Grantham A&E unit's night closure policy to remain (7 August 2017)

A decision to close a hospital accident and emergency unit overnight has been backed by the government.

United Lincolnshire Hospitals NHS Trust (ULHT) closed Grantham Hospital's unit a year ago because a lack of doctors.

In February, Lincolnshire County Council asked Health Secretary Jeremy Hunt to review the decision.

Mr Hunt then called for the Independent Reconfiguration Panel (IRP) review and backed its view the unit should not reopen until it had "sufficient staff".

The county council's Conservative leader Martin Hill described Mr Hunt's decision as a "disappointing result".

"The fear that this 'temporary closure' would be anything but temporary, has proved to be entirely founded", said Mr Hill.

"It is unacceptable that Grantham district has had a substantial change to hospital services for over a year without proper consultation or planning."

ULHT employs about 17 doctors across its three sites in Lincoln, Boston and Grantham, and needs a minimum of 21 to keep all of them open for 24 hours.

The trust's actions led to protests from a campaign group opposed to the closure of the unit from 18:30 to 09:00.... read more


Hospital stops children surgery in a bid to improve services (3 August 2017)

Children's surgery will move out of The Royal Orthopaedic Hospital to others "better placed" to provide the specialist care, says the trust which runs the hospital.

The board of The Royal Orthopaedic Hospital NHS Foundation Trust said the Birmingham hospital will cease providing paediatric surgery by 1 January next year but adds that patients currently awaiting surgery will see "no immediate changes".

The decision follows a report by the Care Quality Commission earlier this year which said the hospital "required improvement" within several areas, including it's services within intensive and critical care.

The Trust has undertaken a significant amount of work and investment to meet these recommendations, and progress has continued to be made. However, recent external reviews over the last few weeks have reiterated that paediatric inpatient surgery would be better delivered in a hospital setting with access to extensive centralised care facilities at all times.

The Royal Orthopaedic Hospital Statement

.... read more


Lack of mental health support leaving children stuck in hospital – thinktank (The Guardian: 26 July 2017)

Children with serious mental health problems are becoming trapped in NHS psychiatric units, unable to leave because care is unavailable outside hospitals, a thinktank has said.

NHS figures show that between October 2015 and September 2016 children and young people in England spent almost 9,000 days in hospital after being declared fit to be discharged. Some end up stuck in units for several months.

NHS England did not tell the Education Policy Institute how many patients were involved in the 9,000 days, despite being asked this in a freedom of information request. But the thinktank said data showed the problem was growing.

The total number of what the EPI termed “wasted days” was 42% higher between December 2016 and February 2017 than in the same period in 2015-16. In January alone this year, under-18s spent 804 delayed days in mental health inpatient units, compared to 553 the previous January.

Delayed discharges of such patients can occur because their home area cannot provide the specialist support they need to ensure they remain safe.

Sarah Brennan, chief executive of the charity Young Minds, said: “Far too many young people are being left in limbo in mental health hospitals because the right support isn’t available in their community. In some cases they may have to wait weeks or even months before they are discharged.”... read more


Sick patients dying ‘unnecessarily’ in NHS because of poor care (15 July 2017)

Some of the sickest patients that hospitals treat are dying unnecessarily because they receive poor care, blighted by shortages of staff and equipment, a new NHS inquiry has revealed.

A death rate of one in three among inpatients who need emergency help with breathing is already high by international standards, and is getting worse.

The analysis by the National Confidential Enquiry into Patient Outcome and Death of NHS services for the 50,000 patients a year who receive emergency oxygen treatment uncovered a series of major flaws in the care they received. It described its findings as “shocking”.

The growing numbers of patients who receive non-invasive intervention (NIV) – oxygen through a face mask – usually have chronic obstructive pulmonary disease, pneumonia or other conditions which mean they cannot breathe unaided. Despite their lives being at risk, the vast majority receive sub-standard care, according to an in-depth examination of 353 patients during February and March.

“The care of these patients was rated as less than good in four out of five cases. The mortality rate was high: more than one in three patients died,” the inquiry found. “Supervision of care and patient monitoring were commonly inadequate. Case selection for NIV was often inappropriate and treatment was frequently delayed due to a combination of service organisation and a failure to recognise that NIV was needed.” In addition, investigators found from examining case notes that “the quality of medical care provided was often poor. This poor care included both non-ventilator treatment and ventilation management, which were frequently inappropriate”.... read more
Children's hospital units forced to close to new patients due to staff shortages (The Guardian: 27 April 2017)
Hospital units that treat children and very sick babies are having to shut their doors temporarily to new patients because they are “dangerously” short of specialist staff, a new report reveals.

Widespread shortages of paediatric doctors and nurses also means that the care children receive is being put at risk, according to the Royal College of Paediatrics and Child Health.

A chronic lack of staff is forcing doctors to take potentially life or death decisions about which patients to treat quickly, one paediatrician said. “Last night we only had one registrar instead of two. We had an emergency in A&E and [the] labour ward at the same time and she had to make a snap decision which to go to. It’s being forced to dice with death,” said the medic, who asked to remain anonymous.

Another paediatrician said: “It’s becoming normal to do the work of two or three so corners are constantly being cut and kids don’t get the time and attention they deserve.” Read more


Continued STP hospital closures risk A&Es reaching ‘danger point’ (NHS England 24 April 2017)

The performance in North West London A&E departments has suffered considerably following the closure of two emergency departments in the area, sparking concern about the effect that 24 potential closures across STPs in England could have on national performance and patient safety.

In the ‘Can we afford to close any more A&E departments?’ report released today by the Centre for Health and the Public Interest (CHPI), it was revealed that following the closure of the A&E departments, performance in North West London hospitals has seen a considerable drop, with performance against the 95% four hour waiting time target falling to as low as 60% in some hospitals.

The research found that before the closure of Central Middlesex A&E and Hammersmith A&E, the performance of Type 1 A&E departments across North West London hospitals met the four-hour target between 78% and 95% of the time during the winter months....Read more


NHS staff ask 'least bad' patients to sleep in corridors amid hospital demand crisis (The Telegraph: 28 February 2017)

Patients are being asked to volunteer to sleep in corridors in order to free up spaces on overrun NHS wards, a new report reveals.

An anonymous survey of front-line doctors found staff are deliberately approaching the “least bad” patient in their ward to ask them to give up their bed.

The report on NHS performance in December and January by the Royal College of Physicians also reveals concerns that “panicking” managers desperate to get new patients into recently vacated beds are sidelining proper infection controls.

Patients groups said the document showed that quality hospital care has now become “a lottery” and that, despite a relatively mild winter, the NHS is “on course for catastrophe”.

Approximately 60,000 patients visited A&E a day in England in the last week of December, and early data indicates that a quarter had to wait for more than four hours to be seen, with many having to wait for up to 12 hours...Read More

Hospitals could join prisons in cycle of 'crisis, cash, repeat', says report (The Guardian: 28 February 2017)
Better financial planning and reforms needed to avoid ‘disastrous combination of failing public services and breached spending controls’

Hospitals could join prisons and social care in a cycle of “crisis, cash, repeat” unless they receive better financial planning and reforms, a Whitehall report has warned.

Without improvements, public services are doomed to fail or breach spending controls, the report by the Institute for Government and the Chartered Institute of Public Finance and Accountancy (Cipfa) said.

The government’s austerity programme of delivering good services while cutting spending “ran out of steam” in 2015, according to an analysis of official figures. Both organisations are urging the chancellor to ensure any measures in the budget have sound evidence behind them.

The findings come as Philip Hammond comes under pressure to use an unexpected rise in tax receipts to aid public services in his first full budget next week.

Julian McCrae, the Institute for Government’s deputy director, said that unlike others, this report was not calling for more money but instead better organisation to shore up the public sector.

“As we’ve seen with prisons, social care and now potentially hospitals, the government risks getting into a cycle of crisis, cash, repeat,” he said. “This report is a call for better financial planning and reforms that are robust enough to survive public scrutiny."...Read More

Hospitals feel the strain all year (The Argus: 21 February 2017)
 The impact of cuts in health and social care is becoming extremely dangerous for patients with crucial hospital space being taken up by those ready to leave, campaigners have warned.

On one day last week more than 160 people were stranded on hospital wards despite being ready to be discharged.

The delays were caused by there not being enough beds in the community or support in their own homes had not been arranged.

Last Thursday Brighton and Sussex University Hospitals had 58 delayed discharges...Read More 
British Medical Association: 'NHS at breaking point' as shortage of beds compounds situation (ITV News: 20 February 2017)

The NHS is at "breaking point" with a decline in the number of hospital beds compounding the situation, according to the British Medical Association.

A reduction in bed numbers has led to delays in admissions and cancelled operations, the BMA claimed.

In a report, based on official statistics, almost three-quarters of NHS trusts were found to have a bed occupancy rate of over 95% on at least one day in the first week of January this year.

The BMA also reported that in November 2016, 14.8% of patients spent more than four hours waiting for a hospital bed, having been seen in an A&E department.

Its findings have been described by Labour as a "wake-up call which Theresa May must not ignore".

The Liberal Democrats, meanwhile, warned that the situation in the NHS was becoming "intolerable"...Read More

NHS Health Check: A&E waits for January 'worst ever' (BBC News: 9 February 2017)

Record numbers of patients spent more than four hours in accident and emergency units in England in January, figures leaked to the BBC suggest.

During a difficult winter for the NHS, January appears to be the worst performing month in the past 13 years.

The figures also suggest record numbers of people waited longer than 12 hours for a hospital bed once seen in A&E.

The BMA said the prime minister could no longer "bury her head in the sand" over increasing pressure in the NHS.

And it accused the government of failing to grasp the seriousness of the situation.

But a spokesman from the Department of Health said the vast majority of patients were seen and treated quickly, and busy periods in hospitals were supported by an extra £400 million of more
NHS Health Check: Nine in 10 hospitals ‘overcrowded’ this winter (BBC News: 6 February 2017)

The number of patients on hospital wards in England has been at unsafe levels at nine out of 10 NHS trusts this winter, BBC analysis shows.

To minimise the risk of infections and delays in getting treatment, hospitals are meant to have no more than 85% of beds occupied.

But the analysis showed 137 out of 152 hospital trusts have been above that level since the start of December.

NHS bosses said hospitals had major problems discharging frail patients.

One experienced hospital boss described some of the weeks this winter as the “worst” he had seen in his career...Read More


One in six A&E departments at risk of closure or downgrade (The Guardian: 6 February 2016)

One in six A&E departments face being closed or downgraded in the next four years, according to an analysis of NHS proposals.

About 33 casualty departments in hospitals in 23 areas of the UK are facing either complete closure or being replaced with minor injuries units.

The plans are part of efforts to plug a £22bn hole in the health service budget by 2021. Health officials insist the changes will come alongside efforts to modernise services and increase specialist urgent care.

In seven cases, proposals have been drawn up, some of which have been issued for local consultation. According to research by the Health Service Journal (HSJ), 26 more hospitals are now considering plans to close or downgrade services but no final decision has been made.

The seven hospitals for which there are public proposals to downgrade or close emergency departments include Sandwell and West Birmingham hospitals trust’s City hospital and Sandwell district general hospital, which are due to be replaced by a new department at the Midland Metropolitan hospital that is scheduled to open in 2018.

The remaining 26 hospitals may have their A&Es downgraded or closed but, equally, they could be kept or upgraded. Decisions are expected to be made between either Shrewsbury or Telford, Bedford or Milton Keynes and Darlington memorial hospital or the University hospital of north Tees.

In total, about 24 of the 33 hospitals under discussion are likely to lose full A&E services, the HSJ said.

Hospitals across UK cancelling 'urgent' cancer operations as NHS winter crisis worsens (The Independent: 15 January 2017)

Hospitals across the UK are cancelling "urgent" cancer operations as the NHS winter crisis worsens.

Some patients have reportedly been told with just a day's notice that their surgery has been postponed, with a leading surgeon saying it was "extremely worrying" that hospitals had resorted to the decisions.

Cancer operations have previously held a protected status but the demand for beds and lack of social care capacity has encroached on that.

Clare Marx, president of the Royal College of Surgeons, told The Observer: "Feedback from our members suggests that since the start of January, a large number of hospitals across the UK are now cancelling cancer surgery. This will be extremely worrying to patients and their families.

"It is heartbreaking for a surgeon to have to explain to a patient who has cancer that their operation has had to be cancelled as there are no beds available. It is increasingly clear that no part of the system and no patient is immune from the pressure the NHS is experiencing." more


Thousands forced to wait outside swamped hospitals as cold spell hits (The Telegraph: 3 January 2017)

Heaving A&E departments are forcing thousands of patients to wait for hours in ambulances outside hospitals as freezing conditions hit the UK.

Health chiefs were forced to apologise yesterday after spiraling waiting times in one hospital caused a queue of 20 ambulances unable to offload patients.

In London alone, the winter crisis means more than 6,000 patients each week are being left in the back of emergency vehicles because A&E departments are too busy to admit them, new figures reveal.

The turnaround issues means an unfortunate delay for our patientsSouth Central Ambulance Service

The crisis in hospitals means that ambulance services are then unable to respond to subsequent 999 calls.

Last night Britain’s most senior emergency medicine doctor said departments across the country were “buckling under pressure” with staff “working at the very limits of their abilities”...Read More


NHS could face its worst January as it struggles with festive backlog, warns doctor (The Guardian: 2 January 2017)

The NHS is facing “potentially the worst January” ever as it struggles to deal with the backlog of patients occupying beds over Christmas, a leading doctor has warned.

Dr Mark Holland, president of the Society for Acute Medicine (SAM), said hospitals had already seen large numbers of elderly patients over the festive period and that the health service was on the brink of a major crisis.

Holland, who is based in Manchester, said hospitals were operating under a “false sense of security” as elective procedures dipped during the Christmas period with those beds becoming available for emergency patients.

Once routine operations start up regularly this week, hospitals must make these allocated beds available again. A bout of flu, the winter vomiting virus, or even a cold snap, could prove the tipping point, he warned....Read More


Jeremy Hunt accused of compromising weekday hospital care (The Guardian: 2 January 2017)

The health secretary, Jeremy Hunt, has been accused of compromising the care patients receive during the week by not taking forward his pledge to hire more junior doctors to help deliver a seven-day NHS.

The Liberal Democrats’ health spokesman, Norman Lamb, said that with juniors now having to work more at weekends, already under-staffed hospitals had fewer medics on duty on weekdays.

He said Hunt had done little to make good on the hiring pledge he made in parliament during the year-long dispute over junior doctors’ contracts.

“My fear is that unless you can guarantee that there will be more junior doctors employed, imposing a change which involves more hours being worked at weekends will inevitably reduce the numbers of hours worked during weekdays when the pressure is at its greatest,” Lamb said. “This could result in real safety concerns.”

In a letter to Lamb, Hunt failed to provide any detail of how many more junior medics would be trained and employed this year or any other year before the end of this parliament in 2020.

He has previously acknowledged the potential for too few doctors being on duty between Monday and Friday as a result of the new contract he imposed in October on all 54,000 junior doctors working in the NHS in England.

Hunt told Lamb that it was up to hospital trusts to expand their junior doctor workforce, raising doubt that his previous assurance would be acted on.

Nor did the letter provide any detail on how many extra trainee medics would join the NHS this year, despite Hunt having told Lamb in the House of Commons on 5 September that he would give him a number.....Read More


Hospitals ordered to divert patients from overstretched A&Es (The Telegraph: 18 December 2016)

Hospitals have been ordered to divert thousands of patients from Accident & Emergency units in an unprecedented step to help stave off a winter crisis.

GPs and nurses will be sent to the front doors of casualty units to turn away less serious cases, in a bid to tackle record demand and overcrowding as Christmas approaches.

At least 14 hospitals have already set up such schemes, which are supposed to ensure that the sickest patients get priority treatment, in the face of mounting strain. NHS England has now ordered dozens more struggling hospitals to set up such services in a matter of days.

The requirement is for every single acute provider to have streaming/co-located services during peak hours in the first instanceNHS England board papers, 15 December

Hospitals have already been ordered to stop carrying out the majority of operations for at least a month, in a bid to reduce dangerously high levels of bed occupancy. They were given a deadline of Monday December 19 to reduce occupancy from 95 per cent to a recommended safe limit of 85 per cent.

The new measure, revealed in papers to the board of NHS England, is an attempt to reduce numbers coming through the front door of A&E, amid warnings of “unprecedented demand” for services.

The paper, discussed by NHS England’s board on Thursday, warns that health officials have found "significant gaps" in health service plans for more


Hospitals in England told to put operations on hold to free up beds (The Guardian: 16 December 2016)

Hospitals in England have been advised to halt elective surgery over Christmas to ensure enough beds are free for patients who need emergency treatment at the end of the year.

In a sign of the intense pressures on NHS resources over the winter months, the regulator NHS Improvement said all hospitals should make more beds available between now and mid-January.

Jim Mackey, the chief executive of NHS Improvement, said the focus needed to be on emergency patients at what he called a critical time for the health service. Many hospitals take steps to wind down the number of operations they perform over the Christmas period, but a letter obtained by the Health Service Journal states that operations may need to be postponed “beyond any current plans”.

“In preparing for managing winter pressures, it is recommended that all providers pace their elective work by introducing elective breaks where trusts cease most in-patient elective activity and focus on treating emergence activity and non-admitted patients.”

Highlighting how much spare capacity is thought to be necessary, hospitals are being advised to reduce their bed occupancy to 85%. The rate currently stands at 95% across NHS more


Sharp rise in 'trolley waits' for hospital beds in England (The Guardian: 7 December 2016)

There has been a sharp rise in “trolley waits” – the length of time people wait for a hospital bed in England after being admitted in an emergency, figures show.

Data analysed by the BBC shows 473,453 patients waited more than four hours between October 2015 and September 2016 – almost a fivefold increase since 2010-11.

The figure represents 11% of the 4.2 million patients admitted over the period. More than 1,400 patients faced delays of more than 12 hours.

In 2010-11, there were 97,559 trolley waits – although NHS England said a small fraction of the rise could be attributed to a change in the way the waits were measured last December.

While the waits are known as trolley waits, the figures include patients waiting in side-rooms, seats in the A&E department and spare cubicles before being admitted to a ward.

The BBC also reported that three-quarters of hospitals in England are reporting bed shortages. Bed occupancy is not meant to exceed 85%, to give staff time to clean beds, keep infections low and ensure patients who need beds can be found them more


Sick children moved as NHS intensive care units run out of beds (The Guardian: 3 December 2016)

Seriously sick children are having to be transported long distances to receive intensive care this weekend because of a lack of beds in major cities.

In England, 85% of beds available in paediatric intensive care units were full on Friday night. But some units in cities including London and Leicester have been forced to declare themselves as “at capacity”. Planned operations are, in some cases, being delayed to prepare for any possible emergencies, as the system shows signs of serious strain as winter starts to bite.

The director of communications at NHS England, Simon Enright, tweeted: “It is true that the NHS is very busy at the moment – record demand.”

It has long been feared that this winter would expose the frailties of the health service. Last month, the cross-party health select committee, chaired by Tory MP Sarah Wollaston reported widespread concerns among medics at the beginning of December because they had already been struggling to deal with the level of demand.

As part of the NHS’s contingency preparations, every hospital trust was ordered to draw up plans to cope, with new “A&E delivery boards” to be set up. Thousands of non-emergency operations and appointments in the run-up to Christmas have been cancelled to enable doctors to concentrate on discharging patients who can safely be sent home, in an effort to free up beds. Official figures show 6,000 more A&E attendances daily compared with six years ago.

Yet last week it emerged that ambulance response times were declining in England, Scotland and Northern Ireland, and last night senior doctors said the problems in paediatrics were a sign of systemic more


NHS transformation plans may be used as cover for cuts, says BMA (The Guardian: 21 November 2016)

Controversial plans put forward as a way of improving the health service in England and ensuring its sustainability risk being used as a cover for cuts and running down the NHS, the head of the British Medical Association (BMA) has said.

The doctors’ union says the 44 regional sustainability and transformation plans (STPs) amount to £22bn in cuts by 2020-21 to balance the books, which will have a severe impact on patient care.

Guardian analysis of the plans that have been published has found that thousands of hospital beds are set to disappear, pregnant women will face long trips to give birth and a string of A&E units will be downgraded or closed.

Dr Mark Porter, the BMA council chair, said: “Improving patient care must be the number one priority for these plans. Given the scale of the savings required in each area, there is a real risk that these transformation plans will be used as a cover for delivering cuts, starving services of resource and patients of vital care.”

NHS England is expected to find £22bn in efficiency savings by 2020-21 but its finance directors and independent experts have suggested the target is unattainable, as the health service struggles with unprecedented demand and more


A&E, cancer and maternity units to close in major NHS overhaul (The Guardian: 18 November 2016)

Thousands of hospital beds are set to disappear, pregnant women will face long trips to give birth and a string of A&E units will be downgraded or even closed altogether as part of controversial NHS plans to reorganise healthcare in England.

A Guardian analysis of the 24 NHS regional plans that have now been published – more than half the total of 44 – has found that health service chiefs plan to push through an unprecedented centralisation of key hospital services across England.

Opposition to the plans is growing among campaign groups, councillors and a growing number of MPs, including Conservatives, in areas where major changes are planned amid fears that patients will be unable to access urgent care quickly enough.

Dozens of England’s 163 acute hospitals look likely to have services, including cancer, trauma and stroke care, removed as a result of the plans, which are at the heart of the new funding package for the NHS. The thinking behind the changes is that some NHS services can be rationalised and managed more efficiently, helping improve patient care, tackling understaffing and helping the NHS save £22bn by 2020 as part of the wider financial settlement agreed for the current more


NHS bosses 'trying to keep cuts secret' (BBC: 14 November 2016)

NHS chiefs are trying to keep plans to cut hospital services in England secret, an investigation has found.

Full details of 44 reviews of services around the country - which involve closing some A&Es or, in one case, a whole hospital - are yet to emerge.

That is because NHS England told local managers to keep the plans "out of the public domain" and avoid requests for information, the King's Fund suggested.

Managers were even told how to reject freedom of information requests.

The King's Fund report did not include any details of cuts, but from the leaks and plans that have been published so far a partial picture is emerging of what is involved.

This includes:

  • Plans in south west London to close one of five hospitals - St George's, Kingston, Croydon, St Helier or Epsom
  • The North Tees proposal to centralise specialist services, including A&E, on two sites. It would lead to services being downgraded at one of the three major hospitals in the area
  • In Devon bosses are looking at whether to close some A&E, maternity and stroke services at hospitals across the county so they can be centralised at bigger sites
  • In Merseyside there has been talk of merging four hospitals - the Royal Liverpool, Broadgreen, Aintree and Liverpool Women's - to plug a £1bn shortfall, according to leaked documents
  • Plans in Birmingham and Solihull involve reorganising maternity services with fears this could result in fewer units
  • Bosses at North Central London have talked about a consolidation of services on fewer sites, leading to fears that the Whittington Hospital could lose its A&E more


All eyes on Horton General Hospital as maternity unit changes begin in Banbury (BanburyCake: 3 October 2016)

ALL eyes will be on the Horton General Hospital this week as its maternity service closes its doors to all but low-risk expectant mothers from across Oxfordshire.

The temporary move, brought about by chronic under-staffing at the Banbury unit, is aimed at ensuring patient safety, but poses risks of its own.

Last week campaigners were left bitterly disappointed as Oxfordshire County Council's health overview and scrutiny committee decided not to refer the matter to the Secretary of State, voting five to three that enough evidence for the move had been provided by Oxford University Hospitals NHS Foundation more


NHS facing 'pockets of meltdown' this winter (The Guardian: 11 September 2016)

The NHS will experience “pockets of meltdown” this winter as the service comes under increasing pressure, a leading doctor has warned. Dr Mark Holland, president of the Society for Acute Medicine, said the resilience of medical units was being “put to the test like never before”.

It comes a day after the chief executive of NHS Providers, Chris Hopson, said the government would fail to achieve its aim of a seven-day NHS without more cash.

Writing in the Observer, he warned that hospitals are cutting services and the NHS risked “slowly deteriorating” as it did in the 1990s.

Holland echoed the warnings about a service under pressure, saying those parts of the NHS where performance was already weak would find the winter months particularly difficult.

He also pointed to the “national emergency” of medically fit patients not being discharged home from hospital. This is partly due to inadequate social care in the community.

He said the current concern was “that hospitals where performance is already weak will find it very difficult to cope during the winter and that will lead to pockets of meltdown”.

He added: “At the core of the issues facing the NHS is the rapidly increasing number of delayed discharges. The figures are spiralling and are fast becoming more


NHS chiefs warn that hospitals in England are on the brink of collapse (The Observer: 11 September 2016)

The body that represents hospitals across England has issued a startling warning that the NHS is close to breaking point because of its escalating cash crisis.

Years of underfunding have left the service facing such “impossible” demands that without urgent extra investment in November’s autumn statement it will have to cut staff, bring in charges or introduce “draconian rationing” of treatment – all options that will provoke public disquiet, it says.

In an unprecedentedly bleak assessment of the NHS’s own health, NHS Providers, which speaks for hospital trust chairs and chief executives, tells ministers that widespread breaches of performance targets, chronic understaffing and huge overspends by hospitals mean that it is heading back to the visible decline it last experienced in the 1990s.

“Taken together this means the NHS is increasingly failing to do the job it wants to do and the public needs it to do, through no fault of its own,” Chris Hopson, the chief executive of NHS Providers, writes in the more


NHS 'in perpetual winter of Narnia' as waiting list reaches record 3.9m (The Guardian: 8 September 2016)

The NHS is missing so many of its key performance targets that it has entered “the perpetual winter of Narnia”, a medical leader has said, after figures revealed the highest ever number of patients on waiting lists.

Claire Marx, president of the Royal College of Surgeons, criticised the NHS’s failure to give patients planned care in hospital within the required 18 weeks, such as surgery for cataract removals, hernia repairs and hip and knee replacements.

The number of people in England who are awaiting such treatments has climbed to almost 3.9 million.

Hospitals met the 92% target in nine categories of RTT patients, including those requiring treatment for eye problems (92.7%), cardiac care (92.7%) and gynaecological problems (92.3%). However, it missed the target in 10 other categories. It treated barely four of of five (81.7%) of all those awaiting neurosurgery within 18 weeks, 86.9% of those needing plastic surgery and 88.9% of trauma and orthopaedic more


Demand for NHS care is dangerously high, says thinktank (The Guardian: 8 September 2016)

Demand for NHS care has reached record levels, with unprecedented numbers of patients being treated in A&E units, a new report reveals.

But that has left hospitals dangerously full and growing numbers of patients who need to be admitted are having to wait longer than they should because no bed is available, according to health thinktank the King’s Fund.

A total of 5,873,998 patients sought help in all types of A&E units in April, May and June – the largest number ever to do so in any three-month period – leading the Royal College of Nursing (RCN) to warn that the NHS had become “a pressure cooker” and was buckling under the weight of demand.

An unusually high number of patients were admitted to hospital during the same period, in a sign that the NHS is dealing with growing numbers of people who are so unwell they need inpatient care. In all just over 1 million of those who attended A&E ended up being admitted, one of the largest numbers on record.

Overall there were an extra 54,000 A&E attendances a month and 14,200 extra emergency hospital admissions a month in the first quarter of 2016-17 than in the same period the year before.

Experts said that the record high, revealed in official NHS statistics analysed by the King’s Fund, was surprising because it occurred in a period when hospitals used not to be especially more


The NHS secret is out. And local communities won't like it (The Guardian: 26 August 2016)

When Simon Stevens became NHS England’s chief executive in April 2014 he disavowed his predecessor David Nicholson’s radical centralisation of specialist hospital treatment into far fewer places.

Stevens also went further, using his first interview in the post to pledge to maintain local hospitals. Every NHS leader, and every MP, knows how attached the great British public is to the bricks and mortar of their local NHS. The last thing Stevens wanted was to face opposition by campaign groups, councillors and MPs to a particular A&E or maternity unit being downgraded or closed, and certainly not a wave of such protests in many parts of England simultaneously battling to save much-loved local services.

Yet that is the growing risk he now faces as a result of the 44 regional sustainability and transformation plans (STPs). The disclosure of controversial changes planned in north-west London, Leicestershire and the West Midlands – including entire hospitals being downgraded or closed – could easily result in England-wide protests.

NHS bosses say the plans are necessary for the sake of better care, modernisation and financial balance but an angry, disbelieving public is expected to fight tooth and nail against the loss of the local more


Stafford hospital suspends 'unsafe' children's A&E (The Guardian: 25 August 2016)

A Staffordshire hospital has suspended its A&E service for children after senior staff said it was “not currently clinically safe”.

The drastic measure, implemented at 10am on Thursday, came after County hospital in Stafford was found to have insufficient staff trained to the required level in resuscitation and life-support for children.

University Hospitals of North Midlands NHS trust advised parents not to bring their children to the hospital, and instead to take them to a GP or pharmacist in the case of minor illness or injury, or to call 999 in the event of an emergency.

It said any sick children brought to the hospital would be cared for by staff until a transfer to another hospital could be more


Doctor shortage may see maternity unit downgraded (HSJ: 16 August 2016)

A shortage of doctors may lead to an Oxfordshire maternity unit being downgraded next month.

Oxford University Hospitals Foundation Trust, which runs Horton General Hospital, has scheduled an extraordinary meeting of its board of directors on 31 August to decide whether to downgrade the unit to midwife led only.

Horton has one of the smallest obstetric units in the NHS

The trust has faced an ongoing recruitment crisis at Horton’s maternity unit, having held three recruitment rounds for the middle grade obstetric posts since the start of the financial year. It warns that from the end of September, six out of the eight required doctor’s posts may still be more


CCG consults on closing four hospitals (Pulse: 16 August 2016)

NHS South Devon and Torbay CCG are consulting on closing four local hospitals in order to increase 'community-based care'.

The proposals, aim to swap 'resources from bed-based hospital care to community-based care' by reducing the number of hospital beds, and therefore closing Ashburton, Bovey Tracey, Dartmouth and Paignton hospitals.

The CCG says that that this will allow 'investment in community-based services including community nurses, physiotherapists occupational therapists and social care staff to support people in their own homes.' more


NHS problems only going to get worse, says Patients Association (The Guardian: 16 August 2016)

Problems within the NHS are only going to get worse, the Patients Association has warned, after a study showed that tens of thousands of people are being forced to wait more than 18 weeks for routine surgery.

report entitled Feeling the Wait found that hospital trusts across England each cancelled an average of 753 operations on the day in 2015. Equipment shortages, a lack of beds and scheduling errors were the main reasons given to patients in such cases, the authors said.

The total number of procedures cancelled by individual trusts ranged from eight to 3,269.

The report said: “We have grown increasingly concerned at the waits patients are facing for surgery and the amount of patients who have had their operation cancelled on the day.

“There is a significant psychological burden on patients waiting to be given a date for surgery and for patients whose surgery has been cancelled (often on the day the surgery was due to take place).”

The study highlighted substantial increases in the number of patients waiting longer than 18 weeks for routine more


Hospital A&E wards 'in crisis over shortage of emergency doctors' (The Guardian: 10 August 2016)

Hospital accident and emergency wards are in crisis as the supply of doctors fails to keep pace with demand for them in A&E departments according to medics’ representatives.

The warning from the Royal College of Emergency Medicine came as an A&E in the east Midlands announced it may have to temporarily close its doors at night owing to a national shortage of emergency doctors.

United Lincolnshire hospitals NHS trust (ULHT) said that a “crisis point” had been reached and patients’ lives could be put at risk if action was not taken at Grantham and District hospital.

Management at ULHT said they were looking to reduce A&E hours because the department was facing a severe shortage of doctors. 

The trust, which runs the A&E, as well as two others in the region, said that it had been seriously affected by a “national shortage of appropriately trained doctors to work in A&Es”, adding: “We have reached a crisis point and we may put patients at risk if we don’t act.” more



Crisis-hit hospital trust may close Grantham A&E at night (BBC News: 10 August 2016)

Hospital bosses could shut an accident and emergency department at night in order to combat a staffing crisis.

United Lincolnshire Hospitals NHS Trust said it is considering slashing opening hours at Grantham and District Hospital due to a severe shortage of doctors.

It said closing the Grantham A&E rather than the departments at Lincoln County Hospital or Pilgrim Hospital in Boston was the "safest option".

A spokesman for the trust said failing to act "may put patients at risk".

The Royal College for Emergency Medicine (RCEM) said news of the potential closure was "disappointing, yet unsurprising" more


Inadequate staffing levels found at Southend trust (Nursing Times: 2 August 2016)

Staffing numbers at an Essex hospital were not adequate to meet patient needs and shortfalls were compromising safety during a recent visit by Care Quality Commission inspectors.

The CQC said there “must be sufficient and appropriate staff available in medical services to provide care and treatment” at Southend University Hospital NHS Foundation Trust.

The trust must also take action to “ensure sufficient numbers of suitably qualified, competent, skilled and experienced nurses are available at all times on wards caring for palliative and end of life patients”, said the regulator in its report on the South East Essex more


North West trust in turnaround scheme could slash workforce by 7% (Nursing Times: 29 July 2016)

A hospital trust in the first wave of a national turnaround programme for struggling NHS organisations has announced plans that could reduce its staffing establishment by 7%.

Stockport NHS Foundation Trust, which is one of 16 organisations in the first wave of NHS Improvement’s financial turnaround scheme, says it may cut up to 350 whole-time equivalent posts.

Retiring staff and not filling current vacancies should account for a proportion of the reduction, but a voluntary redundancy programme will also be launched. The trust has not ruled out cuts to clinical posts.

A senior source at the trust said that the reductions could include clinical and non-clinical posts, but any proposed cuts to clinical posts would have to go through a risk assessment panel.

Around 30 vacant posts could count towards the total, they told Nursing Times’ sister title Health Service more


Teaching hospital pleas for any junior doctors to help staff A&E (HSJ: 30 June 2016)

One of the country’s largest teaching hospitals appealed to all its junior doctors regardless of experience or specialty to help staff its two emergency departments including a major trauma centre.

Leeds Teaching Hospitals Trust sent an email last week to all junior doctors asking for help covering day shifts, night shifts or part-time shifts to fill gaps in its rota on Saturday and Sunday last weekend. The trust appealed to all junior doctors to cover shifts at Leeds General Infirmary

The trust told HSJ it sent the email after agency and locum staff declined work at the hospitals despite offers to pay above NHS Improvement’s cap on locum pay rates.

Royal College of Emergency Medicine president Clifford Mann told HSJ the issue was indicative of the national shortage in emergency medicine more


‘Concerning’ lack of diabetes inpatient specialist nurses (Nursing Times: 28 June 2016)

A lack of specialist nurses and other expert staff is continuing to contribute to unnecessary pat

More on quality: 






Trends in reported problems





Examples of problems (by provider)



Care UK




Harmoni (Care UK)








Understaffing at Kings Health Centre



Share your examples about the impact of NHS changes - in a community d/base


Recent reports:

The A&E Winter Crisis: lessons from last year

Nuffield Trust report on the reasons for the A&E crisis in winter 2014/2015

Mental Health Under Pressure

Report into the state of NHS mental health services by Helen Gilburt of The King's Fund, November 2015

The State of Healthcare and adult social care in England 2014/2015

The Care Quality Commission's annual report

Quarterly survey of NHS financial directors by The King's Fund - February 2013 report

‘Making it better? Assuring high-quality care in the NHS

NHS Confederation discussion paper on the quality of care in NHS following the Francis report - February 2013

Care Quality Commisson State of Care report 2011/12

Annual survey by the Care Quality Commission