Patients are being forced to wait in ambulances outside hospitals for hours because accident and emergency departments cannot take them, according to research.

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4:35pm Our story on NHS England agreeing over 1,000 derogations to specialised services has also provoked reader comment:

“There are service reconfigurations required at regional and national scale that will shape the future of the specialised hospital.’ Enjoy trying to do that a) legally b) without creating significant risks to the local and regional structure of supply.”

“Whilst a lot of the [new service specifications] make sense there are also a lot which reflect the self interest of the specialists at tertiary centres which have compiled the specifications in a silo approach. There has been no thought given to the huge extra cost of implementing ‘gold plate’ solutions which will undoubtly deprive non-specialist services of vital resources with the resultant effect on patient care. It is hardly surprising the number of derogations given the content of some of the specifications.”

3:51pm Our story on patient ambulance waits outside hospitals has attracted some interesting reader comments:

“… we need more ambulances and paramedics not fewer. East of England Ambulance Service Trust say they need over 400 extra staff (some to cover for past redundancies) but the government are insisting on £50m cuts over the next three years.”

“It doesn’t necessarily mean patients are waiting outside hospitals. It’s the time taken to completely hand over care to the hospital and leave the site. Often hospital staff are caring for the patient, but they are still on an ambulance wheelchair, and on occasion, the ambulance staff are having a coffee before leaving the hospital without logging this as a break. Breaches need to be validated by both the hospital and the ambulance service, but I wonder how many actually are - I can’t believe that 6 hour wait myself.”

3:24pm Your Humble Servant on China, A&E waiting times, and Christmas good cheer

2:33pm Magnetic resonance imaging (MRI) of rectal cancer has been found to provide crucial prognostic information which improves patient survival. Research published in this month’s Journal of Clinical Oncology found that pre-op MRI assessment can help to inform a more advanced treatment approach for rectal patients by predicting  local recurrence and disease-free survival.

Rectal cancer currently accounts for one third of all colorectal cancers and is a leading cause of cancer death in the western world. 

1:50pm NHS England has launched a £100m Nursing Technology Fund. NHS organisations will be able to bid for a share of the fund - which was first announced by the prime minister last year - to buy technology to support nurses, midwives and care staff with improving patient care. Funds will be available for mobile and digital technology which allows staff to work more flexibly, which helps them do their jobs better, increases patient safety, creates a better patient experience and reduces paperwork.

The fund will be split £30m/£70m between projects which can be delivered in 2013/14 and 2014/15. The deadline for first round applications is 15 January 2014, with funding decisions to be announced in February.

1:36pm There’s been some reaction to the news that some patients are being forced to wait in ambulances much longer before being admitted to A&E departments than the NHS guidance of 15 minutes (one patient in Wales was made to wait for more than six hours). Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing, said it was “time for those in authority to stop downplaying the gravity of the situation at our A&E departments”.

Dr Carter said that “cuts to social care budgets that have made it difficult to discharge older patients from hospital” and the closing of a quarter of walk-in centres were responsible for the current pressure on the A&E system. He added: “we need to see action taken quickly to ensure our emergency departments are fit-for-purpose and patients get the care they deserve.”

1:15pm We’re publishing the 2013 HSJ100 - our annual list of the hundred most influential people in healthcare - on Wednesday. Want to remind yourself who made the 2012 list? Refresh your memory here.

12:42pm A doctor is to face medical watchdogs accused of carrying out female genital mutilation on a patient.

Sureshkumar Vallabhdas Pandya, who practises in London, is said to have undertook the procedure, sometimes called female circumcision, which has been outlawed in the UK for the past 28 years. Dr Pandya will go before the Medical Practitioners Tribunal Service sitting in Manchester on Monday.

12:38pm A review by the Wessex Clinical Senate into specialised vascular services in Hampshire has recommended centralising surgery in Southampton, meaning that neighbouring Portsmouth would lose some services.

The decision over whether to implement the proposals will be made by NHS England’s Wessex local area team.

12:33pm HSJ has learned that NHS England has agreed more than 1,000 temporary contract variations when providers of specialised services have failed to meet new service standards.

The variations, known as derogations, could include failure to meet a range of standards laid out in any one of 128 specifications for services including organ transplantation and secure mental health provision. HSJ understands that the scale of failure to comply with the specifications exceeds expectations, with NHS England’s interim policy on derogations anticipating they would be agreed only “occasionally”.

12:26pm An HSJ exclusive: three plans to integrate patient records across a number of health and social care organisations are among 135 projects to have secured a share of NHS England’s £260m technology fund.

Speaking to HSJ, NHS England director of strategic systems and technology Beverley Bryant said she was unable to name specific projects at this point, but confirmed the integrated records projects aligned with the Department of Health’s “integration pioneers” programme.

12:15pm Interesting health story in the Financial Times from the other side of the Atlantic. The newspaper reports that people in the US buying insurance plans under “Obamacare” will have limited access to leading hospitals, as insurers try to cut costs.

One of the objectives of Barack Obama’s Affordable Care Act, which comes into effect next year, was to make healthcare more affordable while ensuring benefits such as maternity care were covered and people with previously-diagnosed medical conditions could not be denied access. However, faced with these restrictions, there is evidence that insurers are coming up with ways to cut the cost of their products, including by limiting access to hospitals viewed as too expensive. Most plans being sold online in New York, Texas and California for example, do not cover treatment in two leading cancer centres in Manhattan and Houston.

11:51am In the HSJ Resource Centre, David Stalker, chief executive of ukactive, writes about the physical activity care pathway being rolled out across Bedford Borough, Central Bedfordshire and Luton Borough councils this month.

David says that such schemes will play a key role in combating the inactivity “public health epidemic” which is estimated to cost England £8.2bn a year. But he argues that for this to work, commissioners will have to view increasing physical activity as a higher priority, rather than just tagging on “exercise on referral” as a side note to other public health services.

11:26am Doctors have warned that pressure on GPs not to refer patients to hospitals may be behind delays in people with cancer symptoms being seen by specialists, The Telegraph reports.

League tables published last week found that 59 per cent of GP practices in England referred less than half of patients who went on to be diagnosed with cancer within the national guideline time of two weeks. Dr Robert Walker, a GP in Cumbria, said in a letter to The Telegraph that referral management schemes were giving GPs a financial incentive “to reduce referral of their patients to specialists to save NHS expenditure”.

11:06am Also in The Guardian, a group of doctors and health workers have written to Jeremy Hunt arguing that encouraging older people to have healthier diets could be more effective in combating dementia than “dubious” drugs.

The letter, whose signatories include the former chair of the Royal College of General Practitioners, professor Clare Gerada, comes ahead of an international dementia summit in London this week convened by the prime minister, David Cameron.

10:58am The Guardian has a health front page splash based on the Dr Foster figures, reporting that more than half a million people have been hospitalised in the past three years because of alcohol or drugs. The vast majority of the admissions were for conditions related to alcohol abuse, such as liver problems.

The figures also show that patients between the ages of 40 and 49 accounted for one fifth of the admissions, raising fears that the early middle aged are risking cancer and other health problems as a result of their drinking habits.

10:46am Turning to the national papers, The Times reports that a campaing encouraging people who have had a cough for more thanthree weeks to see a doctor has led to 700 more patients having lung cancer diagnosed than during the same period the previous year.

The campaign, backed by celebrities including Ricky Gervais and Sir Alex Ferguson, increased the number of lung cancer diagnoses by 9.1 per cent on the same period in 2011. When lung cancer is diagnosed at its earliest stage, 80 per cent of people survive for at least five years, compared with only 7 per cent who are diagnosed at a late stage.

10:33am People undergoing routine operations on a Friday are 24 per cent more likely to die than if they were operated on during the week, according to research by health analytics firm Dr Foster.

The findings follow a series of high-profile studies in recent years which have shown that patients admitted to hospital on weekends and bank holidays have poorer outcomes and are more likely to die than those admitted on weekdays. Lack of senior staff working on NHS wards is cited at the factor behind the higher mortality rates on these days.

10:24am Patient reported outcome measures have not driven expected improvements in treatment during their first three years and do not support claims the NHS is treating too many patients, researchers have found.

10:17am Community providers have called on Monitor to divert resources away from acutes and to the community sector, HSJ reports. The NHS Confederation’s Community Health Services Forum has called for a “deliberate journey” away from acute provision, with “increased investment in the [community] sector matched by the development of new capacity and services” led by community providers.

10:10am A very good morning and welcome to HSJ Live. We kick things off with the news that patients are being forced to wait for hours outside hospitals in ambulances because accident and emergency departments are too busy to admit them, according to freedom of information requests by the BBC.