hospitals

Care providers ask for doubled fees to care for people discharged from hospitals

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With a disproportionately higher proportion of rural dwellers in the care demographic and a shortage of local choice this story highlights the differential impact the health and care crisis if likely to have on people living in rural settings…

Care providers are demanding double the usual fees to look after thousands of people who need to be discharged from hospitals to ease the crisis in the NHS.

Care England, which represents the largest private care home providers, said on Sunday it wanted the government to pay them £1,500 a week per person, citing the need to pay care workers more and hire rehabilitation specialists so people languishing in hospital can eventually be sent home.

The rate is about double what most local authorities currently pay for care home beds, an amount Martin Green, the chief executive of Care England, described as “inadequate”.

The demand comes as the health secretary, Steve Barclay promised “urgent action” with up to £250m in new funding for the NHS to buy care beds to clear wards of medically fit patients. The money will be used to buy beds in care homes, hospices and hotels where people are looked after by homecare providers, as well as pay for hospital upgrades. Stays will be no longer than four weeks until the end of March.

NHS to buy care beds to make space in hospitals

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Innovation in action, the second story in Hinterland this time pointing to the pivotal role of social care in our current travails…

Thousands of NHS patients in England will be moved into care homes as part of the government’s plan to ease unprecedented pressure on hospitals.

The NHS is being given £250m to buy thousands of beds in care homes and upgrade hospitals amid a winter crisis.

The move aims to free up hospital beds so patients can be admitted more quickly from A&E to hospital wards.

Labour’s shadow health secretary, Wes Streeting, said the announcement was “another sticking plaster”.

The plans will be included in an emergency package to be unveiled by Health Secretary Steve Barclay.

Later in the day, Mr Barclay will outline a series of measures to address pressures on the NHS, including long waits for emergency care and delays to discharging patients who are medically fit to leave hospital.

Flu comes early in England, with hospital cases rising

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I fear that rural England will be reaping a difficult harvest arising from this burgeoning flu risk in the upcoming winter.

Cases of flu have climbed quickly in the past week in England, suggesting the season has begun earlier than normal, say officials.

People may have little immunity to flu after a break from the disease during Covid pandemic restrictions.

The UK Health Security Agency (UKHSA) says hospital and ICU admissions for the respiratory disease are rising the fastest in children under five.

Hospital rates are going up among the elderly too.

It’s not clear how big a wave the UK might be in for – levels are still relatively low overall.

But health experts are urging anyone who is eligible for a flu shot to get one.

Many southern hemisphere nations have just had their most rampant influenza season for years and officials have been warning that the UK must prepare for a big, early wave of flu too.

More than 40 million people, including young children, in the UK are being offered a flu vaccine.

The over-50s and younger adults with health conditions are also being offered a Covid booster jab this autumn and winter.

Hospitals ‘desperate’ to discharge patients admit ambulance delays are a ‘threat to life’

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Scary stuff…..

Hospitals “desperate” to free up beds could be putting patients in danger, The Independent has been told.

NHS trusts are being forced into “risky behaviours” in the push to free up hospital beds and A&E departments, experts have warned.

It comes as new data reveals that waits for ambulance crews outside hospitals hit 26 hours in September, with more than 4,000 patients likely to have experienced severe harm due to delays.

In documents leaked to The Independent, hospital leaders in Cornwall warned staff that current pressures in its emergency care system combined with ambulance delays have “tragically resulted in deaths”.

Royal Cornwall Hospitals Trust and the Cornwall Partnership NHS Foundation Trust said in the document that ambulance delays and waits in A&E were causing a “risk to life”, and that as a result they were planning to begin discharging patients into the care of the voluntary sector.

Huge gulf in hospitals’ ability to contain Covid

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I’m itching to know more about the rural/urban split in terms of this article and the performance of the hospitals concerned.  I suspect that small rural hospitals may feature prominently and if its anything like their performance in other aspects of care, not uniformly in a good way….

A major analysis of the spread of Covid within hospitals has shown a massive gulf in ability to contain the virus during the first wave.

Overall, more than one in 10 people in hospital with Covid actually caught the virus while they were there.

But the analysis of 314 UK hospitals showed that ranged from just one in 100 cases caught in hospital, to more than one in four.

The researchers said the wide variation needed “urgent investigation”.

Stark difference

The study, by nine UK universities and published in the Lancet, analysed hospital data from two-thirds of Covid patients in the first wave.

They estimate between 5,700 and 11,900 people were infected in hospital.

“There will be tragedy behind this story, people that came into hospital with one problem, caught Covid and sadly died,” one of the researchers, Prof Calum Semple, from the University of Liverpool, said.

There was a stark difference between general hospitals, which the researchers said could not be explained by the number of patients coming in the door.

Reliable tests

“Even hospitals with literally thousands of patients coming in there are outstanding examples of infection control,” Prof Semple said.

“There’s a number of factors – we know there were challenges around PPE [personal protective (or protection) equipment] at the start.”

The design of some hospitals – such as those with more side rooms – would also affect how easy it was to contain Covid.

The availability of testing, which is now used to separate Covid and non-Covid patients, may also have been an issue.

“Reliable tests in the emergency department, that come back within the hour, has been a game-changer and has made my life a million times easier,” critical-care consultant Dr Annemarie Docherty, from the University of Edinburgh, said.

More infectious

Specialist residential hospitals had even bigger challenges with the virus spreading.

More than two-thirds of Covid cases in mental-health hospitals were caught there.

Things are improving, though.

The average proportion of cases caught in hospital was 11% in the first wave but now stands at 2-5% despite the emergence of the more infectious Delta variant, first identified in India.

Part of this will be down to understanding of the virus and how it spreads, such as airborne and asymptomatic transmission, that has emerged since the early days of the pandemic.

Hospital waiting times at worst-ever level

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I suspect those rural hospitals (affectionately known in the NHS as “unavoidably small due to the challenge of remoteness”) will be at the forefront of this challenge – this story tells us:

Hospital performance in England is at its worst level on record, data shows.

Key targets for cancer, hospital care and A&E have been missed for over three years – with delays for hospital care and in A&E hitting their highest levels since both targets were introduced.

The monthly figures – the last before the election – prompted Labour and the Liberal Democrats to attack the Tories’ record on the NHS.

But Prime Minister Boris Johnson said “huge demand” was to blame.

He said only the Tories could be trusted to have a “strong, dynamic economy” to ensure the rises in the NHS budget being planned could be made.

“I’m afraid when I look at the rival proposals and the economic disaster that Jeremy Corbyn and the Labour Party would cause, that will make it impossible for us in the long term to fund the NHS.”

But Labour leader Mr Corbyn said the performance figures were “disgusting” and a lack of staff and funding was to blame.

And Liberal Democrat health spokeswoman Luciana Berger said the Tories had a “shameful” record.

A&E pressure causes ‘critical incident’ in Nottingham

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Just to prove this is more than a rural phenomenon and to indicate that I am sure there are many more of these announcements to follow over the winter…. The big issue in rural places is that chronic underfunding of, for example the 7 most rural hospitals in England, means it is impossible to escape from these structural challenges. The long term solution lies in a different approach to the supply and management of clinicians within acute trusts and more and focused investment in primary care. This story tells us:

A hospital trust has declared a “critical incident” because of the “exceptional” pressure on A&E.

Nottingham University Hospitals Trust (NUH) runs the Queen’s Medical Centre (QMC) and City Hospital and has been on OPEL 4 – previously known as black alert – since Monday morning.

On Wednesday it raised the level further.

Some routine operations have been cancelled as the trust prioritises those who need emergency care.

Health bosses do not want to operate on patients who cannot be guaranteed a bed in which to recover.

Lisa Kelly, NUH chief operating officer, said: “This is following a number of days seeing exceptional pressure across the system, with high numbers of very poorly patients arriving at our emergency department.”

She added they were working closely with health and social care partners and trying to discharge patients in a “timely” manner to free up beds.

Seven in 10 hospital trusts failing to meet safety standards

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We know that one of the biggest and most fundamental challenges facing rural hospitals is staffing. That’s why the most remote 7 hospitals in England account for almost a quarter of all the debt in the hospital sector. This article tells us:

Patient safety is frequently at risk in NHS hospital trusts in England, with 70% of them failing to meet national safety standards, according to an Observer analysis of inspection reports, with staff shortages the biggest problem.

Reports by the regulator the Care Quality Commission (CQC) reveal that managers at one trust failed to act on staff reports of abuse and violence, while a shortage of critical beds at another trust led to three serious incidents resulting in patient harm.

Of 148 acute and general hospital trusts, safety standards at 96 are rated as “requires improvement” by the CQC; six are rated inadequate, the lowest category. The others are rated good, with none outstanding.

Of the 14 inspection reports published since the start of June, half raised concerns over inadequate staffing levels. One trust, Imperial College Healthcare in London, “did not always have enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment”.

Shrewsbury and Telford hospital trust was rated inadequate for safety last year. The number of nurses in its urgent and emergency services was “not sufficient to manage the department safely”, and the inspectors “saw these low staffing levels directly impact on patients’ safe care and treatment”. Nurses who had not received the right support or training had to co-ordinate the department for two months before the inspection because of staff shortages. A trust spokesman told the Observer improvements were being made.

Dorset NHS plan: Health secretary orders review

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And here is the second story about cuts in health funding in a rural setting. It tells us:

Plans to restructure NHS services in Dorset are to be investigated by a government-appointed panel.

Dorset Clinical Commissioning Group (CCG) has begun a shake-up, including shutting Poole’s A&E department.

In 2018, the county council sent the plans to health secretary Matt Hancock over concerns about patient travel times and community hospitals.

It said the minister had asked for the Independent Reconfiguration Panel (IRP) to give “initial advice” on the plans.

The restructure aims to avoid a projected funding shortfall, estimated to be at least £158m a year by 2021.

Under the CCG Clinical Services Review, Poole’s A&E, maternity and paediatric services will be lost to Bournemouth, which will become the area’s main emergency hospital.

Poole is set to become a centre for planned treatment and operations.

Changes to mental health acute care include the closure and relocation of beds at Weymouth’s Linden unit and the creation of extra inpatient beds at St Ann’s Hospital in Poole and Forston Clinic near Dorchester.

Beds at Portland Hospital have already been closed.

The IRP is a national body that reviews proposals for major changes to health services where there are concerns about the safety and/or value of those changes.

Dorset Council said the referral focussed on “the capacity of ambulance and community services and their abilities to cope with demand arising from those changes”.

It said it hoped the investigation would “provide some reassurance to residents”.

Dorset CCG said it “welcomed the opportunity for further independent scrutiny of the changes to healthcare services in Dorset”.

UK hospitals expecting ‘mayhem’ when cold snap hits, top doctor says

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I don’t mean to cheer you all up so soon into the new year with this story but it is very topical. At the heart of the issues (and this article intimates as much) is the dislocation between adult social care and acute care – meaning hospitals are often too clogged up to manage extra demand. 

This is further exacerbated by chronic under staffing and for rural hospital trusts, particularly those with multi-site operations, an unfair payment regime which fails to recognize the additional cost of delivering services in rural areas. You can read more about your individual acute trust’s record on delayed discharges at:

https://www.england.nhs.uk/statistics/statistical-work-areas/delayed-transfers-of-care/delayed-transfers-of-care-data-2017-18/ 

Hospitals will be hit by “mayhem” this weekend because of the coming cold snap, a growing number of people with flu and the NHS’s staffing problems, a leading doctor has warned.

Dr Nick Scriven, president of the Society for Acute Medicine, said hospitals will face “severe difficulties” this weekend as lower temperatures lead to a surge in patients needing care.

“Influenza is here and is already impacting the NHS and, with colder weather starting to set in, this will further stress already stretched services.

“I and many colleagues across the country are anticipating mayhem this weekend as temperatures drop, but it will come as no surprise to us,” Scriven said.

Some A&E units and intensive care units are already full, especially with people who have serious breathing problems, he disclosed.

“Within the last week I have had colleagues warning of emergency departments and intensive care units being full, and that will only worsen in the coming weeks,” added Scriven.

 “Skeleton staffing” of social care services over the festive period has meant patients who were medically fit to leave had not been able to get home from hospital, he added. “The capacity problems this will cause will be profound,” he added.

Hospitals’ ability to withstand a sudden increase in winter-related illness will also be compromised by the NHS being “horrendously understaffed”, Scriven said. Official figures show that the NHS in England has 103,000 vacancies, including for 42,000 nurses and 10,000 doctors.

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