A&E cuts will hit 23m people, British Medical Association says

Nearly 23 million people in England – more than 40% of the population – could be affected by proposed cuts to A&E departments, doctors are warning | BBC News


The analysis of NHS plans by the British Medical Association also warned the changes were being rushed through without the evidence they will work. The proposals have been put forward by local managers seeking to make savings under the direction of NHS England. Bosses have argued services in the community will be boosted in return.

Under the so-called “sustainability and transformation programme” (STP), England has been divided into 44 areas and each asked to come up with its own proposals.

After analysing local plans, the BMA found:

  • 18 of them, covering a population of 22.9 million, involved the closing or downgrading of an A&E department
  • 14 of them, responsible for 17.6 million patients, propose closing or merging a hospital
  • 13 of them, covering a population of 14.7 million, have put forward closing hospital beds

Read the full news story here


Emergency departments under pressure

The Institute of Health Care Management has published The Winter’s Tale: leadership lessons from emergency departments under pressure.


Image source: ihm.org.uk/

The report focuses on the processes and behaviours of the emergency teams that are managing to deliver outstanding results despite the ever increasing challenges.

This report highlights the importance of using data to identify and shape solutions to the pressures in emergency departments.  It identifies key lessons for managers working in or with emergency departments.

The full report can be read online here.

 Emergency hospital care for children and young people

What has changed in the past 10 years? | QualityWatch


Image source: QualityWatch

This short research summary explores how children and young people’s use of emergency care has changed over the past 10 years and seeks to understand what this might mean for care quality.

Emergency care across the NHS in England is under great pressure. The number of people attending Accident & Emergency (A&E) departments is at an all-time high demand for beds is also at record levels and the four-hour A&E target (of seeing 95 per cent of patients arriving at A&E within four hours) has not been met since July 2013.

Discussion of the pressures on emergency care within the NHS tends to focus predominantly on older people. This is understandable – the over 65s account for the majority of emergency bed days in NHS hospitals, stay longer in A&E than the rest of the population and are more likely to be admitted to hospital in an emergency.

However, children and young people – defined as people under the age of 25 – are also frequent users of emergency care, attending A&E more frequently than the adult population. Their healthcare needs can be very different from adults, meaning they often require specialist support, and – like older people – they can be particularly vulnerable and dependent on carers.

Download the full report here

A&E under pressure

The number of patients waiting four or more hours at A&E has risen more than 300% at some hospitals |  BBC News


In total, 2.2 million patients were not seen within the target time in 2015-16 – more than double the one million figure in 2013-2014.

The Royal College for Emergency Medicine (RCEM) says there is a “large and systemic problem” caused by a lack of hospital beds.

NHS England said hospitals were under pressure but continuing to cope. Across England in 2015-2016, 85% of patients were seen within four hours.

Full story via BBC News

Sicker patients the main reason for A&E winter pressures

Sicker patients with more complex conditions are the main reason for worsening performance in A&E departments, according to The King’s Fund’s latest quarterly monitoring report.


Eighty per cent of NHS finance directors who responded to the latest Kings Fund survey identified higher numbers of patients with severe illnesses and complex health needs as a key reason for the pressures on A&E units, while 70 per cent cited delays in discharging patients from hospital. In contrast, only 27 per cent pointed to poor access to GPs and 20 per cent identified shortages of clinical staff as key factors.

The survey also highlights the effort made by the NHS to prepare for increased pressure on services during the winter. More than 70 per cent of the trusts surveyed increased their staff, while 80 per cent of clinical commissioning groups (CCGs) paid for extra resources in primary care. Other common measures included postponing planned treatment, paying private companies to take on NHS work, and paying higher rates to recruit more agency staff.

Read the full report here


Shifting the balance of care

Imison C, Curry N, Holder H, et al. Shifting the balance of care: great expectations.  March 2017 | Nuffield Trust.


Moving care out of hospitals into the community can deliver holistic, patient-centred care closer to home.  In most cases however, it is unlikely to save money, according to a  report published today by The Nuffield Trust.

The report is based on a review of 27 schemes to reduce hospital activity, which included changes to urgent and emergency care pathways; speeding up discharge; managing ‘at risk’ groups; supported care at home; and cutting down on admissions.

Most of the initiatives demonstrated the potential to improve patient experience, and in some cases, outcomes. The evidence on cost savings was much less clear cut, partly because good economic evaluations have often not been carried out.

Several schemes did seem to be cost-effective in the right circumstances, but where schemes had been evaluated, most were cost neutral or were more expensive.

Download the full report here 

Report summary available here


Review of winter pressures on the NHS

NHS Providers call for urgent review as winter pressures remain severe


NHS Providers is calling for an urgent review of managing winter pressures to be led by NHS Improvement and NHS England with input from trusts.

The review would investigate how effectively the NHS prepared for this winter, looking at how funding for winter pressures is distributed and how services are supported by social care and GPs.

NHS Providers believes a review of how the NHS has handled winter pressures should include the following:

  • The review should be lead by NHS Improvement and NHS England
  • Frontline trusts should have the opportunity to contribute to the review
  • Expert organisations such as the Royal College of Emergency Medicine should also be consulted
  • The review should be conducted rapidly, with a target finish date of end April 2017 at the latest
  • The results of the review should be made public

Read more at NHS Providers