'Lucky' NHS struggles through the winter (The BBC: 13 April 2017)
As warmer weather and the Easter holidays arrive, the NHS in England is reflecting on what looks like the busiest, some would say the worst, winter on record.
Official figures reveal the stresses and strains being felt during February after torrid times over the previous two months.
February's A&E waiting time performance was slightly better than December's and January's, with 87.6% of patients treated or assessed within four hours.
But it was still one of the worst monthly figures since records began more than a decade earlier, and it came after a fall in the number of people coming in to A&E units.
Once patients got through A&E there could still be long waits.
Adding up the number of patients between December and February, who waited more than four hours for a bed after a decision to admit, there was a total of 196,000, which was a 45% increase on the same period the previous year.
Delayed transfers of patients who were medically fit to leave continued to cause problems for hospitals.
There was a 17% increase in the number of beds not available to other patients in the year to February...read more
NHS finances facing 'nasty hangover' after bid to avert winter crisis (The Guardian: 2 March 2017)
The NHS’s already precarious finances are facing a “nasty hangover” after hospitals cancelled tens of thousands of operations recently in a bid to avert a full-blown winter crisis, experts have said.
Handing large numbers of operations over to private providers and hiring extra staff to cope with extra demand during December and January has also dealt a big blow to NHS trusts’ efforts to balance their books, the King’s Fund said.
The backlog of patients needing non-urgent surgery as a result of the widespread postponement of procedures this winter will also force patients to wait even longer for their operation, Richard Murray, its director of policy, said.
“Increasing spending on agency staff, outsourcing work to the private sector and suspending planned treatment may have helped to relieve pressure in the short term but are likely to result in a nasty hangover as hospital finances take a hit and waiting times increase further,” said Murray.
The service’s finances are deteriorating so sharply there is a real risk the Department of Health could bust its budget for 2016-17, according to the thinktank’s new analysis of NHS performance.
Its latest quarterly monitoring report on how the NHS in England is faring predicts that it is facing several more years of finding it impossible to live within its budget, despite government orders to do so. Hospital trusts ran up a deficit of £2.45bn last year and are on course to overspend by over £1bn again this year....read more
NHS Health Check: Nine in 10 hospitals 'overcrowded' this winter (The BBC: 21st 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.
Meanwhile, patients have been contacting the BBC to report the chaos they have experienced in overcrowded hospitals, including long waits for treatment and operations being cancelled at the last minute...Read More
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."...read more
How the ‘humanitarian’ crisis in the NHS is paving the way for private healthcare (The Independent: 13 January 2017)
t has been a calamitous winter inside the NHS. Last week, three people tragically died at Worcestershire Royal hospital with a women dying of a heart attack after waiting for 35 hours on a trolley. A similar picture has developed across the country with patients on trolleys due to lack of beds, many hospital trusts on red alert and ambulances missing targets for life-threatening emergencies. The British Red Cross declared a humanitarian crisis in the NHS.
The return of the Red Cross to Europe, over the last few years, for the first time since the Second World War is a terrible indicator of the toll austerity is taking. Wall-to-wall coverage and acres of column inches have generally failed to examine the root causes. Health journalists and correspondents seem perfectly content to recycle the crisis mantra. This is extremely convenient for the government and vested interests. What is missing from this picture is that the NHS crisis is manufactured by deliberate policies of cuts and privatisation.
The NHS will have endured an unprecedented nearly £40bn in cuts by 2020. Prime Minister Theresa May’s response – notably in last Sunday’s interview with Sophy Ridge on Sky News – has been to downplay the crisis. Hunt followed suit and his statement to the Commons on Monday was a typical masterclass in deflecting the blame. The initial response in the government playbook was to change the subject to mental health. Hunt also raised the possibility of axing the 4-hour A&E waiting target....read more
Theresa May urged to get a grip on NHS as winter crisis spirals (The Guardian: 7 January 2017)
Theresa May is under intense pressure to announce an emergency NHS rescue plan to parliament – amid a chorus of warnings that hospitals and GP services across England have finally reached breaking point.
Labour and the Liberal Democrats are demanding the prime minister, or Jeremy Hunt, the health secretary, appear before MPs on Monday – when parliament returns from the Christmas break – as doctors and medical organisations said the winter crisis was reminiscent of the chaos that engulfed the service in the dark days of the 1990s. Former Tory health minister and practising NHS doctor Dan Poulter said it was essential that ministers disclosed the extent of the problems, because there was an urgent need to focus minds and build momentum behind the search for a cross-party solution.
In a further sign of spiralling pressures on health and social care services, the president of the Society for Acute Medicine, Dr Mark Holland, called on May to convene a special version of Cobra, the committee that is summoned only in national emergencies.
While Department of Health sources said that they understood the concerns, they said ministers had addressed the problems by announcing more funding for social care and the NHS. They also said the NHS was equipped to deal with winter pressures that they said were no more serious than last year. The demands for a plan of action and statement to parliament came after the British Red Cross, which has been providing help to dozens of overstretched hospitals, said the situation affecting the NHS in England was a “humanitarian crisis”....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
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.
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 winter....read 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 the letter to NHS trusts, the regulator says: “Given the level of risk facing the system, it is clear that having sufficient bed capacity going into Christmas is critical, and we know most organisations will already have this in hand as part of local planning arrangements.
“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 England....read more
Care for elderly ‘close to collapse’ across UK as council funding runs out (The Guardian: 26 November 2016)
Theresa May is under intense pressure from senior doctors and a powerful cross-party alliance of politicians to avert a collapse in care for the elderly, as shocking new figures show the system close to meltdown.
The medical profession, together with Tory, Labour and Liberal Democrat leaders in local government, have demanded a funding U-turn, warning that the safety of millions of elderly people is at risk because of an acute financial crisis completely overlooked in chancellor Philip Hammond’s autumn statement.
New figures obtained by the Observer show that 77 of the 152 local authorities responsible for providing care for the elderly have seen at least one residential and nursing care provider close in the last six months, because cuts to council budgets meant there were insufficient funds to run adequate services.
In 48 councils, at least one company that provides care for the elderly in their own homes has ceased trading over the same period, placing councils under sudden and huge pressure to find alternative provision.
In addition, 59 councils have had to find new care arrangements after contracts were handed back by a provider who decided that they were unable to make ends meet on the money that councils were able to pay them.
The medical profession, council leaders and even the former Tory health secretary, Andrew Lansley, are appalled that the social care crisis – exacerbated by growing numbers of elderly people and the rising costs of paying staff – was not addressed in the autumn statement.
In a letter to the Observer, the leaders of the four main political groups in local government expressed their disquiet at the chancellor’s dismissing talk of a crisis despite calls from politicians, NHS leaders, doctors and others....read more
NHS financial problems endemic and no longer sustainable, say auditors (The Guardian: 22 November 2016)
The financial problems of the NHS are now “endemic” and have worsened so significantly in the past year that the situation is no longer sustainable, Whitehall’s official auditor has warned.
Two-thirds of health trusts in England are now in deficit, the National Audit Office has discovered, while their total debt has almost trebled since 2015 to £2.45bn. Auditors were particular alarmed by the decision to transfer £950m from the NHS’s budget for buildings and IT to pay staff’s wages.
MPs say the report amounts to one of the the most critical assessments of NHS finances by official auditors, as their reports usually err on the side of caution. The report will add to pressure on Theresa May and the chancellor, Philip Hammond, to set aside extra money in the autumn statement on Wednesday to plug the funding gap in the health service.
Meg Hillier, the chair of the public accounts committee, said the Department of Health was making “pie in the sky assumptions” about closing that gap.
She added: “I call on the prime minister to address [in the autumn statement] the realities of increasing deficits in NHS trusts, long-term workforce problems, unrealistic efficiency targets and the impact these financial stresses are having on the quality of services.”
Amyas Morse, head of the NAO, said: “With more than two-thirds of trusts in deficit in 2015-16 and an increasing number of clinical commissioning groups (CCGs) unable to keep their spending within budget, we repeat our view that financial problems are endemic and this is not sustainable.”
The NHS overall entered the current financial year with a “worse than expected starting point”, which could hamper plans to close the estimated £22bn gap between patients’ needs and resources by 2020/21, auditors said....read more
NHS crisis plan to cancel operations and appointments as winter draws in (The Telegraph: 21 August 2016)
Hospitals are to cancel thousands of operations and appointments in a desperate bid to stop the NHS "buckling" this winter, under Government plans.
Health officials are drawing up contingency measures to attempt to safeguard emergency care by diverting senior doctors from operating theatres into wards and Accident & Emergency departments as winter sets in.
The national plan, detailed in evidence to the Commons health select committee, comes amid concern that the NHS is already in the grip of the worst bed-blocking crisis on record.
Last night, Britain’s most senior A&E doctor said hospitals were under such strain that a bad outbreak of flu this winter would be enough to leave services “poleaxed”....read more
NHS records worst ever performance figures (The Guardian: 10 March 2016)
The NHS recorded its worst ever performance in the first month of the year as services struggled to cope with unprecedented demand for A&E care, hospital beds and ambulances.
Hundreds of thousands of patients were forced to wait longer than they should for time-critical care as the NHS missed almost all its key waiting time targets.
The latest monthly performance data, released on Thursday by NHS England, shows that hospitals buckled badly during January, partly because the traditional “winter pressures” arrived later than usual.
A total of 212,136 patients waited more than the maximum four hours to be admitted, transferred or discharged from hospital A&E units – the highest number ever. Hospitals only treated 83% of A&E patients within four hours, way below the 95% standard they are meant to achieve...read more
Winter Pressure: What's going on behind the scenes (The Health Foundation: February 2016)
Starting in early December each year, so-called NHS ‘winter pressures’ make the headlines. Attention invariably tends to be focused solely on the performance of A&E units. We examine whether the relentless focus on the four-hour A&E target for hospitals gives the full picture of pressures on NHS trusts.
Winter pressures: what’s going on behind the scenes? finds that pressure normally seen during the winter months is now increasingly visible at other times of the year. The analysis also highlights that, in some areas, the NHS has been coping well with winter pressures.
Other key findings include the following:
- A&E attendances each year are increasing – seven per cent over the last five years.
- While the trend in the number of people attending A&E units each year is increasing, fewer people attend during winter compared to the rest of the year. But of those who do attend there is a larger proportion of older people attending and a larger proportion of people requiring an emergency admission to hospital.
- The pressure on primary and community services in winter is largely unquantifiable at a national level because of a lack of available data.
One in four trusts plunge deeper into the red (HSJ: 25 February 2016)
More than a quarter of acute trusts reported a financial position which was more than £5m worse than planned for the first nine months of 2015-16.
The majority of these trusts had already planned for large deficits at the start of the year, but are now even deeper in the red than expected.
Last week, regulators said the NHS provider sector had reported a combined deficit of £2.3bn for the nine months to December, which was £622m worse than planned. The deterioration came almost entirely from the acute sector...read more
Hospital on black alert as patients face diversions and long waits in A&E (The Argus: 25 February 2016)
A HOSPITAL has been placed on the highest level of alert as it battles to control demand from patients and a shortage of beds.
One patient at the Royal Sussex County Hospital in Brighton was reported to have waited for more than 20 hours in the accident and emergency department before they could be moved on to a ward.
Another patient reportedly waited more than 12 hours to be formally handed over to hospital staff by the ambulance service because the department was too busy to take them when they were brought in...read more
NHS providers facing £2.8bn deficit for 2015-16 (HSJ: 19 February 2016)
NHS providers have reported a combined deficit of £2.3bn for the nine months to December – £622m worse than planned.
The sector’s current trajectory would result in a full-year deficit of £2.8bn for 2015-16, according to performance figures published by Monitor and the NHS Trust Development Authority on Friday.
High use of agency staff was cited as a reason for overspending However, the regulators’ finance chiefs say they are still targeting a year-end deficit of £1.8bn, to prevent the Department of Health breaching its revenue spending limit.
The NHS has been told that any overspend this year would need to be repaid from its 2016-17 allocation...read more
Elderly hospital patients given eviction warnings (The Telegraph: 17 February 2016)
Amid soaring levels of 'bedblocking' in the NHS, elderly hospital patients are being warned that they could face eviction if relatives cannot find a care home within three weeks.
Hospitals have begun imposing eviction notices on frail elderly patients who are left on wards because relatives cannot find a satisfactory care home, an investigation has found.
It comes amid a growing crisis in care of the elderly, with soaring levels of bed-blocking in parts of the country with some of the highest care home fees.
Official NHS figures show more than 220,000 days of delays are being caused each year when patients are stuck in hospital because relatives cannot decide on a care home.
Hospitals in the West Midlands are warning elderly patients who need residential care that they could face legal proceedings if they are not out within three weeks of being declared medically fit.
NHS trusts in Northamptonshire have drawn up similar policies, while trusts in Yorkshire say they are considering how best to respond to delays caused when families cannot decide on a care home...read more
"Unnecessary" A&E visits blamed for black alert at five West hospitals (BBC News: 6 January 2016)
Five hospitals across the West of England have declared a "black alert" saying they are being overwhelmed by the level of demand on health services.
The situation is being blamed on too many people coming to Accident and Emergency departments "unnecessarily".
The hospitals are the Bristol Royal Infirmary, Bristol Royal Hospital for Children, Southmead, Weston General and Yeovil District.
Black escalation status means there is severe pressure on services.
"The evidence from hospital A&E Departments is that many people are still continuing to use A&E unnecessarily," said Dr Peter Goyder, of the Bristol Clinical Commissioning Group...read more
NHS will struggle to cope this winter, new analysis finds (Nuffield Trust: 10 December 2015)
Just 3.6 per cent of patients took up over a third of all bed capacity in acute hospitals in England last year, new analysis by the Nuffield Trust of pressures on the NHS last winter has found. The analysis comes on the day that NHS England publishes its latest monthly figures on how the Health Service is performing against a number of targets.
The patients in this group were likely to have been frail or elderly people who the system was not ready to return to their own homes or to nursing or residential homes, despite their medical treatment being finished.
This new figure for bed occupancy helps to explain why the Health Service still suffered a winter ‘crisis’ last year, the authors say, despite receiving record extra funding from NHS England of almost £700m specifically to deal with pressures caused by winter.
The fact that no extra funding for winter is being allocated this year means the position will be even worse in the coming months, they argue. The Health Secretary Jeremy Hunt announced in November 2014 that the money was being awarded to the NHS to ‘make sure it is better prepared [for winter] than ever before’ - yet by January this year, a string of Trusts in England had declared major incidents or ‘black alerts’, whereby hospitals were closed to all new admissions, while performance against the four hour A&E standard was the worst in a decade.
The way in which this small group of patients was treated meant that bed occupancy rates in many hospitals were running far higher last winter than the 85 per cent generally recommended by experts as the maximum that should be reached in the NHS – which in turn held up the admission of patients from emergency departments, thereby preventing those arriving at the ‘front door’ of A&E from being seen quickly enough and causing the four hour A&E standard to be breached repeatedly. See Nuffield Trust report for further details: The A&E Winter Crisis: lessons from last year
Nurse shortage sparks fears of NHS winter crisis (ITV: 21 December 2015)
Nine out of 10 hospitals in England are reporting dangerous shortages of nurses with staff worried services could be "tipped over the edge".
The figures show some hospitals have just one nurse for 22 patients fuelling fears of an NHS winter crisis.
The report found that 207 of the 225 acute hospitals in England have been unable to find enough nurses to staff their wards, a decline on last winter.
This comes after a parliamentary report warned a cap on immigration into the UK could be responsible for the nursing crisis in the NHS.A survey of almost 1,000 nurses in the Nursing Times also reveals growing strain, with more than half warning that low staffing levels mean that they can no longer guarantee safe care for their patients all of the time...read more
Number of 'fit' patients stuck in hospital hits all-time high (The Guardian: 10 December 2015)
The number of patients who are trapped in hospital despite being fit to leave has reached an all-time high, putting extra pressure on the NHS as it enters its critical winter period.
Such patients, who cannot be safely discharged usually because local social care is inadequate, accounted for 160,094 bed days in October – the highest number since records began more than five years ago. That is the total number of bed days in effect lost to the NHS because hospital staff could not use them for another patient, which leads to hospitals getting overcrowded.
In all 5,328 patients who were fit to go but could not leave – mainly frail, elderly people were still in hospital at the end of October. That is almost 50% more than the previous month, suggesting a sudden worsening of the problem in the late autumn, and about double the 2,647 such patients who were in the same position in September 2010.
In addition, hospitals are already struggling to treat and either admit or discharge A&E patients within the required four hours and to give patients key diagnostic tests quickly enough, ambulance services are missing key targets to respond to 999 calls, and growing numbers of cancer patients are not being treated within 62 days.
The worrying signs of faltering NHS performance in key areas, contained in the latest statistics for how the service in England did in October, have renewed concerns it is facing a potentially very difficult “winter crisis” worse than the one that last year forced many hospitals to declare major incidents because they could not cope...read more
Twelve NHS trusts run out of beds as winter pressures mount (The Telegraph: 10 December 2015)
New figures, which show that last weekend, 12 NHS trusts were so full they did not have a single bed to spare, have fuelled fears of a looming NHS winter crisis.
Twelve hospitals were so full they did not have a single bed available last weekend, official NHS statistics show.
Labour said the figures show health services under unprecedented pressure, and raised fears that services will reach a point of crisis as winter takes hold...read more
NHS misses key targets in run-up to busy winter period (The Guardian: 12 November 2015)
The NHS in England missed several key targets for A&E admissions, cancer referrals, ambulance response times and NHS 111 calls in September as it braces itself for a busy winter period.
Against a target of 95%, 93.4% of patients attending emergency departments were seen within four hours in September. The figure was 94.3% the previous month. The A&E data for September is often cited as an indicator of pressure on the NHS as it prepares for winter.
Dr Mark Holland, president of the Society for Acute Medicine, has warned that A&E units are facing a a nightmarish scenario that will heap on the pressure in the buildup to winter. He told Sky News that a lack of staff and possible industrial action by junior doctors were very worrying at this time of year, adding there had been a rise in the number of patients needing emergency care...read more
Prepare for a catastrophic NHS winter meltdown (The Guardian: 23 September 2015)
The NHS is on the brink of a major, messy failure. If nothing is done to address the underlying issues now, the failure will be deep with grave consequences and a long recovery. This winter things are set to go catastrophically wrong.
Pressure on health services normally reduces in summer, often producing undue optimism about how they will cope come winter and delaying necessary preparations. Last summer there was virtually no reduction in pressure. Oddly, this failed to dent the optimism. The revised story was that unrelenting pressure had become a year-round phenomenon, so increased numbers and longer waits were now normal and the coming winter wouldn’t be any worse.
Unfortunately it was, the worst in 20 years. Demand for healthcare had simply reached a new (summer) plateau, with new peaks of winter demand inevitable and predictable – but not predicted and not prepared for. Waits and delays soared, even though demand increased modestly, following a well-established trend.
The crisis happened because the NHS starved itself of the capacity it needed, in the futile belief that lack of supply would constrain demand and so save money. This led not only to running out of spare capacity, but to shortages and the loss of the elasticity to cope with new peaks in demand. The result was waits and delays multiplied rather than increased, and it contributed to the worst NHS deficit in a decade.
Despite this, the lesson has not been learned that the NHS’s struggles this summer foreshadow a meltdown this winter...read more