Sunday, 30 November 2014

Crisis-hit A&E department tells 999 ambulance crews: Ring first to see if we've got space or we won't let you in

  • -London Ambulance Service made warning over struggling emergency unit

  • -Paramedics now can't take patients directly to Northwick Park in Harrow

  • -Only London hospital which has the 'call ahead' arrangement in place
  • -Move came after closure of emergency treatment in two nearby hospitals 


Paramedics have been told to ring ahead before taking patients to an A&E struggling to cope after the closure of departments at two nearby hospitals.
In the latest blow for health bosses who claimed their massive hospital reorganisation programme would improve care, the London Ambulance Service has put out the warning over patients being taken to Northwick Park in Harrow.
Two weeks ago, The Mail on Sunday revealed that the same hospital was experiencing the longest waits in the country following the closure of casualty units at West London’s Central Middlesex and Hammersmith hospitals.

The London Ambulance Service put the 'call ahead' arrangement in place at Northwick Park Hospital in Harrow, London, following the closure of two casualty departments in nearby hospitals (file photo
Paramedics would usually take patients to the nearest department, but this is no longer necessarily the case at Northwick Park.
A spokesman for London Ambulance Service confirmed the ‘call ahead’ arrangement was now in place, saying: ‘We are working with the hospital, so before crews go directly to Northwick Park, they need to call our control room. They are then advised if that is appropriate.’ It is the only London hospital with such an arrangement.

According to official guidelines, ambulances should have to wait no more than 15 minutes outside A&Es to drop off patients, but at a meeting last week, Northwick Park executives admitted this was exceeded hundreds of times at the site in September alone.
Crews had to wait because there was either no room in A&E to take the patients, or there were no staff free to care for them.
The waiting not only affects patients already in the ambulances, but also ties up crews urgently needed elsewhere.

The Mail on Sunday has revealed that Northwick Park has been experiencing the longest waits in the country

In September, ambulances had to wait outside Northwick Park for more than half an hour on 179 occasions. Of those, 30 patients had to wait more than an hour.
Brent Council leader Muhammed Butt said his worst fears about the effects of closing local A&Es were coming true.
‘Immediate action needs to be taken to resolve this as we are talking about life-and-death emergency treatment. Our residents deserve the best healthcare and we need to understand why the reconfiguration of local health services has been botched so badly.’
The Mail on Sunday has campaigned for two years to keep A&Es open nationwide, pointing out the problems that health bosses frequently gloss over.
Meanwhile, more than 20 health chiefs from West London have just flown to the United States on a week-long ‘fact-finding’ mission – at a cost of more than £5,000 a head.
The taxpayer-funded trip to New York, Boston, Richmond and Baltimore began yesterday, with 22 officials due to visit ‘innovative organisations renowned for excellent community care and partnership models’, according to an official briefing.
Andy Slaughter, Labour MP for Hammersmith, said: ‘People will see it as extraordinary that during an A&E crisis, senior management are jetting off on a jolly.

Mail On Sunday

Friday, 28 November 2014

Healthcare commission announced - Independent commission to review A&E closures in West London

An independent commission, chaired by leading barrister, Michael Mansfield QC, is being set up by four local councils in north west London, who have been deeply concerned by deteriorating local hospital services.

The closures of hospital A&E services in west London have been followed by lengthening waiting times for residents struggling to get seen at over-burdened neighbouring hospitals. With the expected imminent spike in demand from winter pressures, fears are rising that lives are being put at risk.

Growing disquiet at the knock-on effect on other hospitals, of the closure of emergency services at Central Middlesex and Hammersmith, has also resulted in the surprise announcement by NHS England of its own inquiry into how hospital reconfiguration in west London is being handled.

Official NHS figures show the trusts that run St Mary's, Charing Cross, West Middlesex, Ealing and Northwick Park hospitals have all failed to meet A&E waiting time targets over recent weeks.

In the three weeks after 19 October, all three hospital trusts dipped below the national target, which says 95% of patients should be seen within 4 hours. Performance at North West London Hospitals Trust, which runs Ealing and Northwick Park hospitals, fell to just 67.8% of patients being seen within 4 hours, the second worst result in the country.

Now, four councils in Hammersmith & Fulham, Ealing, Brent and Hounslow have got together to set up an impartial inquiry to look in depth at the impact local closures are having, and at the implications of further hospital reorganisation proposals, including the planned closure of services at Charing Cross hospital in Hammersmith.

As well as reviewing the evidence provided by the NHS to support their reorganisation, the commission will be asking others to contribute evidence. It will also commission further research to fill the gaps in existing evidence.

Councillor Julian Bell, leader of Ealing Council said: "Since plans to change emergency services in our area were first suggested we have felt that our very real concerns have been largely ignored. We have heard lots of spin about what will replace A&E services at Ealing, Charing Cross, Central Middlesex and Hammersmith hospitals but before these changes go any further we need proper answers. By engaging someone of the calibre of Michael Mansfield QC to carry out this independent review we know that the public will get a true picture of what is happening and if the NHS is keeping its word about providing new services before others are closed."

Councillor Muhammed Butt, leader of Brent Council, said: "Our worst fears, about the effects of closing local A&Es before the expansion of Northwick Park was complete, have come true. Brent residents now face the longest A&E waiting times in the country and immediate action needs to be taken to resolve this situation as we are talking about life and death emergency treatment. Further delays to the A&E improvements at Northwick Park will only make the problem worse. We will support the Independent Commission, and will be demanding answers from NHS bosses at our next scrutiny committee. West Londoners deserve the best healthcare and this joint review will be vital in shining a light on what has gone on with these botched A&E closures."

"A&E closures are already putting dangerous additional pressures on other hospitals and will only get worse if services at Charing Cross are also closed," says H&F Council Leader, Councillor Stephen Cowan. "The official figures speak for themselves, but we plan to bring some extra, independent scrutiny to examine what local trusts are doing to our hospital services.

"Hundreds of thousands of residents' lives are affected by the closures, but local people have little say over the decisions NHS managers are making. As their elected representatives, the four councils have concluded an impartial review is needed, free of vested interests, of the real and likely impact of these major hospital re-configurations and the financial reality behind them.

The leader of Hounslow Council, Councillor Steve Curran said: "Ensuring a safe and sustainable future for West Middlesex Hospital remains one of Hounslow Council's top priorities. We continue to work closely with Hounslow Clinical Commissioning Group and the NHS Trust to make sure local residents receive the best possible care."

Michael Mansfield QC last year chaired the Lewisham People's Commission, an inquiry into the proposals to close services at Lewisham Hospital. He has represented defendants in criminal trials, appeals and inquiries in some of the most controversial legal cases in the country. He represented the family of Jean Charles de Menezes and the families of victims at the Bloody Sunday Inquiry. He chaired an inquiry into the shoot to kill policy in the North of Ireland and has represented many families at inquests, including the Marchioness disaster and the Lockerbie bombing. He also represents the family of Stephen Lawrence.

He will be joined on the commission by Dr Stephen Hirst, a retired GP from Chiswick with extensive local knowledge and John Lister, researcher on the People's Inquiry into London's NHS in 2012 and Senior Lecturer in Journalism at Coventry University. Tim Rideout, former chief executive of Leicester City PCT, will be writing a report on the commission's findings.

Are They Making It Up as They Go Along?

Ross Lydall’s article (24 Nov 2014) on Charing Cross hospital provides more evidence of how little those responsible for the changes to health provision in NW London actually know about their own proposals!

Imperial Health Trust say they will sell 55% of the land, but can’t say which 55% - and who is it the property developers are talking to? Imperial deny discussion with developers. Who is Dr Spencer talking to, and on whose authority?

Dr Spencer and Imperial are still not clear just what hospital provision will be at Charing Cross or Ealing, or how these will be staffed. And they haven’t a clue what the ‘emergency services’ at those hospitals will be.

There is no evidence that so-called Out of Hospital services will reduce the present need for blue light A&E services and acute inpatient beds. And hospitals in NW London are already breaching ambulance target times at an unprecedented rate, falling significantly compared to other N HS areas – all since the closure of 2 small A&Es in the area in September.

Save Our Hospitals has been asking for details of what our health services will be for over 2 years. Neither the CCG nor Imperial Health Trust can give us answers.

We are now demanding a moratorium on further closures/reorganisations and demanding a new consultation on real proposals rather than Dr Spencer’s ‘pie-in-the-sky we’ll know some day’ proposals for local health care.

Merril Hammer

Chair, Save Our Hospital: Hammersmith and Charing Cross

Please sign our petition:

Steve Pound MP: Health Service in Ealing is shrinking before our eyes

Labour MP for Ealing North, Steve Pound, talks Christmas and the local NHS in his latest getwestlondon column.

Ealing North MP Steve Pound

The snow may not be sparkling on our streets but it is certainly floating down on our television screens and while some of you may be already tiring of Christmas Carols on a tape loop in the department stores, there is more than enough of the Advent Season to send a shiver down the spine and to put a smile on the face of the most miserable.
In all the years I spent working in the National Health Service I came to love working at Christmas. Admittedly I didn’t have children then and as my wife was a nurse who also worked at the Middlesex Hospital we were happy to take on the holiday season shifts to allow colleagues to spend some time under the tree with their families.
Patients may have winced as this porter pushed their trolley through the corridors of the Middlesex while wearing a paper hat and a silly grin but most people seemed pleased to join in with a bit of seasonal jollity and there was always a sense of camaraderie between us ancillary workers and the nurses, medics and catering staff in the hospital and the police and paramedics who appeared with increasing frequency in Casualty.
None of us would have thought for a moment that our beloved Middlesex Hospital would now be a hole in the ground or that our local services in Ealing would be shrinking before our eyes. The very idea of an Urgent Care Centre replacing A&E would have seemed ridiculous and the prospect of the place where my wife went on to work as a sister on a cancer ward, Charing Cross, being flogged off to property speculators and hedge fund spivs would have seemed nothing less than a bitter, sick joke.
I actually accept that change is inevitable and the concentration of stroke services on fewer sites has been a great success and has actually confounded my initial misgivings and proved to be a life saver. Even allowing for that I cannot help but look at the devastation that has been wrought on our local health services and feel the Christmas spirit draining away.
All current indicators point towards a severe worsening in the service provided at Ealing Hospital. I have a natural disinclination to alarmism but this is beyond paranoia and in the realm of real and present danger.
Protest against closure Central Middlesex Hospital A&E at Central Middlesex Hospital, Acton Lane, Park Royal NW10 7NS. Acton

The revelation that the Secretary of State for Health, Jeremy Hunt, has so little confidence in GP provision that he took his children to A&E over the weekend does not fill me with confidence and I shudder to think what might be our fate here in Ealing if we suffer from what are known as “winter pressures” or when we experience outbreaks of influenza or, God forbid, a serious road or rail accident.
I’m lucky enough to have a truly excellent GP and anyone who can keep me upright and compos mentis deserves a medal at the very least but I am really seriously worried about Ealing Hospital. I went in for an x-ray the other day and was seen promptly and efficiently with the greatest of courtesy and professionalism but everyone I spoke to was desperately anxious about the future. Not their personal future but that of the hospital.
We face a general election in a few months and, quite rightly, the National Health Service will be front and centre in the campaign and certainly in the debates before polling day on May 7th. I'm not going to get all political on you and I always respect any individual’s decision to cast their vote however they choose. All I ask is that you think about the NHS in the next few months and ask those who are asking for your vote what they will do to earn it where the NHS is concerned.
It wouldn’t do any harm to say thanks to the people who are running our health service on behalf of all of us. If you’re visiting anyone at Ealing why not bring a card or a little something for the staff and I hope that you pop in to the truly excellent League of Friends cafĂ© for a cup of something warm and cheering and a chat with the volunteers who prove their support for our NHS in the best and most practical way.
We are all immensely grateful to everyone working in the health service in our part of the world and I know that we all wish them the very best of the season and warmest greetings to their friends and families. When they come off shift and head for home there may well be a light dusting of snow on the streets and there will certainly be lights twinkling in the windows and in some cases illuminations blazing out over the whole house.
I want the NHS workers to come home to a warm welcome but, above all, I want them to look forward to a New Year free of the awful anxiety that besets us at the moment. That would be the best possible Christmas present for us all!
Read more columns by Ealing's leading politicians: For Labour - Councillor Julian BellVirendra Sharma MP and Steve Pound MP, for the Conservatives Angie Bray MP and Councillor Greg Stafford and for the Liberal Democrats Councillor Gary Malcolm.

Weekly A&E SitReps 2014-15

The Weekly A&E collection collects the total number of attendances in the week for all A&E types, including Minor Injury Units and Walk-in Centres, and of these, the number discharged, admitted or transferred within four hours of arrival.

Also included are the number of admissions via A&E, and any waits of over four hours for admission following decision to admit.
Data are shown at provider organisation level, from NHS Trusts, NHS Foundation Trusts and Independent Sector Organisations.
In addition to the weekly data we have provided quarterly aggregates for users that require data over several weeks.
Further information for this collection, including the guidance document, can be found here

Thursday, 27 November 2014

Inquiry launched into 'long waiting times' at Northwick Park Hospital following London A&E closures

One in four patients have had to wait more than four hours for treatment since the closures of neighbouring units nine weeks ago

Gareth Thomas, left, and Muhammed Butt, right, have called on David Cameron to provide more funding for the NHS

Health chiefs have launched an inquiry into ‘unprecedented’ long waits for patients at Northwick Park Hospital’s swamped A&E following the closure of two other units.
One council leader said the reconfiguration of north-west London’s acute health services, known as Shaping A Healthier Future and jointly conducted by the now-defunct Primary Care Trusts, had been ‘botched’ and that he and his colleagues would ‘demand answers’.
Since the A&Es at Central Middlesex Hospital in Park Royal and Hammersmith Hospital in East Acton closed on September 10, consistently more than one in four visitors to Northwick Park Hospital in Watford Road, Harrow, fail to be seen by staff within the government’s four hour target, NHS England’s figures reveal.
For the week ending November 16 this year, the figure dropped as low as 68 per cent seen within four hours.
Tina Benson, director of operations at London North West Healthcare Trust, said: “We are working closely with the Shaping a Healthier Future programme to review the original modelling that was used for the planned reconfiguration of A&E services in North West London.”
GV's Harrow: Northwick Park Hospital, Watford Road, Harrow.

Labour’s MP for Harrow West, Gareth Thomas, said: “Northwick Park Hospital has seen an unprecedented increase in demand following the closure of nearby A&E departments, and it is clear that it is not able to cope with this.
“Twenty-five per cent of patients have had to wait more than four hours for treatment in the nine weeks since the closures, and more than 250 patients were forced to wait in ambulances before even being able to enter A&E in September alone.”
Inspectors from the Care Quality Commission rated the A&E as “requiring improvement” and demanded increased staffing.
The trust launched a recruitment drive for medical staff at what it modestly describes as a ‘busy’ emergency department where ‘exciting things are happening’.
Brent Council’s scrutiny committee was due to meet yesterday (Wednesday) evening to look into the situation including why the opening of the £21million replacement A&E building, now expected on December 10, has been delayed three times.
Councillor Muhammed Butt, Brent council leader, said: “Our worst fears about the effects of closing local A&Es before the expansion of Northwick Park was ready have come true.
“Immediate action needs to be taken to resolve this as we are talking about life and death emergency treatment. We will be demanding answers from NHS bosses.
“Our residents deserve the best healthcare and we need to understand why the reconfiguration of local health services has been botched so badly and get answers about how the trust plans to improve the care they offer urgently.”
A spokeswoman for Community Voice, a grass roots NHS watchdog for north-west London, said: “I would be concerned about the wellbeing of local residents.
“There is an issue with the capacity of the new A&E building that needs to be looked at together with arrangements between A&E and the admissions team, and what the four-hour wait target actually covers.”

Senior NHS doctors fear A&E is heading for winter crisis

The Accident & Emergency service at 50 hospitals is already struggling heading into the winter, according to leading NHS doctors.
By Lewis Vaughan-Jones: ITV News Correspondent
Medway Maritime Hospital in Kent is one of the worst hospitals in England. Last month a patient waited in Accident and Emergency for nearly 35 hours. I've spoken to patients who've been in there for between 12 and 20 hours.
The problems there may be specific but there are concerns about many of our A&E departments across the country. Doctors have told ITV News about growing delays and people waiting on trollies in corridors.

One doctor told us around 50 hospitals are "struggling to cope" at the moment. Another told me things are as bad as he's seen in 20 years.

There are calls for more money to try to fix this. Next week's Autumn Statement is likely to be the time we find out if there will be any extra funding. All this and the grip of a cold winter, which sees more hospital admissions, hasn't even tightened yet.

Northwick Park Hospital A&E: Ambulance crews to call ahead

                                                 Northwick Park is struggling with a lack of beds

Ambulance crews will now have to contact their central control room before taking any patients to an under-pressure hospital's A&E department.
Northwick Park Hospital is the only one in London with such controls in place.
It has also written to local GPs asking them to refer patients to other hospitals to help it cope.
London North West Healthcare Trust said it was working with London Ambulance Service and NHS England to find out why so many patients were going to its A&E.
The hospital has been struggling to cope since two nearby A&E units, at Central Middlesex and Hammersmith, closed in September.
Its board meeting on Wednesday heard that in September ambulances had to wait on 179 occasions for more than 30 minutes to hand over a patient, while 30 patients had to wait more than an hour. The national target is 15 minutes.
'Absolutely disgusting'
Board papers blame a "poor level of staffing on wards" and say the "primary cause of breaches of national target is a lack of beds."
Muhammed Butt, Labour leader of Brent Council, said: "It's absolutely disgusting that my constituents are going to be suffering - they have to travel so much further.
"It's putting their lives at risk and we warned about this; that beds should be in place, the A&E should have the proper staff and the hospital should have the proper number of beds. They're not in place and God knows when they would be in place."
In December, the hospital will gain an extra 20 beds, another 24 in February and a further 60 the following year.
In the House of Commons, Prime Minister David Cameron said more A&E consultants and nurses were being recruited for north west London.
He added: "Both Hammersmith and Central Middlesex hospitals have GP-led urgent care centres on site that are open 24 hours a day, seven days a week."
Earlier this month a report found that patients requiring emergency treatment at the hospital had the longest waits in the country.
In August the Care Quality Commission said some patients were being discharged too early because of patient flow through its A&E department.
Watch the BBC video here:

Monday, 24 November 2014

Charing Cross Hospital tower block could be sold off as flats

Development plan: The tower at Charing Cross hospital Picture: Google Street View

One of London’s most famous hospitals could be turned into designer flats as part of a controversial shake-up of A&E care, the Standard can reveal.

A developer has approached GPs considering how to downsize Charing Cross hospital to suggest converting its 16-storey tower block into homes rather than having it demolished.

The details emerged as it was confirmed that the A&Es departments at Charing Cross and Ealing are to be replaced with “emergency centres” run by GPs and specialist nurses.

These will not have surgeons or intensive care units and will be unable to receive “blue light” — full emergency— ambulances. The Department of Health insists that the hospitals will continue to provide “A&E services” but campaigners believe the units are being downgraded.

Dr Mark Spencer, clinical lead for the Shaping A Healthier Future programme that is centralising major emergency care at five west London hospitals, said there were a number of options for Charing Cross. He told the Standard: “One option is you could use the rest of the site [for housing] and maintain the tower block. Other options are that the tower block could be turned into residential housing and other parts of the site could be used.

“We’ve had people come and say: ‘Why knock it down? We could convert it.’ If you go to the top floor and have a view across London, it’s quite nice. But those are all in discussion. No decision has been made.”

Imperial College NHS Trust, which runs Charing Cross, has already agreed to sell off more than half the site, in Fulham Palace Road, and axe all but 24 of the hospital’s 360 inpatient beds.

Dr Spencer said the hospital was likely to specialise in urology — prostate and bladder disease — and retain its chemotherapy services.

He said Ealing’s maternity department would close next year, with its 12-bed inpatient paediatric ward “likely” to close soon after. Breast cancer surgery was also “likely”expected to be axed. The hospital was “likely” to specialise in orthopaedic day surgery, with surgeons visiting from Northwick Park and the Royal National Orthopaedic Hospital.

Ealing’s new “emergency centre” would be part of an “emergency network”, with consultants at the five “specialist emergency centres” — St Mary’s, Northwick Park, Chelsea and Westminster, Hillingdon and West Middlesex — available on the phone or via “teleconferencing”. It is likely to open in three years.

Most patients using Ealing were likely to be elderly, suffering confusion or urinary tract infections. Children with minor illnesses could also be seen.

He said the changes at Ealing and Charing Cross would fit into the England-wide plan for emergency care being finalised by Sir Bruce Kehoe and Professor Keith Willett, which is due to be published within two months.

Dr Spencer said: “[Kehoe and Willett] are talking about emergency centres, and Ealing hospital will be an emergency centre, working in a network with specialist emergency centres. We would have specialist emergency centres at our five major hospitals.”

He said Ealing received an average of three “blue light” ambulances a day, while Charing Cross received “three to four”. If necessary, future patients would be “seen and stabilised” and then transferred to one of the specialist emergency centres.

“What [Ealing and Charing Cross] won’t take is someone with crushing heart pain or somebody who looks so seriously ill they need an intensive care unit,” Dr Spencer said.

“The biggest thing we are changing in north-west London isn’t the hospitals. The biggest thing is the investment in GP practices and the community.

“That is where we can really make a difference in mortality if we can get primary care services to manage diabetes better, manage hyper-tension better. It has a much bigger impact than patching up somebody when they are ill.”

Evening Standard

Updated: 11:24, 24 November 2014

Sunday, 23 November 2014

NHS bosses finally order investigation into A&E closure chaos after two-year campaign by MoS that exposed deaths and delays

Investigation launched into whether closure of two A&Es triggered long waits at nearby hospitals

  • -Investigation launched into whether closure of two A&Es triggered long waits at nearby hospitals.

  • -It comes just days after The Mail on Sunday highlighted the problem.
  • -Inquiry ordered by Dr Mark Spencer, the GP in charge of huge hospital reorganisation in North-West London.

  • -Said he was 'not happy' with A&E performance at Northwick Park and Ealing hospitals after closure of two other London units in September.

  • NHS bosses have launched an official investigation into whether the closure of two A&Es triggered long waits at nearby hospitals – just days after The Mail on Sunday highlighted the problem.
    Dr Mark Spencer, the GP in charge of the huge hospital reorganisation in North-West London, said he was ordering the inquiry because he was ‘not happy’ with A&E performance at Northwick Park and Ealing hospitals, following the closure of two other London units in September.
    The surprise decision comes after repeated denials by NHS managers that closing A&Es around the country has a ‘domino effect’ on other emergency departments.

  • NHS bosses have launched an official investigation into whether the closure of two A&Es triggered long waits at nearby hospitals – just days after The Mail on Sunday highlighted the problem (file picture)

  • The probe will look at whether the controversial closures of A&Es at Central Middlesex and Hammersmith hospitals caused lengthy delays at nearby casualties – and led to a spike in death rates.
    This paper has discovered numerous instances of A&E closures having a knock-on impact elsewhere – leading to longer waits for emergency care, wards bursting at the seams, and more operations being cancelled.

  • Last Sunday, we told how patients at Northwick Park (pictured) and Ealing have faced the longest A&E waits in England this autumn, following the double closure ten weeks ago
  • And in September chief executive David McVittie said he did not expect the closures to have a ‘large impact’ on Northwick Park.
    But now Dr Spencer has said an official investigation will look at the issue. He said local doctors were ‘not happy’ with the recent performance of the A&Es, adding: ‘A lot of this is unexplained. We need to look at that.’
    He continued to believe that the increase in patients waiting more than four hours was not due to the closures, but admitted they could have played a part. He said: ‘If we are wrong, we will find out how we got it wrong and not do it again.’
    Waiting so long for treatment was ‘not good care’, he said. ‘If your relative was stuck on a trolley for four hours you would be cheesed off.’
    The investigation will look at death rates at the hospitals, although he thought it would be ‘hard to say’ if the closures had affected mortality rates. Chris Mote, a Harrow councillor, believed the care of elderly patients had been affected. He said: ‘A month ago I had to go to Northwick Park A&E one evening. I was there for six hours. I met a friend who’d brought his mother in, in her 90s. I went in for a scan at 10am the next day and she was still in casualty – 12 hours later. It was frightening.’

  • The graphic shows the official NHS A&E figures for Northwick Park and Ealing before and after closure of Central Middlesex and Hammersmith, with more patients waiting longer
  • Gareth Thomas, Labour MP for Harrow West, said: ‘Well done to The Mail on Sunday. I am glad to see some action being taken. The investigation needs to be independent and be willing to talk not just to medical experts, but people like councillors and MPs who get feedback from patients who use A&E.’
    For two years, this paper has highlighted problems hospitals have faced following nearby A&E closures – including at Wexham Park in Slough; Stoke Mandeville in Aylesbury, and North Middlesex Hospital in Edmonton, North London. People have also been waiting longer for ambulances in Newark, Nottinghamshire, which lost its A&E in April 2011.
    Those in charge of the ‘reconfiguration exercises’, as they call them, argue centralising emergency services in larger hospitals drives up standards. They enable the remaining A&Es to be properly staffed at nights and weekends, they say as Britain has a chronic shortage of A&E doctors. But campaigners claim closures are made to save money, not improve care.


    Tens of thousands of patients are resorting to A&E for dental treatment because they find dentists too expensive, official figures suggest.
    Since 2010, the number citing cost as the reason they do not go to an NHS dentist has risen by 50 per cent, to just under a million. At the same time the number receiving treatment at A&Es in England for dental problems has leapt fourfold, to 14,500.
    The true number going to A&E for dental help is likely to be far higher, because almost half of those who attend casualty receive no actual treatment – only advice.

  • Tens of thousands of patients are resorting to A&E for dental treatment because they find dentists too expensive, official figures suggest (file picture)

  • Dr Cliff Mann, president of the College of Emergency Medicine, said as many as one in 20 visiting A&Es at the weekends or bank holidays was now seeking dental help. But he cautioned: ‘We don’t have any dental equipment or dental skills, so beyond giving them painkillers or antibiotics, there’s nothing we can do.’
    NHS dental charges have increased 12 per cent since 2010 – roughly in line with inflation. The cost of a check-up has risen to £18.50, a filling to £50.50 and work such as a crown to £219.
    The British Dental Health Foundation suggested a key factor behind the rise in A&E attendances – revealed in figures unearthed by Shadow Health Secretary Andy Burnham – was the dismantling of NHS Direct, which used to employ dental nurses to give advice.
    The Department of Health said most people could afford a dentist. A spokesman said dental care was free for all children and a third of adults.


  • Winter crisis in A&E: Hospitals declare 'black alerts' as admissions shatter records, but full stats still unpublished

    Extra funds have little impact as fears rise of 'breaking point' NHS unable to handle major flu outbreak

    Jeremy Hunt is under pressure to order the publication of a set of reports showing the full extent of pressures on hospitals in England, amid accusations that the Government is attempting to downplay the scale of a potential winter A&E crisis.
    Labour said the failure of the NHS to publish its weekly "winter pressures situation reports" raised fears that the Health Secretary "doesn't want people to know what's happening on the NHS frontline". And experts believe that vulnerable people are having more accidents in the home because of cuts in social care.
    The NHS insists there has been no political interference. Nonetheless, the reason for the delay remains unclear. If previous practice is followed, whereby figures are published weekly, the delay means that most of the November weeks' figures would not be made public.
    The accusation comes amid mounting signs that hospitals are struggling to cope with a surge of patients arriving at A&E. There were more emergency admissions to English hospitals in the second week of November than in any week in NHS history. Performance against the target to treat or admit 95 per cent of patients within four hours has deteriorated rapidly, despite the mild weather. A colder than average winter is forecast.
    A number of hospitals have been forced to declare "black alerts" in recent weeks – the highest level of alert, which usually means bed capacity has been reached and that patients arriving at A&E will have to be taken to another hospital or that routine operations will be cancelled to free up bed space.
    The winter pressure situation reports, which set out national data on cancelled operations and numbers of ambulances directed away from overcrowded A&Es, were published weekly from November to April last winter. Health analysts had expected comparable data to be published over the same period one year on. NHS England officials are said to have initially blamed a "technical error" for the delay, but this week claimed the reports had been scheduled for release at the start of December instead.
    Andrew Gwynne, Labour's shadow Health minister, said: "This sudden decision raises fears Jeremy Hunt doesn't want people to know what's happening on the front line. The Government's boasts on transparency may be proved hollow.
    "In recent days, we've seen A&Es reach bursting point and effectively shut their doors to new patients. Hospitals in England are under extreme pressure before winter even sets in. Jeremy Hunt must share what he knows and present a credible plan to bring things back up to scratch."
    Hospitals in Peterborough, Portsmouth and King's Lynn have all declared temporary black alerts since mid-October. A major incident at Colchester Hospital in Essex – after an inspection by the Care Quality Commission found "unprecedented" levels of A&E demand – has gone into a second week. Several hospitals now warn patients to think twice before attending A&E, and to attend only in a real emergency.
    Winter is always a busier time for hospitals, as respiratory illness are exacerbated by the cold weather. However, NHS bosses are particularly concerned now because demand is growing sharply and performance is dipping despite a mild November and without a major winter flu outbreak.
    Richard Murray, a former senior Health Department official, said it was also worrying that extra funds – amounting to £700m – to shore up A&Es did not seem to be having a major impact: "It's nice to get the money, but you need to have nurses... to come in to open up wards."
    Typically NHS hospitals cope with winter by opening extra wards, but Mr Murray, the director of policy at the King's Fund think-tank, said many hospitals had not closed these "escalation wards" this year because demand had remained high.
    Figures released last week showed that hospitals were already operating near capacity in the summer months, with one in three at occupancy levels of more than 90 per cent between July and September.
    "The system is running much closer to the wire than it has run for over a decade," Mr Murray said. "Everyone will be watching the temperature. A sustained cold snap would put a lot more older people in hospital."
    He said the heightened demand could not be explained solely by the ageing and growing population.
    "If you look at the number of people admitted [to hospital] this year, the population has not got that old, nor that frail, that quickly," he said. "We've been rolling back social care spending and the number of people getting services for a couple of years has been falling, as part of local government's contribution to deficit reduction. The risk is, what we're seeing now is the consequences of that rollback."
    A Department of Health source said the decision on when to publish the reports was "nothing to do with the Secretary of State". A spokesman for NHS England said: "Weekly information on winter NHS services and activity will commence in the week starting 8 December following a short review of information requirements … It is for NHS England to decide when to start and stop the publication of winter data."


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