Sunday, June 16, 2013

4,000 lives a year lost by poor hospital care at weekends

Poor care in hospitals at weekends is claiming more than 4,000 lives a year, NHS officials have warned.

NHS England is beginning a public consultation on a review which could lead to a major restructuring of the NHS.
NHS England is beginning a public consultation on a review which could lead to a major restructuring of the NHS. Photo: CHRISTOPHER FURLONG/GETTY IMAGES
The disclosure comes in an official review of Britain’s emergency and urgent healthcare which says the current system is unsustainable, unaffordable and soaking up more than half of the health service budget.
Health officials will on Monday launch plans which attempt to tackle a deepening crisis in Accident & Emergency (A&E) units, hospital wards and out-of-hours GP services.
They have collected evidence of system buckling under the strain and placing patients at increased risk - especially if they fall sick at weekends.
The dossier is published as NHS England begins a public consultation on a review which could lead to a major restructuring of the NHS, with specialist services concentrated in larger units and changes to put hospitals on a “seven-day” footing, with more consultants and diagnostic tests available at weekends.
The damning official report warns of: 
* More than 4,400 lives a year lost in England because hospital mortality rates are worse at weekends, largely because of shortages of senior doctors;
* Spiralling numbers of patients readmitted to hospital because they were discharged too quickly, because of cuts to bed numbers;
* Evidence of a 30 per cent rise in death rates when casualty units are crowded;
* Widespread shortages of A&E doctors, with half of training posts unfilled for the past two years;
* Confusion among the public about how to access urgent care and lack of confidence in the care provided by GPs;
Despite widespread concerns about failings of the non-emergency 111 telephone line, which was introduced in most parts of England this year, the official leading the review said the future model of urgent and emergency care will rely heavily on phone-led services.
The report comes amid increasing fears about the pressures on A&E departments, which senior doctors have likened to “warzones,” while the head of the NHS regulator has said emergency care is “out of control”.
Ministers have indicated that they want GPs to take more responsibility for the care given to their patients when surgeries are not open, but it remains unclear how this will work.
NHS England is now undertaking a review of “urgent and emergency care,” which on Monday publishes a case for significant changes in the way health services are provided.
Specific proposals will be published in September, but ideas under consideration include increasing specialisation of some services, such as stroke and trauma, a drive to train more A&E doctors, investment in telemedicine, and changes to the disastrous 111 non-emergency phoneline, so that more clinically-trained staff are involved in decisions.
Professor Keith Willett, the director of NHS England in charge of urgent and emergency care, told The Daily Telegraph: “We need to redesign the system because it is not sustainable as it is. We need a lot more care closer to home and we also have to have high-quality specialist services.”
He said changes which have already occurred in some parts of the country - such as the reorganisation of specialist stroke services in London, into a smaller number of units - had saved lives and reduced disability levels of stroke sufferers because patients received expert care more quickly.
Pressures on A&E units in recent months have come amid the national roll-out of the 111 phone line, which was supposed to reduce the number of people arriving at hospitals, by diverting those with minor complaints to out-of-hours GP services.
Instead, there have been widespread concerns about areas in which the service has collapsed under the pressure of calls, while in others, call handlers without clinical training dispatched paramedics to the most trivial cases, heaping pressure on A&E units.
There have been investigations into at least 22 potential “serious untoward incidents” since April, including three deaths.
A separate review by NHS England will recommend changes to the way the phonelines are run.
However, Prof Willett, a consultant trauma and orthopaedic surgeon at the John Radcliffe Hospital, in Oxford, indicated that the future model is likely to rely heavily on phone access to services.
He said those in need of urgent NHS care needed to be directed to the right place, so they did not just turn up at hospitals without a full range of services.
He said: “The concept behind 111 is really good - where the delivery falls down may be to do with the need for senior clinical input.”
Prof Willett said it was “a really important principle” of any future model of services that the public would be expected to phone first to ensure they got the right help. He said: “If you don’t phone first, the risk is you are essentially joining the wrong queue.”
The report does not single out any one factor for the current pressure on hospitals, but says public confidence in 999 services is far higher than that in family doctors, while one in ten patients who fail to get a suitable GP appointment turn up at A&E.
In less than a decade, the number of calls for ambulances has risen from 4.7 million to over 8 million.
The report says many such calls relate to non life-threatening conditions, and are made because the public does not know where else to turn, with a “perceived or actual lack of alternative options” in parts of the country when GP surgeries are closed.
It also describes ageing and increasingly frail population, and says that the increasing number of emergency admissions to hospital, combined with cuts to bed numbers, have meant patients have been discharged too quickly, without being properly assessed or given help at home.
As a result, the number of patients readmitted to hospital within one month has increased by more than 50 per cent between 2003/2004 and 2010/11, the report says. Over the same period, the number of hospital beds has been cut by more than 80,000, down to 104,000, separate figures show.
Dr Cliff Mann, from the College of Emergency Medicine, which represents A&E doctors, urged the Government to take quick action, and said the most pressing problem was the crisis in staffing.
“From this August we will be short of between 200 and 300 registrars [trainee doctors] in A&E, and just as many consultants,”he said. “That means the pressures we are seeing now are going to be exacerbated. We need a clear signal that there will be some quick action to tackle this - I am worried that despite all this analysis, what we will see instead is an exercise in prevarication.”

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