A&E waiting time over 12 hours for more than 100,000 in England

More than 100,000 patients spent at least 12 hours in A&E departments in England last year, data seen by the BBC's 5 live Investigates shows.

The figures from the Health and Social Care Information Centre (HSCIC) also show the number of people waiting that long has been rising.

There were 124,000 such events (1% of attendances) in the first 10 months of 2015 against 68,000 in all of 2013.

NHS England said the proportion of extended waits was extremely small.

However, it added that even one 12-hour wait by a patient was too many.

The NHS target is for 95% of patients to be discharged, transferred or admitted into hospital for treatment within four hours. All nations currently report performance against this target publically but England is the only nation which does not report 12-hour waits from arrival in A&E.

Dr Adrian Boyle, chair of the Quality Emergency Care Committee at the Royal College of Emergency Medicine (RCEM), said: "It's not just about tedious waits for patients.

"Studies have repeatedly shown that there is an increased mortality in people who spend a long time in emergency departments, so crowding kills patients."

The data includes all patients still in A&E after 12 hours but does not say why they were there so long.

Dr Boyle said: "These are almost always people who need admission to hospital, so these are the most vulnerable and the most seriously ill patients."

NHS England should report 12-hour breaches from the moment a patient arrives in A&E, the RCEM says

The nations measure long waits in different ways. Scotland, Wales and Northern Ireland start the clock from when the patient arrives, whereas the NHS in England does not.

England's published data on 12-hour waits counts the time spent in A&E from the point at which a doctor decides a patient should be admitted - so this figure does not include time spent in casualty prior to a decision being taken, or those patients who are discharged or treated in the casualty department.

Dr Boyle said: "The effect of that is there is a big discrepancy in the figures for how long someone actually spends in an emergency department and breaches of the 12-hour standard.

"NHS England needs to report 12-hour breaches from the moment a patient arrives in A&E."

As a result, trusts in England reported 1,282 breaches of the 12-hour decision to admit standard to the end of November 2015 - compared with the 124,000 occasions provisional HSCIC data shows up to the end of October for the same year.

NHS England said: "The focus in England is the four-hour standard to admit, transfer or discharge, and this applies to all attendances at A&E."

Although there are some differences in definitions, the new figures on 12-hour waits for England mean data is now available for all four UK nations for the first time.

NHS England said: "In terms of comparing NHS England with the NHS in other areas of the UK, we have different standards and different monitoring of such standards. Any comparison, therefore, needs to be approached with caution."

Wales differs from the rest of the UK in how ambulance arrival times are recorded.

ree years, and reached 3.1% up to the end of October 2015 - up from 1.8% in 2013.

The Welsh population is older and generally suffers from higher levels of deprivation than the population of England. There are also differences in how ambulance arrival times are recorded in Wales.

A Welsh government spokesperson said: "The four NHS systems in the UK record A&E data in different ways, including the time the 'clock' starts and stops which is very different in each nation.

"The most up-to-date data for Wales shows the number of people spending more than 12 hours in A&E departments in Wales has fallen - with a 23% drop in December 2015 compared to November 2015.

"The Welsh government will continue to work with the NHS in Wales to reduce the number of people who spend more than 12 hours in A&E departments. However, it should be noted that many people will be receiving active treatment during this time."

In 2015 Northern Ireland reported almost 3,200 12-hour breaches, up to the end of October, representing 0.6% of all major A&E department patients.

Scotland had the fewest with nearly 1,700 12-hour breaches from arrival over the same time period, representing 0.15% of all attendances to major A&E units.

Hear the full report on 5 live Investigates on BBC 5 live on Sunday 7 February 2016 at 11:00 GMT. Or download the programme podcast.

By Faye Kirkland and Gail Champion5 live Investigates 7 February 2016http://www.bbc.co.uk/news/health-35503631?SThisFB

Consider a vote of No Confidence in Jeremy Hunt, Health Secretary

Mr Hunt recently gave totally inappropriate advice to Google conditions before seeking medical opinion. He referred to Paramedics as Ambulance Drivers and has caused the first Doctors strike in years of the NHS. Mr Hunt is destroying all staff morale in the NHS & will cause recruitment issues.

https://petition.parliament.uk/petitions/121152


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Andrew Mitchell's daughter calls for sacking of Jeremy Hunt

Dr Hannah Mitchell, in a letter to the Guardian, says health secretary is ‘either dishonest or stupid’

The health secretary, Jeremy Hunt, leaves his home amid the furore over his imposition of a new contract on junior doctors. Photograph: Dan Kitwood/Getty Images

The daughter of the former cabinet minister Andrew Mitchell, a junior NHS doctor, has called for Jeremy Hunt to be sacked, accusing the health secretary of misusing statistics and alienating “an entire generation of junior doctors”.

Dr Hannah Mitchell, who is currently working on a research fellowship in Botswana as part of her post-foundation programme, warns that the morale of junior doctors is at “breaking point” after Hunt imposed a new contract.

Jeremy Hunt is dishonest or stupid. Either way, he must be sacked

Letters: The health secretary has alienated an entire generation of junior doctors. We have no confidence in him

Read more

In a letter to the Guardian, Mitchell writes: “What Jeremy Hunt has managed to achieve is nothing short of spectacular. Health secretaries have come and gone, imposing new measures of varying unpopularity on the NHS, but not one has managed to so completely unite doctors in their dislike and alienate healthcare workers across the board in the way he has.

“He says we lack vocation, he paints us as the problem. The morale of the workforce is at breaking point; with imposition, the goodwill of doctors who work hours beyond those they are rota-ed and paid to do [so] will dry up.”

Mitchell, who says she is likely to seek permanent work in South Africa after her research fellowship and then a posting in Sierra Leone, said her colleagues have been incensed by Hunt’s claim that the new contract needs to be introduced to avoid preventable deaths at the weekend. Under the contract, doctors will be paid their normal rate for working on Saturdays between 7am and 5pm as part of the government’s plan to create a seven-day NHS.

“I am one of the many junior doctors who have left the UK. If he goes ahead with imposition of [the] contract, I am certainly unlikely to return to the UK to continue clinical practice. The health secretary has alienated an entire generation of junior doctors, we have no confidence in him, he must be sacked,” she said.

Hunt has been accused of distorting the findings of a report, published in the British Medical Journal last year, which highlighted the fact that 11,000 more deaths occur within 30 days of admission to hospitals between Fridays and Mondays.

 What junior doctors should do next in their battle with government

John McTernan

 

Read more

Mitchell said Hunt has misused the report. “The health secretary is not even clear on what he means by a seven-day-week NHS. He continues to misuse research to support his arguments. He has been told the statistics he uses are not correct, meaning he is either dishonest or stupid, I don’t know which is worse. He demonises the BMA, and lies about their actions. They are not a militant union; they are the very moderate voice representing junior doctors in the UK,” she said.

Mitchell is also furious with Hunt’s suggestion that the new contract will introduce a sense of vocation for medical staff. “That is the most inflammatory and appalling thing to say as a health secretary about junior doctors,” she said.

Andrew Mitchell, the former international development secretary, told the Guardian: “There is no three-line whipping system in the Mitchell family. We are an open democracy and there is no dad in the country who is prouder of his daughters and the fantastic doctor that Hannah has become.

“Whatever the merits of this matter, the junior hospital doctors are a dedicated, hardworking and inspiring group of people, although inevitably the government is responsible for managing this resource.”

Nicholas Watt Chief political correspondent

Friday 12 February 2016 16.54 GMT http://www.theguardian.com/politics/2016/feb/12/andrew-mitchell-daughter-calls-for-sacking-of-jeremy-hunt?CMP=share_btn_link

This NHS crisis is not economic. It's political

As the health services endures its biggest squeeze, talk of it being unviable is wide of the mark. We cannot afford to do without it.

H

ow many times have you read that the NHS is bust? No need for answers on a postcard: I can tell you.

Over 2015, the number of national newspaper headlines featuring “NHS” alongside the words bust, deficit, meltdown or financial crisis came to a grand total of 80. Call this the NHS panic index – a measure of public anxiety over the viability of our health service. Using a database of all national newspapers, our librarians added up the number of such headlines for each year. The index shows that panic over the sustainability of our healthcare isn’t just on the rise ­– it has begun to soar.

During the whole of 2009, just two pieces appeared warning of financial crisis in the NHS. By 2012 that had nudged up a bit, to 12. Then came liftoff: the bust headlines more than doubled to 30 in 2013, before nearly tripling to 82 in 2014. Newspapers such as this one now regularly carry warnings that our entire system of healthcare could go bankrupt – unless, that is, radical change ­are made. For David Prior, the then chair of the health watchdog the Care Quality Commission - and now health minister, that means giving more of the system to private companies.

This means that the press and political classes are now discussing a theoretical impossibility. Think about it for a moment, and you realise the NHS can’t go broke. It’s not an endowment with a set pot of cash, but a giant service with a yearly budget. Unlike a business, it doesn’t need to raise money from sales – as taxpayers and voters, we have the final say over how much funding it gets. This panic isn’t economic at all, but politically created.

The balance to be struck with the NHS, as with all public services, is between how much cash we sink into it and how much we expect in return. Give the NHS less money, get less healthcare. Give it more, and the opposite happens. As Rowena Crawford at the Institute for Fiscal Studies says: “Financial stability just requires that healthcare demand and expectations are constrained to match the available funding.”

And that right there is the rub. Because the NHS is enduring the sharpest and most prolonged spending squeeze in its history – even while the government pretends no such thing is happening and the public expect the same service. Our health service is where all the paradoxes of austerity come home to roost.

This may seem an odd thing to say. Isn’t the NHS one of the very few parts of the public realm to be sheltered from this decade’s cuts? Didn’t David Cameron promise before the last general election to “protect the NHS budget and continue to invest more”?

The figures suggest otherwise. True, the NHS is seeing a rise in its funding. Between 2010 and 2014, health spending went up 0.8% each year, adjusting for inflation. A plus sign in front, granted, but a teeny-tiny one – since its creation in 1948, the health service has never had it so bad. Over this decade as a whole, that allocation will amount to 1.2% a year, which is way down on the average 3.7% that health spending grew each year between 1949 and 1979. And, coming after the 6.7% extra that Gordon Brown was shovelling in annually by the time of the banking crash, it feels like a recession.

So on the one hand, you have a healthcare system that can cause even the most secular of Brits to get religion, that can drive Telegraph-reading colonels to channel their inner Nye Bevan – hell, that even beats Justin Bieber to a Christmas No 1. And on the other you have a Tory prime minister who wants to cut public spending but knows that harming the NHS will be electoral poison.

Put the two together and what do you get? A dangerous muddle of overspending, frontline service cuts and political self-denial.

Cameron pretends the NHS isn’t on austerity rations and expects it to do the same work to pretty much the same targets. The various parts of the NHS try to do just that with a budget smaller than they need, with the result that they begin missing targets and making cuts even while breaking their budgets.

Take the A&E waiting times. Under Labour, the old rule was that 98% of patients must be seen within four hours. Soon after Cameron moved into Downing Street in 2010, the target was watered down to 95% of patients – even so it is now routinely missed. The number of patients stuck on trolleys in A&E, while staff try to find them beds is now at levels that “no civilised society should tolerate”, according to the Royal College of Emergency Medicine .

Even while falling short, arm after arm of the NHS is now in the red: 95% of hospital and other acute care providers in England plunged into deficit in the first half of the financial year starting in April, joining 80% of ambulance providers and 46% of those in mental health.

Demoralised staff can resign, go on an agency book, pick their shifts and earn more

You might treat all this as argument for NHS staff to be more productive. Except that, as John Appleby of the King’s Fund thinktank argues, they are. He calculates that, had NHS activity only gone up in line with government money, between 2010 and 2015 it would have treated 3.7 million fewer outpatients and 4.5 million fewer A&E patients than actually got seen.

This is productivity as doing more with less, which is almost always unsustainable. A real increase in productivity would come from doing things differently. There’s certainly scope to do that – by doing more phone consultations with GPs, perhaps, or upgrading technology. One joke among NHS professionals runs that, in all of China, there’s but one factory left still making fax machines, and that its only client is the NHS. But this sort of change is never going to come in an organisation now in a frenzy of cost-cutting.

One example of NHS austerity’s screwy logic is its sudden reliance on expensive agency staff. This, says Anita Charlesworth of the Health Foundation charity, is a direct result of staff pay freezes and overwork: “If you’re a permanent member of staff and you’ve had no pay rise and you’re demoralised and disengaged you can resign from the NHS, you can go on an agency book, you can pick your shifts, you can pick your wards and you earn more.”

The result is that agency staff costs are rising at over 25% a year.

NHS funding is falling behind European neighbours' average, research finds

King’s Fund study ranks UK 13th out of 15 original EU members and casts doubt on ministers’ claims they are giving the NHS generous cash settlements

Read more

Meanwhile, NHS England pretends it can cap hospital deficits for the year at £2.2bn – even though in the first six months alone that hadalready hit £1.6bn . Some of Britain’s biggest and most renowned hospitals are now actively planning on ending the year in the red. And Appleby points out that everything from patient time with doctors and nurses to repairs of your local hospital’s roof is being sacrificed in order to do the same work with less money.

“I can see another Jennifer’s ear coming,” Appleby says, referring to the five-year-old with glue ear who waited a year for a simple operation and ended up being used by Neil Kinnock to attack John Major on health spending. “Only this time it probably won’t be something as innocuous as glue ear. It might be a child who dies of cancer because their medical care has been so drastically cut.”

As societies get richer and older, they spend more on healthcare. Compared with nearly everyone else in western Europe, the UK spends much less of its national income on health. By the end of this decade, we will be even further behind. Meanwhile, pundits will continue to claim the entire system is unaffordably expensive, even while the public still want and need doctors and nurses, their medicines and operations.

This is the paradox of austerity: pretending that you can scrap and scrimp on the services and institutions that make you a civilised country, without making your country less civilised.

Monday 8 February 2016 12.15 GMT

Aditya Chakrabortty

http://www.theguardian.com/society/2016/feb/08/this-nhs-crisis-is-not-economic-its-political?CMP=share_btn_link

Calls for Jeremy Hunt to meet west London council leaders over controversial health reforms

H&F boss Stephen Cowan says the Secretary of State must discuss plans for future of health care

Health Secretary Jeremy Hunt

Health Secretary Jeremy Hunt has been urged to act now over the “spiralling” costs of contentious health care reforms.

Hammersmith and Fulham Council leader Stephen Cowan says the money needed to deliver the controversial Shaping a Healthier Future (SaHF) programme is rising with each day that passes and has called for Conservative cabinet member to meet him and other who oppose the plans.

Reports claim the cost of delivering the programme, which has already led to the closures of A&E departments at Hammersmith and Central Middlesex Hospitals, the maternity unit at Ealing Hospital and concerns over emergency care provided at Charing Cross Hospital, has risen by more than 1,000% - from £112 million in 2012 to £1.3 billion now.

​Labour leader Stephen Cowan

Last year, a report led by Michael Mansfield QC and commissioned by five Labour-run councils found SaHF to be “deeply flawed” .

It called for the reopening of the closed A&E units and urged Charing Cross and Ealing to retain full services for the foreseeable future. The Independent Healthcare Commission also suggested legal challenges may be necessary to halt the NHS’ SaHF programme,

But some criticised the findings, claiming a commission set up by five councils opposed to the SaHF was not independent.

Cllr Cowan and the leaders of the four other boroughs who commissioned the report - Hounslow, Ealing, Brent and Harrow - have written to Mr Hunt urging he meet with them to discuss the report and its recommendations.

He said: “Michael Mansfield’s superb independent report drove a coach and horses through the plans to close Charing Cross Hospital, and called for an immediate stop to the process.

“But as each day passes without a halt, we are seeing costs soar to eye-watering levels, with current estimates putting the price of this scheme at £1.3 billion.

“As Secretary of State, Jeremy Hunt has the power to call a halt to these dangerous changes before any further damage is done – or any more money wasted.

“I am hopeful that, when confronted with the impact these plans will have and their massive cost, he will see sense and act. That’s why I have called on him to get round the table with me and other local council leaders to hammer out a sensible way forward.”

The Department of Health confirmed a letter had been received with a response due to be sent in due course.​

• 17:16, 26 JAN 2016
• UPDATED 17:16, 26 JAN 2016
• BY GOOLISTAN COOPER

http://www.getwestlondon.co.uk/news/west-london-news/calls-jeremy-hunt-meet-west-10786389

NHS NW London’s ‘Shaping a Healthier Future’ (SaHF) Payments to Management Consultants Since 2009/10 Now Exceed £71 Million

​Colin Standfield of ‘Save Our Hospitals’ has assiduously submitted Freedom of Information requests in order to track NHS NW London’s SaHF payments to management consultants. Since 2009/10 to date the payments total £71,640, 908.65. Almost half of this cash has been paid to McKinsey and Company.
One might reasonably ask what measurable benefits have accrued from this massive outpouring of public funds? There has been no discernible improvement in A&E performance. We can all make our own minds up as to whether the closure of two hospital A&E units and the closure of a hospital maternity unit actually count as benefits.​

​

http://www.ealingsaveournhs.org.uk/2016/01/29/sahf-payments-to-management-consultants-since-200910-now-exceed-71-million-2/?utm_content=buffer345e0&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer​

Support Mansfield's Call to Stop The Cuts & Closures

Recent stalls have been very busy and we're set to run another with a new leaflet (Ta Jim & Patrick)

SOH Stall  Sat 30th Jan 2 - 4pm Lyric Square King St - join us if you can.

H&F Council Public Meeting on Mansfield Report

The new leaflet (attached) advertises this upcoming meeting called by the council and supported by SOH designed to inform & listen to local peoples' views about Michael Mansfield QC's findings and his call to stop the cuts & closure plan known as Shaping a Healthier Future. In the meantime council leader Stephen Cowan has, with 4 neighbouring boroughs, written to Jeremy Hunt urging crisis talks. 

H&F Council Public Meeting on Mansfield Report Tues 23rd Feb 7 for 7.30 Hamm Town Hall 

GP Practices receive more money not to refer

Do you remember the news that H&F Clinical Commissioning Group are paying financial incentives to some Gps not to refer people to hospital? Jim challenged them at the last CCG meeting and got lots of flannel. Since then we've found that this spending has almost doubled in the last year to £87,178. To quote GP leader Dr Maureen Baker " it undermines the doctor-patient relationship and the trust that underpins it." 

http://www.swlondoner.co.uk/gp-financial-incentives-slash-patient-hospital-referrals-doubled-south-west-london/

H&F NHS losing 10%

GP incentives seems a peculiar spending priority given the CCG's worsening finances. Andy reports on a recent meeting with H&F CCG leaders in which he was told that our local NHS will be losing more than 10% of the budget over the next three years (about £25 million).  He says "H&F is one of only six areas in the country to lose out in this way – so much for beefing up community to make up for the closure of acute services."

Neighbourhood Health Forums

There's a chance to feedback your experiences about this or other local health services (the good as well as the rarer not so good) at the series of Neighbourhood Health Forums set up by the council to improve local care.

Thurs 4th Feb 7 - 9pm St Matthew’s Church, Wandsworth Bridge Road, SW6 2TZ (for Fulham South)

Will the Mayor back Mansfield?

It will be an enormous boost to the campaigners against SAHF if the new London mayor demands a halt to the SAHF closure plan - in particular to keep Charing Cross as an acute hospital. Some of us have suggested questions and got tickets for a mayoral hustings organised by the Evening Standard in Kensington. It's too late to apply for tickets but we plan to give SOH leaflets to audience and candidates as they file in. (We're not party political, we will be asking people to vote for any candidate who supports the local NHS).

Leaflet the Hustings Wed 3rd Feb 5.30 - 6.30pm Royal Geographic Society Exhibition Rd

Ealing Save Our NHS

Over in Ealing local people are also battling for their acute services - facing a SAHF plan to close the childrens' unit at Ealing hospital this summer as part of a run-down strategy. Consultant paediatrician Tony O'Sullivan, local GP Dr Ajai Sandhu and Dr John Lister of London Health Emergency are putting the case against the closure plan and suggesting how campaigners can most effectively block it.

Ealing Save Our NHS Public Meeting Tues 2nd Feb 7.30pm Ealing Town Hall W5 2BY

Report from Imperial NHS Trust Board Meeting

Worsening finances (and vacancies, A&E waits, staff sickness and turnover) were major themes from the board meeting. At the same time it's important to acknowledge the excellent health outcomes delivered by Imperial's front line staff. Attached is a copy of the board papers with most relevant info highlighted. Interestingly we gave away all our copies of the Mansfield Report to board directors so there's obviously an appetite amongst some for an alternative to the current hospital closure plans. 

A&E Staffing Problems Suppressed

Hopefully the board will also read this shelved report from the government's own advisory clinical panel which highlighted the problem of staff shortages and issued guidance on minimum staffing levels (a critical problem for St Mary's and Charing Cross Hospitals). Against a backdrop of a 35% increase in A&E attendances in England since 2003 Dr Mann, President of the Royal College of Emergency Medicine called for the guidance to be published and considered. Click here to read more.

Regards,

Anne Drinkell (SOH secretary)

Crisis talks urged as hospital closure costs spiral

Charing Cross Hospital

Hammersmith & Fulham leader, Cllr Stephen Cowan has called on Health Secretary, Jeremy Hunt, to ‘act now’ as the cost of contentious changes to local health services spirals out of control.

The North West London NHS ‘Shaping a Healthier Future’ programme has been dogged by controversy since its launch, with a recent Independent Commission chaired by Michael Mansfield QC calling for an immediate halt to the scheme, which would see a majority of services at Charing Cross Hospital axed.

Figures in the report show how costs have soared, ballooning from £112 million in 2012 to £1.3 billion now, a ten-fold increase.

Hammersmith & Fulham leader, Cllr Stephen Cowan, said: “Michael Mansfield’s superb independent report drove a coach and horses through the plans to close Charing Cross Hospital, and called for an immediate stop to the process.

“But as each day passes without a halt, we are seeing costs soar to eye-watering levels, with current estimates putting the price of this scheme at £1.3 billion.

“As Secretary of State, Jeremy Hunt has the power to call a halt to these dangerous changes before any further damage is done – or any more money wasted.

“I am hopeful that, when confronted with the impact these plans will have and their massive cost, he will see sense and act. That’s why I have called on him to get round the table with me and other local council leaders to hammer out a sensible way forward.”

H&F leader Cllr Stephen Cowan and the leaders of four neighbouring boroughs have written to Jeremy Hunt to discuss the Independent Healthcare Commission report and recommendations.

Michael Mansfield QC’s landmark report highlighted a catalogue of deficiencies with the North West London NHS ‘Shaping a Healthier Future’ programme, including plans to axe a majority of services at Charing Cross Hospital.

The public consultation on SaHF, presented in 2012, estimated the capital costs of the scheme would be £112m.

The latest estimates, as of the end of 2015, project capital costs of £1.3 billion.

You can read the background to this story, including Michael Mansfield QC’s landmark report into the North West London NHS ‘Shaping a Healthier Future’ programme here.

» Send us your comments now at Hammersmith and Fulham Council website:

http://www.lbhf.gov.uk/Directory/News/Crisis_talks_urged_as_hospital_closure_costs_spiral.asp#3