Emergency patients are being let down by the health service because managers are more concerned with meeting targets by treating those with appointments, the heads of Royal Colleges warn.

In a letter to The Daily Telegraph, some of the country’s most senior doctors say they are “deeply frustrated” at the low priority given to Accident and Emergency.

Targets concerning waiting times and cancelled operations, introduced under Labour, result in managers pushing doctors to operate on patients whose care has been pre-planned, in order to avoid financial penalties. But they can also mean that those who come in as emergency cases are stabilised and admitted but then left to wait for surgery.

Studies have shown that elderly people with fractured hips who do not undergo surgery within 48 hours are less likely to regain full mobility. Younger patients with shattered pelvises, from motorcycle or horse-riding accidents, are less likely to walk again if their operations are delayed.

A report published on Thursday criticised care for the elderly, finding that two thirds of those who died within a month of surgery had not received proper care and that they had often been left in pain.

Most of those patients were being treated for bowel conditions or broken hips, which are usually admitted as emergency cases.

John Black, president of the Royal College of Surgeons, said the report echoed concerns that surgeons had been raising for some time.

In the letter, Mr Black said: “It is a source of deep frustration to our members that hospitals have become organised to deal quickly with elective operations at the cost of properly managing emergency care.”

The Coalition’s reforms of the NHS could help by making hospitals more accountable to GPs for the care they provide, he said.

The letter was signed by Peter Nightingale, president of the Royal College of Anaesthetists; Peter Kay, president of the British Orthopaedic Association; Finbarr Martin, president of the British Geriatric Society; Mike Horrocks, president of the Association of Surgeons; and Clare Marx, the Royal College of Surgeons’ lead representative in matters of patient safety.

Mr Horrocks said: “In recent years, the NHS has been set targets for elective operations to bring down waiting lists.

“This has been fantastic for patients with non-emergency conditions, but came at the detriment of those who require urgent treatment as hospitals focused on hitting those targets.

“The new government has committed to moving away from targets and towards measuring and rewarding hospitals who deliver good outcomes and this report should provide further evidence that this approach is correct.”

Under Labour, patients had to be treated within 18 weeks of a referral by their family doctor.

Surgeons have told the Telegraph that this resulted in extreme pressure to operate on any patients in danger of failing to meet that target, ahead of cases that came in as emergencies.

Any pre-planned operation that was cancelled was recorded and the data published. The patient then had to be rescheduled within 28 days, adding to the pressure to give elective operations priority, doctors have said.

Mr Black added: “Surgeons have been saying for some time that emergency surgery is a Cinderella service in the modern NHS.

“We will only solve these problems if focusing on emergency care becomes a priority in the boardroom as well as the ward.”

Katherine Murphy, director of the Patients Association, said: “It can be so debilitating for someone who has a fracture to be left for a couple of days or longer, waiting for an operation when the trust is focused yet again on meeting these pernicious targets. It is an appalling way to determine who gets care. An emergency should be an emergency.

“The financial rewards for elective surgery are more lucrative for the trust than for emergencies and that is why trusts continue to focus on elective treatment. We cannot make savings by putting patients through unnecessary pain and suffering.”

From: http://www.telegraph.co.uk/Emergency-patients-let-down-by-targets-say-surgeons

More than half of sufferers with brain tumours or acute leukaemia are diagnosed only in an emergency.
The National Cancer Intelligence Network said 23 per cent of all cancer cases went undetected until the emergency admission stage.

Pensioners and the poor were most at risk of being diagnosed late. The detection rate is even worse among sufferers of brain tumours or acute leukaemia, with more than half of these cancers diagnosed only in an emergency.

The figures were described as “shocking” by leading cancer charities. Spokesmen said a lack of awareness of symptoms among the general population and a failure by doctors to identify the early warning signs were largely to blame.

They called for new screening programmes as quickly as possible and for public awareness campaigns to highlight the symptoms of cancer.

Patients whose cancers are diagnosed only when they reach A&E departments are more likely to have advanced forms of the disease, making it often impossible to treat.

Experts say England’s poor detection rates could explain why the country has much lower survival rates than other countries in Europe. They believe that many hundreds of lives could be saved each year if more early diagnoses were made.

The study comes after the Office for National Statistics disclosed that the cancer death rate among British women was higher than in countries such as France, Italy and Portugal.

Britain has national screening programmes for only three types of cancer: cervical, bowel and breast cancer.

Harpal Kumar, the chief executive of Cancer Research UK, said: “The figure for diagnoses via emergency presentations is way too high.

“This statistic helps explain why we have lower survival rates than we would hope to have, lower than the best countries in Europe.

“We need screening programmes to be rolled out as early as possible and GPs given rapid access to the tests that will enable patients to be moved quickly through the system.” Mr Kumar said people should be better educated about the possible signs and symptoms of different types of cancer.

Prof Sir Mike Richards, the National Cancer Director, who acted as clinical director to the project, said the overall figure of 23 per cent had been “quite a surprise”.

“We need to look at this group of patients and see what we can do to reduce the proportion coming in as emergencies,” he said.

The NCIN, part of the NHS-run National Cancer Programme which coordinates national information on cancer, looked at all English patients diagnosed in 2007 and worked through their files to find when their disease was diagnosed.

The proportion of cancers identified during an emergency varied widely between different types, depending on how easy they are to identify and on general awareness.

Only a small number of skin and breast cancers – 3 and 4 per cent respectively — were diagnosed at emergency, with most identified by doctors or screening programmes.

Overall, 23 per cent of cancer cases were diagnosed during an “emergency presentation” by the patient, most often to A&E departments. Of those with brain or central nervous system cancer, 58 per cent were not picked up until they were seen in hospital, along with 57 per cent with acute leukaemia and 47 per cent with pancreatic cancer.

Patients under 25 and over 75 were the most likely to present as emergencies, as well as poorer ones. These patients were less likely to survive for a year than those whose illness was detected in the doctor’s surgery.

The authors of the study said: “One-year relative survival rates were lower for patients presenting as emergencies than for those presenting via other routes.”

From: http://www.telegraph.co.uk/Cancer-detected-late-in-quarter-of-cases

Britain’s armed forces serving in Iraq show less signs of psychological distress than  doctors in emergency departments.
Psychologists discovered that just over one in five servicemen on deployment showed signs of psychological distress and less than four per cent showed signs of post-traumatic stress disorder (PTSD).

These levels of mental health are the same as soldiers, sailors and airmen in training and less than those in other high-stress occupations, such as police officers, doctors in emergency departments and disaster workers.

Focusing on the mental health of UK armed forces while on deployment, the study by researchers at the Institute of Psychiatry, King’s College London, included servicemen and women at eight locations across Iraq in January and February 2009.

Of the 611 surveyed, 20.5 per cent demonstrated symptoms of psychological distress, while 3.4% showed signs of PTSD.

Respondents were more likely to report good health if they were of officer rank, if they felt their unit was very cohesive and had supportive leadership, and if they had taken a period of rest and recuperation in an area outside an operational theatre.

Those who reported psychological distress were most likely to be young, female, in the Army, and of junior rank.

Personnel belonging to junior ranks were also more likely to show symptoms of PTSD, along with those who felt they were in danger of being killed.

The report showed that sickness levels were very low with only 1.6 per cent of personnel taking more than three days off during their six month deployment.

While a lot of research on the mental health of UK armed forces personnel has been conducted either before or after deployment, very little is known about their mental health during employment, Professor Neil Greenberg from the Academic Centre for Defence Mental Health said.

“Interestingly, those who told us they remembered having a pre-deployment stress briefing reported significantly better mental health than those who did not,” he said.

Although most units had medical support, Prof Neil said training for medical staff had only recently begun to be standardised to ensure it covered mental health disorders.

“Improving training, as well as raising awareness among staff of the link between these personnel reporting sick and having poorer mental health, may help identify those in most need of psychological help,” he said.

Those who took part in the survey, published in the British Journal of Psychiatry, represented about 15 per cent of personnel deployed in Iraq at the time.

From: http://www.telegraph.co.uk/Servicemen-in-Iraq-less-stressed-than-emergency-services-in-Britain

Nearly 100 bereaved relatives and victims of the Stafford NHS scandal are to be paid a total of more than £1 million following Britain’s largest ever group claim against a single hospital.
In total, 97 families of patients who died and victims who survived “appalling” standards of patient care will receive compensation payments, of up to £27,500.

Lawyers for the victims said the failings of Stafford Hospital left patients degraded and humiliated, and amounted to human rights’ abuses.

The trust has offered a total compensation settlements of £1.1 million, which the families are expected to accept, and apologies in each case. It did not accept the failings were breaches of human rights.

A public inquiry into the worst hospital scandal in more than a decade opens next week.

Last year, inspectors found that hundreds more patients died than would have been expected at the hospital between 2005 and 2008, amid “appalling” conditions.

Dehydrated patients were forced to drink out of flower vases, while decisions about treatment for Accident and Emergency patients were left to receptionists.

Up to 1,200 patients may have died needlessly over the period, as managers attempted to cut costs and hit targets.

The settlements for the group of 97 cases, including 84 deaths, covers failings as recent as this year, and dating back to 2002.

Among those to receive a payment is Heather Wilhelms, 55, who lost her mother, father, and husband at the hospital in the space of 18 months.

Her mother’s ovarian cancer was missed, while her father was sent home without treatment days before he died, after blood poisoning went undetected.

Nine months later, her husband died from lung disease in wards which his widow described as “filthy”. She told how her loved ones went to hospital for treatment and one by one, came out in their coffins.

The compensation payouts range from £1,000 to £27,500, with an average payment of just over £11,000 for bereaved relatives and those who survived failings in care.

Emma Jones, from lawyers Leigh Day & Co, which represented the families, said the action was believed to be unprecedented, with the 97 cases representing the largest group to be offered payouts by one hospital.

She said lawyers argued that the hospital’s failings were so basic and substantial, that they amounted to breaches of patients’ fundamental human rights.

Miss Jones said: “This was about basic neglect; food and drink placed out of reach, buzzers unanswered, people left after soiling themselves.

“In some cases we argued that the poor treatment caused the deaths – in many, the argument was that basic fundamental human rights were being denied – that people were being degraded, neglected and humiliated.”

Often, when elderly people die following failings in hospital, compensation is low, especially if no spouse is bereaved.

The lawyers said the case was significant because the arguments had centred on how badly patients had been treated, rather than proving their deaths had been hastened.

“For the relatives it was never about the money but more a recognition that their mum, or dad should never have been left to suffer in that way,” said Miss Jones.

She added: “We don’t know of any bigger group claim against any one hospital, we think this is unprecedented.”

The Labour Government refused to hold a public inquiry to find out what went wrong, and to prevent a repeat of the scandal.

Since taking power, the Coalition Government has ordered such an investigation – one of the key demands of The Sunday Telegraph’s Heal Our Hospitals campaign – which is due to start taking evidence next week.

On Saturday an inspection report revealed that the hospital is still failing to meet most basic standards of patient care.

The Care Quality Commission said it had concerns about the care and welfare of patients, and respect shown to them, its safeguarding of patients from abuse, the management of medicines, the safety of premises and equipment, staffing and complaints.

Inspectors said the trust had made progress, and that some of the concerns involved changes which would take time to “bed in”.

Last week it emerged that the trust had paid a locum Accident & Emergency doctor more than £5,000 to work a single 24-hour shift, in response to a sudden staffing crisis.

Julie Bailey, who founded local campaign group Cure the NHS as a response to the standard of care given by the hospital to her own mother, who died in 2007, said: “The size of the group exposes the scale of this crisis; it is an absolute disgrace that in the 21st century, the most vulnerable people were treated so appallingly.”

She added: “For relatives who have gone through this, no amount of money can ever compensate for what happened to their loved ones.”

Mrs Bailey said there were many more relatives and victims who had never received a penny. “Every day, someone comes to me who has never even spoken before about what they went through.

“There are so many people suffering as a result of this scandal, and no one has been held to account for what we are going through.”

Antony Sumara, Chief Executive of Mid Staffordshire NHS Foundation Trust, said: “As always, I offer our sincerest apologies to the families concerned, for the distress caused by the poor care their relatives received at our Trust in the past.

“We have made a lot of progress over the last year in improving the care for our patients and will continue to focus our efforts on building on these improvements and making sure that they are sustained.”

From: http://www.telegraph.co.uk/Almost-100-victims-of-Staffordshire-scandal-receive-payouts-after-unprecedented-group-claim

NHS patients will be denied hospital beds because they will be bed blocked by the elderly and vulnerable who are unable to get council care after government cuts, a health service chief has warned.The Coalition has promised to increase the NHS budget over the next four years, even as it cuts more than £40 billion from other public services.

Patients will be left untreated as the NHS struggles to mop up the consequences of severe cuts in local authority funding, said Nigel Edwards, the head of the NHS Confederation.

The Coalition has promised to increase the NHS budget over the next four years, even as it cuts more than £40 billion from other public services. Local councils will bear some of the heaviest cuts.

In a letter to The Daily Telegraph, Mr Edwards — whose organisation represents NHS trusts running hospitals and ambulance services — says the cuts in local authority budgets will force them to reduce care services for the elderly and vulnerable.

“Less support from council services will quickly lead to increased pressure on emergency services and hospitals,” he writes. “Hospital beds will be blocked for those who badly need care because the support services the elderly require after discharge will not be available.”

Calling for a greater co-ordination of council care services and NHS facilities, he says: “When it comes to the care of the most vulnerable in our society, it really is essential that the NHS and local authorities are in it together.”

His warning coincides with the most explicit admission yet from a Cabinet minister that the Coalition’s cuts in public spending will cause genuine distress.

Danny Alexander, the Chief Secretary to the Treasury, says in an interview with The Daily Telegraph that the cuts will mean real hardship for many. “For a lot of people it’s going to be very difficult indeed,” he says.

Mr Edwards’s warning comes in response to this week’s spending review, which set out Coalition plans to address the deficit in public finances. Central government support for councils in England will be reduced by 27 per cent over the next four years, leaving them seeking deep cuts in the services they offer.

Councils last year spent £14 billion on adult social care services. Care funding is the largest part of council budgets not legally ring-fenced, leaving it vulnerable to cuts.

To reduce the scale of any cuts in care, the Treasury this week earmarked £2 billion over the next four years for councils to spend on adult care services. However, local government leaders and charities said it was not enough to compensate for larger cuts in council budgets.

The Local Government Association, which represents councils in England and Wales, said even with the extra cash councils would still face a £4 billion shortfall in budgets for adult social care by 2014. A spokesman for the LGA said the spending review would have a significant impact on care services.

Some councils have already begun raising the entry criteria for care to those judged to be in the most severe need.

Government sources said ministers were aware of the likely pressure on the health service and had set aside funds in the NHS budget for care services.

A spokesman for the Department of Health said it was understood that social care could have an impact on NHS demands and that is why they were strengthening programmes that would integrate hospital care with care in the community, as well as providing the extra funding.

He added that “we expect local health and social care professionals will work together” to “improve outcomes for everyone”.

Kieran Mullan, from the Patients Association, said: “Social care and the NHS do not exist in silos. One impacts directly on the other. Poor services in the community lead to admissions to hospital and lack of services prevent discharge when it might be best for the patient.”

From: http://www.telegraph.co.uk/Spending-Review-2010-NHS-faces-bed-blocking-crisis

The number of under-18s admitted to hospital because of drinking has increased by a third, according to a new report.The figure went up by 32 per cent between 2002 and 2007, with 36 children a day being admitted for alcohol related conditions, the study by the charity Alcohol Concern found.

Over the last five years, London Ambulance Service responded to 11,780 alcohol-related call-outs involving under-18s at a cost of more than £2.5m, the research showed.

In 2009/10, West Midlands Ambulance Service responded to 1,296 alcohol-related call-outs involving under-18s at a cost of almost £250,000, while the North East Ambulance Trust responded to just under 1,000 at a cost of £175,000.

In all cases, more young girls were seen by ambulance crews than young boys, the charity said.

Alcohol Concern also found that between 2004 and 2009 28% more girls were admitted to hospital via accident and emergency departments for alcohol than boys – 23,347 girls compared to 18,159 boys.

The report ‘Right time, right place: Alcohol-harm reduction strategies with children and young people’ calls for earlier identification of young people engaged in ‘risky’ drinking such as young people attending A&E or getting into trouble with the police for alcohol, so they can access information, advice and support.

The charity’s chief executive, Don Shenker, said: “As long as alcohol remains as heavily promoted as it currently is, young drinkers will continue to consume far more than they might otherwise, leading to inevitable health harms, wasting ambulance and police time.

“As well as tackling the ludicrously cheap price of alcohol in some settings, we want all under-18-year-olds who turn up at A&E to be advised and supported to address their drinking.”

A spokesman for the Department of Health said: “This report shows the devastating impact that alcohol has on the lives of young people who drink too much. We must educate them so they understand how bad it is for their health now and in the long term. And we must do more to stop shops selling alcohol to under 18s.

“Everyone has a part to play in this. Parents, police, education and social services need to work together. The new Public Health Service will give communities the power and budget to tackle alcohol problems in their areas.”

From: http://www.independent.co.uk/figures-show-rise-in-drinkrelated-hospital-admissions-for-children

The Summary Care Record IT program  is to go ahead, but its content will be limited to core information with an opt out form will be included in patient information packs.

The Department of Health has published the results of two simultaneous reviews of the SCR, covering the content of the record and the information patients receive before their record is uploaded.

The reviews were set up by the coalition government this summer, following concerns about patients’ awareness of the SCR and the kind of information added to it. This had led to the suspension of further patient information programmes.

The review of the content of the record, led by NHS medical director Sir Bruce Keogh, concluded that the core record should only contain a patient’s demographic details, medications, allergies and adverse reactions, and that these should continue to be copied from the GP’s medical record.

The review group said the DH should only consider expanding the content of the record “when we have built trust in the system and when patients request that we should do so.”

Sir Bruce said: “In an advanced national health system, it is reasonable for citizens to expect that when they arrive in accident and emergency or require treatment out of hours, the clinicians treating them have access to enough basic medical information to prevent anyone making wrong or even dangerous decisions.”

The separate Patient Information and Preference Review group, led by national director of patient and public affairs Joan Saddler, concluded that an opt-out form should be included in the patient information packs, and that these should also be simplified.

It said services such as HealthSpace should also continue to provide access to SCRs.

Almost 30m patients have already received information about the SCR but the review concluded that there should be no requirement to send another letter to those patients.

However, it said but there should be awareness raising campaigns at local, regional and national levels to ensure patients realise that an SCR is being created for them unless they choose to opt out.

Health minister Simon Burns said he was pleased that a consensus had emerged about the importance of the SCR in supporting safe patient care, so long as the content of the record was limited to core information.

He added: “Coupled with improvements to communication with patients which reinforce their right to opt out, we believe this draws a line under the controversies that the SCR has generated up to now.

“We see this review as having taking a significant step towards the goal of patients owning their records and using them to share decision-making with healthcare professionals.”

A BMA spokesperson said: “We welcome the progress that has been made towards an emergency electronic record that supports urgent care, yet recognises many of the understandable concerns of patients and clinicians.

“Much will depend on the way the amended scheme is put into practice, and the BMA looks forward to continuing our work with government on its implementation. It is essential that patients have genuine control over who has access to their records, and when changes are made to them.”

The review groups concluded that patients should play a key role in deciding the evolution of the record and that new arrangements should be introduced to define responsibility for decisions about the introduction of any new content to the record.

They said the principle should be that any change to the scope of the record should be driven by citizens and patients with appropriate advice from professional bodies and in line with the IT capability.

Saddler said the availability of core information when patients need care was essential if patients were to be at the heart of care but it should also be easy for patients to opt-out.

She added:”Patients must be the ones who decide if any additional information should be included in their SCR, supported by appropriate professionals. This is the only way we will build trust in the SCR and its use.”

The SCR Content Review group said standards should be defined to support a patient’s wish to add information to their SCR such as end of life preferences, a care plan for patients with long term conditions or the inclusion of a patient’s significant medical history.

The review groups, which between them took evidence from almost 50 bodies, said it had heard strong opinions that the use of smartcards was not universal within GP practices which had implications for accurate updating of the SCR.

The reviews said use of smartcards was outside their remit but recommended that further options were investigated to mitigate the risk of practices not using smartcards.

The review group on Patient information and Preferences also recommended that the outer envelope that patients receive should have clear emphasis that the information contained in the envelope is about “Your health records, you need to make a choice.”

John Heyworth, president of the College of Emergency Medicine, said the college welcomed the decision to proceed with the SCR.

He added: “Clinicians working in emergency departments are currently often deprived of key background and patient information, particularly during the initial phase of time critical treatment and this may significantly compromise the quality and safety of care provided.

“Immediate access to such records will lead to better and safer care for our emergency patients.”

The review’s conclusions were backed by a range of bodies including the Patients’ Assocation, The Royal College of Nursing, Asthma UK and Sue Ryder Care.

From: http://www.e-health-insider.com/summary_care_record_given_go-ahead

Intensive care bed experts believe there will not be more intensive care beds as health budgets shrink.
The relatively low number of intensive care beds in UK hospitals means it is poorly prepared for major disasters, a report in the Lancet says.

Critical care experts say there may be as few as 3.5 intensive care beds per 100,000 people in the UK, compared with more than 24 per 100,000 in Germany.

Dr Gordon Rubenfeld, from Sunnybrook Health Sciences Centre in Toronto, said that huge investment would be needed to keep pace with the growing demand for intensive care services.

One figure suggests that by 2030, the incidence of acute lung injury will have risen 50%, driven by pneumonia cases in older people.

Dr Rubenfeld analysed the availability of critical care beds in various countries, and while conceding that the figure of 3.5 per 100,000 might under-represent the true position, he concluded that, at present levels, the UK would not be in a good position to deal with the extra demands of a disaster.

If we have a pandemic of normal winter flu we would be stretched to the limit”

Currently, an intensive care bed costs the NHS about £1,500 a day, and Professor Mervyn Singer, from University College London, said it was unrealistic to expect a significant expansion of intensive care at a time when health budgets were shrinking in real terms.

He said: “We are clearly in a worse position than some other countries because there is no spare capacity in the system, with many units running at 100% capacity, or close to it.

“While it would be nice to have extra wards and staff ready in the event of a disaster, it is not a particularly pragmatic expectation.

“There are things you can do in the event of a disaster, such as cancelling surgery, which frees up beds, but it is very much a ‘make do and mend’ approach in these circumstances.”
Local demands

Dr Kevin Gunning, a consultant in intensive care at Addenbrooke’s Hospital, Cambridge, and a spokesman for the Intensive Care Society, said that in the event of a major pandemic or other disaster, the true determinant of intensive care capacity would be staff such as trained nurses rather than beds or equipment.

While there had been significant improvements since the year 2000, when a severe outbreak of winter flu caused problems across the NHS, he said the UK was still relatively poorly resourced compared with much of western Europe.

He said: “It’s fair to say that we would have struggled with a flu pandemic of the scale some were predicting last year.

“If we have a pandemic of normal winter flu we would be stretched to the limit.”

A Department of Health spokesman said: “The number of beds has increased and continues to increase but more does need to be done in some areas.

From: http://www.bbc.co.uk/news/health-11503873

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