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 doctors....read more

 

Brexit 'will make NHS staff shortages worse' (BBC News: 30 June 2016)

The vote to leave the EU risks making staffing shortages in the NHS worse, health leaders are warning. The NHS Confederation said doctors and nurses from Europe may be put off accepting jobs after the referendum.

If that happened the NHS could face some major problems, it said. The organisation, which represents health managers, said there were currently 130,000 EU health and care workers in the UK, including 10% of doctors and 5% of nurses.

Elisabetta Zanon, the director of the NHS Confederation's European office, said: "There is a real risk the uncertainty and the falling value of the pound will make people think again.

"If that happens, we could see shortages in some key areas get worse."

A report earlier this year from the House of Commons Public Accounts Committee warned the front line in England may be as many as 50,000 staff short - out of a workforce of slightly more than 800,000 clinical staff.

Ms Zanon also said Brexit could have an impact on medical research and the free healthcare Britons received when abroad. But she said the workforce issue was the most pressing, as the impact could be felt straightaway.

And there were signs this had already started happening, with reports that an EU recruitment drive in West Yorkshire had already run into difficulties....read 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 patient harms in hospital, according to the latest major audit of diabetes care.

It found a significant fall in diabetic foot ulcers over the last five years, but few changes in other patient harms and a continuing lack of specialist nurses in many hospitals.

Only 1.1% of inpatients with diabetes developed a new foot lesion during their admission to hospital, a significant decrease from 2.2% when inpatient auditing began in 2010.

But 67% of inpatients in the latest audit did not have a specific diabetic foot risk examination while in hospital and 31% of sites do not have a multi-disciplinary diabetic foot care team.

The findings form part of the 2015 National Diabetes Inpatient Audit, which is carried out by the Health and Social Care Information Centre in collaboration with the charity Diabetes UK....read more

 

Budget cuts leave occupational therapy posts unfilled as referrals rise (The Guardian: 28 June 2016)

Occupational therapists (OTs) make up 2% of the adult social services workforce but are responsible for around 40% of referrals, illustrating just how vital their expertise is. But cuts to council budgets are putting them under increasing pressure as vacancies are left unfilled and waiting lists for services increase. National figures show that the number of OT posts in adult social care in England fell by 4% in the year to September 2015. And in London, 18% of vacancies for experienced OT practitioners in adult and children’s services are being left unfilled. Harold Bodmer, president of the Association of Directors of Adult Social Services and director of adult services for Norfolk county council, says: “Some of that is down to the cuts. What we are trying very hard to do is to put occupational therapy expertise to best use, so that some of their work can be done by other people with OTs overseeing them.”

Julia Skelton, director of professional operations at the College of Occupational Therapists, says the figures speak for themselves: “OTs are working very hard to keep the waiting lists for assessments down. When you consider we make up 2% of the workforce and take 40% of referrals, the figures say everything.”

The picture is similar in the NHS. Some parts of the UK which historically find it hard to recruit – rural Lincolnshire and the north of Scotland – are still struggling to fill posts across the board. In London, NHS trusts are seeing nearly 20% of their band 6 posts left vacant – these are qualified OTs with around two years’ experience, who make up the largest OT group. Most of these vacancies are in acute care, particularly mental health...read more

 
Government cuts are brewing a sexual health crisis (The Guardian: 27 June 2016)
 
Sex has got a lot to answer for. The UK is facing a rising demand for sexual health and contraceptive care. Unacceptable levels of sexual coercion and female genital mutilation (FGM) are being reported, sexually transmitted infection (STI) diagnoses are increasing [pdf], and the UK still has the highest rate of teenage pregnancy in western Europe.

Despite all of this, key services are facing monstrous budget cuts alongside so many other sectors of our increasingly weary NHS. This means clinic closures, the dissolution of preventative health programmes, further pressure on already overloaded GP practices, and horrifying long-term financial costs.

In truth, sexual health services have suffered financially for some time. With the implementation of the Health and Social Care Act 2012, responsibility for sexual health funding was allocated to local authorities and these services put out to tender.

Private companies can bid for control over them, which the government claimed would improve standards “through competition and choice”. In reality, the winning bids are often ones that offer immediate cost-saving rather than long-term financial benefits and the best possible standards of care.

In 2015, the government announced its £200m public health budget cut, resulting in local councils spending millions of pounds less than planned on sexual health services nationwide. Add to this a potential 40% cut in central funding to local authorities [pdf] and you can see how pressure is mounting.

Elizabeth Carlin, president of the British Association of Sexual Health and HIV (Bashh), is one of many specialists to express concern. “Sexual health services play a key role in protecting the health of the nation,” she says. “Coordinated care with sufficient funding is crucial.”...read more

 

'Desperate situation' faced by public health (BMA: 24 June 2016)

In 2014, the Five Year Forward View said ‘… the future health of millions of children, the sustainability of the NHS and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health’ — to which the chancellor has responded by cutting public health budgets. Twice — and with more on the way.

The impact of the cuts in areas such as drug misuse and alcohol was a major focus of this year’s BMA annual representative meeting.

In his keynote address, BMA council chair Mark Porter condemned the ‘shoddy sleight of hand’ by which the Government had circumvented its promise not to decrease NHS spending by placing public health outside the NHS.

He said smoking cessation and sexual health services were among those under threat, adding: ‘You can't trade a public health policy for an e-cigarette and crossed fingers.’

At the ARM, doctors condemned the cuts in strong terms — for their impact on patients and on the workload of doctors as the opportunity to tackle the burden of  avoidable illness was squandered.

Cambridge GP Alice Hodkinson said the Government had ‘initially supported public health’ before embarking on the damaging cuts.

She added: ‘What will those cuts mean? Reductions in services, impacting on the poorest families… Public health cuts put pressure on the NHS. These cuts will impact most on the vulnerable.’

The threat posed by the reduction in public health budgets, now in the hands of local authorities, are very real, according to our research.

Cuts to Brighton and Hove’s sexual health service risk ‘increasing the prevalence of sexually transmitted diseases, including HIV’, its council says.

Meanwhile, cuts in Surrey are predicted to have an adverse effect on support for women suffering domestic abuse, while older and vulnerable adults in south London are likely to be lonelier and more isolated when its befriending service is cut, according to an impact report from Merton Council....read more

 

The other NHS crisis: the overworked nurses who are leaving in despair (The Guardian: 25 June 2016)

At what point is a qualified nurse – who entered the NHS expecting long hours and low pay – pushed so far that they can no longer carry on? For Stacey, a 27-year-old nurse from Liverpool, it was when she had become so broken that she felt she had lost every one of the “five Cs” that are instilled in nurses during their training: commitment, conscience, competence, compassion, and confidence.

Stacey worked in A&E for five years. When she started, there were 20 nurses on the emergency ward; by the time she left last month, there were 11. Meanwhile, there has been a dramatic increase in patients going to A&E: a rise of 400,000 in a decade. Stacey, like many other nurses across the country, felt she had reached breaking point.

“With A&E, you never know what is coming through the door,” she says. “It has to be very organised. We had three wards – majors, minors and observation – and each is supposed to have at least two nurses. But when I left, we were so stretched that there was often only one. There’s a reason you need at least two.”

She thinks back to her most stressful nights, on the observation ward, which admits patients suffering from problems such as overdoses or brain injuries, who are then observed over 24 hours.

“It was impossible to keep my eye on everyone, and there were times when someone would rapidly deteriorate and I would be too busy with other patients,” she says. On really busy nights, the observation ward became a “dumping ground” for patients with complex medical problems who could not get a bed anywhere else. “It was really tough. There were cases where patients were just put there, and I hadn’t been trained to deal with their problems....read more

 

Major hospital incidents becoming year-round occurrence, nurses warn (The Guardian: 21 June 2016)

Mounting pressures on hospitals mean that patients are being treated in storerooms, frail and elderly patients are being moved around in the middle of the night and ambulances are queuing outside A&Es, leading nurses have warned.

Major incidents in hospitals are usually seen only in the busy winter months but are now becoming a problem all year round, the Royal College of Nursing (RCN) said.

The college, which is holding its annual congress in Glasgow, said that across England, the hospital sector is feeling the strain of financial pressures and increased demand.

It highlighted a series of issues facing local hospitals that are “adding to the chaos” at hospitals across England. These include:

- Beds being placed in corridors and patients treated in storerooms in order to move people out of A&E.

- Ambulances queuing outside A&E units or the regular use of “jumbulances” – large ambulances which can accommodate multiple patients – to treat patients while they wait to enter the units.

- Patients, often frail older people, being moved at night due to intense pressure for beds.

- Hospitals running with no spare capacity at all....read more

 

Virgin set to take over outstanding GP practice forced to close by £400,000 cuts (GP Online: 20 June 2016)

A GP practice in Essex rated outstanding by the CQC will be taken over next month by the private provider Virgin Care after £400,000 cuts to PMS funding forced existing partners to hand in their notice.

NHS England confirmed the private provider would take control of the Sutherland Lodge Surgery, in Chelmsford, from July.

GP leaders fear the takeover by a commercial provider could be the first of many, as hundreds of PMS practices face huge pressure from sharp reductions in contract funding.

The Essex practice is among the 35% of GP surgeries in England that operate under PMS contracts, which have faced cuts worth more than £200m under a national review process carried out over the past two years....read more

 

Teaching hospital discovers dozens of year-plus waiters (HSJ: 17 June 2016)

Imperial College Healthcare Trust has declared 47 patients who have waited more than a year for elective treatment, latest board papers reveal.

The teaching hospital said that at the end of March it had 47 patients who had waited over a year – some it already knew about but “the majority” were discovered after a review of records.

The trust said most of the year-long waiters ‘had not been tracked consistently’

A report to the most recent board meeting said: “A minority of these 47 patients are patients whom we had been reviewing regularly, but whose treatment took longer than it should have done because of capacity problems and in some cases also because patients had chosen to postpone appointments or operations.

“However, the majority of the 47 patients waiting over 52 weeks are patients whom we had not been tracking consistently. This is because we had applied referral to treatment rules incorrectly at an earlier stage of the patient’s treatment pathway.”....read more

 

Patients ‘at risk’ as the anaesthetists shortage is predicted to increase (The Observer: 12 June 2016)

The NHS faces a critical shortage of anaesthetists that could force operations to be delayed and even threaten patient safety, doctors’ leaders have warned.

New research shows that by 2033 every hospital trust will have 10-20 fewer consultant anaesthetists than they will need to meet rising patient demand. It estimates that, while the NHS has agreed that its total of anaesthetists should expand to 11,800 by that date, on current trends it is likely to reach only 8,000 – a shortfall of 3,800, or about 33%.

Anaesthetists play a vital role in preparing patients for surgery and monitoring them, are key members of the medical teams in maternity units and intensive care, and deliver pain relief and resuscitation. They become involved in the treatment of two-thirds of hospital inpatients.

Like many other areas of medical care, anaesthesia already has too few practitioners. Rota gaps – where there are too few doctors to cover every shift in hospital units – are increasingly common.

The Royal College of Anaesthetists (RCoA), which carried out the research, warned that patients and the smooth running of hospitals would be hit if the existing shortfallin numbers was allowed to increase. Dr Liam Brennan, the college’s president, said: “Anaesthetists possess a unique and non-transferable skill set that is essential to maintaining core hospital services, so the potential impact of a reduced anaesthetic workforce would have serious implications for patient safety across the whole NHS. We already have fewer than we need and the shortages are worrying.”

The college’s latest census of the UK’s anaesthesia workforce, the first since 2010, also found that 74% of hospitals already rely on locum anaesthetists hired from medical employment agencies to ensure their rotas are full. The cost of that is part of the NHS’s huge annual bill – £3.7bn a year in England alone – for temporary staff....read more

 

Patients ‘at risk’ as the anaesthetists shortage is predicted to increase (The Observer: 12 June 2016)

The NHS faces a critical shortage of anaesthetists that could force operations to be delayed and even threaten patient safety, doctors’ leaders have warned.

New research shows that by 2033 every hospital trust will have 10-20 fewer consultant anaesthetists than they will need to meet rising patient demand. It estimates that, while the NHS has agreed that its total of anaesthetists should expand to 11,800 by that date, on current trends it is likely to reach only 8,000 – a shortfall of 3,800, or about 33%.

Anaesthetists play a vital role in preparing patients for surgery and monitoring them, are key members of the medical teams in maternity units and intensive care, and deliver pain relief and resuscitation. They become involved in the treatment of two-thirds of hospital inpatients.

Like many other areas of medical care, anaesthesia already has too few practitioners. Rota gaps – where there are too few doctors to cover every shift in hospital units – are increasingly common.

The Royal College of Anaesthetists (RCoA), which carried out the research, warned that patients and the smooth running of hospitals would be hit if the existing shortfallin numbers was allowed to increase. Dr Liam Brennan, the college’s president, said: “Anaesthetists possess a unique and non-transferable skill set that is essential to maintaining core hospital services, so the potential impact of a reduced anaesthetic workforce would have serious implications for patient safety across the whole NHS. We already have fewer than we need and the shortages are worrying.”

The college’s latest census of the UK’s anaesthesia workforce, the first since 2010, also found that 74% of hospitals already rely on locum anaesthetists hired from medical employment agencies to ensure their rotas are full. The cost of that is part of the NHS’s huge annual bill – £3.7bn a year in England alone – for temporary staff....read more

 

‘This isn’t acceptable’: outcry at state of NHS mental health care funding (The Observer: 11 June 2016)

A cross-party inquiry by MPs into the funding of mental health services has received more than 95,000 personal submissions in an unprecedented display of anger over the state of the NHS.

One woman who submitted testimony linking the lack of support to suicide rates said the failure of the system to respond to people in trouble was often “what pushes you over the edge”. She wrote: “I’m scared my husband could become one of these statistics.”

A separate YouGov poll commissioned and crowdfunded by the campaigning organisation 38 Degrees found that 74% of voters believe that funding for mental health should be greater or equal to funding for physical health. The amount actually spent on mental health by the NHS last year, despite government pledges to establish parity, was just 11.9% of overall NHS spending.

Meg Hillier, chairwoman of the public accounts committee holding the inquiry, said the scale of the response underlined the strength of feeling that mental health was being underfunded. “We shall question NHS England and the Department of Health on how they can meet the government’s pledges,” she said.

The poll findings come as a new report, to be published on Monday by the NSPCC, says NHS commissioners are failing to take abused children into account when planning mental health services. The charity says the government’s £1.4bn investment in children’s mental health services is not being deployed to aid children who need help after abuse. Peter Wanless, chief executive of the NSPCC, said: “Often, it’s only when children reach rock bottom, regularly self-harming or feeling suicidal, that the services they need so desperately open up to them. This isn’t acceptable.”....read more

 

Four practices set to close leaving 10,000 patients displaced (Pulse: 7 June 2016)

Four practices in Brighton and Hove which together service over 10,000 patients are to close after having funding pulled through the review of PMS contracts.

Pulse reported in January that The Practice Group handed back its contract for the five practices after PMS funding was cut by 20%.  Although the provider agreed to continue providing services past its contract in March, NHS England has now announced that the practices will close.

According to a letter sent to stakeholders from NHS England, patients at three of the practices will be automatically transferred to other GP practices when theirs closes in July, September and November. The includes 4,000 patients of The Practice Whitehawk Road who will be able to attend a GP practice run from the same building. However, the 2,000 patients at The Practice North Street will have to register for a new GP themselves after the practice closes in July. The fifth practice currently run by the Practice Group is for homeless people, and NHS England is re-procuring this service....read more

 

GP practice forced to stop patients booking appointments in advance (Pulse: 6 June 2016)

A GP practice in Carlisle has stopped allowing patients to book appointments in advance because of the immense pressure it is facing.

Fusehill Medical Practice has introduced a telephone triage system, with a doctor speaking to all patients before they can book an appointment, and appointments only available on the day.

Partners at the practice have said that they have had trouble with the pre-bookable appointment system, and recruitment problems are worsening the situation.

It is the latest practice to do so, following a similar measure being taken by a practice in Swindon....read more

 

Child deaths in Priory hospitals provoke calls to cancel NHS contract (The Observer: 4 June 2016)

It was a heartbreaking moment. Tearful jury members embraced a bereaved mother after hearing how her 14-year- old daughter had died neglected at the Priory Ticehurst House hospital in East Sussex, one of the country’s most expensive private hospitals, which was being paid to care for her by the NHS. It is the latest indictment of the state of child mental health care in this country. Questions are now being raised about both the Priory Group – Britain’s biggest private mental health provider – and the way private companies are receiving millions of pounds from public funds each year to care for nearly half the NHS’s child mental health patients.

Amy El-Keria’s death was the culmination of months of serious failings at the hospital. Staff failed to pass on the fact that she had spoken of wanting to end her life, and in November 2012 the girl was found with a football scarf tied around her neck. Even though she had a history of using ligatures, opportunities to remove the scarf had been missed, and it had not been placed on a list of banned items. Also, her risk level had mistakenly been downgraded from high to medium....read more

 

Majority of nurses 'would not have trained without bursary' (Nursing Times: 4 June 2016)

Two thirds of nurses would not have studied to join the profession if they had been unable to receive a bursary for their tuition fees and living costs and had to take out a full loan instead, a survey has suggested.

The Royal College of Nursing, which carried out the survey of 17,000 of its members, warned the findings indicated government plans to scrap bursaries in England next year would put off thousands of potential nurses.

Around 80% of nurses taking part in the survey said they believed the changes would have a negative impact on patient care.

In addition, almost 90% said they either “disagreed” or “strongly disagreed” with the plans, which will apply to all new nursing, midwifery and allied health professionals from August 2017.

The survey also revealed 80% of nurse educators did not agree with the plans....read more

 

GPs told to ignore NICE statin prescribing guidance in cost-cutting drive (Pulse: 2 June 2016)

GPs have been told to ignore current NICE lipid modification guidelines on statin prescribing in low-risk people, under a cost-saving policy at one CCG.

NHS Stockport CCG has advised GPs should only prescribe statins to people if they are found to be at a 20% or greater risk of cardiovascular disease – and not at the lower NICE-recommended threshold of 10%-20%.

The CCG has also stipulated that GPs should prescribe simvastatin first-line rather than the NICE-recommended lipid-lowering drug atorvastatin, as part of measures to control spending.

NICE condemned the decision, which it said meant people were being denied the opportunity to lower their risk of a disease that 'maims and kills one in three'.

The GPC said that the CCG's decision was 'strange' and 'born out of desperation'....read more

 

Practice 'loses £55,000' as CCG cuts £1m enhanced service without warning (Pulse: 1 June 2016)

A CCG has cut more than £1m in practice funding after decommissioning an enhanced service designed to improve care for vulnerable patients, without consulting the LMC. 

Walsall LMC said that practices had employed staff as a result of the enhanced service run by NHS Walsall CCG, which involved elderly patients receiving extra health checks, care plans and medication reviews and had 100% sign up from local practices.

But the CCG has pulled the £1.13m funding - which was worth £55,000 for one practice - leaving practices having to make staff redundant.

The CCG said that this was because the scheme was 'not able to demonstrate value for money'.

However, the LMC said that it was primarily decommissioned because the CCG has a £20m budget gap.

The enhanced service was initially funded via the £5 per patient that CCGs were supposed to redirect from hospital budgets to support GP practices in reducing avoidable hospital admissions, as part of the Avoiding Unplanned Admissions DES....read more

 

GP vacancy rates at highest recorded with one in eight positions unfilled (Pulse: 1 June 2016)

Around 12% of all GP posts in the UK are vacant, the highest proportion recorded, a Pulse survey has revealed. The Pulse survey of 690 GPs has found that 11.7% of posts are currently vacant, up from 9.1% last year and 6.4% in 2014.

It also reveals that almost half of practices have had to recruit a partner within the past 12 months, taking longer than six months on average. GP leaders told Pulse this is a major reason why practices are closing, while other GPs said they have had to recruit advanced nurse practitioners (ANPs) as they are unable to recruit.

NHS England’s General Practice Forward View acknowledged the difficulties in recruitment, and committed more than £200m on a number of schemes, including recruitment of pharmacists, retention of GPs and training nurses, clerical staff and practice managers.

It comes as official figures have revealed there was a 2% drop in GP numbers last year, while a Pulse investigation has cast doubt on the Government’s pledge to recruit 5,000 extra GPs by 2020. Pulse’s survey on vacancy rates is the most robust study on the issue, and has frequently been cited by official bodies.

This year’s survey has revealed the situation is worse than ever, with more than one in nine posts vacant, despite many practices appointing non-GPs to fill the gaps....read more

 

CCGs win legal battle over Virgin community contract (HSJ: 1 June 2016)

COMMERCIAL: Kent clinical commissioning groups have won a legal bid to lift the suspension of a contract they awarded to Virgin Care.

Swale CCG and Dartford, Gravesham and Swanley CCG awarded a £127m community services contract to the private firm in January.

However, the move was challenged by incumbent provider Kent Community Health Foundation Trust. It argued the assessment process was flawed and that transferring the work to Virgin Care would cause legal, IT and human resources problems which would affect patient care.

The High Court in February suspended the award of the contract until the trust’s legal case had been made.

The CCGs applied to challenge this earlier this month, and on Friday the court lifted the suspension....read more

 

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