The new NHS health direct non-emergency advice line had a “very disappointing start” and is still not operating properly in several parts of the country Ministers have admitted.Health officials have launched an investigation into the advice line after a number of potentially serious incidents, including three deaths, have been linked to the service.

Patients have complained about calls going unanswered and poor advice being given, with frivolous calls being passed on to ambulance services, while serious concerns did not receive a prompt response.

Speaking at the National Institute for Health and Care Excellence annual conference in Birmingham, Lord Howe, a Health Minister admitted that in some parts of the country, the service “fell down”.

He said concerns remained about the way the 111 line is operating in the south west and south east coast.

“We are worried about services in the south west and the south east coast but the rest of the country – we have got 90 per cent of the country covered by 111 – is experiencing a good, if not excellent, service all the time. So we need to get this in proportion.

“We are not happy with those two particular areas and NHS England are gripping it.  We have been very candid about where NHS 111 fell down, we did not want to duck that.”

The extent of the telephone line’s teething problems were laid bare yesterday when official figures revealed a stark rise in abandoned calls.

The number of people who hung up after waiting for more than 30 seconds increased from 6,976 in February to 29,100 in March, according to NHS England figures.

And the average call length also increased from 14.19 minutes in February to almost 18 minutes in March.

Although the total number of calls also increased by 140,000 during the same period as the 111 pilot scheme was adopted more widely, the proportion of abandoned calls increased from 3.2 per cent to 8.1 per cent, the figures show.

Last week, leading doctors warned that the “problematic” roll-out of NHS 111 has left patients not knowing where to turn to for help as posted in the Health Direct blog  NHS 111- warnings over seriously flawed health cover.

The Royal College of General Practitioners said patients have “lost confidence” in the new number before it is even fully up and running across England.

The service was supposed to be rolled out on April 1, but officials were forced to relax the deadline after it emerged that many of the advice lines – which are run by 44 individual local bodies across the country – were not ready to “go live”.

And, more than a month on, seven of the regional bodies are still not even ready to start giving advice to patients in their areas.

The NHS will collapse without decisive action to get more elderly people out of hospitals, Norman Lamb, the health minister, has warned. Mr Lamb, the care minister, said Britain’s system of health and social care is becoming “dysfunctional” and could “buckle under the pressure” unless radical changes are made to the way it operates.

He issued his warning amid growing concern that Accident & Emergency (A&E) departments and ambulance services are failing to cope, with rising numbers of patients forced to endure long waits.

Last week one of Britain’s most senior A&E doctors said units had begun to feel like “war zones” while the head of the NHS and social care watchdog said such services were “out of control”.

Regulators have also announced a review of the NHS funding system for which currently means that hospitals are paid to keep patients in hospital rather than discharging them to their homes or to care homes.

Mr Lamb said the NHS and social care system was under “huge pressure” from an ageing population, with high numbers suffering complex and chronic conditions and that tackling it was “the challenge of the 21st century”.

Mr Lamb said that addressing the funding system so that hospitals did not have a financial incentive to hang on to patients would be a priority.

“The hospital gets paid for a patient arriving in hospital but there is no incentive for them to leave,” he said.

Mr Lamb said the failure of health and social care to work together meant worse care for elderly people and wasted scarce resources.

The Lib Dem minister said: “At the moment the system is horribly fragmented and that means bad care – distress, crises occurring that could be avoided, massive disruption to people’s lives. If we carry on as we are the system will collapse.”

Mr Lamb’s warnings came as the government announced a review of services for elderly patients which could see elderly patients given their own personal NHS worker to oversee their care.

A single “named individual” would manage all care needs for elderly patients from arranging physiotherapy to home help and medical treatment.

The system of paying doctors by results will also be overhauled to focus on rewarding improvements in patients’ health rather than simply completing specified activities.

Your waist should be no more than half the length of your height- according to experts who claim that having too large a trouser size can dramatically shorten your lifespan.Measuring the ratio of someone’s waist to their height is a better way of predicting their life expectancy than body mass index (BMI), the method widely used by doctors when judging overall health and risk of disease, researchers said.

BMI is calculated as a person’s weight in kilograms divided by the square of their height in metres, but a study found that the simpler measurement of waistline against height produced a more accurate prediction of lifespan.

People with the highest waist-to-height ratio, whose waistlines measured 80 per cent of their height, lived 17 years fewer than average.

Keeping your waist circumference to less than half of your height can help prevent the onset of conditions like stroke, heart disease and diabetes and add years to life, researchers said.

For a 6ft man, this would mean having a waistline smaller than 36in, while a 5ft 4in woman should have a waist size no larger than 32in.

Children in particular could be screened as early as five using the waist-to-height ratio to identify those at greatest risk of obesity and serious health conditions later in life, it was claimed.

Researchers from Oxford Brookes University examined data on patients whose BMI and waist to height ratio were measured in the 1980s.

Twenty years later, death rates among the group were much more closely linked to participants’ earlier waist-to-height ratio than their BMI, suggesting it is a more useful tool for identifying health risks at an early stage.

By comparing the life expectancies of various groups of people at different waist-to-height ratios, they were able to calculate how many years of life were lost as people’s waistlines increased.

For example, a man aged 30 with a waist-to-height ratio of 0.8, representing the largest one in 500 men, stood to lose 16.7 years of life due to their size.

A 50-year-old woman with the same ratio, accounting for about one in 150 women of the same age, would lose 8.2 years of life on average.

Dr Margaret Ashwell, whose previous research has suggested that the waist-to-height ratio could be a better tool than BMI for predicting a range of diseases, presented her findings at the European Congress on Obesity in Liverpool.

She said: “If you are measuring waist-to-height ratio you are getting a much earlier prection that something is going wrong, and then you can do something about it.

“The beauty is that you can do it in centimetres or inches, it doesn’t matter. We have got increasing evidence that this works very well with children as well, because whilst they grow up their waist is growing but also their height.”

Patients have already lost confidence in the 111 non-emergency number because it is providing a “seriously flawed” service in some parts of the country, one of Britain’s most senior doctors has warned.Dr Clare Gerada, chairman of the Royal College of General Practitioners, attacked the Government for putting patients at risk by introducing a completely new system on a bank holiday amid the largest reorganisation of the NHS in its history.

She said the service had been only saved from “total collapse” because GPs had shored up the system in parts of the country where it had failed.

Doctors say lives have been put at risk, with desperately-ill patients left waiting hours for help while ambulances have been dispatched to trivial cases.

Dr Gerarda said patients across the country had been left not knowing where to turn for help because the rollout of the phonelines had been “significantly problematic”.

Last weekend it emerged that 22 serious incidents are being investigated in connection with the line, including three deaths.

Further cases to emerge include that of a grieving widow who spent the last hours of her husband’s life on the phone to a call centre walker, begging for pain relief and a man who died of a heart attack last week after 111 staff did not recognise the urgency of his symptoms.

Dr Gerada said: “We now have a situation where patients have lost confidence in the new NHS 111 service before it is even fully up and running. The responsibility for this lies at the door of the Government and it is unacceptable to carry on blaming GPs for what is going wrong with the system.”

The warning came as a senior hospital leader accused the Coalition of causing disorder and overcrowding in Accident & Emergency (A&E) departments, because too many senior staff had been diverted from their work to bring in structural reforms.

Chris Hopson of the Foundation Trust Network said that recent problems are the “chickens coming home to roost” after ministers ordered changes which saw 150 NHS organisations abolished and replaced by 212 groups of GPs last month.

In recent days there have been growing warnings that A&E units have become unable to cope, with senior figures warning that emergency care is now “out of control” across swathes of the country.

Mr Hopson told Health Service Journal that part of the problem was that NHS managers have had to spend too much time bringing in new structures.

He said: “We all know everybody’s attention has been diverted to planning the [changes to] organisations, while the front line has been trying to pull the system together with duct tape, and generally doing a good job.

Mr Hopson said that NHS management bodies and regulators had not co-ordinated their efforts. He said: “From the outside this looks like an omnishambles.”

More than 750 patients have suffered after preventable mistakes in England’s hospitals over the past four years.The incidents, such as operating on the wrong body part or leaving instruments inside patients, are categorised by the Department of Health as “never events”.

This means they are incidents that are so serious they should never happen.

NHS England admitted the figures were too high and said it had introduced new measures to ensure patient safety.

The department has categorised 25 incidents that should never happen if national safety recommendations are followed by medical staff. The BBC discovered through Freedom of Information requests to NHS trusts that the majority of mistakes fell into four categories.

There were 322 cases of foreign objects left inside patients during operations; 214 cases of surgery on the wrong body part; 73 cases of tubes, which are used for feeding patients or for medication, being inserted into patients’ lungs; and 58 cases of wrong implants or prostheses being fitted.

He argued that hospitals have no incentive to report “never events” because they may have to reimburse the cost of the procedure to the NHS as well as paying for the patients’ long-term care.

Horrific as these incidents are, it is important to put them in context. On average each year there are 4.6 million hospital admissions to the NHS in England that require surgery. The NHS says the risk of a “never event” happening to you is one in 20,000.

Dr Mike Durkin, director of patient safety for NHS England, said the 700 “never events” were “too many”. He said: “One is too many in any week, in any day, in any hospital.”

He added that NHS England had started collating the data to help educate staff on better practice.

The World Health Organisation’s patient safety checklist has also been adapted for use in England and Wales.

Accident and Emergency (A&E) departments are facing a “serious problem” a health minister has said, after NHS chiefs ordered urgent action to tackle growing pressures.Rising attendances have meant A&E units in England have started struggling to hit the four hour waiting time target.

The problem has got so bad that NHS England has pledged extra money to help hospitals that are struggling.

But Health Minister Anna Soubry warned there would be “no quick and easy solution”.

She said: “We have a serious problem, we’ve had a problem for a while. If you look at the number of people presenting to A&E it’s grown by a million in just the last year.”

“And unfortunately unless we take urgent action, which we’ve been doing, it’s a problem which will grow. It’s very complicated. There is no quick and easy solution.”

It has been clear for some time that pressures have been growing in A&E.  For the past decade the numbers attending the units have been rising year by year. There are now more than 21 million visits annually – up 50% in a decade.

There is a combination of reasons why they have grown, including a rise in number of people with chronic conditions, such as heart disease, that end up having emergencies; the ageing population; and problems accessing out-of-hours GP care. A&E units have also had problems recruiting middle-grade doctors, which creates staffing problems.

But until recently, hospitals had just about been coping. The harsh winter seems to have tipped A&E units over the edge.

In the past few months, the waits that patients face have reached their worst levels for a long time.

The four-hour target – 95% of patients have to be seen to in this time – started to be breached in many places. Since the start of last month, the NHS overall has missed it.

There are signs that, with the weather improving so have the waiting times, but not as much as many would have liked.

The problem is that A&E is the safety net of the NHS: the place people go when there is no other option. If it breaks there is a real problem.

The situation prompted the Care Quality Commission to issue a stark warning about the future of A&E.

CQC chairman David Prior said: “Emergency admissions through accident and emergency are out of control in large parts of the country. That is totally unsustainable.”

He added: “The patient or resident is the weakest voice in the system. It is a classic market failure. The user doesn’t know nearly as much as the professionals, even with the internet.”

Soon after the CQC warning was made, NHS England announced it was asking regional health bosses to work together to ensure plans are in place for each A&E in their patch by the end of the month.

Health Minister Anna Soubry says lack of access to GP surgeries is “one of many factors” putting pressure on A&E services.

Social care in England is facing a bleak future despite planned changes as services have been forced into budget cuts.Research by the Association of Directors of Adult Social Services showed £800 million was likely to be taken from the £16 billion budget this year.

The group warned it meant “the bleak outlook becomes even bleaker”.

It comes as the government looks set to signal later in the Queen’s Speech its determination to reform the system.

The draft social care and support bill, which is expected to be included in the speech, will be used to clarify the law on social care and pave the way for the introduction of a cap on the costs people face for elderly care.

Currently anyone with assets of more than £23,250 faces unlimited costs, but ministers have said they want to see lifetime costs capped at £72,000 from 2016.

The result of the move would be that many more people would be brought into the state system. Estimates have suggested an extra 450,000.

Health Secretary Jeremy Hunt said the changes to the social care system needed to be made quickly, as the UK faced a “very big challenge” because of its ageing society.
Resorting to rationing

But the ADASS figures, compiled from a survey of directors at 145 of the 152 councils, illustrate the problem councils are facing trying to provide services to the elderly and disabled.

The projected £800 million reduction in spending comes after nearly £2bn has been trimmed from budgets in the past two years.

While social care directors said they were trying to make savings through measures such as more efficient working and better procurement, nearly a fifth thought the quality of life that could be provided would worsen in the coming years.

Half said the numbers able to access services would reduce too as councils resorted to rationing.

ADASS president Sandie Keene said: “Gazing into the next two years, without additional investment from that already planned, an already bleak outlook becomes even bleaker.”

The way the potential closure of NHS residential homes in Northern Ireland has been handled has been “disastrous”, Health Minister Edwin Poots has said.He was speaking as the western trust became the latest NI trust to confirm it plans to close all its NHS homes.

The western trust defended its actions, saying it had tried to be “honest” with people during its discussions.

Deputy First Minister Martin McGuinness criticised the anxiety the plans had caused to elderly care home residents.

Mr McGuinness and Northern Ireland’s first minister, Peter Robinson, re-stated their backing for the policy of caring for older people in their own homes but they hit out at the health trusts.

“Unfortunately, we have seen fear and anxiety on our television screens over the last few days and that is unacceptable,” said Mr McGuinness.

The Southern trust’s decision will affect 80 residents, in the Northern trust the number is 154, and in the South Eastern trust area 128.

In the Western trust there are 128 places available. A spokesperson said 73 of these beds are currently occupied.

Belfast, the largest trust area, began the process in 1990 and has since closed 10 homes.

The remaining three, Pine Lodge, Chestnut Grove and Grovetree House, will close in five years, under natural circumstances according to a spokesperson.

The three have a total of 20 residents.

Over the past decade, a majority of older people who required care in Belfast have moved to places in the private sector/independent sector.

“I think it is incumbent on the department to get a grip on what is happening within the trust and make it clear that this is going to be dealt with in a very sensitive way to ensure that we meet the needs of our older generation.”

Mr Robinson said moving around was “not the kind of thing you want to be doing at any stage of your life least of all when you are in your 80s or your 90s.  That has to be handled very carefully and very sensibly.”

“I think the policy, which was to approximately reduce by half the number of care homes over the next five years, was a sensible enough policy. I’m not quite sure how any trust can justify the closure of their homes and I think they need to seriously look at that again.”

Large providers of care homes in England are to have their financial records regularly checked in future to spot potential business problems.Under the government’s plans, the Care Quality Commission and local authorities will also ensure care continues if a company does go bust.

It comes after provider Southern Cross collapsed, causing distress and anxiety to its residents and their families.

Care minister Norman Lamb said the move would give reassurance to people.

The Care Quality Commission (CQC) will start to make checks on between 50 and 60 of the largest care companies in England, including those that provide care in a person’s home.

CQC chief executive David Behan said the measures – to be set out in new legislation – would provide early warning of potential company failures in the care industry.

The CQC will have the power to:

• Require regular financial and relevant performance information
• Make the provider submit a “sustainability plan” to manage any risk to the organisation’s operation
• Commission an independent business review to help the provider to return to financial stability
• Get information from the provider to help manage a company collapse

The Department of Health said the powers would bring care in to line with other services such as hospitals and holiday operators, which have procedures to check on the “financial health” of organisations.

In the case of the collapse of a national provider the effects would be felt in many parts of the country, so it would be unfair for local councils to have to deal with the problem, the department said.

Mr Lamb said: “Everyone who receives care and support wants to know they will be protected if the company in charge of their care goes bust.

“The fear and upset that the Southern Cross collapse caused to care home residents and families was unacceptable.

“This early warning system will bring reassurance to people in care and will allow action to be taken to ensure care continues if a provider fails.”

Southern Cross, the country’s biggest care provider, had thousands of elderly residents at more than 750 care homes across the UK when it collapsed in 2011.

The firm was brought down by having to pay a £250m rent bill as local authorities made cuts.

After its collapse, other operators had to step in to take over the care of more than 30,000 people.

Patients who missed hospital appointments cost the NHS in the eastern region more than £42 million in the past year alone.There were nearly five million appointments in the east’s 24 NHS hospital and foundation trusts in 2012.

But in about 418,000 cases- nearly ten per cent, the patients failed to turn up.

Automated reminders are cutting the number of wasted appointments but hospitals say patients must do their bit by not wasting resources.

The figures have come from a mix of Freedom of Information requests lodged with the various hospitals and data from the Department of Health.

Although the cost of missed appointments varies widely, a number of hospitals apply a rough figure of £100 – and this has been used to arrive at the £42 million overall cost amount.

A spokesman for Colchester Hospital University Trust said: “It is important that members of the public appreciate that they too have responsibilities, like not wasting precious NHS resources.”

One hospital to see a significant drop in the number of ”did not attends’ (DNAs) was the East and North Hertfordshire NHS Trust.

In April 2011, 4,173 DNAs cost it £417,000. By November 2012, the bill had fallen to £284,670 for 2,847 DNAs.

Dr Tim Walker, a consultant anaesthetist at East and North Hertfordshire, said: “It has been a significant issue because we have a limited capacity to see patients in clinics. If people then don’t turn up we have wasted capacity.

Cambridge University Hospitals had the highest number of DNAs last year with 35,225- it is also one of the region’s largest hospitals.

The cost of appointments varies widely. At James Paget University Hospitals, for example, first appointments tend to cost about £160 and follow-ups about £80

“We can be saving up to £1.5 million a year to the outpatient service without having to lose services or staff.”

Jason Foster, deputy general manager for the hospital’s outpatient service, said simply reminding patients had played a key role in reducing missed appointments.

While hospitals say they are making efforts to reduce the number of DNAs, not all hospital staff regard them as a problem.

One hospital spokesman, who asked not to be identified, said: “Some doctors actually like DNAs because it means they can spend more time with the patients who do show up.

“In terms of the patient experience it can be a good thing – it is not uncommon for consultants to complain about clinics being overbooked, which is one of the reasons why they overrun.”