain Duncan Smith for misusing figures.
Labour have accused the Prime Minister of “cynical spin”. The shadow Health Secretary Andy Burnham, who alerted the UKSA to the contested statements on Friday, said that Mr Cameron had “serious questions to answer”.

The investigation comes as official NHS statistics reveal that a record number of people attended Accident and Emergency departments between April and June, while the country’s major Accident and Emergency departments have now failed to meet the target of seeing 95 per cent of patients in less than four hours for 50 consecutive weeks.

Accident and Emergency performance is seen as a key barometer of the health of the wider NHS, and there are concerns at the highest level of Government that the health service, which has had to cope with five years of efficiency savings and ever increasing demand, is beginning to show signs of serious strain.

Conservative leaders are fearful that an Accident and Emergency crisis this winter, when pressure on emergency departments typically spikes, could damage voters’ confidence in the party’s stewardship of the NHS.

Mr Burnham said that the Prime Minister was “failing to face up to what is happening on the ground”.

“It is deadly serious out there and he is spinning a different story,” he said. “What is urgently needed is honesty from the Prime Minister and a plan to turn round pressure on Accident and Emergency departments.”

Mr Cameron’s original claim that Accident and Emergency waits were down was based upon data which shows the mean average wait from the moment a patient arrives at Accident and Emergency to the moment they are first assessed by a medical professional had dropped from 77 minutes under the Labour government to 30 minutes under the Coalition.

This claim was challenged in a blog posted online by the politically neutral House of Commons Library, which pointed out that the median average wait was a more reliable measure, and had remained unchanged at 10 minutes for several years.

Furthermore, the Commons Library said that measuring the time between arrival and first assessment was “not a natural indicator of the typical waiting time in Accident and Emergency”.

This original version of the blog, which stated that the PM’s claims were based on “a simplistic reading of the data” was removed from the Commons Library website on Thursday night, with the Library stating that it had not met its own “expected standards of impartiality”.

A House of Commons spokesperson said that the decision to remove the blog had been “removed by the Commons library on its own initiative”.

“There was no discussion with No 10, or with any other Government department on the matter,” the spokesperson said.

A new, edited version of the blog was posted today, standing by the original analysis but carrying a message explaining that “the description of the Prime Minister and Health Secretary’s use of these statistics did not meet our expected standards of impartiality”.

Dr Cliff Mann, president of the College of Emergency Medicine said that the debate about these figures was of “limited value”.

“The important figures [for Accident and Emergency departments] remain the demand (attendances and admissions) versus supply (head count of senior decision makers). This ratio is not improving and in many places is getting worse,” he said.

The emphasis being placed on Accident and Emergency pressures was signalled again today as the Department of Health announced that £1bn of its flagship Better Care Fund – a major reallocation of resources from the NHS to the social care sector – will be held back unless local authorities can meet targets on reducing emergency admissions to hospital, by providing preventative care in the community.

A spokesperson for the UKSA said: “The UK Statistics Authority is currently reviewing various ministerial statements recently made in the House of Commons about waiting times in Accident and Emergency units in England, and has seen an online article published on 3 July by the House of Commons Library. The Authority will publish its findings when our investigations are complete.”

Source The Independent

Doctors paid up to £3,000 a shift to plug ‘endemic’ gaps in A&E rotas in a practice slammed as ‘shocking and ludicrous’ by top hospital consultant

Doctors are being paid up to £3,000 per shift to fill gaps in NHS A&E rotas.

Wye Valley NHS Trust, in Hertfordshire, paid £3,717 for one doctor to work a 30-hour shift, the highest single payment of any NHS body.

Some doctors were paid not just for the hours they spent in the hospital, but also time they spent on call, including time they spent asleep.

In total £242million was spent by a&e departments in 2013 on agency doctors, enough to pay for 3,00 full time consultants

In total £242million was spent by A&E departments in 2013 on agency doctors, enough to pay for 3,00 full time consultants

An investigation by The Sunday Telegraph revealed that a total bill for all agency workers in 2013 was £242million, enough to pay for 3,000 consultants or 7,000 junior doctors.

Data showed that NHS hospitals are regularly employing shift workers to cover staff shortages, despite senior managers insisting that rates of £1,000 or more were only paid in crisis situations.

Heart of England NHS Foundation Trust paid above that rate on 719 occasions last year, Kettering General Hospital Foundation Trust paid out 595 times.

Barking, Redbridge, and Havering University HospitalsTrust in Essex, which was placed into special measures over a severe shortage of senior casualty doctors, had the highest total bill at £7.9million.

Dr Cliff Mann, the most senior A&E doctor in the UK, told The Sunday Telegraph: ‘The use of agency doctors has become endemic in the NHS.

‘There are units which would implode if they weren’t relying on them day in, day out.

‘The worst of it is that with the money we are wasting on temporary staff we could double the number of A&E consultants, if only a more long-term approach was taken.’

A freedom of information request found that hospitals were also paying up to £1,600 per shift for nurses.

In January it was revealed that GPs are also being paid nearly £1,500 a shift to work nights and weekends in crisis-hit A&E units.

Four in ten casualty departments are hiring family doctors – already paid an average £104,000 a year – to help deal with the soaring numbers of patients.

Hourly rates vary from £50 at Wirral hospital in Merseyside to £98 at Wrightington, Wigan, and £100 at Portsmouth Hospitals.

Later the same month, understaffed A&E departments were found to be spending more than £80million a year hiring locum doctors.

The average casualty unit is paying £750,000 annually for temporary medics to plug rota gaps, with some shelling out more than £4million.

A&E is in the grip of a recruitment crisis with most junior doctors put off by the intense work, antisocial hours and low pay.

At the same time rising numbers of trained casualty doctors are quitting the NHS to work abroad where salaries are higher and standards of care better.

Hospitals are having to rely increasingly on expensive locums who tend to be less competent, more inexperienced and prone to mistakes as they are unfamiliar with equipment.

Source Mail Online

Safe staff levels ‘should apply to NHS and care sector’

Safe staffing levels should be extended beyond nurse numbers in England to include midwives and doctors, especially in A&E units, MPs say.

The Health Select Committee also suggested breaches should automatically trigger inspections by the regulator.

Currently ministers have ordered only nurse staffing levels to be routinely monitored and published.

The system – ordered in response to the Stafford Hospital scandal – comes into place in April.

But the cross-party group of MPs said there was no reason why it should not be extended across the NHS and social care systems.

Committee chairman Stephen Dorrell said: “This should be applied across the delivery of health and care – doctors, midwives, practice nurses and social workers.

“Part of the difficulty in A&E is driven by the fact there are not enough doctors of all levels.”

‘Tick-box culture’

Figures from the College of Emergency Medicine show that there are shortages among trainees, middle-grade doctors and consultants.

For example, the college recommends 10 consultants for each A&E unit and 16 for the largest ones. But the current average is just below eight.

Labour MP Barbara Keeley, who is also a member of the committee, added: “Staffing levels are absolutely fundamental. It is ludicrous not to be transparent about something that patients and their families can see every day.”

The suggestion was put forward in a report that looked at the progress the Care Quality Commission has been making.

The regulator has been under fire ever since it was created in 2009.

Reports in the past by the National Audit Office and the Health Select Committee have criticised the Healthcare Commission for a “tick-box” culture and failing patients.

But the MPs said the regulator had a “renewed sense of purpose” since a new chairman and chief executive were appointed in 2012.

Last year the leadership appointed three new chief inspectors, covering hospitals, GPs and social care to herald an era of tougher, more specialist investigations.

It has also sought to recruit more inspectors – although it is still 150 short of its 1,100 target.

Mr Dorrell said: “We are not yet saying all the challenges have been met. But by and large we agree with the management of the CQC about their objectives and we endorse them.”

CQC chairman David Prior said: “This report marks an important milestone.”

Source BBC News

Sharp rise in spending on A&E locum doctors

Spending on locum doctors to plug the gaps in A&E units in England has risen by 60% in three years, figures show.

The data obtained by Labour under the Freedom of Information Act showed £83.3m was spent last year, up from £52m in 2009-10.

Employing locum doctors can cost £1,500 a shift, four times as much as filling a shift with permanent staff.

A government spokeswoman said retaining A&E doctors was a longstanding problem in the NHS.

Doctors said spending on locums was a waste of vital NHS funds and it damaged morale.

‘Service getting worse’

Labour received data from 108 trusts – three-quarters of the ones that run A&E units.

It covered all grades of doctors and suggested these temporary staff were now being employed for nearly one in 10 consultant shifts and up to one in six for more junior posts.

Shadow health secretary Andy Burnham said the rise in spending was linked to the “disastrous” reorganisation of the NHS carried out by ministers.

“This government is guilty of gross mismanagement of the NHS.

“They are paying more for an A&E service which is getting worse by the week,” he said.

Dr Cliff Mann, of the College of Emergency Medicine, said: “This sort of spending is very unwise.

“It is not an efficient way of spending NHS money and can be damaging for morale when doctors work alongside other, sometimes less qualified doctors, who are earning much more.

“But this has really been building for the past decade. There has been a lack of job planning and it is now very hard to attract doctors to this speciality.”

Flexible working

Research by the college has suggested half of trainee posts are going unfilled.

It believes the unsocial hours and pressures on A&E departments have made it less attractive than other areas of medicine.

The college has recently worked with Health Education England to draw up plans to tackle the problem, including more flexible working patterns and training opportunities.

A spokeswoman for Health Secretary Jeremy Hunt said: “Holding onto A&E doctors is a longstanding problem in the NHS, just as it was under Labour.”

She added that overall locum spend was down by 10% in the NHS.

Source BBC News

Chaos at casualty: 250,000 patients wait in ambulances for half an hour outside hospital

Patients are being forced to wait in ambulances queueing outside hospitals for over six hours because A&E units are too busy to take them.

One patient in Wales was made to wait six hours and 22 minutes before being admitted, while another in the East of England was delayed for five hours and 51 minutes, figures reveal.

NHS guidance says patients should wait in ambulances for no longer than 15 minutes and delays of more than 30 minutes in England can trigger fines.

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

The figures released under the Freedom of Information Act reveal the longest ambulance waits outside hospital for the 12 weeks from August to October.

Dr Clifford Mann, president of the College of Emergency Medicine, described the figures as “alarming”.

The longest delay of a patient waiting for six hours and 22 minutes was in Wales. The maximum wait there across the last three months was over three hours every week.

In the East of England one patient had to wait five hours and 51 minutes.

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 any data.

Dr Mann said: “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.”

Critics of the Tory-led coalition’s costly health reforms blamed the Government for the delays.

Dr Richard Taylor, co-chair of the National Health Action party, said: “These long waits by ambulances are fuelled by the delay in discharging patients from A&E, either onto wards or into the community.

“Government cuts to hospital beds and community care are creating this ambulance logjam because patients have nowhere to go so end up bed blocking.”

Shadow health secretary Andy Burnham added: “Ambulances are trapped in queues at A&Es, unable to hand over patients at bursting hospitals.

Ministers are leaving large swathes of the country without adequate ambulance cover – people who have faced an anxious wait for an ambulance will be stunned by their complacency.”

The NHS is having to make £20billion in savings by 2015.

UNISON national officer Hope Daley said: “The cuts imposed on the NHS were bound to have a knock-on effect on the ambulance services and on patient safety. There are simply not enough staff in A&E, this means ambulances can’t hand over patients who need vital medical treatment.

“Things will only get worse as the winter pressures kick in. The A&E crisis is spiralling out of control, the pressures on medical staff are reaching breaking point and sadly this may start costing lives very soon.”

But Barbara Hakin, deputy chief executive of NHS England, insisted the NHS was improving ambulance waiting times.

She 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 admitted 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.”

“We try really hard to make sure that patients get absolutely the right treatment, in the right place.

“These long waits are the exception. We are not complacent, we want to make sure they don’t happen. Whatever happens, individual patient safety will take priority.”

Roger Goss, of campaign group Patient Concern, said: “I appreciate that hospitals have all these targets – and you need targets to incentivise people – but if you aren’t meeting them, you have to find out why and do something about it.”

Longest patient wait in ambulance outside hospital by ambulance service between August and October 2013

Wales – 6hrs 22mins

East of England – 5hrs 51mins

East Midlands – 4hrs 37mins

South Central – 4hrs 32mins

North East – 3hrs 43mins

South East Coast – 3hrs 28mins

North West – 3hrs 23mins

South West – 3hrs 13mins

Yorkshire – 3hrs 1min

West Midlands – 2hrs 37mins

Scotland – 1hr 59mins

Source The Mirror

A&Es get extra £150 million as winter bites

The government is expected to make an extra £150m available for A&E units in England as they gear up for what looks set to be a tough winter, the BBC understands.

Ministers are known to be worried about how hospitals will cope this winter.

The major A&Es are already missing the four-hour waiting time target even though winter is just beginning.

The money comes on top of the £500m bailout fund announced in the summer, which is being spread over two years.

When that pot was announced, ministers said it would allow the NHS to prepare properly.

Only last week NHS England deputy chief executive Dame Barbara Hakin was saying the NHS was “ready for winter”.

The College of Emergency Medicine welcomed the news, saying: “This winter is likely to present real challenges to A&Es.”

More details on where the money will go are expected to be revealed by the government soon.

Source BBC News

Do not take all your patients to hospital, paramedics told

Call for emergencies to be treated in homes to ease pressure on A&E as NHS faces the ‘worst winter yet’
Paramedics will be told to take fewer patients to hospital as part of radical reforms of the NHS to be unveiled this week.
A review led by the NHS medical director will call for sweeping changes to ease pressure on Accident & Emergency (A&E) units, and is expected to conclude that up to half of 999 calls should result in patients receiving care at home.
Amid a growing NHS crisis, Prof Sir Bruce Keogh will say that the total number of A&E departments should not be reduced — and may need to be expanded.
However, his report is understood to say that the system can only work safely if an illusion is exposed that all units are equally equipped to deal with every emergency.
Sir Bruce has said extra money and “outsourcing” of some services to the private sector will be used to attempt to head off an immediate crisis, but will say the whole system of health care needs to be redesigned to meet growing long-term pressures.
Sir Bruce’s inquiry has heard evidence that more than 4,000 lives a year could be saved if hospitals were re-organised.
Under the plans, some specialist services are likely to be concentrated in larger units, with patients suffering from conditions such as strokes or major trauma taken directly by blue-light ambulance to designated centres, with particular expertise.
Senior doctors have said that they fear “the worst winter yet” for the NHS, with figures showing a 44 per cent rise in those waiting more than four hours in casualty units in the past two years.
Sir Bruce is expected to call for sweeping changes in the care offered outside hospitals, including faster access to GPs.
The report will make the case for improved training and investment in community and ambulance services, so that paramedics provide more help at the scene of an incident, with nurses and care workers dispatched to offer support in the home, so fewer patients are taken to hospital.
The review has found wide variations in current practices across England, but is expected to say that the “default” response of automatically sending an ambulance to 999 calls, and taking most patients to hospitals, does not always offer the best care, and places too much pressure on A&E.
In the North West, more than three quarters of patients are taken to hospital following a 999 call, while in the South West fewer than half receive such a response.
Ambulance trusts have previously introduced controversial bonus schemes, whereby organisations are paid to keep patients out of hospital.
Last winter, London Ambulance Service offered staff bonuses of £250 if they dispatched fewer ambulances, with payment received if 30 per cent of 999 calls were referred to other health care services, instead of patients being brought to casualty.
A previous scheme saw the service paid £38 for every patient kept out of A&E after a 999 call is made.
Research for Sir Bruce’s review suggests that of the five million patients admitted to hospital each year, one million might not have needed to be — if the right help was available from GPs, ambulance services, social services and voluntary agencies.
The report is also expected to call for more use of telephone advice services, despite difficulties with the non-emergency 111 phoneline as it was extended nationally.
The College of Emergency Medicine, which represents A&E doctors, has said that the NHS is facing its worst winter yet, and that, without changes and investment, probably has “just one year left” of safe care before the service buckles.
Last week, Sir Bruce said there was “a feeling that this year was worse” in terms of pressure on A&E departments at this point in the calendar.
The latest figures show the number of patients waiting more than four hours in A&E between April and October of this year was 513,626 — 44 per cent more than in the same period two years before.
The figures also show 87,000 patients waited between four and 12 hours on a trolley —almost twice as many as in the same period two years ago.
Jeremy Hunt, the Health Secretary, has blamed the A&E crisis on poor access to GP out-of-hours services — because of a contract introduced by Labour — and difficulties getting an appointment during regular hours, leaving millions of patients turning to A&E because they have nowhere else to go.
He has said that any pay rise for NHS staff next year should only be made if doctors and other workers agree to reform the way they work, to improve the way care is delivered at evenings and weekends.
However, Labour says the crisis has been made worse by job cuts under this Government — such as the loss of 6,000 nursing posts since the election, and decisions to axe NHS Direct and close walk-in centres.
The review follows investigations earlier this year by The Sunday Telegraph highlighting the numbers of patients forced to wait in ambulances parked outside A&E, as well as the failures of some trusts to achieve targets for reaching 999 cases within times set by the Government. 
In some cases, the delays were linked to the deaths of patients.
Source The Telegraph

‘I would worry if my family was taken to hospital at weekends’: NHS boss admits he is concerned about staffing levels

The head of England’s Accident and Emergency departments has said he would ‘worry’ if his loved ones were taken to hospital at the weekends because there aren’t enough consultants.

Keith Willett, NHS England director of acute episodes of care, said that there was a ‘vulnerability’ in hospitals over the weekend.

Writing in an article for the NHS England website, he said: ‘All consultants recognise there is a vulnerability in hospitals over the weekend and I would challenge any consultant not to have a degree of anxiety if one of their own relatives was admitted to hospital at a weekend knowing the amount of current senior involvement there is.’

He said patients were ‘taking up hospital beds’ at the weekends and ‘treading water’ with no treatment or diagnosis.

He drew on his own experience as an orthopaedic trauma surgeon in Oxford 20 years ago as proof that keeping hospitals running at the weekend can actually save the NHS money.
He said routine surgery should be scheduled on Saturday and Sunday. He said consultants could be present to carry out routine operations when they were not dealing with emergencies, the Sunday Times reports.

He said: ‘We also showed in Oxford in 1994 how a seven day service could be highly efficient and cost effective. We reduced admissions and shortened length of stay– and we did it in a hospital that wasn’t really otherwise offering full seven day services.

‘We found that we were able to close down the number of beds – in fact it was reduced by 25 per cent – and that meant we released nursing costs, with that money going into the extra physiotherapy support we needed at weekends.

He added: ‘In terms of cost efficiencies in designing seven-day services, I believe the planned services must be looked at too – particularly for those specialties with lower demand of emergency work which alone wouldn’t justify senior doctor presence.

It comes after NHS England medical director for London Dr Andy Mitchell said hospitals in the city were occasionally ‘unsafe’ because medical staff were spread too thinly.

He warned that hospitals in the capital were ‘at breaking point’ and admitted senior managers are constantly ‘trying to patch up’.

Dr Mitchell, the medical director for NHS England in London said: ‘At times, throughout the week, even throughout the day, services aren’t safe.

‘I feel anxious sometimes about saying it is unsafe, because I, of course, have got a responsibility to change it and improve it, but we are trying to patch up all the time.

‘What we cannot do is carry on with the idea that all hospitals provide a whole range of services.

‘That is completely unsustainable and would become, frankly, unsafe, and is becoming unsafe in many areas.

‘The public doesn’t fully understand, isn’t really sufficiently aware, that many places don’t meet acceptable standards of care.’

Last week a report by the health watchdog Monitor warned that the NHS would be £30 billion in the red every year unless it made crucial changes to the way hospitals and other services run.

Source Mail Online

Rise in number of A&Es failing to hit targets

The number of NHS trusts in England failing to meet target A&E waiting times has more than doubled in the last year, the regulator Monitor has said.

Between April and June, 31 trusts failed to meet their target of seeing patients within four hours of their arrival.

Just 13 trusts missed their waiting times commitment over the same period last year.

The Department of Health said A&Es saw 95% of patients within their targets.

But Monitor raised concerns that services – which usually improve over the spring and summer months – had instead remained challenging.

The regulator’s report looks at the key trends drawn from individual reports of England’s 146 foundation trusts.

Winter warning

It warned that ongoing problems meeting A&E targets may result in “unsatisfactory care” for patients, adding that trusts should prepare for the winter months by putting the right funding in place.

The number of trusts running a financial deficit increased from 36 in the first quarter of 2012/13, to 48 over the same period this year.

During that time, trusts generated £57m less in cost savings than originally planned.

Jason Dorsett, Monitor’s financial risk and reporting director, said: “The increased demand has also prevented trusts from delivering their planned financial savings.

“We expect to see trusts planning now for how the increased demand will impact on their finances, so that they are not storing up trouble for the future.”

‘Severe storms ahead’

Labour responded to the figures by warning there will be “severe storms ahead” for A&E units this winter unless the government addresses issues in staffing and social care.

Shadow health secretary Andy Burnham said: “David Cameron’s ill-judged… re-organisation has placed the NHS in the danger zone.”

A Department of Health spokesperson said the ageing population had put pressure on departments across the UK – with more than a million extra visits made to A&E over the past four years.

The spokesperson said: “A&E departments have been seeing 95% of their patients within four hours since the end of April – as they were before last winter. This is testament to the hard work of staff working throughout the health and care system.”

The government is investing £500m over the next two years to help ensure A&E departments are prepared for the winter.

Source BBC News