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14th March 2024
Artificial intelligence (AI) software that aims to reduce missed appointments is being rolled out to 10 NHS trusts in England following a ‘successful’ pilot.
The tool predicts likely missed appointments through algorithms and anonymised data and details the reasons why this might be the case using external insights, such as the weather, traffic or jobs.
Appointments can then be rearranged for better times, for example it will give evening or weekend slots to those less able to take time off in the day. It also offers ‘back-up’ bookings to maximise efficiency.
In a six-month pilot of the technology at Mid and South Essex Foundation Trust, there was a 30% drop in non-attendance, with 377 DNAs prevented and an additional 1,910 patients seen.
NHS England said this tool, developed by Deep Medical, has the potential to save £27.5m a year for a trust of 1.2 million people and can help to bring down long waiting lists.
Dr Vin Diwakar, national director for transformation at NHS England, said: ‘Not only can these technologies help to free up doctors’ time to treat more patients and reduce waiting times for planned care, it means a significant amount of money can be invested in frontline care rather than lost to missed appointments.
‘And the work being done across the country through these AI pilots shows that initiatives like this can deliver results in a short period of time, while also supporting patients to take control over their own care and help to better understand and reduce health inequalities.’
Charlotte Williams, chief strategy and improvement officer at Mid and South Essex NHS Foundation Trust, said: ‘Embracing new technologies is something the trust is passionate about, it also supports better access for people who are disabled and for working women, as a working mum I know how sometimes it can be hard to juggle work and childcare as well as managing your own health needs.’
Eight million outpatient appointments were not attended across NHS England in 2022/23, which equates to 6.4%, according to NHS figures. The highest proportion of missed appointments were physiotherapy (11%), cardiology (8.9%) and ophthalmology (8.8%).
A version of this article was originally published by our sister publication Healthcare Leader.
13th March 2024
By some indices, the NHS workforce appears to be recovering from the impact of the Covid-19 pandemic, according to the newly-released NHS Staff Survey 2023, but concerns were raised over issues with sexual harassment identified in a new survey question.
Across England, over half of the 700,000 surveyed staff (55.17%) reported that they now look forward to going to work – the best result since 2020.
Some 69.02% reported being enthusiastic about their job, which was, again, the best result since 2020 but remains around six percentage points lower than in 2019. Enthusiasm amongst medical and dental staff increased following four consecutive years of decline on this measure, the results showed.
When it came to the issue of wellbeing, staff reported experiencing less pressure at work than before, with the work pressure sub-score having improved in 2023 after a sharp decline between 2020 and 2021 and little change in 2022.
A total of 46.71% said they were able to meet all the conflicting demands on their time at work, however this remained lower for medical and dental staff (34.44%) than for many other staff groups and over 12 percentage points lower than the average.
Professor Em Wilkinson-Brice, director for staff experience and leadership development at NHS England said: ‘It is really encouraging that the experience of NHS staff at work improved over the past year, even as they faced near record levels of pressure including the busiest summer recorded in A&E, as well as managing the disruption of industrial action.‘
And Dr Navina Evans, chief workforce, training and education officer at NHS England, said: ‘While there is still more to do, it is good news that less than 12 months on from the publication of the NHS Long Term Workforce Plan staff are happier at work than last year thanks to initiatives such as flexible working hours, clinical support squads to help menopausal women at work, and human resources stay advocates.‘
However, Dr Emma Runswick, deputy chair of the British Medical Association council, noted that ‘while there have been some small positive changes made in certain aspects from staff shortages to time pressures, it’s imperative to differentiate between “improvements” and what is deemed as satisfactory or acceptable’.
The NHS Staff Survey arrives at a time of ongoing workforce shortages, mounting pressures and widespread dissatisfaction with pay.
While satisfaction with pay recovered to levels similar to 2021 across a number of staff groups, the survey found only 32.05% of medical and dental staff were satisfied with their pay. This adds to the persistent decline over the last three years and is 23 percentage points lower than in 2020.
Dr Runswick said: ‘The vast majority of medical and dental staff (68%) are dissatisfied with their pay, all while clearly struggling with unacceptable workloads, unreasonable time pressures, and inadequate resources.
‘The Government must recognise the urgent need for fair pay and systemic improvements to support and prioritise the wellbeing of our invaluable healthcare workforce.’
The survey results also revealed widespread reports of discrimination and sexual harassment by patients and colleagues.
Discrimination hit a record high, with one in 12 staff (8.48%) having reported facing discrimination from patients, service users, their relatives or other members of the public, up from 7.20% in 2019. This rose to 9.07% for people who reported personally experiencing discrimination from managers, team leaders or colleagues, up from 7.68% in 2019.
However, overall, staff were reportedly increasingly likely to feel their organisation respects individual differences such as cultures, working styles, backgrounds and ideas (70.63%). This measure is up two percentage points since 2021.
This was the first time the NHS Staff Survey ran a question on sexual harassment, and the results showed that 8.67% of staff said they had faced sexual harassment from patients, patients’ relatives, or other members of the public within the last year.
In fact, more than 58,000 NHS staff reported experiencing ‘unacceptable’ levels of unwanted sexual behaviour from the public.
The survey also found 3.84% of staff faced unwanted sexual behaviour from staff or colleagues.
Commenting that these figures are very distressing, Dr Evans said: ‘Such conduct should not be tolerated in the NHS. That is why the NHS launched its first ever Sexual Safety charter last year which provides clear commitments to improve reporting on unacceptable behaviour, as well as appointing more than 300 domestic abuse and sexual violence leads who will review and improve trust policies for reporting of sexual harassment.
Medical leaders condemned the survey findings on sexual harassment. Dr Adrian Boyle, president of the Royal College of Emergency Medicine, said: ‘Discrimination or abuse of any kind must not be tolerated – anywhere, ever. Everyone has a responsibility to call it out.
‘Such behaviour is abhorrent and in a clinical setting, utterly disrespectful to our hardworking NHS staff and to patients receiving or waiting for medical attention. Staff are most effective when they feel psychologically safe in a workplace.
‘NHS staff cannot walk away when someone needs help – being harassed or feeling vulnerable should never be considered “part of the job”.’
Professor Vivien Lees, vice president of the Royal College of Surgeons of England (RCS England) and lead on sexual misconduct, said: ‘Gathering this data is an important step as it gives us a better picture of the scale of the problem.
‘It is essential that staff members feel empowered to report instances of misconduct without fear of reprisal or negative impact on their career progression. They also need to feel confident that reports will be believed.’
She added: ‘RCS England is committed to a zero-tolerance approach to sexual misconduct, and we will actively work to eradicate this behaviour in surgery and healthcare.’
Coinciding with the publication of the NHS Staff Survey, the Royal College of Physicians and Surgeons of Glasgow launched its 10-point action plan aimed at tackling sexual misconduct in healthcare.
5th February 2024
Both the global cancer burden and inequity in cancer and palliative care services are growing across the world, according to new figures released by the World Health Organization (WHO).
Published to coincide with World Cancer Day (4 February 2024), the survey undertaken by the WHO’s cancer agency, the International Agency for Research on Cancer (IARC), shows a growing need for more cancer-related health services worldwide.
Over 35 million new cancer cases are predicted in 2050, a 77% increase from the estimated 20 million cases in 2022, the IARC said.
This ’rapidly growing global cancer burden’ reflects population ageing and growth, as well as changes to people’s exposure to risk factors such as tobacco, alcohol, obesity and air pollution, it added.
The figures show that 10 types of cancer collectively comprise around two-thirds of new cases and deaths globally. Lung cancer is the most commonly occurring cancer worldwide, followed by female breast cancer and colorectal cancer.
In 2022, there were an estimated 20 million new cancer cases and 9.7 million deaths, with lung cancer accounting for 2.5 million or 12.4% of the total new cases.
Female breast cancer ranked second with 11.6% of new cases, followed by colorectal cancer, which accounted for 9.6% of new cases. Prostate cancer and stomach cancers were the next two most common, respectively.
Lung cancer was also the leading cause of cancer death, accounting for nearly a fifth of the total cancer deaths, followed by colorectal cancer 9.3% of deaths and liver cancer 7.8% of deaths.
Differences were seen between sexes, with breast cancer being the most commonly diagnosed cancer and leading cause of cancer death amongst women, whereas it was lung cancer for men.
Prostate and colorectal cancers were found to be the second and third most commonly occurring cancers for men, with liver and colorectal cancers second and third most common causes of cancer death.
For women, lung and colorectal cancer were second and third for both the number of new cases and of deaths.
Lung cancer’s re-emergence as the most common cancer is likely related to persistent tobacco use in Asia, the IARC said.
The figures also show that a majority of countries do not adequately finance priority cancer and palliative care services.
Only 39% of participating countries covered the basics of cancer management as part of their funded core health services for all citizens, and only 28% of participating countries additionally covered care for people who require palliative care.
In areas where patients are underserved in relation to cancer treatments, rates of cancer are higher, highlighting a growing inequity in cancer services worldwide.
Dr Panagiota Mitrou, director of research, policy and innovation at the World Cancer Research Fund, stated that the UK Government needs to prioritise cancer care in light of the increasing number of global cases.
She said: ‘These new estimates show the increased burden that cancer will have in the years to come. UK Governments’ failure to prioritise prevention and address key cancer risk factors like smoking, unhealthy diets, obesity, alcohol and physical inactivity has, in part, widened health inequalities. We know around 40% of cancer cases could be prevented.’
She added: ‘Now is the time to turn the tide by implementing policies that enable people to live healthier lives by reducing their exposure to risk factors and prioritising a national cancer plan which includes better screening and early detection.’
The WHO figures come as NHS England announces the launch of a national gene testing programme to identify cancer risk for people with the BRCA gene.
The BRCA refers to two genes, BRCA1 and BRCA2, which repair DNA damage and help to protect against cancer. If one of the genes is faulty, this can increase a person’s chance of getting cancer significantly.
People with Jewish ancestry are around six times more likely to carry such genetic faults than the rest of the population and are therefore at increased risk of developing some cancers.
Through genetic testing, the NHS plans to identify people carrying faults in the BRCA gene to ensure those affected have access to early surveillance and prevention services.
People with at least one Jewish grandparent can register for a saliva test kit, and following the success of the pilot programme, it is expected that the national roll-out will see around 30,000 people tested over the next two years.
Commenting on the programme, Peter Johnson, national clinical director for cancer at NHS England, said: ‘BRCA testing for the people most at risk has the potential to save lives by allowing them to take steps to reduce the chance of cancers developing or making sure that any cancer can be detected as early as possible, with those at increased risk able to take advantage of surveillance and prevention programmes with their health teams.’
A version of this article was originally published by our sister publication Nursing in Practice.
16th January 2024
A new platform allowing recently retired consultants who still hold a license to return to the NHS in a more flexible capacity has been launched by NHS England as part of a range of measures to bring down the elective care backlog.
The NHS Emeritus pilot scheme will run for a year across England and it is expected Emeritus consultants will be able to start carrying out appointments from February 2023.
This will follow a full registration process, which includes pre-employment checks and face-to-face interviews with NHS Professionals.
Once registered, a cloud-based platform will link Emeritus consultants with secondary care providers who upload the activity they would like supported. This could range from outpatient appointments, specialist advice requests and education and training support.
The Emeritus consultants can then express their interest in undertaking the specific work listed, and providers will choose the consultant whose skillset and availability best matches the appointments they need covered.
Appointments would be scheduled and arranged with patients in the normal way and carried out in-person or remotely, if clinically appropriate.
This means Emeritus consultants could be based anywhere in England and support hospitals in areas with workforces shortages in a particular specialty or a higher demand for services, or more remote areas where travel is difficult for patients.
The platform aims to provide trusts with an alternative to using agency staff, while allowing experienced specialists who are nearing retirement but want to keep working in the NHS longer, or recently-retired consultants who want to re-join, with an easy route back in with more flexibility.
Stella Vig, NHS national clinical director for elective care, said: ‘The NHS prides itself on its hard-working and committed staff, and it is often the most experienced and knowledgeable clinicians who are lost to the NHS once they retire, even though they still have a lot more they can give to benefit patients.
‘Many have said they want to be able to keep giving back to the health service once they have retired, but in a more flexible way – through the NHS Emeritus initiative, we can provide an opportunity for consultants to continue to work in the NHS in a way that fits in with their life and schedule, and ensures the NHS can still benefit from their skills and knowledge, whether that be through providing training and education, or continuing to see patients and help add much-needed capacity as we work toward our aims of bringing down the longest waits for elective care.’
Consultant urologist Simon Williams is currently employed by University Hospitals of Derby and Burton, and going through the final stages of the registration process for the Emeritus scheme ahead of retiring soon.
He said: ‘Having spent 32 years working in the NHS I have built up a wealth of experience and skills. NHS Emeritus is a great way to continue to share that and still see patients, but in a more flexible way.
‘The programme will enable me to help trusts across the country using remote consultations, not just those in my local area, which could really help free up capacity for their consultants to see more patients in-person and help bring down some of the longer waits for routine appointments.’
Dr Sarah Clarke, president of the Royal College of Physicians, said: ‘At a time when the NHS is facing unprecedented demands, paving a way for our recently retired experienced doctors to be able to contribute their skills again as emeritus consultants is a very welcome step forward.
‘As outlined in RCP’s Later Careers Guidance, we know that more than a third of physicians who are not yet retired say they want to retire early, but almost 60% of physicians would delay retirement if they could work flexibly or reduce their hours, highlighting that integrated flexible working would greatly improve retention.
‘We will closely follow the Emeritus pilot and very much hope that it offers a flexible opportunity for experienced physicians to once again provide vital care for their patients while importantly reducing waiting lists.’
If the pilot is successful, the scheme has the potential to be expended to cover other work areas, the NHS said.
Ms Vig added: ‘It’s a simple concept, but one that we hope will benefit everyone taking part – and we envisage that this is just the beginning, with the potential to broaden NHS Emeritus out to a wider cohort and to include different types of work in the future, which could benefit thousands of patients across the country.’
The new tool is one initiative being rolled out to help deliver the NHS Elective Recovery Plan and to cut the longest waits for routine care.
Recent research has suggested that the NHS must treat 10% more non-urgent hospital cases a month to reverse the increasing waiting list for elective care.
NHS trusts and integrated care boards must work to reduce elective long-waits and meet cancer 62-day backlog targets following this month’s strike action, NHS England has said.
In a letter addressed to chief executives and directors, NHS England outlined its expectations following the disruption caused by the junior doctors’ strike held in January.
It said that trusts will likely face a combination of pressures including seasonal Covid and flu presentations, cold weather-related presentations, staff sickness and the need to reschedule patients’ cancelled appointments.
NHS England urged trusts to ‘continue to prioritise the safety of patients’, including urgent planned surgery and other treatment for time-sensitive conditions, particularly fast progressing cancers.
It said the priorities from January to March remain for:
The latest round of junior doctor strikes lasted for 144 hours from 7am on 3 January to 7am on 9 January as part of their ongoing salary dispute.
NHS data showed that more than 113,700 inpatient and outpatient appointments due to be held during the strike had to be rescheduled.
Since strikes began, the cumulative total of acute inpatient and outpatient appointments rescheduled is now 1,333,221, according to NHS England.
As these latest NHS priorities were shared, a new study suggested that the NHS must treat 10% more non-urgent hospital cases a month to reverse the increasing waiting list for elective care.
Even if system capacity were to increase by 30% – as NHS England’s target sets out – it would still take ‘several years’ to clear the backlog, researchers from Universities of Edinburgh and Strathclyde said.
Published in The Lancet, the research paper estimated there were 10.2 million fewer referrals made to elective care between the beginning of the Covid-19 pandemic and October 2022.
It also highlighted that the NHS waiting list for elective treatment increased between January 2012 and 2020 suggesting ‘a gradual service decline’ even before the pandemic.
The researchers concluded that even if the 30% increase in capacity is achieved during the next three years, ‘several years (beyond the end of 2025) will be needed for the backlog to clear.’
They added: ’Our study emphasises the need to improve healthcare system resilience to ensure that the effects of any future emergencies on the provision of routine care are minimised.’
The most recent NHS England data revealed that the Covid-19 backlog has fallen for two months in a row, dropping by 95,000 individual pathways from 7.7 million in October to 7.6 million in November.
NHS England said this was due to NHS staff delivering more than 1.63 million treatments in November – the highest monthly activity on record and around 150,000 more than the same month before the pandemic.
1st December 2023
The number of patients in hospital with norovirus is triple that of this time last year and is adding to mounting winter pressures, NHS England figures show.
Surveillance data also shows so far in the 2023/24 season, the cumulative number of norovirus cases is 9% higher than the five-year average.
The increased rate is mostly accounted for by unusually high activity earlier in the season, according to a report from the UK Health Security Agency with data up to 19 November.
The data shows that cases had been increasing over the previous two weeks, but remain within the range of what might be seen for the time of year.
Overall, an average of 351 people were in hospital with diarrhoea and vomiting symptoms every day last week compared to 126 in the same week last year, NHS England said.
There were also 13 children with the virus in hospital each day, compared to an average of just three for the same period in 2022.
Laboratory reports for rotavirus are also showing an increase with cumulative figures for the 2023/24 season 25% higher than the average for the past five years.
The figures suggest that winter pressures may be mounting on the NHS with adult bed occupancy already running at more than 95% and 1,200 more patients admitted than the end of November last year.
And problems with discharging patients from hospital into social and community care settings are continuing to have a ‘considerable impact’ with more than 12,600 adult beds a day occupied by people ready for discharge – one in seven of the total, the NHS said.
NHS England national medical director, Professor Sir Stephen Powis, said: ‘We all know somebody who has had some kind of nasty winter virus in the last few weeks and today’s data shows this is starting to trickle through to hospital admissions, with a much higher volume of norovirus cases compared to last year, and the continued impact of infections like flu and respiratory syncytial virus in children on hospital capacity – all likely to be exacerbated by this week’s cold weather.‘
He added that staff were working hard to prepare for winter and there had been a significant reduction in ambulance handover delays. He also urged people to get their Covid and flu vaccines if they were eligible.
However, he concluded: ‘The demand on hospitals and staff is high, with more than 1,200 extra patients in hospital compared to last year, and we know that is likely to grow considerably before Christmas.’
A version of this story was originally published by our sister publication Pulse.
3rd November 2023
A single, national standardised early warning system for paediatric teams in hospital settings is being rolled out by the NHS in England as a way of ensuring deterioration in a child’s condition is detected and escalated quickly.
Available from today (3 November), the new inpatient Paediatric Early Warning System (PEWS) chart allows paediatricians to measure things like blood pressure, heart rate, oxygen levels and levels of consciousness. The system tracks any changes and has different scores representing the level of concern.
If a parent or carer raises a concern that their child is getting ill or sicker than the score shows, this will immediately escalate the child’s care regardless of other clinical observations.
Unlike the similar universal system currently in place for adults, there are four separate charts for different age ranges, including 0-11 months, one to four years, five to 12 years, and those aged 13 and over.
The ultimate aim of the PEWS is to improve working methods and safety to support better health outcomes.
It is part of the System-wide Paediatric Observations Tracking (SPOT) programme, led by NHS England in collaboration and endorsement from the Royal College of Paediatrics and Child Health (RCPCH) and the Royal College of Nursing (RCN).
The partnership has been developing PEWS for three years, with pilots running across 15 sites demonstrating clear benefits for both patients and staff.
Updates to the system – such as those based on any guidance from Martha’s Rule, which gives families and patients the right to a second medical assessment – will continue to be implemented as required.
Professor Sir Stephen Powis, NHS national medical director, said: ‘We know that nobody can spot the signs of a child getting sicker better than their parents, which is why we have ensured that the concerns of families and carers are right at the heart of this new system with immediate escalation in a child’s care if they raise concerns and plans to incorporate the right to a second opinion as the system develops further.’
The NHS will develop and circulate a leaflet and video content for parents to explain how to communicate concerns to healthcare staff and encourage them to escalate if needed.
Dr Mike Mckean, vice president for policy, at the RCPCH, said: ‘The National PEWS chart is an extremely important new tool that will support all paediatricians and wider child health teams to spot deterioration in children in hospital. Alongside training and resources, it will help teams across the country improve patient safety, efficacy and quality of care.
‘The SPOT programme builds on systems already in place in many trusts and has the many advantages of becoming a national system. I’d strongly encourage all paediatricians to look at the chart and consider what they need to do to smoothly transition towards integration and embedding the National PEWS into their trusts.’
Standardised tools and e-learning for using national PEWS charts in a range of health settings are in development.
In 2023/24 trusts are expected to appoint an education/implementation lead who will begin to support their trust to roll out the national PEWS.
Plans are in place to expand the system to emergency departments as well as mental health, ambulance and community services in due course. It is also hoped that the national PEWS chart will become the standard of care in England, meaning all medical and nursing students will receive instruction on its use during their training.
1st November 2023
Around 400,000 patients who have been waiting the longest for elective treatment will be offered the opportunity to travel to a different hospital to be treated sooner, NHS England has said.
Any patient who has been waiting longer than 40 weeks for treatment and who does not have an appointment within the next eight weeks will be contacted by their hospital.
It comes after analysis by the Health Foundation indicated that the waiting list for elective NHS care will peak at eight million next summer if current trends continue, regardless of whether NHS strike action continues.
Patients contacted by their hospital will be asked to specify how far they are willing to travel, with the NHS then identifying alternative hospitals with capacity.
NHS England said in some cases the request will be uploaded to the NHS’s Digital Mutual Aid System – its hospital matching platform – to see if NHS or independent sector providers elsewhere in the country can provide their care.
Patients will remain on the waiting list for their home hospital until there is confirmation that their full care pathway has been moved to another provider. If no alternative is found within eight weeks they will retain their position on their current waiting list.
The NHS estimated that approximately 400,000 patients – or 5% of the overall waiting list – meet the criteria and will be contacted by their hospital.
This system is made possible, the NHS said, thanks to ‘the hard work of NHS staff‘ as well as innovations such as ‘surgical hubs, community diagnostic centres, and the use of robots and AI to speed up surgery and other treatments‘.
NHS chief executive Amanda Pritchard said: ‘Despite pressure and the huge disruption caused by strikes, NHS staff have made great progress in reducing the longest waits for patients. This new step to offer NHS patients who have been waiting the longest the opportunity to consider travelling for treatment is just another example of how we are introducing new approaches to reduce how long patients wait, while improving the choice and control they have over their own care.
‘Giving this extra option to these patients also demonstrates the clear benefits of a single national health service, with staff able to share capacity right across the country.
‘So, whether a patient’s care moves to the next town or somewhere further away, it is absolutely right that we make the most of available capacity across the country to continue to reduce the backlogs that have inevitably built up due to the pandemic and provide the best possible service for patients.’
Louise Ansari, chief executive of Healthwatch England, welcomed the news but said: ‘We’re now calling on NHS England and integrated care boards to work together to ensure everyone choosing to travel for faster treatment is given support, including with the costs of transport and accommodation – as described in the Elective Recovery Plan. Otherwise, this option risks deepening health inequalities by only providing solutions to people who can afford to contribute towards the additional costs of travel.‘
A version of this story was originally published by our sister publication Healthcare Leader.
26th October 2023
Virtual wards should be expanded to include heart failure patients to help reduce recovery times and ease pressure on hospital beds during the winter season, new NHS clinical guidance has outlined.
NHS England has now pushed for integrated care boards to work with cardiac clinical networks to better understand their heart failure population needs and workforce competencies.
The expansion is set to build on the use of and learning from virtual wards for acute respiratory infection and frailty.
It comes after the NHS met its target last month to deliver 10,000 virtual ward beds, through which more than 240,000 patients treated successfully since April 2022.
There are currently a dozen heart failure virtual wards up and running, NHS England said. This includes Liverpool University Hospitals NHS Foundation Trust and Mersey Care NHS Foundation Trust, which together have supported more than 500 people on virtual wards for heart failure.
According to the guidance, as a minimum requirement the new virtual wards should ensure people with heart failure have access to rapid specialist advice and guidance, including via video or telephone, where necessary.
ICBs must also make sure these digital wards feature a daily virtual review with the heart failure team or a multidisciplinary team, with robust processes for escalating concerns.
NHS England also advised an ICB’s approach support ‘seamless patient care’, which may include:
NHS England’s national clinical director for heart disease Professor Sir Stephen Powis said: ‘More than 240,000 patients have already benefitted from virtual wards, and now we are growing this service to patients with heart failure.
‘This is a positive development in how the NHS can treat patients, and testament to the hard work of our staff after hitting our target of 10,000 virtual ward beds last month.
‘The expansion has been implemented at a key time just before winter, when there will be a lot more pressure on our hospitals and will free up beds for those who need them the most.’
Around 200,000 people a year are diagnosed with heart failure and often require significant NHS support, including long or frequent hospital stays. Some 5% of all emergency hospital admissions in the UK are attributed to the condition.
A version of this story was originally published by our sister publication Healthcare Leader.
The quality of patients’ access to urgent and emergency care in England ‘depends too much’ on where they live, the House of Commons Public Accounts Committee (PAC) has said in a scathing new report into urgent and emergency care access.
Entitled ‘Access to urgent and emergency care‘, the report said staff ‘have been let down by a system which has seen performance fall far below the standard the NHS says patients should expect to receive’.
It highlights that NHS’s own target for A&E waits had not been met since 2015, and its target for ambulance handovers had been missed each year since it began reporting against this metric in 2017. Regional variation was found to be particularly prevalent, it said.
Proportions of the most serious A&E patients waiting less than four hours in March 2023 ranged from 53.3% in the Midlands to 62.1% in the South East.
Ambulance services covering large rural areas, like the South West and East of England, are especially challenged, with Category 1 response times in 2021/22 varying from 6 minutes and 51 seconds in London to 10 minutes and 20 seconds in the South West.
The PAC said that evidence suggested the Department of Health and Social Care had ‘not sufficiently held NHS England to account’ for meeting targets and improving urgent and emergency care.
What’s more, differences in the capability of individual trusts, including around management, clinical leadership, and technology, were also highlighted. The PAC said these must be addressed to reduce variations in patients’ access to and experience of services.
Commenting on the report, Dr Adrian Boyle, president of the Royal College of Emergency Medicine, said: ’This is another report that lays out the damning reality of emergency care. Our members and their patients are being let down.’
And he described the Committee’s finding that performance varies from region to region as ‘disheartening but not surprising’.
He added: ’We must be able to better understand what is happening at a local level. At the moment we do not know how well or how poorly individual hospitals are doing because the official data is published by each trust, which may encompass several sites.
’RCEM is campaigning for NHS England to publish transparent performance figures for individual A&Es, so increased resources and support can be provided to the sites that are struggling the most. Improving equality of care and resulting in significant benefit to patients and staff.’
The PAC report also highlighted that not enough is being done to tackle delayed discharges, which has a serious knock-on impact throughout the whole urgent and emergency care system, with beds unable to be released for new patients and thus exacerbating A&E waiting time issues.
The number of patients staying in hospital when they no longer need to stood at an average of 13,623 in Q4 of 2022/23, up from 12,118 in the same period one year before.
To this end, Dr Boyle said: ’We are on the cusp of what looks likely to be another devastating winter. Having adequate capacity for our patients is vital. This will reduce dangerous levels of bed occupancy and improve flow through our hospitals and go some way to easing the pressure on the system.
“We know that since the pledge [to] increase bed numbers by 5,000 was made in January, we have not made nearly enough progress on this fundamental solution. The priority must now be on significantly increasing bed numbers before the cold weather, and the inevitable winter pressures hit.’
The PAC also called into question the ‘assumptions underpinning’ NHS England’s plan to retain 130,000 staff over the next 15 years, as set out in its recent workforce plan, particularly given the staff turnover rate in the health service was 9% in 2022/23.
And despite having ‘more money and staff than ever before’, the NHS has made ‘poor use of it’ to improve urgent access for patients with urgent and emergency services ‘deteriorating’ in spite of greater spend, it concluded.
It also flagged a 23% fall in NHS productivity following the Covid-19 pandemic, even though it had been improving pre-pandemic.
It has now called on NHS England to set out its understanding of the causes for the fall in productivity and how it will address them.
Similarly, it urged NHS England to establish the causes for variation in performance, and how it might bring the ‘worst-performing organisations’ closer in line to the standards achieved by the best.
Committee chair and Labour MP Dame Meg Hillier said: ‘Excluding demand-led spending such as welfare payments, health takes up approximately 40% of day-to-day budgeted spending by Whitehall departments. It is vital this is delivering benefits for patients. The Government and health system need to be alert to the serious doubts our report lays out around the workforce crisis, both the approach to tackling it now and the additional costs funding it in the future.’
Responding to the inquiry report, NHS England’s national clinical director for urgent and emergency care, Professor Julian Redhead, said: ‘While this report includes data which is more than two years old and coincided with a once in a generation pandemic, it is right to note the NHS has been under increasing pressure with staff experiencing record A&E attendances, hospitals fuller than at any point in their history and with thousands of beds taken up each day, in part, due to pressures in social care.
‘It is testament to the hard work of staff and results of our NHS winter plan – rolling out 800 new ambulances, 10,000 virtual ward beds and work towards 5,000 extra core beds – that waiting times for ambulances, 999 calls and in A&E have improved across the country during this financial year.
‘This progress has come as the NHS has committed to delivering £12bn of annualised savings by 2024/25 – all while dealing with more than a 100,000 staff posts being vacant.’
A version of this story was originally published by our sister publication Healthcare Leader.
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