One in six A&E departments at risk of closure or downgrade

One in six A&E departments face being closed or downgraded in the next four years, according to an analysis of NHS proposals.

About 33 casualty departments in hospitals in 23 areas of the UK are facing either complete closure or being replaced with minor injuries units.

The plans are part of efforts to plug a £22bn hole in the health service budget by 2021. Health officials insist the changes will come alongside efforts to modernise services and increase specialist urgent care.

In seven cases, proposals have been drawn up, some of which have been issued for local consultation. According to research by the Health Service Journal (HSJ), 26 more hospitals are now considering plans to close or downgrade services but no final decision has been made.

The seven hospitals for which there are public proposals to downgrade or close emergency departments include Sandwell and West Birmingham hospitals trust’s City hospital and Sandwell district general hospital, which are due to be replaced by a new department at the Midland Metropolitan hospital that is scheduled to open in 2018.

The remaining 26 hospitals may have their A&Es downgraded or closed but, equally, they could be kept or upgraded. Decisions are expected to be made between either Shrewsbury or Telford, Bedford or Milton Keynes and Darlington memorial hospital or the University hospital of north Tees.

In total, about 24 of the 33 hospitals under discussion are likely to lose full A&E services, the HSJ said.

The news comes at a time when hospitals are under severe strain. Almost half of NHS trusts declared a major alert in January and record numbers of hospitals have diverted ambulances to other hospitals. The number of life-saving operations cancelled at the last minute has also reached a new high, with more than 4,000 put on hold last year.

An NHS spokesman said: “The number of people seeking urgent care is on the rise so overall we expect the range of services available to them to expand over coming years. Within that overall expansion, it may be possible to improve care and save lives with some concentration of specialist urgent services.”

He said he did not expect significant numbers of A&E changes in the years ahead, with one of the decisions – concerning Sandwell and City hospitals – taken some years ago.

Annual figures show the number of patients stuck on trolleys in A&E units for more than 12 hours has doubled in two years, with a tripling in cases among the elderly.

It has been claimed that one woman died of a heart attack after waiting for 35 hours on a trolley at Worcestershire royal hospital. The hospital’s A&E department has become overwhelmed so often that it has diverted ambulances to other units on 44 occasions since December. Yet the hospital is at the centre of plans by its trust to centralise A&E services and downgrade Alexandra hospital in Redditch.

The King’s Fund’s director of policy, Richard Murray, told the HSJ that the NHS appeared to be “caught betwixt and between”. The number of potential downgrades, he said, “is not high enough to conclude we are seeing a radical redrawing of urgent and emergency care, but it is high enough to suggest a lot of political noise and require a lot of potentially noisy public consultations”.

In November, the Labour leader, Jeremy Corbyn, who grew up in Shropshire, spoke out against plans to close either the emergency department in Shrewsbury or in Telford in what has become a bitter issue locally.

He said: “I want to make sure there are proper A&E facilities across Shropshire. I grew up in Newport and I remember the discussions about opening those A&E departments in the first place. There need to be A&E departments in reasonable reach of everyone’s homes so that, obviously, emergency cases can be dealt with quickly.”

Chris Moulton, vice-president of the Royal College of Emergency Medicine, told the Telegraph the plans were crazy. He said: “Hospitals are under massive pressure, it’s now horrendously common to have 12-hour trolley waits and in some cases 30-hour waits in A&E. The NHS has been desperately short of capacity for the last few years – it’s crazy to close A&E units when there simply isn’t capacity to cope with these patients elsewhere.”

Meanwhile, separate analysis by the BBC has found that the number of people facing longer waits than they should for hospital treatment in England has more than doubled since 2012.

A key target waiting time of 18 weeks is not being met for more than 350,000 patients, resulting in a 163% rise over four years, it was found. The total number of people on the waiting list is 3.7 million. Figures for Wales and Northern Ireland provided by the Royal College of Surgeons show they have also seen a rise.

One in six A&E departments at risk of closure or downgrade

GPs should do more to take pressure off A&E departments, says May

Theresa May is urging GP surgeries to make more effort to provide a seven-day service as she seeks to deflect blame for the deepening crisis in the NHS.

With pressure mounting on the prime minister, amid growing evidence that hospitals are struggling to cope with surging winter demand, Downing Street issued a statement on Friday saying that surgeries should do more to ensure they offer appointments in the evening and at weekends. GP leaders reacted with fury to the announcement and accused May of trying to scapegoat family doctors for the unfolding NHS crisis.

A Downing Street source said: “Most GPs do a fantastic job and have their patients’ interests firmly at heart. However, it is increasingly clear that a large number of surgeries are not providing access that patients need – and that patients are suffering as a result, because they are then forced to go to A&E to seek care. It’s also bad for hospitals, who then face additional pressure on their services.”

Surgeries were told to extend their opening hours, to cover 8am to 8pm, seven days a week, as part of a five-year reform programme, but the government suggested that some GPs were failing to inform patients about the availability of out-of-hours appointments or to offer them at times the public wanted.

Extra funding for out-of-hours care will in future be linked to evidence that it is being tailored by doctors to their patients’ demands and making use of digital technology. Ministers are considering using the digital appointment system to monitor demand and ensure that doctors are responding.

Many doctors already feel they are struggling to meet demand with limited resources. Earlier this week, Simon Stevens, the NHS’s chief executive, suggested May was “stretching it” by claiming that the NHS was getting more than the minimum £8bn by 2020 it had asked for. He made the claim in a combative performance before MPs at the public accounts committee, where he contradicted several of the prime minister’s assertions.

Ministers are determined not to offer additional funding without evidence that the service is being more efficiently managed, and Stevens is pressing ahead with changes he has promised.

Philip Hammond, the chancellor, told the Economist earlier this week: “We don’t have any spare cash. There isn’t a pool of cash available. We’ve been asked to provide the NHS with a certain amount of funding by its own management through to 2020. We’ve done that and more and we expect the NHS to deliver within that envelope.”

Dr Chaand Nagpaul, chair of the British Medical Association’s GPs committee, said: “This is not the time to deflect blame or scapegoat overstretched GP services, when the fundamental cause of this crisis is that funding is not keeping up with demand.

“This is evidenced by the fact the UK spends less on health and has fewer doctors and beds per head than other leading countries, as highlighted by the head of NHS England, Simon Stevens, only this week. Rather than trying to shamelessly shift the blame on to GPs, the government should take responsibility for a crisis of its own making and outline an emergency plan to get to grips with the underlying cause, which is the chronic under-resourcing of the NHS and social care.”

Nagpaul pointed out that GPs already provided care around the clock through their involvement in GP out-of-hours schemes and that many practices already offered evening and weekend appointments. “However, there are examples where extended opening has been abandoned due to lack of demand,” he said. “Government funding for extended opening has also been halved in some areas.”

The Royal College of GPs denounced the government’s move in unusually strong terms and described it as nonsensical. “It’s extremely unfortunate that the prime minister is being reported as pushing forward with a misguided scheme to force GP surgeries to offer routine services from eight to eight, seven days a week, regardless of patient demand or local resources,” said Prof Helen Stokes-Lampard, the college’s chair.

“It is not the case that GP surgery routine opening hours are contributing to the pressures our colleagues in A&E departments are currently facing. GPs and our teams are also struggling to cope with increasing patient demand without enough investment and without nearly enough family doctors and practice staff to deal with it; this is a year-long problem for us, not just during the winter.

“It has never made sense to force GPs to offer services that there is little patient demand for. In many cases, practices have already had to actually stop offering extended opening hours because of a lack of patient demand for them. Blaming GPs for the crisis facing our NHS is not going to help anyone. Instead we need to start investing in our health service properly, so that there are adequate resources and clinical staff to deliver the care our patients need and deserve.”

The shadow health secretary, Jon Ashworth, said: “The Conservatives promised this in their manifesto six years ago. We don’t need more broken promises, but clear action, starting with facing up to social care needs that have been subjected to cuts of £4.6bn under the Tories. This is another example of Theresa May’s floundering in the response to the NHS crisis.”

GPs should do more to take pressure off A&E departments, says May

Federal Bungling Of ObamaCare Verification Creating Nationwide Chaos In Medicaid Departments

Co-authored with Nic Horton, Policy Analysis Analyst at the Foundation for Government Accountability.

Increased Medicaid enrollment has extended been heralded as a rare “success” of the ObamaCare rollout. Lately, CMS launched a new report boasting about growing enrollment in Medicaid. “These gains are produced attainable by collaboration among CMS and the states that operate these applications,” CMS explained. But how many of the new 6 million enrollees actually meet the eligibility demands for Medicaid?

Some state officials have began to push back on the claims of the Obama Administration on Medicaid, and a number of have quietly began to eliminate ineligible people that have been enrolled due to continued concerns with the federal website. The number of examples that have grow to be public from about the nation call into query the validity of these Medicaid enrollment numbers, painting a dire picture for taxpayers and the actually needy.

Last July, the Obama administration announced that — by executive directive — it would delay ObamaCare’s income verification needs. As an alternative, men and women who wanted to obtain overall health insurance via the ObamaCare exchange would be on the “honor system” and self-report their earnings without having any evidence necessary. This modify was only supposed to impact enrollees in state-based exchanges, but troubles with HealthCare.gov have produced chaos for states with a federal exchange as effectively.

States proceed to grapple with the collateral harm of ObamaCare’s implementation. However, the bungling of the overall health law’s rollout is wasting even far more taxpayer bucks and hurting even far more sufferers in need.

Quickly to be Secretary of HHS Sylvia Mathews Burwell may possibly have to answer for the developing variety of improperly enrolled folks onto Medicaid under the ACA due to continued problems with healthcare.gov. (AP Photograph/J. Scott Applewhite)

The Federal “Fix”

The federal government’s failure to confirm applicant earnings has put states in an unworkable circumstance: there is no way to establish if an applicant should go into Medicaid, into an exchange plan, or if that applicant is eligible for any sort of taxpayer-funded subsidies at all. To “solve” this dilemma, the administration announced in December that it would offer states “flat files” of incomplete eligibility data obtained for the duration of the exchange application approach, but, in the meantime, would let states to go ahead and enroll people in Medicaid. Even the loudest cheerleaders for ObamaCare could’ve envisioned how horribly incorrect this might go.

Politico stated at the time that this maneuver by the administration forced states to:

make a decision whether they’re prepared to chance the integrity of their Medicaid plans to sign up people more rapidly.

Some states rolled the dice now individuals and taxpayers are getting forced to settle up with the property.

Fraudulent Medicaid Enrollment Surges

Final December, HHS spokeswoman Joanne Peters said, “Claims from some states about our process for testing the Medicaid eligibility and enrollment systems are inaccurate.” It appears her data is as incomplete as the fed’s earnings verification information.

Texas

Take, for illustration, Jason Hawkins of Plano, Texas. Mr. Hawkins Hawkins earns $ 50,000 a yr and has a family of 3.  Primarily based on his cash flow, he is ineligible for Medicaid, but the fed’s HealthCare.gov gave him the go-ahead for free taxpayer-funded wellness care.

Texas officials also confirmed other significant flaws in the files they received from the federal government.  A lot of of the candidates supposedly eligible for Medicaid in Texas included people who did not even reside in the state and folks who are previously signed up for Medicaid.

Florida

By February, the federal government offered data on tens of thousands Floridians it determined to be eligible for Medicaid based on applications processed by the ObamaCare exchange. After overview, Florida officials found that significantly of the data was totally unreliable, containing duplicate applicants and candidates that had been certainly ineligible for Medicaid.

Federal Bungling Of ObamaCare Verification Creating Nationwide Chaos In Medicaid Departments

Government failing on violence reduction scheme by means of A&E departments

A violence reduction sheme involving A&ampE departments sharing anonymised data with police has not been fulfilled. Photograph: Bethany Clarke/Getty Images

Ministers are failing to fulfil a coalition pledge to roll out a violence reduction scheme that has been proven to reduce attacks by as much as 40%, top accident and emergency surgeons claim.

The Tories and Liberal Democrats agreed in 2010 to introduce the nationwide scheme, which involves A&ampE departments sharing anonymised data about violent incidents with police forces, enabling problem spots to be targeted.

But as handful of as a third of A&ampE departments in England have completely adopted the programme, which was pioneered in Cardiff 20 many years ago and has been copied as far afield as South Africa and the US.

Department of Wellness officials have created it clear that A&ampEs ought to share info with police, but a spokesperson admitted it basically did not know how a lot of hospitals have been working the model. It is undertaking a assessment this summer season to discover out.

Dr Adrian Boyle, chair of the good quality in emergency care committee of the University of Emergency Medication (CEM), said he was annoyed at the lack of progress. “The implementation is not functioning as effectively as we would have liked,” he mentioned. “It is aggravating.”

Boyle, an A&ampE consultant who has worked closely with the Division of Wellness and NHS England to get the system up and running, referred to as for the government to give hospitals incentives to introduce the scheme. He mentioned there was a wariness within hospitals about workers to liaising with experts “out of their silo”. The reorganisation of the NHS may possibly also have hampered the programme, he said.

An audit two years in the past discovered two-thirds of A&ampE departments were not sharing information to the standard advisable by the CEM. Boyle mentioned he did not feel the new audit would present any progress.

The architect of the unique Cardiff scheme, Jonathan Shepherd, professor of oral and maxillofacial surgery at the Cardiff school of dentistry, expressed concern at the slowness of the adoption of the model.

He mentioned there was even now as well great an acceptance of “schedule” street violence. “Folks grow to be immune to the concern and the social catastrophe it represents. For health-related personnel, police and local authority employees it becomes a schedule portion of what transpires when you’re on shift at the weekend.

“Pros are used to getting reactive, suturing folks up and arresting offenders rather than taking a a lot more preventative approach. I’m not shocked it is taking some hospitals so prolonged [to adopt the Cardiff model] and others aren’t doing it properly.”

Shepherd’s thought stemmed from research he did in the 1980s which located only a quarter to a third of violent incidents resulting in a journey to A&ampE come to the interest of the police. He realised that for forces to have a full image of what was happening they ought to know about all situations of emergency treatment.

His scheme – the Cardiff violence prevention programme – launched in 2003. Hospital personnel recorded anonymised information of where, when and how a victim had been attacked. This info was shared, making it possible for maps of violence hotspots to be developed and the organisation of operations to tackle the problem.

The outcomes were striking. Inside 5 years there had been an estimated 42% fewer woundings in the Welsh capital in contrast with similar cities.

There was a 35% decrease in the number of sufferers seeking emergency treatment method and one particular study place the savings in economic and social expenses at just below £7m a 12 months. For every £1 invested on the scheme, £82 was saved.

Shepherd mentioned he realised the scheme was working when the price of violence in Cardiff, a well-liked get together city, dropped to amounts noticed in towns this kind of as Eastbourne and Harrogate. Shepherd advised the government essential to do more to fulfil its coalition agreement guarantee. He explained: “In the runup to the 2015 election I feel people will want to be reassured that this government commitment has come to fruition.”

Shepherd’s model or variations of it are in place in Amsterdam and the Western Cape in South Africa. Milwaukee in the US has also been investigating it.

Alun Michael, a former Labour minister and now police commissioner for south Wales, was also surprised that a lot more hospitals had not adopted the model. “Analysing incidents which brought victims of violence to A&ampE has led to considerable and sustained reductions in the variety and seriousness of violent incidents,” he said.

Gary Smith, the director of Cardiff Street Pastors, which assists keep revellers safe in the city centre on Friday and Saturday nights, said he had noticed a big difference in the city in excess of latest many years. “It feels a secure, area to be now. I feel that’s partly because everybody performs collectively so nicely now.” Michael and Smith each explained the programme in Cardiff had led to a wider cultural shift with companies far more utilised to functioning closer and better together.

South Wales police created it clear it believed the scheme was worthwhile. A police spokesperson mentioned the scheme had produced a “important contribution” to the reduction in violent crime. “It is an superb illustration of how partnership perform in Cardiff is producing a genuine big difference to retaining our communities protected.”

There are examples that display the scheme has worked nicely in other places the place it has been adopted. In some, violent crime has fallen by 40%. In Cambridge, for example, analysts realised foreign college students had been being injured on Monday evenings after Addenbrooke’s hospital shared info. Officials found that drinks promotions aimed at foreign students were currently being offered by bars. The premises have been told they must end such promotions.

In the south-east of England, people began attending an A&ampE having been hit by planks of wood and bricks. The information was passed on and council officials realised an open skip had been left close to a nightclub. Such skips had been banned from the area.

Mark Bellis, who advises the World Wellness Organisation on violence prevention who has implemented a productive info sharing scheme in the north west of England, said there remained a reticence in some locations to take it up. “It can function phenomenally well but some are reluctant since of the investment and the time.”

Caroline Shearer, of the anti-knife campaign group Only Cowards Carry stated the government essential to do a lot more to tackle violent crime – like generating sure hospitals shared information.

“The government talks challenging, it demands to act difficult,” she said.

A spokesperson for the Department of Overall health mentioned: “We have been clear A&ampE departments should share details with police and we are about to assessment compliance ahead of the rollout of a new legal regular which all key A&ampEs will be obliged to meet. We’re also supporting hospitals to train nurses to specifically champion this.”

Government failing on violence reduction scheme by means of A&E departments

Why A&E departments are fighting for their life | Allyson Pollock

‘Contrary to popular belief, attendances have stayed static because 2003 in what the Division of Health calls type one units – the large hospital-primarily based A&ampE departments.’ Photograph: Christopher Thomond

Not a week passes with out a information story about A&ampE departments: seven threatened with closure in London ambulances queueing close to the block as patients wait for hrs to be seen insufficient staff large paying on locums. Emergency medication is a small speciality, with fewer than four,000 medical professionals in contrast to 32,000 GPs – and but it consumes an inordinate sum of airtime. Why?

A&ampE is the canary in the mine it tells the story of what is going on elsewhere in the support. Cuts, competition and the battle for survival are at the heart of the story. Above the previous twenty many years several hospitals and A&ampE departments have been closed, typically as element of private finance initiative projects: what drove the closures was the substantial value of PFI, not shifting patient demands.

Hospital beds have been lost at a fast speed as well, not simply because there isn’t a want for them, but since the government is paving the way to divert sufferers to the private sector in the future, or removing NHS providers to allow foundation trusts to create revenue from private individuals. Above two and half decades successive governments have closed in excess of 50% of NHS beds. In 2013/14 there were 135,000 NHS beds in contrast with 297,000 in 1987/88. England now has a single of the lowest variety of beds in Europe and the highest bed occupancy – more than one hundred% in some specialities – which signifies health-related individuals are being displaced on to surgical wards, major to cancelled elective surgical treatment and improved waiting times.

And without having beds, stress builds in A&ampE. No 1 is monitoring or measuring this: community well being councils, when the voice of nearby folks, have lengthy because been abolished, and there is no census of emergency departments.

At the exact same time, the government is closing providers in principal care and neighborhood authorities are axing solutions in social care. GP out-of-hrs solutions are no longer functioning as they must and neither are social companies and local community support. More stress builds.

The Labour government set up walk-in centres and minor damage units as an different to GP out-of-hours services. But now these are also currently being closed of the 230 opened underneath Labour, 53 have shut down in the previous 3 many years.

Contrary to well-known belief, attendances have stayed static considering that 2003 in what the Department of Wellness calls variety one units – the massive hospital-based A&ampE departments. The enhance has occurred in type two and three units – the small injury and stroll-in centres – and so can be explained by the decline in GP out-of-hours companies. So why are alarm bells sounding in the large A&ampE departments?

Because the Health and Social Care Act eliminated the duty on the secretary of state to supply universal care, it is each hospital for itself, competing against each other in a marketplace area there is no preparing, only forecasting for revenue and revenue. But A&ampE is pricey and, like geriatric care and children’s companies, the value the government pays could not meet the expenses. Hospitals would rather concentrate on niche markets like cancer, cardiac and elective care, especially if they can increase some personal income at the very same time. Markets will not like threat or uncertainty.

Therefore the new NHS pricing model functions against A&ampE. Professor Keith Willett, the man leading NHS England’s overview of emergency solutions, has described the model as “wrong”, and says it has led to an “adversarial” romantic relationship amongst hospitals. But it is not just between hospitals – it is also inside of every single hospital, as speciality fights speciality for survival. This means specialisms lobbying for sources, and attempting to raise their voices above all the other individuals in purchase to be heard. At the moment A&ampE is shouting the loudest.

Why A&E departments are fighting for their life | Allyson Pollock