Professor Keith Willett, director of acute care for NHS England, has said that the NHS is in an unsustainable position and is running at full capacity. He said fundamental change is needed within the NHS to improve healthcare and ease pressure on hospitals which are already at capacity.
Professor Willett added that urgent changes need to be made as hospitals struggle with the burden of the large number of people going to A&E. He dismissed the mild winter as the reason for easing the pressure on emergency care, and warned that hospitals are already running on stretched resources.
“It’s in an unsustainable position in terms of urgent care for the future. We will have to make substantial changes to the way our patients are cared for outside hospital.”
“The majority of people do seem to recognise that A&E is under pressure, but one in four said they would go again if they couldn’t access their GP. In the long term we will run into problems again.”
Professor Willett said the problem facing A&E departments is not the number of people attending but the volume who now need to be admitted because care outside hospital is not good enough – emergency admissions to hospitals have increased by 47% in the last 15 years.
Margaret Hodge, chairwoman of The Public Account Committee (PAC), said:
“Any attempt to improve emergency admissions services in the NHS is being completely stymied by the chronic shortage of specialist A&E consultants. Nearly one fifth of consultant posts in emergency departments were either vacant or filled by locums in 2012. There are also major problems in training enough doctors in emergency medicine.”
A poll commissioned by patient watchdog Healthwatch England has revealed that almost one in five patients in England have misused Accident and Emergency departments. The survey of over 1,700 people found that 18% owned up to visiting A&E when they needed non-emergency care outside of normal GP opening hours.
The survey also showed a widespread lack of awareness about the other options available. About a third of those who responded said they did not know where their nearest minor injury unit or walk-in centre was, while just one in five said they had used the non-emergency number 111 and NHS Direct when in need. Nevertheless, the survey did show that two-thirds of patients were worried about the pressures on the system.
Anna Bradley, chair of Healthwatch England, said:
“A&E has become NHS Express. The problem is it was never designed to be a catch-all service and nor should it be allowed to become one. But blaming people for going to the ‘wrong place’ when we need care and support is the wrong way of looking at the problem.”
“I’m not absolving us of our responsibility not to clog A&E whenever we get the sniffles, but until the health and care sector offers a more consumer-friendly experience, things are unlikely to improve.”
Katherine Murphy, Chief Executive of the Patients Association, said:
“The NHS drastically needs to improve the out-of-hours care to ensure patients in acute emergencies are able to receive the high quality of care that A&E departments provide. Until then people will turn up at A&E in desperation with everyday medical problems.”
The release of the survey comes as MPs call for emergency care doctors to be paid more to work at struggling hospitals.
The Royal College of GPs (RCGP) have highlighted that GP services will be under huge pressure this year due to funding cuts. They are predicting that patients will fail to get a GP appointment when they are unwell on at least 34 million occasions in England.
The professional body says that GP practices are being “brought to their knees” by an unprecedented fall in money for healthcare in the community and rising demand for their services. This will inevitably result in further pressure on A&E departments, because more patients are likely to turn up at emergency wards if they are unable to get appointments at their local surgeries.
Dr Maureen Baker, chair of the RCGP, said:
“GPs and practice nurses can’t keep doing more for less and now that funding for general practice in England has slumped to just 8.5% of the NHS budget the service we provide is in crisis.
“All three political parties say they want to see more patients being treated in the community, where care can be provided to patients more economically, in their own surroundings, and yet resources are increasingly being diverted away from communities and into hospitals.”
Successive governments have promised to make it easier for people to get GP appointments, amid persistent complaints about unavailability in some areas. David Cameron last year said he would like to force surgeries to open from 8am to 8pm and over the weekend to ease pressure on A&E units, a scheme currently being piloted.
The RCGP said it calculated the 34 million figure from data in the GP Patient Survey, which found that 10% of patients who sought a consultation with a GP or practice nurse failed to get one. They added that almost 11% of the NHS budget was spent on general practice in 2005, compared with 8.5% in 2011.
However, the Department of Health accused the RCGP of using partial and conflated data, confusing the number of people and consultations. They say:
“The GP survey showed the vast majority of patients are satisfied with their GP and rated their experience of making an appointment as good.”
Sir David Nicholson, the outgoing Chief Executive of NHS England says he bitterly regrets not speaking to patients and their families who were caught up in the Stafford Hospital scandal.
Sir David described it as his “biggest mistake” during his 36 years of service in the NHS, saying he had avoided speaking to those affected for fear of becoming embroiled in a media circus.
He told delegates at the Health and Care Innovation Expo in Manchester:
“The biggest and most obvious mistake that I made was when it became clear, when the Health Care Commission reported on Mid Staffordshire, and I went to the hospital and I didn’t seek out the patients representatives and the people who were in Cure The NHS, and I didn’t do it because I made the wrong call.”
Sir David announced he was stepping down last year after facing repeated calls to resign over his role in the scandal. Campaigners and MPs had called for him to resign after publication of the Francis inquiry into the failings, which involved the neglect and abuse of vulnerable patients.
The report published a year ago said the system had “betrayed” the public by putting corporate self-interest ahead of patients.
Sir David initially said he was determined to carry on, but in a letter announcing his retirement in May he said: “Recent events continue to show that on occasion the NHS can still sometimes fail patients, their families and carers.”
The Parliamentary and Health Service Ombudsman investigated five complaints about University Hospitals of Morecambe Bay NHS Foundation Trust in relation to the way in which they handled a family’s complaint concerning the death of their baby.
They found that a lack of openness and honesty at the Hospital Trust caused unnecessary distress and further pain to a family who had already suffered from the tragic and avoidable death of their baby.
Julie Mellor, Parliamentary and Health Service Ombudsman, said:
“We are publishing these reports as they highlight the need for more openness and transparency in the way hospitals and the wider health and social care system deal with complaints.”
“When serious untoward incidents happen there needs to be an independent investigation which looks at the root cause of the complaint and the role of human factors such as people and the organisation’s culture. We expect all service providers to adopt this approach to help them understand why mistakes happen and help improve services for everyone.”
The Health Secretary, Jeremy Hunt, has agreed to dissolve the trust that runs the scandal-hit Stafford Hospital. The trust was heavily criticised in a public inquiry led by Robert Francis QC for causing the “suffering of hundreds of people” under its care between 2005 and 2008.
Mr Hunt said Mid Staffordshire NHS Trust would be scrapped and, while its two hospitals would remain open, many services would move to other hospitals. He said the changes would “secure the safe and high-quality services that the people of Stafford deserve having endured years of uncertainty and failures in care”.
He added: “I want Stafford to be a proper district hospital that continues to meet the needs of patients nearby, including for emergency care and births.”
However, campaigners who oppose the move said they may challenge the decision in the courts. Sue Hawkins, from the Save Stafford Hospital group, said:
“We were expecting the trust to dissolve. We understood from the outset that would be the case but we are a semi-rural area and people are going to have to travel long distances to receive care.”
“It’s been a very lengthy process. I wouldn’t wish this on any other hospital.”
Maggie Oldham, chief executive of the trust, said she wanted to “pay tribute” to staff at the hospitals:
“Mid Staffs has come a long way over the past few years and I am very proud of all of our staff and what they have achieved.”
Responding to this Katherine Murphy, Chief Executive of the Patients Association, said:
“The decision to close Stafford Hospital will no doubt be welcomed by those who have suffered or have seen relatives suffer at the hands of poor care at the hospital, and will allow the people of Mid Staffs to move on from the terrible reputation their local hospital has gained.
“The real issue though is the culture that still exists in the NHS that puts processes above patient care. The behaviour and culture that permeated Mid Staffordshire could well be found in other hospital wards around the country. The Government must act now to ensure that we are not talking about closing other hospitals in the future because their reputation has been sullied by poor patient care.”
The National Institute for Health and Care Excellence (NICE) is currently seeking community members to join the committee developing guidance on community activities or services which improve people’s health or wellbeing.
NICE produces guidance on the most effective ways to prevent, diagnose and treat disease and ill health, and provide social care support.
Community members are paid a fee to attend meetings, and travel and other expenses are covered.
The National Institute for Health and Care Excellence (NICE) has been accused of “playing fast and loose” with the lives of cancer sufferers following the announcement that thousands of men with prostate cancer could be denied life-extending treatment following a U-turn by the NHS rationing body.
Each year more than 40,000 British men are diagnosed with prostate cancer. More than 10,000 develop an advanced form of the disease which resists standard hormone treatment and chemotherapy and most will die within five years, making the disease the second most common cause of cancer death in men.
Trials found that the drug Xtandi® on average gave patients an extra five months of life – bringing their survival to 18 months. Three months ago NICE ruled that the drug would be made available to those with cancer which has spread beyond the prostate, and stopped responding to treatment, after the manufacturers agreed a discount on the £25,000 per patient price. But the watchdog has now issued new restrictions, which mean that the NHS will only fund the drug if men have not tried the only other drug available for such cases.
Owen Sharp, Chief Executive at Prostate Cancer UK, said Nice had acted in secrecy, and had given no explanation for a “blatant U-turn” which will cost lives. He said, “Nice is playing fast and loose with men with prostate cancer in the advanced stages of the disease who may become resistant to other treatments, and what’s worse without saying why.”
Last week Prof David Haslam, the chairman of Nice, said British patients should be more assertive in ensuring that they obtain drugs which the watchdog has backed, and learn from the attitudes of Americans, who were more likely to see themselves as equal partners with their doctors
Nice said it changed its recommendation because of responses to its consultation, and because trials on Xtandi® did not include patients who had previously received the standard treatment of abiraterone, leaving them unable to draw conclusions about its effectiveness in such cases.
The Health Service Ombudsman, the body with ultimate responsibility for complaints against the NHS, has been accused of failing thousands of patients and bereaved relatives after admitting it fully investigated less than 400 of 16,000 patient complaints made last year. The watchdog’s own records disclose that during the year 2012/13, less than 3% of complaints which came to them were fully investigated.
In the vast majority of cases, those seeking help were told that an investigation would not achieve anything, that there was no case to answer or that they should return to the organisation which they said had failed them to argue their case.
Professor Sir Brian Jarman, emiritus professor of Imperial College London, said:
“It’s an appalling situation. These complaints – which we should treat as ‘gold dust’, because they are the lessons we need to learn to prevent future tragedies – are being virtually ignored and thrown away.”
In response, a spokesman for the Ombudsman said:
“We changed our criteria for investigating complaints last year. We now always begin our consideration of a complaint about potentially avoidable death with the assumption that we will investigate. In fact, if any complaint meets some basic tests, we will usually investigate it. These changes were prompted by feedback from people whose complaints we had not investigated.”
A huge central database called Care.data due to be launched after April will enable experts to assess diseases, examine new drugs on the market and identify infection outbreaks as well as monitor the care patients get. Information is already available about what happens in hospitals, but to date it has been difficult to link those records with the information that was available about what is happening to patients when they are discharged back to the care of their GPs.
Just last month NHS England started a mass mail-out to every household explaining the project and giving people the chance to opt out. However, people were struggling to understand what it was about and there have been cases where GPs have decided to opt out all their patients themselves.
Concerns have been raised about the prospect of keeping all of the information in one place, with campaigners saying that it could lead to privacy problems and data breaches. There is a proposal, to be discussed next month, which could give access to non-NHS bodies, including private firms.
Dawn Monaghan, of the Information Commissioner’s office, also said she had concerns:
“At the moment, we don’t think it is clear enough on the website or in the information that has been sent out exactly what data is going to go and what is not going to go.”
But Tim Kelsey, NHS England’s national director for patients and information, said patients need not have concerns as the information would not be “identifiable”.