NHS hits AnE waiting times target

The NHS in England has met its four hour Accident and Emergency (AnE) waiting time target.

The NHS in England has met its four hour Accident and Emergency (AnE) waiting time targetThe 95% target had not been hit for 33 consecutive weeks, since late last September.

Figures for the week ending 24 May show that 95.1% of A&E patients spent four hours or less from arrival to admission, transfer or discharge.

NHS England praised its front line staff for dealing with high workload demands during a tough winter.

A spokesman said: “These latest figures are testament to the excellent services our front-line staff continue to deliver while coming under sustained pressure.”

The improvement comes as the NHS enters the summer period when these pressures tend to ease.

Dr Clifford Mann, president of the Royal College of Emergency Medicine, said there was no room for complacency.

“There is still pressure on the system, which in our view is operating at full capacity.”

He said some A&E units were still not meeting the four-hour target and were stymied by a shortage of hospital beds.

“This exit block must be addressed otherwise the winter of 2015-16 will be hugely challenging,” he warned.

Latest figures show targets for waits in A&E are being missed in other parts of the UK.

In Wales, 83% of patients are being seen within four hours. In Scotland, the figure is 92% and in Northern Ireland it is just under 74%.

NHS track record over the winter

The NHS has had it’s hardest difficult winter for a long time- so haow has it coped?

NHS track record over the winterThe four hour target to be seen in A&E has been missed in each nation – and that has had a knock-on effect on other parts of the hospital system.

In England all the evidence points to it being the worst winter since the target was introduced at the end of 2004.

The target is officially measured on a quarterly basis and covers the point from arrival to when a patient is discharged, transferred elsewhere or admitted into hospital for further treatment, .

During the last three months of 2014 92.6% were seen within four hours – the worst figure during this whole period.

We will have to wait until the end of March to get the next quarterly data, but performance is on track to be even worse than that.

And NHS England has already admitted the average for the whole of 2014-15 will be below 95% – the first time this has happened for a whole year under the target.

The situation was particularly bad at the turn of the year. A number of hospitals had to declare major incidents, a move normally associated with accidents involving multiple injuries.

To the NHS’s credit, performance did pick up after that point – although not enough to return above the 95% mark.

However, it is worth noting that the UK’s National Health Service has one of the toughest waiting time measures in the world.

Another way to look at it is to see the performance of individual trusts. Take a look at this chart.

England – as the biggest health service and the one that produces the most up-to-date data – has received the most attention.

But the problems have been just as acute elsewhere in the UK. In fact, England could be said to have faired the best.

In January waiting times reached their worst levels in Wales since the current way of recording performance was introduced in 2009.

It got so bad that one police force reported it had had to start taking people to hospital because there weren’t enough ambulances.

Of course, A&Es do not work in isolation and so, unsurprisingly, other parts of the hospital system have experienced problems.

Analysis by the House of Commons Library shows how such pressure points got worse this winter between November and March.

The simple answer is the number of people coming to A&E has gone up. Take a look at these figures.

Between November and February just over 7m visits were made to A&Es in England – 190,000 more than the year before.
The busiest week – the one ending 21 December – saw 446,000 people arrive, up by nearly 10% on the same week the year before and the highest ever recorded.

There were 1.82m emergency admissions – the most complicated cases that cannot be dealt with by A&E – up 51,000 on last year.

But this winter there has also been heated debate about what other factors may have played a role. These have ranged from the new 111 urgent phone service not being as good as it should to problems accessing social care and GPs.

Last spring and summer were also difficult, with the target being missed several times in England.

What is more, Scotland, Northern Ireland and Wales are all still a long way from achieving the target. The A&E story is unlikely to go away just yet.

NHS A&E has worst week in 2014

Pressures in England’s NHS A&E units have hit record levels- with the lowest percentage of patients seen within four hours since monitoring began.

NHS A&E has worst week in 2014New data showed just under 90% of patients were seen within four hours in the seven days up to December 14. Major units particularly struggled, with just six out of 140 meeting the target to see 95% within four hours.

As England is the only part of the UK that produces weekly data, how the NHS is performing here gives the best indication of the pressure the system is under.

Just over 440,000 patients visited A&E in the week ending 14 December with 89.8% seen within four hours.

As well as posting the worst performance against the four-hour target, other measures also show the service is under strain.

There were over 111,000 emergency admissions to hospital – 80,000 from A&E units – which is an all-time high.

Trolley waits – that is waits of four hours or more for a bed once a decision to admit a patient into hospital from A&E is made – topped 10,000 for the first time which compares to under 4,000 for the same week last year.

Delays getting patients out of hospital once they are ready for discharge are also much higher than average.

Performance in England has hit an all time low since weekly monitoring began in 2010, but this looks like it will just be the start of what promises to be the most difficult winter for the NHS for a generation.

The four hour target was introduced in 2004 to combat the long waits patients faced for treatment, since then hospitals have performed remarkably well.

During winter months it has tended to dip below the target level, but not for long. The scale of the drop is causing concern not only to the health service, but to the government too with an election just around the corner.

As health is devolved, data is published differently across the UK.

While England publishes weekly data, the others release it monthly or quarterly. In Wales the data from November shows just 83.8% of patients were seen in time.

Northern Ireland is performing even worse – just over 80% of patients were seen within four hours in November. Scotland has a slightly tougher waiting time target – 98% of patients should be seen in four hours – but in September 93.5% were.

Comparing the September figures for England and Scotland shows England was performing slightly better in that month.

It means according to latest data all parts of the UK are missing the A&E waiting time target.

Each nation has set aside extra money for winter pressures:.

  • In England an extra £700m has been set aside to help the NHS. This is paying for the equivalent of 1,000 extra doctors, 2,000 nurses and 2,000 community staff, including social workers and physios.
  • Ministers in Scotland have announced a total of £28.2m for the NHS to increase capacity and improve the way patients are discharged during winter.
  • In Wales the NHS has been given an extra £200m for this year. The money is for the whole health service, but ministers say it will help relieve the pressures in the coming months.

A&E units start to miss four hour waiting targets

The NHS in England is starting to miss its four hour Accident and Emergency (A&E) waiting time targets for the first time this winter.A&E units start to miss four hour waiting targetsOver the past week, 94.8% of patients were seen within four hours compared to 95.6% the week before. The target is 95%.

The figures cover all 242 centres – major A&Es, smaller minor injury units and urgent care centres. The figures show two thirds of the 144 trusts with major units are missing the target.

It is the first time since April the target has been missed overall – although the major units have been below the 95% mark since July.

It is not unusual for performance to drop in December. For the last three years individual weekly figures have fallen below 95% before Christmas- indeed last winter the NHS was consistently below the 95% figure overall from January to April.

Hospitals are given a 5% leeway to allow doctors to prioritise the sickest patients.

NHS England chief operating officer Dame Barbara Hakin said it was “disappointing” performance had dropped, but said last week was the busiest so far this winter with more than 415,000 people attending A&E, while the numbers that needing admitting to hospital for further treatment – emergency admissions – hit its highest level since 2010.

She added: “We know the A&E standard is ambitious and that is only right. This is the first week since April the 95% standard has not been met, however we do know that sometimes this will happen.”

“Every year we see a dip in the figures for December, with week on week variations which is why we fully assess how local systems are coping with winter pressures over a longer period.”

“We knew this winter would be difficult but it is important to stress the NHS continues to deliver a good service. This is thanks to the hard work and dedication of our frontline staff.”

The drop in performance comes despite the government giving the NHS extra money to cope with winter – £250 million was announced in the summer and another £150m was pledged last month.

A Department of Health spokeswoman added: “We have always been clear that this could be a difficult winter – and there could be more difficult weeks ahead. But the majority of patients continue to get the excellent care they deserve.”

A&E must change or face collapse NHS warned

Urgent changes must be made to the way Accident and Emergencies (A&E) units are run – or the system could collapse, doctors and managers say.A&E must change or face collapse NHS warnedBoth the College of Emergency Medicine and Foundation Trust Network have put forward proposals to overhaul the system.

Funding and staffing have been highlighted as key issues.

Health Secretary Jeremy Hunt said it was “very tough out there” and ministers would deal with it by “better joining up” health and social care.

The warnings come as fears grow over whether the NHS can continue to cope with rising demand.

Last week both ministers and the NHS regulator admitted the problems were a cause for concern.

A&E attendances have risen by 50% in a decade and this winter the NHS in England started missing its four hour waiting time target.

The review by the College of Emergency Medicine – based on feedback from more than half the A&E units in the UK – said the scale of the challenge was the biggest for a decade.

It said there were shortages in both middle-grade and senior doctors. As well as highlighting the workforce problem, the college also said more needed to be done to reduce unnecessary attendances.

It believes between 15% and 30% of patients do not need A&E care and instead could be treated in non-emergency settings.

Meanwhile, the Foundation Trust Network (FTN) highlighted the funding system in England which penalises A&E units seeing a rise in patients.

Under rules designed to encourage the system to reduce A&E admissions, hospitals are only paid 30% of the normal fee for an emergency admission when the numbers rise above the levels that were seen in 2008-9.

But with the NHS failing to curb the rise in patients, that is costing some hospitals millions of Pounds a year.

Across the NHS more patients are being seen, but the upward trend is perhaps the greatest in A&E.

The lack of out-of-hours GP care is the cause of rising demands on A&E.

Since 2004 GPs have been able to opt out of providing night and weekend cover, leaving it to agencies to provide care.

A lack of confidence in the service has meant patients have to turn to A&E when they have not always needed emergency care.

This has been further compounded in recent months with the roll-out of the new 111 non-emergency phone line. Hospitals have reported rises in patients either because they cannot get through to 111 or have got poor advice and been told to go to their local A&E for trivial reasons.

But this does not tell the full story. The ageing population means there has been a rise in long-term conditions – about £7 in every £10 spent goes on patients with problems such as dementia and heart disease for which there is no cure.

111 health direct helpline has been very disappointing admits ministers

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.111 health direct helpline has been very disappointing admits ministersHealth 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.

A&E- accident and emergency facing serious problems

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.A&E- accident and emergency facing serious problemsRising 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.

Scottish waiting list scandal shows Nicola Sturgeon failure as Health Minister

The Scottish waiting list scandal shows Nicola Sturgeon failure as Health Minister.Scottish waiting list scandal shows Nicola Sturgeon failure as Health MinisterNicola Sturgeon must be judged a failure as Health Minister after the discovery of the shambles surrounding NHS waiting lists, Labour’s Scottish leader has said.

Johann Lamont told MSPs that Ms Sturgeon failed to “get out” of politics before her legacy in the health service was unearthed by Audit Scotland in a report this week.

She accused the former Health Minister of using “false statistics and public deceptions” to create the impression her increasingly stringent waiting times targets were being met.

The Liberal Democrats said the Scottish government had published 50 press releases boasting about NHS waiting times. Family doctors have claimed that, in reality, patient care was being sacrificed for politically-motivated targets.

But, in angry exchanges, Alex Salmond defended his deputy by arguing that Labour were more interested in attempting to “get Nicola Sturgeon” than improving standards in the NHS.

The row broke out at First Minister’s Question hours after Audit Scotland disclosed that health boards trebled the number of patients classified as unavailable for treatment as they strove to meet Ms Sturgeon’s waiting times targets.

The former Health Minister and NHS managers were criticised for failing to question how waiting lists were being cut or why the number of patients deemed unavailable was increasing so rapidly.

Ms Sturgeon stepped down in the role in September last year to take charge of the independence referendum. Mr Salmond compared her at the time to Nye Bevan, the founder of the NHS.

But Ms Lamont told MSPs: “What we have found out from Audit Scotland is that patients come second to propaganda for this government.

“Someone should tell Nicola Sturgeon false statistics and public deceptions don’t cure patients and they don’t win referendums either.”

She concluded: “It has been said that in politics there are two types of health ministers, failures and those who get out in time. Isn’t the truth laid bare today that, despite the spin, Nicola Sturgeon didn’t get out in time?”

However, the report found they could not make a judgment in the vast majority of cases as medics had failed to record why the patient had been classified unavailable.

They noted that the proportion of patients deemed unavailable only began to fall after one health board, NHS Lothian, was caught manipulating waiting lists.

Willie Rennie, the Scottish Liberal Democrat leader, asked Mr Salmond if he regretted his Government issuing “50 press releases bragging about his waiting times initiative”.

“He was telling us how good the system was at the same time as thousands were being sent to the waiting times equivalent of Siberia. Has he got anything humble to say to those people?” Mr Rennie asked.

Alex Neil, Ms Sturgeon’s successor as Health Minister, later announced NHS boards will be asked to review their waiting time figures within a year.

From: http://www.telegraph.co.uk/Waiting-list-scandal-shows-Nicola-Sturgeon-failure-as-Health-Minister

Hunt criticises health trust for bullying whistleblower

The Health Secretary Jeremy Hunt, has criticised a hospital trust’s actions after a gagging order was broken to raise concerns about patient safety.Hunt criticises health trust for bullying whistleblowerGary Walker, a former chief executive at United Lincolnshire Hospitals Trust, broke the order when he was interviewed by the BBC.

Lawyers for the trust then warned him he would have to repay £500,000.

Mr Hunt said the trust should have been concentrating on the concerns raised, not heading straight for the lawyers.

“I have written to the chairman of the United Lincolnshire Hospitals Trust to ask him why their first reaction when faced with this was to get their lawyers to send a letter rather than to get to the bottom of the patient safety issues that were raised.”

He told the World at One on BBC Radio 4 that: “I don’t think it’s acceptable, I think it was the wrong thing to do.”

He attacked a culture of “institutional self-preservation” in parts of the NHS.

Gary Walker said he had no choice but to sign an agreement linked to a confidentiality clause in April 2011. He was sacked in 2010 for gross professional misconduct for allegedly swearing in a meeting.

He said he was gagged by the NHS from speaking out about his dismissal and his concerns over patient safety.

Mr Walker told the BBC that demand for emergency hospital beds in 2008 and 2009 became so acute that he felt he had no other choice than to abandon the 18-week Whitehall target for non-emergency cases.

ULHT is one of 14 hospital trusts in England currently being investigated for high death rates, in the wake of the Stafford hospital scandal, where hundreds are believed to have died after receiving poor care.

He said: “It’s a simple decision: you have emergency care or you have care that could wait.”

“It’s not nice to wait but it could wait and therefore we chose as a board – it was not just me – that we should take priority, that emergency care should take priority.”

He said the message from the East Midlands Strategic Health Authority was to hit the targets “whatever the demand” and that he was ordered to resign when he refused to back down.

After the BBC interview, Mr Walker was threatened with legal action for breaching the terms of a package reported to be worth £500,000.

A note from lawyers DAC Beachcroft said: “Having seen an outline of the issues, we have advised our client that if you have provided an interview, or should this interview proceed, you will be in clear breach of the agreement.”

It said that, as a result, “the Trust would be entitled to recover from you the payments made under the agreement and any costs including its legal costs”.

The health secretary said he did not want to make a judgement about Mr Walker’s claims but there were “a lot of very serious allegations that we need to get to the bottom of”.

He said this could become a test case for other “gagged” NHS employees, but said he did not know how many of these orders were in place.

From: http://www.bbc.co.uk/news/health-21471159

Monday mornings are the A&E rush hour

Beware going to your hospital this morning- Doctors and nurses say that Monday mornings are the busiest time of the week.Monday mornings are the A&E rush hourThe busiest time in accident and emergency departments in England is Monday morning, hospital data shows.

There are 4,000 cases every hour between 10am and noon on Monday – twice the average.

Late morning was the busiest time of day throughout the week but Monday came out on top, figures from the Health and Social Care Information Centre show.

There were 17.6 million A&E visits in 2011-12, up from 16.2 million in the previous year.

The chief executive of the Health and Social Care Information Centre, Tim Straughan, said: “It is well-known of course that accident and emergency departments are very busy places.

“The fact that A&E services in England on average see twice the average number of new cases coming through the door collectively on a typical Monday morning indicates just how much society relies on these front line services.”

Dr Clifford Mann from the College of Emergency Medicine said: “As it is implausible that there is an acute deterioration in population health on each and every Monday morning the message inherent in these figures is a lack of primary care capacity.

“This in turn reflects the fact that there is a significant spill over effect from the weekend – again because of a lack of primary care provision.”