Hospitals across the country struggle to cope with accident and emergency numbers, plus the rest of today’s news and comment

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3.58pm Professor Martin Green, chief executive of Care England, a representative body for independent sector care providers has written the following letter to HSJ:

The news that some accident and emergency departments in hospitals have had to declare a critical incident to deal with serious over-crowding, is partly the result of failure of the system to be truly integrated and the inability of the NHS, and particularly acute trusts, to think strategically about how they work with social care providers to

deliver the solution to winter pressures.

For several years we in social care, have been talking to the Department of Health about the many things that we could do to ensure that people leave hospital in a timely fashion and are given the support necessary to regain

their independence.

The care home sector has enormous potential to deliver rehabilitation and support services that will reduce hospital admissions, enable appropriate discharge, deliver improved outcomes, and offer a better experience for

the patient, as well as better value for the taxpayer. However, there seems to be no capacity within the NHS to think beyond health services, and to use the social care sector as a vital resource in maintaining independence

and reducing the pressure on hospitals.

Until we see both the government and the health system more effectively integrating acute and primary health services with social care, we will be locked in the constant cycle of crisis.

There is another way in which we can deliver better outcomes and more efficiency in the system, and that requires a different apportionment of money, rather than just more money to sustain our existing services.

The social care sector wants to deliver integrated care, and we are waiting for the Government and the NHS to make all the rhetoric about integration real.

2.00pm An acute trust in Surrey has declared a ‘major incident’, as it struggles to cope with the number of emergency patients, according to local press reports.

Ashford and St Peter’s Hospitals has cancelled the majority of outpatients due to what a spokesman described as “severe pressure”.

Separately, nearby Royal Surrey County Hospital in Guildford has said it is in a similar “severe” situation.

Both trusts have said non-emergency patients would face an “extremely long wait”.  

1.42pm Peterborough and Stamford Hospitals Foundation Trust has declared an ‘internal major incident’ due to its level of emergency admissions. A small number of planned operations have had to be cancelled.

Neil Doverty, trust chief operating officer, said in a statement: “The Trust declared an internal major incident on Monday morning following a weekend of greater levels of emergency admissions and fewer patients being discharged, due to either being medically unfit or awaiting further care arrangements to be put into place in the community across all counties we serve.

“When we declare an internal major incident this triggers additional internal hospital actions as we prioritise care for our emergency patients. This includes taking an hourly assessment of the situation as it develops and addressing issues as they arise.

“All staff pull together to ensure patients are continuing to receive good quality care and are given clear information on the reasons for any delays to them getting to a bed on a ward.

“At times such as this the Trust is reliant upon support by all our external healthcare partners locally, such as GP’s, community services and health and social care partners.

“Sadly we have had to cancel some planned operations in order to ensure beds are prioritised for emergency patients. We cancelled 9 operations on Monday and a further 8 today. All day cases, cancer surgery and urgent and emergency operations are still taking place.

“I would like to apologise to those patients who have had their operations cancelled as we appreciate it causes them great inconvenience. We will be rescheduling these operations as a priority in the coming weeks.”

“I would like to thank our staff for continuing to go the extra mile in ensuring we look after our patients to the same standards as ever despite the pressures on our hospital. It is down to their commitment and efforts that we have been able to keep the situation from escalating further.”

1.10pm The Parliamentary Health Service Ombudsman has been criticised over its handling of four contracts worth more than £1m by the National Audit Office, but ombudsman Dame Julie Mellor was cleared of any wrongdoing, HSJ can reveal.

The report, dated September 2014 but made public shortly before Christmas, said: “We found no evidence of material irregularity, or undue influence… arising from conflicts of interest.”

However, the NAO highlighted a catalogue of governance failings and poor processes, which it concludes could leave the ombudsman body “exposed to the criticism it had not exercised the expected stewardship and governance over public funds”.

HSJ revealed back in October that the Ombusdman’s office was subject to the NAO investigation after it awarded a former business partner of Dame Julie Mellor a six figure contract.

1.00pm Patients and staff are paying the price for the government’s failure to manage and invest sufficiently in the NHS, the GMB union has said in a statement.

GMB, whose members include NHS and ambulance staff, responded to figures released today by NHS England showing that the government has missed the four-hour A&E waiting time target by the widest margin since the target was introduced a decade ago.

From October to December 2014 92.6 per cent of patients were seen in four hours. The figures for major A&E departments are especially alarming, with only 88.9 per cent of patients seen in four hours.

NHS A&E figures have deteriorated since the 2010 general election. In October to December 2009, 97.8 per cent of patients were seen in four hours.

A number of hospitals have recently declared “major incidents” as they struggle to find the capacity to meet demand.

GMB members in the ambulance service in England and Northern Ireland are considering a 48 hour continuous strike at the end of January as part of an escalation of strike action with other health unions in the pay dispute in the NHS.

The two day stoppage by GMB members in the ambulance service, should it go ahead, will commence at 12pm on 29 January and will continue until 12pm on 31 January.

Martin Jackson, a theatre nurse and chair of the GMB NHS committee, said: “Frontline staff worked very hard over Christmas, often cancelling leave to deliver care and took the flak when all the while the chief, Mr Hunt, congratulates us for our efforts and insults us by not even awarding an expected 1 per cent pay uplift.

“Overstretched wards are not the fault of frontline NHS staff. Staff demand that the problem is sorted out, as we are not just getting the time needed to help patients achieve the best outcomes.”

12.55pm Managers at Queen Elizabeth Hospital, King’s Lynn are urging patients to consider alternative treatment options as the site remains on black alert, according to local press reports.

The Lynn News reports that the Gaywood Road site has been on an internal black alert, which generally means bed capacity has been reached, since Saturday as winter pressures have created problems.

A spokesman said: “The Queen Elizabeth Hospital has at no point closed its doors to patients.

“The hospital is currently on internal black alert, this is in the main due to winter pressures and the effect of those pressures on other care providers in the community.

“The public are reminded to consider alternative options for treatment during this time, those include GPs, pharmacies and the NHS 111 service. For full information visit”

The QEH previously announced a black alert at the beginning of December.

12.27pm ITV news reports that Croydon University Hospital has declared an ‘internal major incident’ because of unprecedented demand on A&E. Bosses say the hospital has admitted more patients than available beds.

12.25pm Hospitals say there is ‘unprecedented’ demand on their emergency services as admissions hit their highest level in 10 years.

Accident and emergency departments also recorded their worst performance against the four hour target in 10 years with only 88.9 per cent of patients at major A&Es treated, admitted or discharged within four hours between October and December.

The latest data from NHS England shows that the already struggling performance of A&Es fell to its lowest level since 2004-05 as emergency admissions through major A&Es topped the 1 million mark for the first time.

Emergency admissions were at 1,013,307 in quarter three, a 43.5 per cent increase on the same period of time in 2004-05 and a 5.6 per cent increase on last year.

Attendances to major A&Es have increased by 12.5 per cent since 2004-05 and 5.4 per cent since last year.

There were 174 patients waiting over 12 hours to be admitted in quarter three compared with 42 last year.

12.22pm The Times reports that Labour would fund 1,000 new nurses in Scotland from a mansion tax raised overwhelmingly in the south of England, the party’s new Scottish leader said yesterday.

Jim Murphy admitted that Holyrood “couldn’t afford” the extra spending on Scotland’s NHS without revenues from taxes raised on English homes.

The Times reports that thousands of patients a year die needlessly because of overcrowding in accident and emergency units, doctors have said.

The College of Emergency Medicine said the problem of exit block was growing. Cliff Mann, president of the college, said: “When the A&E becomes crowded because of exit block we know that patients do less well. We know that crowding kills”.

The Times reports that interpreters are being drafted on to labour wards at an annual cost of at least £1.5m.

Data from 55 NHS hospitals obtained under the Freedom of Information Act showed that they had spent £1,536,497 on interpretation in maternity services in 2013-14 with Polish the most commonly requested language.

12.03pm A new scheme to train NHS finance staff to become “Finance Educators” will be launched in January 2015.

“Finance Educators” will be recruited from finance staff across the NHS to engage doctors and nurses to understand the value of their decisions. This follows the recent publication of NHS England’s Five Year Forward View, outlining the stark realities of NHS funding against constantly rising demand, and how all parts of the NHS need to respond.

The aim is for Finance Educators to engage with and train clinical staff in finance and the financial consequences of clinical decisions, and for NHS finance staff to likewise learn more about the thinking behind the decisions doctors and nurses make.

Every NHS organisation in the country has been invited to nominate a Finance Educator, who will undergo a “Train the Trainer” programme to equip them to effectively engage clinicians, and train them in essential aspects of Finance to help inform their clinical decision-making.

The programme has been developed by clinicians, finance staff and patients and will draw on training resources provided by the leading professional bodies such as the Healthcare Financial Management Association, as well as best practice case studies within the NHS.

It is expected that the training will qualify for Continuous Professional Development for both finance staff and clinicians involved.

Evidence has shown that where clinicians and finance teams understand each other and work more closely together, not only can services be delivered more efficiently, they can result in better overall outcomes for patients.

To release the maximum resources for patients, and ensure our NHS is sustainable, means enabling our clinicians, who make the day-to-day decisions on diagnostics and treatments, to fully understand the value of these decisions. Switched-on staff realise that cutting out wasteful activity will release resource for other valuable treatments and investments.

Dr Sanjay Agrawal, a consultant respiratory intensivist at Glenfield Hospital in Leicester, is the senior responsible officer for close partnering as part of the Future Focused Finance initiative.

Dr Agrawal said: “I agreed to lead this work because I fundamentally believe that the decisions that clinicians make have a major impact on the resources we have available to treat patients. For too long, in too many places, clinicians and finance staff have spoken a different language, or not spoken at all. Finance Educators will spread the pockets of best practice we have right across the NHS, and will help clinicians like me to understand finance, and help the finance team understand the clinical perspective. Where we work together better, outcomes for patients are better.”

NHS England chief nurse Jane Cummings, speaking at December’s HFMA national conference said “The impact on outcomes of coming together and discussing key issues should not be underestimated”.

Bob Alexander, director of finance at the Trust Development Authority, speaking at the same conference, reinforced the point that focusing just on finance alone would not work: “It’s not quality OR money, it’s both and it always has been.”

10.55am In response to the latest figures from NHS England on  A&E attendances and emergency admissions, Janet Morrison, chief executive of Independent Age said: “These new A&E  figures demonstrate deepening problems in our whole health and social care system, not just accident and emergency departments.

“Cuts to social care, which is funded not by the NHS but by councils, mean fewer frail elderly patients receive the support they need to stay out of hospital. And once in hospital, there are too few support services available for them to be quickly and safely discharged.

“As a result the entire system is in danger of becoming blocked at times of increase demand, such as we are seeing now.”

10.53am Responding to the publication of figures which show pressures in England’s A&E departments has now reached record levels, Dr Mark Porter, BMA council chair, said:“Patients should be treated on the basis of need, rather than arbitrary targets, but these figures show the NHS is under unprecedented levels of pressure.

“Staff are working flat out but the system is struggling to cope with the sheer number of patients coming through the door. Growing pressure on services throughout the year means hospitals have no spare capacity to deal with the winter spike in demand. So patients are enduring delays in their treatment, and the NHS finds itself running just to stand still.

“Doctors must be able to treat the patient who’s in front of them based on their individual needs, which is why doctors don’t agree with targets for targets’ sake.

Moving away from a system which prioritises targets above all else can help to improve the quality of care doctors are able to give patients by preventing rushed admissions or leaving those most in need waiting longer for treatment. But this will only work in the best interests of patients if the NHS has the staff and resources it needs to meet rising patient demand.

“In the longer term, for the NHS to meet rising demand we need to address the underlying problems in the system. Preventing unnecessary A&E admissions by having an effective, out-of-hours telephone service is an important part of this, so there needs to be a marked improvement in NHS 111 to ensure it is clinician-led.

“We also need a long-term solution to the crisis in social care, to reduce the number of patients being inappropriately held in hospitals. Outside of hospitals, we need to support general practice which is struggling to cope with unprecedented levels of demand and a shortage of GPs. There is no getting away from the fact the NHS needs more investment, so we must also ensure that plans to deal with rising demand on the NHS, as outlined in the Five Year Forward View, are backed with proper funding.”

10.49am An interesting analysis in The Financial Times this morning casts doubt on shadow health secretary Andy Burnham’s warnings that the NHS would be sunk by a “toxic mix of cuts and privatisation” under another Conservative-led government.

Mr Burnham’s argues that legislation that allows hospitals to earn up to half their income from treating private patients would “change the way our hospitals work”, creating a two-tier US-style system.

However, the paper’s public policy editor Sarah Neville cites data from hospital accounts notes that non-NHS income made up less than 1.6 per cent of the total operating income for the foundation trust sector and private patient incomse stood at 0.92 per cent, or £380m, a small rise on the previous year.

10.27am The Guardian reports that Labour has said it will only fund higher increases in NHS pay if it can find a way to pay for the increased salaries through cuts elsewhere.

Ed Balls, the shadow chancellor, said: “At the time this was announced, I said it was a mistake of Jeremy Hunt to reject the pay review bodies but I also… said I can make no commitment now to pay for that.

“I think the priority next year for us is going to be putting money into more doctors and nurses rather than pay.”

In an editorial, the paper says that Ed Miliband can use the NHS to make a wider argument in favour of an “activist state”.

The Labour leader’s policy on the NHS could “ be the basis for a powerful narrative about the value of the state, a way of winning voters’ attention and encouraging a more sceptical attitude to partisan claims,” it argues.

The Guardian also reports that the number of people in the UK who have cancer will reach a record high of 2.5m this year, up 400,000 from five years ago, according to a charity.

Macmillan Cancer Support says the rise is largely due to improvements in treatment and detection.

10.13am Elsewhere, the paper reports that cancer is becoming a “crisis of unimaginable proportions” for the NHS, according to warnings from a leading charity, after figures show soaring numbers living with the disease.

Macmillan Cancer Support said improved detection of cancer, and better treatment has dramatically improved survival rates, although they remain among the worst in Europe.

However, combined with a growing ageing population, this has meant the number of people with cancer has risen by almost 500,000 in just five years - to a record high of 2.5m UK cases.

10.07am The Daily Telegraph reports that accident and emergency departments have had their worst performance in a decade, according to official figures.

Statistics from NHS acute trusts show that in the last three months, 92.6 per cent of patients were seen within four hours.

The national standard is for at least 95 per cent of patients attending emergency departments to be admitted, treated or discharged within four hours.

It is the lowest figure since records began being published in 2004.

Until now the worst quarterly performance was in spring 2013.

Jeremy Hunt, Health Secretary, said there is a “huge amount of pressure” on the NHS in England and hospital bosses feel they are “running just to keep still” to cope with rising demand

9.42am A great deal of media coverage this morning has been given to examining the steady trickle of acute trusts declaring ‘major incidents’ following capacity issues in accident and emergency departments across the country.

The news comes as NHS England this morning releases A&E performance figures from the three months to December.

7.00am Good morning and welcome to HSJ Live. We begin with the news that broke yesterday, that the Liberal Democrats have become the first major party to publicly commit to increasing NHS funding to levels recommended in the NHS Five Year Forward View.

However the pledge depends on ongoing economic growth and the elimination of the budget deficit.

Deputy prime minister and Liberal Democrat leader Nick Clegg committed to raising NHS funding by £8bn in real terms by 2020-21 – but has not yet explained where the majority of the cash will come from.