The rise in emergency admissions to hospitals is “overheating” the system in England and is “unsustainable” in the future, a health think tank says.
Analysis by the Nuffield Trust found there were now 4.9 million unplanned admissions a year – a rise of 12% since 2004-05 – costing the NHS £11bn a year.

It said a rise in patients who spent a day or less in hospital suggested many admissions could be avoided. NHS managers agreed action was needed to tackle the problem.

Emergency admissions include patients admitted through A&E units as well as direct into other parts of hospitals.
Ageing population

The think tank, which analysed a range of official NHS data during its research, found emergency admissions now accounted for more than a third of the total.

The rise seen since 2004-05 is costing the NHS an extra £330m a year alone and the think tank said the issue had to be a priority if the NHS was to prosper in the current economic climate.

Researchers found there was a range of factors behind the trend.

They pointed to the ageing population – the elderly were more likely to be admitted as an emergency – as well as financial incentives in the NHS which were motivating hospitals to admit more.

The report also noted there had been a significant jump in patients being admitted for one day or less.

It said this was partly related to advances in medicine which meant patients did not need to spend as long in hospital, but argued many could have been avoided with better community services.

While the report only looked in detail at the situation in England, it also noted rises had been seen elsewhere in the UK.

And it said the recent announcement by ministers that hospitals would be fined for readmissions would only have a limited impact as many of the cases did not fall into that category.

Nuffield Trust director Dr Jennifer Dixon said: “Reversing this unsustainable rise in emergency admissions must be the number one priority for the NHS – any reform to the health service that does not tackle this will fail. Our hospitals are overheating and are treating patients at great cost to the NHS.”

Nigel Edwards, acting chief executive of the NHS Confederation, which represents managers, said: “This report furthers the case for fundamentally reviewing the urgent and emergency care system.

“Hospital is often the right place for sick patients to be but we know that for many there are better, more convenient and more cost-effective alternatives to hospital admission.

Dr John Heyworth, president of the College of Emergency Medicine agreed there were pressures in the system, but questioned some aspects of the research.

“It is fundamentally incorrect to assume that admissions for less than 24 hours are unnecessary or financially inefficient. In fact, the opposite applies.”

From: http://news.bbc.co.uk/1/hi/health/10490508.stm

NHS Hospital waiting times have been relaxed or scrapped as part of a drive by the new Government to rid the NHS of Labour’s ‘target culture’.

Nursing and doctors’ leaders welcomed the greater flexibility they have been given to treat patients according to clinical need rather than being forced to stick to strict central guidelines.

But patients’ groups expressed concern that the reforms could result in a “free-for-all,” and that without targets long waiting times could return to the NHS.

GPs will no longer be forced to see patients within 48 hours of them seeking an appointment.

The requirement for 98 per cent of patients attending Accident and Emergency wards to be seen within four hours has been relaxed to 95 per cent.

And the target for patients to be given a hospital appointment within 18 weeks of being referred by their GP has been abandoned altogether.

Andrew Lansley, the Health Secretary, insisted that people would still have the right to demand high levels of service from the NHS, but that this would be done locally rather than dictated from the centre.

“I want to free the NHS from bureaucracy and targets that have no clinical justification and move to an NHS which measures its performance on patient outcomes,” he added.

“Doctors will be free to focus on the outcomes that matter – providing quality patient care.”

Katherine Murphy, director of the Patients Association, said: “The targets focused minds in the NHS, made people start realising services had to get better.”

But Dr Laurence Buckman, Chairman of the BMA’s GPs Committee, welcomed the relaxation in targets.

He said: “Patients should have good access to GPs. However, while this target may have been intended to improve access it has in fact had adverse consequences.

“At the moment practices need to have enough appointments available on the day or the following day to meet the target, so those who want to book in advance find there are fewer appointments available.”

Under the changes to the NHS Operating Framework, Mr Lansley has also ordered health bodies to reduce management costs from £1.85 billion to £1 billion by 2013.

While spending on the health service will continue at current levels, he said it was crucial to make “immediate” savings which could be reinvested in patient care.

From: http://www.telegraph.co.uk/NHS-waiting-times-are-relaxed-and-abandoned

There will be a full public inquiry into the scandal hit Stafford Hospital in Mid Staffordshire NHS Trust, the government has announced.The Tories had promised the probe in opposition after reviews had criticised “appalling” standards which were said to have caused needless deaths.

Campaigners consistently said it was the only way to uncover the failings, but previous labour ministers had resisted.

As they emerged into the rain from the House of Commons to pose for photographers, Stafford Hospital campaigners hugged each other and laughed. “It’s the first time we’ve smiled since this whole thing began,” Julie Bailey told me. She’s the woman who founded Cure the NHS after her mother died at the hospital having experienced what Julie says was eight weeks of dreadful care.

The group has been pressing for a Public Inquiry since the Healthcare Commission first uncovered the extent of the problems at Stafford Hospital last year. They argued that anything less wouldn’t have the powers to answer all their questions. Julie Bailey looked tearful as I asked her about her mother’s experience.

“I’ve done this for her,” she said. “She’d have done all this and more if she’d had the chance.” She believes the public inquiry will mean people who’ve been able to duck questions until now will be forced to account for themselves. “It’s not about revenge,” she said, “it’s about accountability and openness. Tomorrow we’ve got to start a new beginning for the NHS because we don’t need any more unnecessary deaths.”

The problems at Stafford – run by the Mid Staffordshire NHS Trust – were laid bare by the NHS regulator in March 2009.

The Healthcare Commission reported there had been at least 400 more deaths than expected between 2005 and 2008.

It cited a catalogue of poor standards, including cases where receptionists had been used to assess emergency patients.

But this was just one of a long-line of reviews.

These included an independent inquiry launched by the government. It was held in private and reported in February, saying the trust had become driven by targets and cost-cutting.

Campaigners believe the failings of Stafford go much further than one badly-run trust however. The trust had been climbing the NHS ratings ladder during the period in question and was even given elite foundation trust status.

So earlier this year the Labour government set up a further inquiry looking at the role of the wider regulatory agencies, but this was not enough for campaigners.

They demanded a more wide-ranging probe which had tougher powers. A public inquiry is held in open and is able to compel witnesses attend hearings and cross examine them.

Mr Lansley said: “We know only too well what happened at Mid-Staffordshire, in all its harrowing detail, and the failings of the trust itself.  “But we are still little closer to understanding how it was allowed to happen by the wider system.  The families of those patients who suffered so dreadfully deserve to know. And so too does every NHS patient in this country.

“This was a failure of the trust first and foremost, but it was also a national failure of the regulatory and supervisory system who should have secured the quality and safety of patient care.”

The inquiry will be chaired by Robert Francis QC who had led the government inquiry and was asked to do the same for the follow up one.

Mr Lansley said he did not want Mr Francis to go over the ground already covered, but focus instead on how the culture in the NHS allowed this to happen.

The final report is expected in March 2011.

The health secretary also said he wanted to strengthen the ability of staff to whistleblow.

He said he would be issuing guidance to trusts on their procedures as well as looking to introduce a contractual right for staff to raise concerns that are in the public interest.

Julie Bailey, founder of Cure the NHS, the campaign group set up by the families of victims, said: “A year ago David Cameron promised a public inquiry and he’s kept that promise.  The terms of reference and scope are just what we wanted.”

“Former health ministers, Department of Health executives in Whitehall and in Stafordshire will now have to exlain why they did not stop this disaster.”

From: http://news.bbc.co.uk/1/hi/health/10274537.stm

NHS Hospitals will face financial penalties if patients are readmitted as an emergency within 30 days of being discharged, under new government plans.
The scheme was unveiled yesterday by Andrew Lansley, in his first major speech as the new health secretary.

Hospitals in England will be paid for initial treatment but not paid again if a patient is brought back in with a related problem, he said.

It has been argued that patients are being discharged early to free up beds.

The Conservatives have said cuts to the number of hospital beds under Labour put pressure on NHS staff to discharge people without support.

Between 1998-99 and 2007-08, the number of emergency readmissions in England rose from 359,719 to 546,354. But there was also a significant rise in the number of procedures performed over the same time period.

Readmissions as a percentage of all patient discharges went up marginally, from 8% in 1998-99 to 10.5% in 2007-08.

Speaking about his vision for the NHS, Mr Lansley called for patients to be given more control over their healthcare.

And he said hospitals would have the responsibility of looking after patients’ health and well-being for up to a month after they are discharged.

Currently primary care trusts and GPs look after patients once they are discharged from hospital.

Under the new plans hospitals would receive funding for the first hospital stay plus treatment for the patient’s first 30 days after discharge.

Mr Lansley promised to “empower patients as well as health professionals” and “disempower the hierarchy and the bureaucracy”.

He said: “We need a cultural shift in the NHS. From a culture responsive mainly to orders from the top-down, to one responsive to patients, in which patient safety is put first.

This change of direction will send a ripple through hospital managers with some enterprising chief executives will see it as a chance for hospitals to extend their services into the community.

If they are to provide extra follow up care, and bear the cost of unavoidable complications, hospitals will be hoping to see that reflected in the price they are paid for each operation.

England is unique in the UK in paying its hospitals for each treatment they carry out, a system called payment by results.

This will be the main lever which the Health Secretary can use to change the incentives in the system.

He said that targets focused on processes, data returns and more Department of Health circulars would not achieve these aims.

“Over the last ten years emergency readmissions have increased by 50 percent. Not, it seems, primarily because patients were more frail, but because hospitals have been incentivised to cut lengths of stay and send patients home sooner – process targets creating risks for patients.

“So in addition to getting rid of these targets – we’re going to ensure that hospitals are responsible for patients not just during their treatment but also for the 30 days after they’ve been discharged. It will be in the interests of the hospital for patients to be discharged only when they are ready and safe.”

And if a patient is readmitted within that time the hospital will not receive any additional payment for the additional treatment – they will be focused on successful initial treatment, he said.

Nigel Edwards, policy director of the NHS Confederation, which represents most NHS trusts, said the proposal to withhold money for readmissions was a good idea.

“The principle of offering this, as long as we don’t have hospitals getting in the way of GP care, is a perfectly sensible one and certainly one we see in other countries.”

Dr Anna Dixon of the King’s Fund said readmissions can occur because of a lack of proper care provision in the community. And she warned that abolishing targets might lead to a rise in hospital waiting times.

The British Medical Association’s Dr Hamish Meldrum agreed saying: “This could result in patients being kept in hospital longer than necessary, when it might be better for them to be at home.

“We should remember that there can be a range of reasons that a patient is readmitted, many of them beyond the control of the hospital.”

Katherine Murphy, director of the Patients Association, said: “We have always campaigned for patient safety to be at the forefront of services and withholding payment to fix poor outcomes and giving patients more information to help them make informed decisions about their care are significant steps towards this.

“We welcome a much greater emphasis on the patient experience and a focus on patient needs and helping patients play a bigger role in shaping their health service.”

From : http://news.bbc.co.uk/1/hi/health/10262344.stm

The NHS is facing upheaval and cutbacks as a decade of budget increases comes to an end and £20 billion of savings must be found over the next five years.

Despite pledges from Labour and the Conservatives to protect front line services, there is evidence that their promises may have come too late.

A list of cuts has already been identified – including job losses, banning certain operations, closing casualty departments, downgrading maternity services and reducing the number of junior doctors. But these have been mostly quietly ignored by the three main parties.

The Conservatives pledged to stop all closures until they could be reviewed but, with billions of pounds of savings needed to cope with growing demand, cuts and closures are almost inevitable.

David Cameron emphasised that he was personally in favour of the NHS, after his experiences with his disabled son Ivan, who died last year, to combat arguments that the health service was not safe in Tory hands. The party manifesto contained promises about dentistry and round-the-clock GP services which appear too expensive in the current climate.

Both the major parties were accused of chasing the “fear of cancer” vote. The Tories said they would fund cancer drugs turned down by Nice, the health rationing watchdog, but did not mention drugs for other illnesses such as arthritis or dementia.

Labour said cancer patients would see a specialist and have test results back within a week. The party was criticised for unveiling its manifesto at a new hospital in Birmingham. It is against the rules to use NHS premises for election events.

But Labour pointed out that the hospital was still in the hands of the private finance initiative organisation – a policy which means the NHS will be repaying billions of pounds for new hospitals for decades.

Nick Clegg refused to ring-fence NHS spending given the size of the national debt.

The Liberal Democrat campaign focused on cutting waste on managers, scrapping regional strategic health authorities and pledging more power to communities to direct the health service locally.

From: http://www.telegraph.co.uk/General-Election-2010-cuts-inevitable-as-NHS-must-make-savings

A quarter of health trusts failed to meet standards over hospital infections while five were warned over blood-spattered walls and mouldy instruments under a toughened regulatory regime.

Of particular concern was the state of ambulances, which were inspected for the first time. Investigators found dirty forceps stored in some vehicles as well as bloodstains.

The Care Quality Commission (CQC) used its sweeping powers last year to assess how well NHS trusts were coping with hospital infections – which affect 300,000 patients a year.

Of the 167 trusts inspected, 42 were found by the commission to be in “breach” of NHS registration requirements by not meeting standards.

All 11 ambulance trusts in England were assessed – and four found to have violated the terms of their NHS contracts.

Things were so bad that ambulance services in the north-west, east of England and east Midlands received formal warnings for the state of vehicles and stations.

The CQC, derided by critics as a toothless watchdog for “naming and shaming but not paining”, revealled that it has been granted the power to impose tough sanctions that could see failing hospitals warned, prosecuted, fined up to £50,000 and ultimately closed down if they fail to comply with the regulator’s edicts.

As a test-run of this regime the commission was authorised to examine the risks in the NHS of healthcare- associated infections and the results revealed that a minority appeared to take a cavalier approach to safety.

The reasons for failure were worrying: 36 trusts were not providing areas to decontaminate instruments; in three trusts there was a failure to regularly flush unused water outlets – crucial for the control of legionella infections; and 13 trusts were criticised for not keeping clinical areas clean.

Nigel Ellis, the CQC’s head of national inspection, said: “Good infection control takes constant vigilance – and meeting that every day, for every patient, is an ongoing challenge for the NHS.

“We have found evidence of a direct risk to patients and have intervened using our new enforcement powers to ensure swift improvements were made.”

Of these failing trusts, five had to be issued with a warning notice – the first step towards losing the right to operate in the NHS. Investigators pinpointed several serious transgressions, especially in ambulances.

In the north-west vans were stocked with dirty neck braces that were continually reused despite health guidelines urging disposal after one patient’s use.

At Stockport ambulance station, vehicle interiors were “seen to have stains (which appeared to be bloodstains) on the walls as well as visible dirt on the floor and walls”.

In Essex “hand wipes were not available” and “poor levels of cleanliness” were found in 22 out of 23 vehicles inspected. Ambulance equipment in the East Midlands was singled out for being “visibly dirty, including suction units, defibrillators and the tips of forceps”.

The hospitals highlighted for poor practice were both foundation trusts: Basildon and Thurrock university hospitals, and the world-famous Alder Hey children’s foundation trust in Liverpool.

In Basildon, where the commission’s old ratings system had come under fire last year for labelling the hospital “good” weeks before it emerged that dozens of patients might have died after receiving substandard care, investigators found a dismal scene: “Procedure trays used by staff to carry equipment when they take blood samples or give injections had blood spattered on them … a commode soiled under the seat.” Out of date equipment was also found in the emergency stores.

In Alder Hey, one of Europe’s largest children’s hospitals, the inspection revealed dirty toys, hair stuck to medical equipment and “nappy changing mats stored on the floor next to a toilet … and a dirty baby bath was inside the full-size bath”. The water “ran brown” from taps in rooms ready for patients to be admitted.

The commission said the threat of further measures had pushed the offenders into cleaning up their act. Hospitals and ambulance trusts were forced to set up better procedures, buy new equipment and “deep clean” wards and vehicles – or face a rolling wave of inspections. The last of the conditions imposed for infection control was removed only last December.

Under the new regime CQC can send teams of investigators, accompanied by groups of patients, to hospitals to see whether they match “client” expectations. The bolstered regime is capable of 2,000 unannounced visits a year – three times the current level. “We want to put the patient at the heart of what we do,” said Dame Jo Williams, acting chair of the commission. “Doesn’t matter if it’s the health service, the banking system or Tesco, there is something about the way you are treated as a patient or a client or a customer.”

From: http://www.guardian.co.uk/quarter-nhs-trusts-failing-hygiene-tests

The NHS has wasted more than £11m using ambulances as “waiting rooms” to get around Labour’s target that patients should be treated within four hours of entering casualty.

New figures reveal the time spent by crews waiting outside hospitals for their patients to be admitted last year was the equivalent to funding 31 fully staffed ambulances to do nothing for 24 hours a day.

The statistics released by NHS ambulance trusts show the amount of time ambulances are forced to remain idle is increasing each year. In the first nine months of 2009 the total so-called “dead time” in England reached 284,000 hours — more than the whole of 2007.

The four hour target was introduced in 2004 in an effort to end the scandal of patients left on trolleys overnight waiting to be seen by doctors.

However, it has led to hard-pressed casualty departments refusing to admit patients until they can be sure they can be seen within the four hour limit. Waits of more than two hours occur in hundreds of cases each year.

Mike Penning, a shadow health minister, said: “It is a scandal that desperately needed frontline paramedics are trapped at hospitals around the country because of Labour’s fixation with the target culture.

“It can’t be right that bureaucracy has taken over from clinicians being able to put patients first, rather than watching the clock. Millions of pounds are being wasted and patients are suffering.”

The Conservatives have promised to slash the number of NHS targets and hand more power to doctors.

From: http://www.timesonline.co.uk/tol/news/politics/article7078867.ece

Doctors say a key NHS target – to treat people visiting accident and emergency units within four hours – is compromising care and patient safety.

The College of Emergency Medicine says the target, at English hospitals, puts staff under “incredible pressure”.

It says it supports having a target in principle, but that doctors sometimes need time to make the right decision.

The government says safety and good quality care should always take priority over targets.

The NHS target in England to deal with patients in A&E within four hours has been highly controversial. Critics say it forces clinical staff to put deadlines before quality of care.

The chairman of the College of Emergency Medicine, Dr John Heyworth, says the target has helped to make emergency care a priority for the NHS. But he says staff are being forced to meet it at almost any cost.

“We’ve had nurses reduced to tears. We’ve had very senior consultants in emergency medicine threatened with a disciplinary process.
 
Patient safety and good quality care should always take priority over administrative targets where a doctor believes that is necessary
Department of Health spokeswoman

“This is an outrageous misuse of the standard.

“It’s not what the clinicians are in the emergency departments for. But it’s representative of the immense pressure being put on chief executives and all managers downwards from there to comply with the target.”

The four-hour target is just one of a range of centrally imposed standards, most of them designed to speed up treatment.

They have been used in other parts of the UK but have been much more heavily enforced in England.

Politicians now dislike the language of centrally-imposed targets in the NHS.

The Conservatives and Liberal Democrats say they will scrap them. Labour now prefers to talk about “standards”, “entitlements” and “guarantees”. The issue promises to be an important dividing line in the general election.

Professor Julian Le Grand, who was senior policy adviser to Tony Blair between 2003 and 2005, says many patients did benefit from targets – but he recalls that the then-PM was troubled by complaints from doctors about the targets regime.
 
“I remember sitting in a meeting once where the prime minister said ‘do we have to just keep beating up on the consultants – in A&E for instance – endlessly to achieve this? Or is there some way we can think of building in incentives within the system so that we’ll get these quality improvements on their own, without always having to crack the whip?’”

That led to a shift towards encouraging more patient choice and competition between hospitals, rather than relying on targets to improve standards.

The trust’s director, Dr Jennifer Dixon, says they are a potent way of achieving quick results.

“I think there’s widespread consensus that targets have resulted in immediate benefits, for example in reduction in waiting times.

“It’s highly unlikely that those other reforms could have had that impact so quickly and so precisely on the waiting times. So it’s really ministerial “diktat” almost that’s produced the goods.”

The Department of Health said that, in England at the beginning of 2003, almost a quarter of patients spent more than four hours in Accident and Emergency. It argued that since then there has been a “revolution in patient care”, reducing that figure to less than 2%.

A spokeswoman said: “The funding for hospitals has risen dramatically and targets are minimum standards which taxpayers have a right to expect from NHS hospitals.

“Patient safety and good quality care should always take priority over administrative targets where a doctor believes that is necessary.

“Despite his concerns over the four-hour standard, Dr John Heyworth from the College of Emergency Medicine said he had nothing against targets in principle. But he said he wanted a more sophisticated measure that accounts for quality of care, as well as speed.

From: http://news.bbc.co.uk/1/hi/health/8580761.stm