“Official figures mask A&E waiting times”

“Tens of thousands more patients spent more than 12 hours in A&E waiting for a bed last year than official figures suggest. Doctors and MPs called for a change to how “trolley waits” were reported in England after an investigation by The Times.

Official numbers show that 2,770 A&E patients had to wait more than 12 hours for a bed last year. These NHS statistics only capture the time between a doctor deciding a patient needs to be admitted and then being found a place on a ward. If the time is recorded between arriving at A&E and being found a bed, the number of patients who had to wait in emergency departments for more than 12 hours leaps to at least 67,406 patients, 24 times higher, according to data obtained under freedom of information laws.

The true figure is likely to be even higher, as only 73 hospitals out of 137 replied to the requests. The Times also asked hospitals for details of the longest wait they had recorded each week. Those revealed about 200 patients waiting more than a day for a bed last year. In December a 103-year-old woman spent 29 hours in A&E before she was admitted to the Great Western Hospital in Swindon, Wiltshire. The trust said that it had been one of the busiest months on record. The longest wait reported to The Times, of almost four days, was a 16-year-old boy at Barking Havering and Redbridge NHS Trust.

Sarah Wollaston, Conservative chairwoman of the health select committee, said that long waits in A&E raised patient safety concerns. “When departments are already at full stretch, having to care for individuals who may be very unwell and waiting for transfer to a more appropriate clinical setting reduces the time clinicians are free to assess and care for new arrivals and this can rapidly lead to spiralling delays,” Dr Wollaston said. “The total length of time that people are spending in emergency departments should be recorded alongside the current figures.”

Paul Williams, a Labour member of the committee, said: “If the clock doesn’t start ticking on ‘trolley waits’ until this decision has been made, then hospitals can legitimately have someone waiting for more than three hours to be seen and assessed, and then another 11 hours on a trolley without this leading to a breach of targets.” In Wales, Scotland and Northern Ireland, 12-hour waits are recorded from when a patient arrives in the department.

Rachel Power, chief executive of the Patients Association, said: “It’s clear from this data that many patients are enduring even longer waits with their safety, privacy and dignity compromised than the official statistics show.”

Taj Hassan, president of the Royal College of Emergency Medicine, said: “I think all independent observers would agree that, at the moment, the way we are describing our 12-hour trolley waits is not accurately describing the numbers.”

An NHS England spokesman said: “In the last 12 months to February 2018 the number of 12-hour trolley waits has dropped by more than 20 per cent on the previous year, and this has been achieved while hospitals also successfully looked after 160,000 more A&E patients within the four-hour target this winter compared to last winter.” NHS Digital is set to publish separate monthly statistics on the total number of patients spending more than 12 hours in A&E, whether or not they eventually needed admission. They said there were more than 260,000 during the financial year 2016-17.

Behind the story

Hospitals are expected to treat, admit or discharge 95 per cent of patients within four hours of their arrival at A&E (Kat Lay writes).

However, they have not met that target since July 2015. In January, only 77.1 per cent of people going to larger A&Es were dealt with within four hours.

For patients who require admission — “the sickest group” attending A&E, says the Royal College of Emergency Medicine — it appears to be worse.

At hospitals that provided figures to The Times, on average only 53 per cent of patients requiring admission were found a bed within four hours in January this year.

A lack of social care means that many of the beds that such patients need to be moved on to are taken up by people who do not need to be in hospital any longer, doctors complain.

Source: The Times (pay wall)

Our NHS: Demo at DCC HQ Thursday 22 March from mid-day

Join SOHS demo from midday – County Hall, Exeter – This Thursday 22nd March.

Save Our Hospital Services (SOHS) Devon are lobbying against plans to introduce structural changes in NHS delivery of services from April 1st with the introduction of an Integrated Care System (formerly known as ‘Accountable Care System’). This is yet another reorganisation of Health & Social Care services, which hasn’t been consulted on and is part of the ‘Sustainability & Transformation Plan’ imposed by the government to cut another £550 million off Devon’s Health care and introduce more privatisation…


We will also address the DCC Health & Adult Care Scrutiny Committee at 2.00pm on Thursday with 12 key questions about Integrated Care Systems (ICS)
planned for introduction by NHS England from April 1st without consultation. SOHS have sent these 12 questions to Dr Tim Burke, Chair of the NEW CCG
which meet also at 1.00pm on Thursday at County Hall.

“The town that’s found a potent cure for illness – community”

What this provisional data appears to show is that when isolated people who have health problems are supported by community groups and volunteers, the number of emergency admissions to hospital falls spectacularly. While across the whole of Somerset emergency hospital admissions rose by 29% during the three years of the study, in Frome they fell by 17%. Julian Abel, a consultant physician in palliative care and lead author of the draft paper, remarks: “No other interventions on record have reduced emergency admissions across a population.”

Frome is a remarkable place, run by an independent town council famous for its democratic innovation. There’s a buzz of sociability, a sense of common purpose and a creative, exciting atmosphere that make it feel quite different from many English market towns, and for that matter, quite different from the buttoned-down, dreary place I found when I first visited, 30 years ago.

The Compassionate Frome project was launched in 2013 by Helen Kingston, a GP there. She kept encountering patients who seemed defeated by the medicalisation of their lives: treated as if they were a cluster of symptoms rather than a human being who happened to have health problems. Staff at her practice were stressed and dejected by what she calls “silo working”.

So, with the help of the NHS group Health Connections Mendip and the town council, her practice set up a directory of agencies and community groups. This let them see where the gaps were, which they then filled with new groups for people with particular conditions. They employed “health connectors” to help people plan their care, and most interestingly trained voluntary “community connectors” to help their patients find the support they needed.

Sometimes this meant handling debt or housing problems, sometimes joining choirs or lunch clubs or exercise groups or writing workshops or men’s sheds (where men make and mend things together). The point was to break a familiar cycle of misery: illness reduces people’s ability to socialise, which leads in turn to isolation and loneliness, which then exacerbates illness.

This cycle is explained by some fascinating science, summarised in a recent paper in the journal Neuropsychopharmacology. Chemicals called cytokines, which function as messengers in the immune system and cause inflammation, also change our behaviour, encouraging us to withdraw from general social contact. This, the paper argues, is because sickness, during the more dangerous times in which our ancestral species evolved, made us vulnerable to attack. Inflammation is now believed to contribute to depression. People who are depressed tend to have higher cytokine levels.

But, while separating us from society as a whole, inflammation also causes us to huddle closer to those we love. Which is fine – unless, like far too many people in this age of loneliness, you have no such person. One study suggests that the number of Americans who say they have no confidant has nearly tripled in two decades. In turn, the paper continues, people without strong social connections, or who suffer from social stress (such as rejection and broken relationships), are more prone to inflammation. In the evolutionary past, social isolation exposed us to a higher risk of predation and sickness. So the immune system appears to have evolved to listen to the social environment, ramping up inflammation when we become isolated, in the hope of protecting us against wounding and disease. In other words, isolation causes inflammation, and inflammation can cause further isolation and depression. …”


Control of community care in Nottinghamshire falls to controversial US company

“NHS Protectors’ worst fears are being realised as USA’s Centene is likely to control Greater Nottingham Accountable Care System, by taking over the NHS Commissioner’s role in a £206m community services contract.

At the very time that its discredited subsidiary Ribera Salud – which is being kicked out of Spain by the Valencia Green/Podemos/Socialist government – has appointed former New Labour Health Secretary Alan Milburn as a Director and has sent lots of executives to UK to help Centene UK with its plan of buying primary care and mental health companies.

The UK subsidiary of Centene – a US sub-prime health insurance profiteer that has got rich off managing Obamacare’s publicly-funded Medicaid programmes which provide health insurance for people on a low income – is likely to take over the NHS commissioner’s role in the £206m, 7 year contract for out-of-hospital community services, that Nottingham City Clinical Commissioning Group recently awarded to Nottingham City Partnership Community Interest Company. …”

This seems to bear out NHS protectors’ worst fears that Accountable Care Systems or Organisations are Trojan horses designed to import US companies into key controlling positions in these new types of local NHS and social care services.

Centene UK, assisted by executives from its discredited Spanish subsidiary Ribera Salud, is also studying the acquisition of primary care and mental health companies in the United Kingdom, according to recent reports from Valencia Plaza.

Ribera Salud recently appointed the former New Labour Health Secretary Alan Milburn to its Board of Directors, to help it “continue with its expansion plans.” In addition, during the recent visit to Valencia of the United Kingdom’s ambassador to Spain, Simon Manley, a British manager of Ribera Salud contacted him to explain the company’s plans. …

Nottingham City Clinical Commissioning Group will become part of the Nottinghamshire/Greater Nottingham Accountable Care System. This will be:

“a single risk bearing entity to managing [sic] the entire care continuum. The successful provider must form part of the ACS and…will be expected to help shape and deliver its part of the single risk bearing entity.”

This sounds like the Accountable Care Organisation contract – which NHS England is not approving now and which is the subject of two Judicial Reviews in the Spring and a public consultation at some unspecified point in time.

The contract notification says that when the Accountable Care System is implemented, this will require a contract variation which:

“will require the successful provider to provide its consent to the potential future transfer of the CCG’s role under the contract.”

This contract variation will mean transferring the contract from Nottingham Clinical Commissioning Group to another provider, or the Care Integrator (Centene UK).

It seems that Nottingham City Clinical Commissioning Group has taken a gamble on the likelihood that NHS England will be approving the Accountable Care Organisation contract by the time the Sustainability and Transformation Partnership has figured out its business case to consider the options for partner organisations in managing the Accountable Care System components and has secured legal and procurement support to advise on this.”


Seaton and Area Health Matters meeting, Friday 23 March 9 am1 pm – registration required

From the blog of DCC East Devon Alliance councillor Martin Shaw:

“A reminder to all involved in local community groups, especially those with an interest in health and wellbeing in the broadest senses, that Seaton and Area Health Matters will convene in the Town Hall on Friday 23rd March, 9 for 9.30 until 1 pm. There is still time to register!

Book here:


You are invited to participate in this community led event with key stakeholders around the future health and wellbeing of all the people in our communities, in response to the new landscape affecting Seaton and surrounding area as a result of NHS and Government policies advocating Place-Based Care in health provision and cross-sector collaborative working with community groups

The aim: To discuss what we know, where there are gaps/challenges and how, as a community we will address these to ensure collaborative approaches to co-design and co-produce local health services/activities that meet the needs of all the people in our communities.

Invitees: Management and senior level employees and volunteers / trustees from community, voluntary and social enterprise sector as well as public and private organisations.

Area to include: Seaton, Colyford & Colyton, Beer, Axmouth, Branscombe


Welcome: Mayor of Seaton – Cllr Jack Rowland

Community Context:
• Dr Mark Welland – Chairman of Seaton & District Hospital League of Friends
• Roger Trapani – Community Representative, Devon Health and Care Forum
• Charlotte Hanson – Chief Officer, Action East Devon

Strategic and Services Overview – Place Based Care:
• Em Wilkinson-Bryce – Royal Devon and Exeter NHS Foundation Trust
• Chris Entwistle – Health and Social Care Community Services
• Dr Jennie Button – Social Prescribing Lead – Ways 2 Wellbeing project in Seaton

Workshop, Networking and Discussion will form the main part of this event:
• Workshop 1 – What is working well and what are the challenges for Seaton and surrounding area?
• Workshop 2 – Working together to improve health and wellbeing outcomes? What support do we need?”

Reminder – Seaton and Area Health Matters meeting in Seaton Town Hall on Friday 23rd from 9.

Devon County Council: the place democracy goes to die

Facebook post by DCC Lib Dem Councillor Brian Greenslade

Late last year we started to learn about plans by the Health Secretary Jeremy Hunt and NHS England to introduce by the 1st April Accountable Care Organisations to replace CCG’s in the Health Service. These organisations would provide health and social care services. Bringing these services together makes sense but democratic oversight appeared to be an after thought. ACO’s seemed to be based on similar type Organisations in the US.

What was clear was that little or no public scrutiny of these proposals had happened. Congratulations to Sarah Wollaston MP Chairman of the Health Select Committee who then intervened to stall this initiative to allow the Parliamentary Health Select Committee chance to scrutinise the proposals. The same was true at Devon County Hall where nothing about this was brought to the attention of members of the Health Scrutiny Committee.

Opposition to ACO’s started to brew up so then suddenly the Government and NHS England started to talk about integrated care systems instead which apparently are different. How different is not clear and I am concerned that this could be a back door attempt to introduce ACO’s.

Yesterday at the DCC Cabinet a report by the Chief Executive about Integrated Care Systems was considered. It failed to answer key questions but it was clear that changes from April were on the way.

My Lib Dem colleagues and I hotly contested the recommendations and called for time to have this report sent to Scrutiny first. This was voted down by the Tory majority.

We reacted to this by calling in the Executive decision for scrutiny. This as the effect of delaying any decision on this being made until 11th April at the earliest to consider representations by Scrutiny.

Amazingly the Tories are rushing scrutiny through by making it an urgent item for the Health Scrutiny meeting on the 22nd of March giving little time for consideration of this critical issue for the health of the people of Devon.

Democratic standards that the Lib Dem’s stand for mean little to Devon’s ruling Tories!”

Royal College of Emergency Medicine dismisses bad weather and flu as cause of A and E crisis

“Unacceptable A&E waits are the new normal, doctors declared today, after NHS hospitals suffered yet another worst month on record.

The Royal College of Emergency Medicine dismissed excuses about bad weather and flu and urged patients to write to their MPs to demand improvement.

A&E units saw only 85 per cent of patients within four hours in February, worse than the previous low of 85.1 per cent seen in December and January last year. In major hospitals, the figure was 76.9 per cent, also the lowest since records began in 2010, and in some units barely half of patients were dealt with in time. It means 100,000 more people suffered longer delays than last year.

NHS chiefs blamed an inexorably rising tide of sicker patients, with this winter seeing 261,000 more people coming to A&E than last year, up 5 per cent. More of these patients were also ill enough to need a bed, with emergency admissions up 6 per cent to 1.4 million. Wards were about 95 per cent full all winter, well above the 85 per cent estimated to be safe.

Taj Hassan, president of the Royal College of Emergency Medicine, said: “Performance that once would have been regarded as utterly unacceptable has now become normal and things are seemingly only getting worse for patients. It’s important to remember that while performance issues are more pronounced during the winter, emergency departments are now struggling all year round.”

In January the heads of half of England’s A&E units wrote to the prime minister to warn her that patients were dying in corridors.

Dr Hassan said: “The current crisis in our emergency departments and in the wider NHS is not the fault of patients. It is not because staff aren’t working hard enough, not because of the actions of individual trusts, not because of the weather or norovirus, not purely because of influenza, immigration or inefficiencies and not because performance targets are unfeasible. The current crisis was wholly predictable and is due to a failure to prioritise the need to increase healthcare funding on an urgent basis.”

He added: “We need an adequate number of hospital beds, more resources for social care and to fund our staffing strategies that we have previously agreed in order to deliver decent basic dignified care. We would urge our patients to contact their MP to tell them so.”

Nigel Edwards, head of the Nuffield Trust think tank, said that A&Es were in their worst shape since 2004.

“The main waiting times targets for cancer and planned treatment are being missed, and there is no sign of recovery,” he said. “Fundamentally, these pressures are driven by a lack of money and staff. If these are not addressed it is inevitable that as difficult as February has been for NHS staff and patients there will be worse to come.”

Figures from the British Social Attitudes survey last week showed dissatisfaction with the NHS up seven points to its highest level since 2007, with most people blaming the government.

A spokesman for NHS England said: “NHS staff continued to work hard in February in the face of a ‘perfect storm’ of appalling weather, persistently high flu hospitalisations and a renewed spike in norovirus. Despite a challenging winter, the NHS treated 160,000 more A&E patients within four hours this winter, compared with the previous year. The NHS also treated a record number of cancer patients over these most pressured months of the year.”

He pointed to figures showing that 22,800 routine operations had been cancelled in January, less than half the number feared.

However, the Royal College of Surgeons pointed out that 62,000 fewer operations were carried out this winter, despite rising demand, because procedures were not scheduled in the first place to help take pressure off A&Es.

Professor Derek Alderson, its president, said: “NHS England’s advice to hospitals to cancel all elective operations in January was a necessary evil under the circumstances. It meant patients avoided the distress of having their operation cancelled after turning up to hospital and it freed up NHS staff and resources to deal with patients needing emergency treatment. However, it also inevitably prevented many patients who are in discomfort or pain from having an operation when they needed it, potentially causing their condition to deteriorate.”

Jonathan Ashworth, shadow health secretary, said: “The government has let NHS patients down this winter. Every year under this government waiting times get worse and more and more patients face hours on end in overcrowded emergency departments. The brilliant staff of the NHS have been working round the clock in the wind and the snow but they’re being undermined by a government which has refused to give the NHS the resources it needs.”

Source: The Times (pay wall)