Sunday, 28 December 2014

Newspapers: 28/12/2014 (NHS, Hospitals and A&Es)

NHS England reveals critical patients waiting too long for ambulances to arrive

The disclosure comes after Jeremy Hunt approved secret plans to increase the response time for cases considered lower risk

Missing targets: NHS hasn't met it since MAY

Thousands of critically ill patients are having to wait more than eight minutes for an ambulance to arrive, new figures reveal.
Ambulances are supposed to respond to Red 1 cases - the most severe category including incidents where people have stopped breathing or there is no pulse - within the time limit.
But NHS England figures show that more than 3,800 patients last month waited more than eight minutes for paramedics to arrive.
The disclosure comes after Jeremy Hunt approved secret plans to increase the response time for Red 2 cases - the second most serious category - from 8 minutes to 11 minutes in January.
And it could be increased to 19 minutes in some cases if ambulance chiefs give the go-ahead.
According to NHS England, the ambulance only responded to 72.2% of Red 1 cases within the eight minute target in October this year - with 3,860 patients having to wait more than 8 minutes.
And the service hasn’t met the target since May.

Patients waiting more than 8 minutes

October (17.8% of total)
 In September this year, the ambulance missed the target for 3,221 cases, in August 3,384 cases, in July 3,874 cases, in June 3,423 and in May 3,434 cases.
The official NHS website says of stroke victims: “The sooner somebody who is having a stroke gets urgent medical attention, the better their chances of a good recovery.”
Shadow Health Secretary Andy Burnham MP said the figures raised “real concerns” that lives are being put at risk.
“For people who’ve suffered cardiac arrest or a stroke, every second counts and that is why this cannot continue.
“People will struggle to understand how, in the middle of this crisis, it makes sense for the Government to make a panic decision to relax 999 standards and leave patients waiting even longer.
"Jeremy Hunt has refused to answer the serious questions put to him since the weekend,” he said.
The controversial plan to relax target times is outlined in a memo drawn up by the Association of Ambulance Chief Executives (AACE).
It says NHS England has agreed “in principle” to relax the maximum wait for Red 2 incidents.
The plan “received approval” from the Health Secretary, the memo states, and is subject to approval by ambulance trust bosses.
Under the proposal, a “small number” of patients will be moved to the Red 1 category alongside heart attack victims and patients with heavy bleeding - cases where a short extra wait “could have a potentially serious detrimental impact”.
Just under half of patients will keep the eight minutes target, while four in 10 will be moved to a 19-minute response target, the memo says.
Mr Burnham added: “David Cameron’s failure to face up to the A&E crisis is having a serious knock-on effect on ambulance services.
"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.
“More and more calls are being attended by police cars and even fire engines on David Cameron’s watch.
“Urgent action is needed from the Government to turn things around. Slower 999 response is yet another sign of an NHS heading in the wrong direction.”

Sunday, 21 December 2014

Slower ambulance response fears

A number of Sunday's papers lead with health stories. The Mail on Sunday says the paper has seen documents suggesting that NHS England is poised to more than double the target time ambulances are supposed to take to reach critically ill patients.

You know that Christmas Day is looming when the papers carry more features, festive quizzes, star interviews and lists than they do news articles.
Amid the slightly lighter fare than usual, several of Sunday's papers take a look at the future of NHS services.
The Mail on Sunday leads on documents it has seen suggesting NHS England want to more than double the target time ambulances can take to reach critically ill patients.
The paper says the leaked memo - which it says shows the plans have been approved - means the service will now set a 19 minute target instead of the current eight.
The Mail adds that the document also shows that NHS bosses want to delay the implementation of the change after the general election, in May.
The proposed change comes as doctors warn that the emergency service is under severe pressure.
Headlining its page "Caution: don't be ill this Christmas" the paper notes that eight of England's ambulance services say they are under "severe pressure" and two - Yorkshire and London - say the situation is "critical".
The new targets apply to response times for "red 2" incidents, including patients with strokes, seizures, and many car crash situations, the Mail explains.
"Doctors say it is often very hard to tell if a situation is immediately life threatening [a "red 1" incident] or not over the phone," it adds.
The paper quotes former government "cancer tsar" Sir Roger Boyle as saying the move will "risk lives".
The Observer pinpoints one of the reasons emergency services are under pressure - changing lifestyles.
The paper says Britons in the 18-34 age group are increasingly heading straight to A&E departments rather than wait for a GP appointment.
The Observer writes, "the findings suggest that, despite repeated promises by successive governments to make GP services more accessible, the NHS is still failing to cater for a working population that wants family doctors to be available at times that fit in with busy working lives."
It adds the move to bypass doctors' surgeries has added to growing pressure on the country's A&E units.
The Independent on Sunday explains the situation is exacerbated in places by a lack of trained GPs.
The situation is particularly difficult in the north-east of England, Yorkshire and Humberside and the East Midlands, the paper adds.
The Royal College of General Practitioners tells the paper that the "pull of London and the south-east" is leaving some areas with a shortage of applicants.
'Terrible accidents'
If you're driving over the festive period you may be pulled over by police wanting to use what the Sun calls the "spitalyzer".
The new kit to be carried by police will test a saliva sample within seconds to see if drivers have taken any of 16 types of drug.
The Sun explains the tests will include prescribed drugs which may impair driving and "legal highs".
The drug tests, part of a crackdown on drug-driving, will first be deployed by Greater Manchester, Hampshire and Gloucestershire police forces, the paper adds.

"Suspects... can escape prosecution if they claim to be unable to give a blood sample for religious or medical reasons, allowing time for the drugs to leave their bodies," the paper notes.The Daily Telegraph, which leads on the story, says the new kit will save police having to go through the current "cumbersome" testing process, which involves having to give a blood sample at a police station and wait days for the result to come back.
Officials estimate that drug-driving causes 200 deaths in Britain every year, the Telegraph reports, but the offence is 50 times less likely to be detected and prosecuted than drink-driving.
Police minister Mike Penning, who has approved the kits for use, tells the paper he has always wanted to do something about the issue, having seen the results of drug-driving accidents when he worked as a fireman.
"Being impaired by taking medication or drugs or legal highs, if that impairs your driving ability, you're going to cause accidents and kill people - and kill yourself. It is just the same as someone who is drunk," he tells the Telegraph.
"The key is it's not just about illegal drugs. If you go and get a prescription for strong painkillers it will say on there, 'This may cause drowsiness, do not use heavy equipment and do not drive'.
"People sadly do, and then you have terrible accidents. We are not penalising motorists. We are trying to keep people safe, exactly as we do with drink."

Ambulance targets: Plan for longer times in England revealed

Target times for ambulances to reach some seriously ill patients could be lengthened, the BBC has learned.
A leaked NHS document includes plans to change the response time for some Red 2 patients - those with "serious but not the most life-threatening" conditions - from eight to 19 minutes in England.
It said the plans had been backed by Health Secretary Jeremy Hunt, subject to approval by ambulance trust bosses.
The government said no decisions had been made. Labour has demanded answers.
Shadow health secretary Andy Burnham has written to Mr Hunt asking him to explain why the measures - proposed to be brought in within weeks - were not disclosed to Parliament days after he signed them off.

The leaked document, drawn up by the Association of Ambulance Chief Executives and dated 16 December, said NHS England had "explicitly stressed" the plans were confidential and "should not be disseminated beyond the group" involved in the discussions.
The document said there were existing plans for changes "after the general election" in May.
But it said Prof Keith Willett, head of acute care at NHS England, had made an "urgent request" for discussions, because due to "unprecedented demand" on health services, the target for implementing the changes was the first week of January.
In an interview with the BBC, Prof Willett stressed nothing had been agreed but the proposals must be taken "very seriously".
By BBC home affairs correspondent Sally Chidzoy

A whistleblower leaked the memo to the BBC because of serious concerns over patient safety, fears the plans were rushed at the height of winter when the service is under unprecedented pressure and anger over the secrecy involved.
To many in the service, the general ideas are good - but there this concern it should have been a more thoughtful exercise where time was taken to consult widely and the public was involved in the process.
Paramedics say response times distort their ability to treat patients because they have to chase the clock.
They say some illnesses such as strokes, should be moved up a category.
The target for these changes was early January, according to the document, but it seems unlikely the proposals will now go ahead by then.
One ambulance service director, who asked not to be named, told the BBC: "This is being done for political expediency rather than patient safety and it's being done with the full blessing of Jeremy Hunt.
"This is being pushed through with limited consultation with the chief executives and the health service as a whole."
Martin Berry, executive officer of the College of Paramedics, said he was not opposed to change but it could not be done "behind closed doors".
"There's been no effort to engage with the paramedic profession. We're just very concerned about the way this has been kept in the dark."
The College, which represents paramedics across the UK, said it would be discussing the proposals with AACE and NHS England and seeking to be involved in negotiations.
President of the Royal College of Emergency Medicine, Dr Clifford Mann, said the proposals appeared "sensible" but they needed to be trialled to provide evidence to prove it was not a "cosmetic exercise".
Call types:
  • Red 1: Respiratory or cardiac arrest - response in eight minutes
  • Red 2: All other life-threatening emergencies, such as stroke and fits - response in eight minutes
  • Other response times are agreed locally
The national target is for ambulance trusts to reach 75% of Red 1 patients within eight minutes, and 95% within 19 minutes. The time starts as soon as an emergency call is connected.
Red 2 targets are currently the same, except that the "clock start" can be up to 60 seconds after a call is connected.
The changes proposed to Red 2 are:
  • A "small number" moved to Red 1 - those where a short extra wait "could have a potentially serious detrimental impact"
  • Just under half to keep the 75% within eight minutes target, but trusts will have up to three minutes from receiving a call before the clock starts
  • About 40% to have a 19-minute response target, as well as three minutes before the clock must start
The Red 2 category includes strokes and fits, but the document does not say which conditions would be put in each of the new categories.
The document said the proposed changes could bring "substantial improvements".
It also said ambulance trusts would be able to cut the number of fast-response cars being used in favour of deploying more double-crewed ambulances.
However, it acknowledged the plans have not had the "breadth of exposure that would normally be expected".
'Full apology'
Mr Burnham said: "Jeremy Hunt was dragged before Parliament last Thursday to answer questions on NHS winter planning but treated [it] with contempt. It is outrageous that he decided to keep MPs and the public in the dark about a decision he had already taken and one which will have far-reaching implications across the NHS...
"This leak leaves Jeremy Hunt with extremely serious questions to answer. He must do so today."
He said if the health secretary did not have an "acceptable reason for withholding information" he should make a full apology to MPs.
Mr Hunt has not commented but the Department of Health said the health secretary "would only agree to proposed changes that improve response times for urgent cases".
21 December 2014 Last updated at 13:59  BBC News 

A&E departments in crisis as hospitals reeling from Coalition cuts struggle to cope

In the seven days up to December 14, only six out of 140 casualty departments met the target to see 95% of patients within four hours

NHS crisis: A&E departments are struggling

Hospital A&E departments have been plunged into in crisis as over-stretched doctors struggle to meet targets of seeing patients within four hours.
Coalition cuts to wards mean the sick are being left on trolleys or in the back of ambulances outside, blocking access to casualty bays.
And the slashing of social care budgets have forced more ill elderly people into hospital emergency departments.
Labour described the past week as “the worst in A&E for many years”.
In the seven days up to December 14, only six out of 140 casualty departments met the target to see 95% of patients within four hours.
Data shows only 89.8% were seen within the target time.
Labour warned the figures showed the Tories and Health Secretary Jeremy Hunt “cannot be trusted with the NHS”.
Shadow health secretary Andy Burnham said: “Emergency services are stretched to the limit.
“Seriously ill people are waiting hours for ambulances to arrive or on trolleys in hospital corridors. This is before winter has begun in earnest.”
NHS England admitted the health service was under huge strain but insisted it was still offering a “robust” response.
Dr Barbara Hakin, national director of commissioning operations, said: “Pressures on our A&E services continue to increase significantly.
“We have admitted more people to hospital (in the week ending December 14) to take care of them than in any previous week on record.”
But Dr Louise Irvine, of the Natinal Health Action party, said: “The reason A&E is in crisis is not because too many people are attending A&E as there has only been a small rise in ​the number of ​people turning up at A&E.
“Don’t blame patients for the A&E crisis. Blame the government. Waiting times are the worst ever yet the number of people attending A&E is up less than 5.5% from the same week last year, from 416,000 to 440,000.

A&E waiting time targets - see 95% of patients within four hours

Number of A&E departmentsNumber who met the target
NHS England
“Blaming increased A&E attendance is a convenient way for the Government to avoid responsibility for the more important factors within its control​ that are contributing to the problem - A&E closures creating more pressure on nearby hospitals, sick patients stuck in A&E as cuts in the number of hospital beds mean they can’t be admitted onto wards, and cuts to social care budgets meaning more elderly people are ending up in hospital and then suffering delayed discharge due to a lack of appropriate care in the community.”
Charities blamed the record-breaking figures on budget cuts in the care sector.
Richard Hawkes, chairman of the Care and Support Alliance, which represents more than 75 charities, said: “The pressure on our health system is being intensified by the squeeze on council-funded local care.
“Chronic underfunding has left hundreds of thousands of older and disabled people, who need support to do the basics like getting up or out of the house, cut out of the care system
“The impact is now being felt throughout the health and care system and the health service is forced to pick up the pieces when people become isolated, can’t live on their own and slip into crisis.”

Dont’ blame patients for A&E crisis – waiting figures worst ever yet attendances up less than 5.5%

Statement from Dr Louise Irvine of the National Health Action Party on A&E’s ‘worst week’ in Englandwith the lowest percentage of patients seen within four hours since monitoring began in 2010.
“The reason A&E  is in crisis is not because too many people are attending A&E as there has only been a small rise in ​the number of ​people turning up at A&E.   Waiting times are the worst ever, with the numbers of people waiting over 4 hours more than doubling from 4000 to 10000 compared to the same week last year. Yet the number of people attending A&E is up less than 5.5% from  the same week last year, from 416,000 to 440,000. (*)
Don’t blame patients for the A&E crisis. Blame the government.
Blaming increased A&E attendance is a convenient way for the Government to avoid responsibility for the more important factors ​ within its control​ that are contributing to the problem: A&E closures creating more pressure on nearby hospitals, sick patients stuck in A&E as cuts in the number of hospital beds mean they can’t be admitted onto wards, and cuts to social care budgets meaning more elderly people are ending up hospital and then suffering delayed discharge due to a lack of appropriate care in the community.  This is known as ‘exit block’. Drastic ​ cuts to social services budgets (*​*​) are leading to delays in arranging packages of care for patients to support them when they come out of hospital.
It has been estimated by the Health Foundation (​***​) that we would have needed an additional 25 A​&Es to meet increased demand just due to population growth since 2003. Instead the number of major A​&Es has been cut by 8% since 2003 and more A​&Es are still scheduled for closure despite the crisis.
This crisis was predictable and should have been planned for. The changing demographics and rising admissions have been known about for years. The interaction between social services budgets and delayed discharge is likewise well understood. The solution is proper planning and investment in NHS and social services. Instead we have had £20 billion “efficiency savings” in the past 5 years and another £30 billion to come.  A+Es have been closed. Hospital, community, GP, mental health, and social care budgets have been cut.
The £700 million ‘winter crisis funding” the Government is throwing at the problem is too little, too late. It is intended to avert political embarrassment in the run up to the election. Sadly it’s unlikely to have much impact on the conditions for patients or staff in our A&Es this winter.”
Notes to editors:

Thursday, 18 December 2014

London ambulance crisis: number of emergency crews queueing for 30 minutes outside A&E quadruples in two years

Stacking: Ambulance crews had to wait for 30 minutes or more on 2,655 occasions last month (Picture: Getty)

The number of ambulances stacking outside A&E departments in London has more than quadrupled in two years, the Evening Standard can reveal, in the latest sign of the soaring demands being placed on the NHS.
Ambulance crews had to wait for 30 minutes or more on 2,655 occasions last month before they were able to unload patients into the care of hospitals, according to new figures.
Between November 3 and December 7, this happened on 764 occasions at the London North West Healthcare trust, which runs Northwick Park and Ealing hospitals and has repeatedly had the worst A&E delays in the country.

Ambulances at King’s College hospital, in Denmark Hill, and its sister hospital Princess Royal, in Orpington, suffered 30-minute handover delays on 456 occasions.
Delayed handovers leave crews unable to respond to other emergencies at a time the London Ambulance Service is reaching less than 50 per cent of critically ill patients in some boroughs within the eight-minute NHS target.
By comparison, there were 644 ambulance 30-minute waits in London during the same period in 2012 and 1,079 last year.
Dr Onkar Sahota, Labour chairman of the London Assembly health committee, who unearthed the figures, said: "While ambulance and A&E staff are doing all they can to minimise delays, the strain being placed on London’s NHS is plain to see.
“The Government... needs to realise that without real and sustainable support for the ambulance service, it is London’s patients who will continue to suffer.”
Tina Benson, director of operations at London North West Healthcare trust, said there was no evidence that patient safety had been compromised as a result of the delays.
She said a task-force had been established to improve A&E performance at Northwick Park. "We are looking at ambulance hand-over times and waiting times every week," she said.
King’s, one of the biggest hospitals in London, said that December 1 was the busiest day for emergencies in its history, with 488 patients attending A&E.
King's said that, like other London hospitals, it had seen a sudden 25 per cent spike in paediatric emergencies month on month, with many babies suffering from the respiratory infections bronchiolitis and croup.
Roland Sinker, chief operating officer at King’s, warned that South-East London may have to follow North-West London in seeking to provide more care in the community or at home to discourage patients from seeking treatment in hospital.
He said: “I think there is going to have to be a rethink about the way capacity is reconfigured across London to be able to cope with the challenges.”
Richard Hunt, chairman of the London Ambulance Service, said the way to ease the crisis was for paramedics to treat more patients over the phone or at the scene rather than conveying them to hospital.
He said less than 10 per cent of patients who received an ambulance in eight minutes were unwell enough to merit such a fast response.
Speaking in his national role as chairman of the Association of Ambulance Service Chief Executives, he said: "Many 999 calls which require double-crewed vehicles, I believe could - and increasingly should - be managed at the scene, avoiding conveyance."

Ambulances waiting 30 minutes or more outside A&E departments, November 3 to December 7 2014

London North West Healthcare NHS Trust

King’s College Hospital NHS Foundation Trust

Barking, Havering And Redbridge University Hospitals NHS Trust

The Hillingdon Hospitals NHS Foundation Trust

Royal Free London NHS Foundation Trust

Lewisham And Greenwich NHS Trust

West Middlesex University Hospital NHS Trust

Barts Health NHS Trust

Epsom And St Helier University Hospitals NHS Trust

University College London Hospitals NHS Foundation Trust

Croydon Health Services NHS Trust

North Middlesex University Hospital NHS Trust

Chelsea And Westminster Hospital NHS Foundation Trust

Source: London Assembly Labour group research

Published: 18 December 2014 Evening Standard

Updated: 09:26, 18 December 2014

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