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The Patients Association was founded in 1963 and continues to listen to patients and speak up for change.

Issue 140

Keeping you informed about the latest developments in Health & Social Care

The wait for NHS operations getting longer and longer “It’s crunch time” say Patients Association


 
NHS patients are waiting longer than ever for surgical procedures such as hip replacements and cataracts, according to new research published by the Patients Association on Saturday 25th July 2015. In its fifth annual report on hospital waiting times for elective surgical procedures in England, the Patients Association declares:
 
“We have now come to the crunch: the average waiting times for each of the seven key surgical procedures we have studied are all above 90 days.  Moreover, in the vast majority of areas, NHS Trusts have breached the NHS Constitution’s 18 week wait limit between referral and undergoing their operation for some patients.”
 
The report found that that there is a wide variation in waiting times across England, with the postcode lottery as stark as ever and overall, there are long, and lengthening, waiting times for hip replacement, knee replacement, operations on hernias, adenoids, gallstones, cataracts and tonsillectomies.
 
Based on the responses from 110 Freedom of Information requests sent to 156 hospital trusts, the Patients Association says that:
 
  • The most significant rise has been seen in the wait for cataracts, up from 69 days in 2013 to 93 days in 2014.
  • Knee procedures continue to have the longest wait at 107 days.
  • The East of England region has the longest waiting times for knee replacements operations with a mean average of 113 days, 6 days above the national average.
  • The shortest average waiting time for any procedure is found within the London region, at 85 days wait for cataract operations, which is still a lengthy time for any patient to wait.
  • The response rate to FoI requests has improved to 70.51% of hospital trusts from 53.7% last year.
  • The London region had the worst response rate at 62.5%.

Katherine Murphy, Chief Executive, The Patients Association said:
 
“Waiting times are more than a statistic.  Delayed and cancelled operations can seriously impact patients’ independence, mobility, ability to work and socialise, and prolong periods of pain or suffering that could be shortened by timely surgery……these findings should be seen as a wake-up call and spur commissioners, policy makers and politicians to take radical steps to improve the speed of NHS provision….patients cannot wait any longer.”
 
“The challenges to the NHS must not excuse failings in the quality of treatment or patients’ experience of care.  As always, patients must come first.”

 

The Law Commission Consultation: Mental Capacity and Deprivation of Liberty

The Law Commission’s consultation paper, Mental Capacity and Deprivation of Liberty has been published. The consultation paper reviews the Deprivation of Liberty Safeguards (the DoLS) in England and Wales. The goal is to replace the DoLS with a straightforward and accessible legal framework which provides appropriate safeguards for people who lack capacity whose care or treatment is becoming restrictive. This consultation paper is over 251 pages with 42 questions. The Patients Association is concerned that this consultation document has the potential to be ignored due to the size of the document and number of questions. However, if you wish to respond to specific questions the Patients Association will be happy to take your views. Please send your comments to dipen@patients-association.com by Friday 30th October 2015
 
Transition between inpatient hospital settings and community or care home settings for adults with social care needs: draft guideline consultation

Link to the Consultation here.
 
This guideline covers all adults with identified social care needs, including older people. It does not include children and young people. It covers transitions between general hospital and community or care home settings. It does not include inpatient mental health settings. A separate NICE guideline on transitions between inpatient mental health settings and community and care home settings is being developed.
 
The Patients Association is preparing a response and invites our readers to give their view. Please send your comments to dipen@patients-association.com by Monday 3rd August 2015.
Consultations



The Department of Health are now consulting on:
 
Local authority public health allocations 
31 July 2015 -28 August 2015

The National Institute of Health and Care Excellence (NICE) are now consulting on

8th July 2015 - 8th August 2015
Dementia (update): the scope

13 July 2015 - 10 August 2015
Faltering growth - recognition and management of faltering growth in children: the scope


25 June 2015 - 06 August 2015
Transition between inpatient hospital settings and community or care home settings for adults with social care needs: draft guideline consultation
 
NHS England are now consulting on:

4th August 2015
Survey on GP services at Millbrook and Lodge House Surgeries


Public Health England are now consulting on:

23rd September 2015
Consultation on draft SACN Vitamin D and Health report

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About Us
 
The Patients Association’s motto is ‘Listening to Patients, Speaking up for Change’. This motto is the basis on which we build all our campaigns. Via our Helpline, we capture stories about Healthcare from over thousands of patients, family members and carers every year. We use this knowledge to campaign for real improvements to health and social care services across the UK. In addition, our Helpline provides valuable signposting and information for patients and supports them as they navigate the Healthcare service.
 
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Our Helpline
 

The Patients Association Helpline is here to help.

 

  helpline@patients-association.com

  0845 608 44 55.

 

This is a local rate number and if a phone provider charges, we are happy to return calls. The Helpline both informs patients and gathers their views.

 

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Health & Social Awareness 
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Sickle Cell Awareness

Ethnic Minority Cancer Awareness


Group B Strep Awareness
 
Patients Association’s response to 'A team without walls' - the RCP's Future Hospital vision in action




 
The Royal College of Physicians is running a Tell us your story initiative as part of their Future Hospital movement. In response to this, the Integrated Respiratory Team (IRT) at King’s Health Partners have shared their ‘A Team Without Walls’ vision.
 
‘A Team Without Walls’ brings specialist care to patients, rather than the other way round; for example, a GP concerned about a housebound patient with a pulmonary disease can arrange a planned joint review in the patient’s home with the IRT consultant or specialist team. Increasing home visits from specialists allows more accurate diagnoses, ensures that future hospital visits by the patient are planned and focussed, and helps reduce the cost of prescribed medications; one clinical commissioning group (CCG) estimated that the service saved them £200,000 in 12 months.
 
Katherine Murphy, Chief Executive, The Patients Association said:

“The Patients Association warmly welcomes the work at King’s to break down the barriers of care between hospital and the community. This `one area example’ demonstrates how listening to patients and their carers, coupled with creative local leadership, can bring the great improvements in well-being demonstrated as well as substantial reductions in costs. This has to be the way forward for the NHS. The Patients Association has been asking for this for some time now. The Integrated Respiratory Team (IRT) at King’s Health Partners, supported by The Royal College of Physicians, are to be congratulated in helping to bring it into practice.”

 


Doctors’ surgeries provided with financial incentives not to refer patients to hospital


 

A new £3.4 million scheme is seeking to reduce unnecessary hospital admissions, while aiming at creating 61,000 more GP appointments a year

Doctors’ surgeries in Bolton are being financially rewarded for not sending patients to hospital. The payments for reducing referrals include orthopaedic conditions, cataracts, dermatology and general surgery. However, CCG bosses hope the £3.4 million scheme will be a major success by saving money on unnecessary treatments which had led to 5.9 million medicines prescribed by Bolton’s GPs in 2013/14 at a cost of more than £50 million. Furthermore, the scheme is aimed at creating 61,000 more GP appointments a year while improving referral quality and identifying opportunities to reduce unnecessary hospital attendances.

Despite the potential benefits of this scheme, assurances must be made that it is in the patients’ interests to give doctors financial incentives not to refer them.

Katherine Murphy, Chief Executive of the Patients Association said:

 “The principle of this scheme is designed to ease the pressure on hospitals, it is innovative and in principle, it should be welcome.  However it does put even more pressure on GPs’ integrity if they have to decide whether a patient is ill enough to be sent to hospital against the receipt of a bonus payment for not sending them. However, every day GPs face difficult decisions and we must have confidence that in this scheme they will continue to put patients’ best interests before any personal financial reward.”

 

Private Sector Provision of Ambulances Increasing


 
 
English ambulance trusts are more reliant on the private sector and voluntary services for the provision of ambulances.
 
Since the beginning of David Cameron’s first term in government, the use of private ambulance services has increased by 150% and voluntary services by 182%. The outsourcing by English ambulance trusts is a reaction to a rise in ambulance calls; in 2014, the Department of Health stated that 2,000 more emergency journeys were being made every day compared to 2010.
 
With demand for ambulances increasing, the Patients Association believes that it is vital for trusts to do all that they can to match patients’ needs.
 
Katherine Murphy, Chief Executive, Patients Association said:
 
 “Ambulance patients’ prime concern is that their experience is safe, dignified and punctual. In practice, the ownership of the service is of no consequence because the government's Care Quality Commission regulates all NHS ambulance trusts, private companies and voluntary organisations on the same basis, to ensure patient transport services are safe and meet standards of patient care. CQC inspection statistics have shown in recent years that the performance of private and voluntary providers is as good as those of NHS ambulance trusts, or even better in some instances”.

 

Cuts to UK mental health services continue to drive people to the edge



 
Analysis shows that £85 million has been slashed from the NHS mental health budget since 2010, including £35 million cuts made last year.

The analysis has been released by YoungMinds, a mental health charity for young people, who contacted every mental health trust, clinical commissioning group and local authority in England. They found that £35 million has been cut from child and adolescent mental health services since 2013/14, with a total of £85 million in cuts since 2010. Furthermore, research has found that three quarters of mental health trusts were forced to either freeze or cut their budgets between 2013/14 and 2014/15, while demand on services continues to rise. This means resources are being stretched leading to patient care being undermined.

Katherine Murphy, Chief Executive of the Patients Association said:

“The Government must provide assurances and adequate provisions that money will be available for mental health services for the long term. Mental Health is far too important to be ignored and policymakers need to understand that the problem will grow as young people with mental health needs become adults with more severe needs. Mental health services should have parity with physical health and protected and promoted in a joined up health and social care system with patient care at the heart of it.

From the calls we receive from our helpline we find that many patients are having to wait increasing amounts of time to be seen by specialists, and stories about people experiencing mental health crises whilst waiting for therapy are common. Coping with reduced resources greatly affects those who directly suffer with the conditions as well as patients’ families and friends.”

 

Patients’ Stories

 

 
This is a new section for our newsletter where we will be featuring real patient stories. If there is a story about you or your loved one’s experiences with the health and social care system, which you would like featured, please contact us at weeklynews@patients-association.com

 
Maladministration of naloxone



Richard’s 87 year old mother died four years ago. She had a horrifically painful last three days of life in an acute hospital because of the hospital’s multiple errors in her opiate pain control. Her inquest’s palliative specialist expert witness concurred there was iatrogenic (hospital induced) suffering.  The most significant error was the maladministration of naloxone which, not only caused her severe uncontrolled pain for two hours, but led to her pain being destabilised for the following 48 hours.
 
The Hospital failings included medical and nursing competency in diagnosing, delivering and monitoring pain relieving medication.  There were also failings to address her rights under the Mental Capacity Act in the light of Richard being her “health proxy” and named as her enduring power of attorney, as she lacked capacity throughout her final admission.

None of the major complaints Richard made were explicitly denied by the Trust but neither were they explicitly acknowledged. Nor was any serious action plan produced which would address the multiple failings that occurred.

The well evidenced complaint led to a three and half day Inquest, a Coroner’s Rule 43 Prevention of Future Deaths Report, an expert palliative report commissioned by the Coroner, and a medico-pharmacological report (MPR).   

Following a direct submission by Richard, due to the lack of effectiveness of any of the complaints or investigation processes (by the Trust, PHSO and CQC) the MPR was finally considered by NHS England Patient Safety who issued a Patient Safety Alert on the use of Naloxone, where they publically acknowledged Richard’s role in bringing this about.     
 
Over two years after the PHSO became involved, they admitted they had "messed up" in their investigation and had made repeated errors.  Now, nearly four years later and after seven different investigators, Richard is still awaiting their new draft investigation plan as well as a review report into the PHSO’S own handling of his case.
 
 
Update

Our patient’s story of July 10th 2015 regarding waiting time for occupational therapists (OTs) has had an update.

“Two weeks ago you printed our story about the lack of OTs and the effect on my husband of having to wait 13 weeks for a first visit.

I have now had a letter from the Community Health apologising for the delay and to say that they are now recruiting to bring the numbers up to the point where the 13 week wait reduces to 8 weeks; even this is not ideal because once the first visit has taken place it can then be several more weeks before equipment can be sanctioned and installed.

We will have waited since March for five and a half months to get my husband another more suitable chair as it has to be ordered and made. In my view taking one month off this time the OT service is still not as responsive as other parts of the social care system.

I thought the PA would like to know.”
 

 
 
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