Precision medicine?
A West Midlands Ambulance Service chief has predicted that the system will collapse on or around August 17th 2022, with no ambulances available.
Source: Emily Townsend Ambulance service will collapse by August, predicts its nursing director Health Service Journal 25 May 2022
Treasury says No?
In May NHS England tendered a contract to buy extra ambulance capacity from outside the NHS, in response to very long waits for emergency calls. The contract, worth up to £30million, is probably the largest to date, although local ambulance trusts have called on the private sector to provide “surge support” in the past. The NHSE is looking for a national service, which probably reduces the choice to the Red Cross and St John’s Ambulance. The question for private providers is: is it worth it? The question for the NHS is: will it really make a difference?
Ambulances are not backing-up outside A&E departments because there are too few ambulances. Buying in extra vehicles and crews is more likely to lengthen the queues of ambulances rather than shrink them. The bottleneck lies inside the hospitals, where the number of patients still in hospital despite being medically fit for discharge slows down new admissions.
The delays in discharge are in part a consequence of having insufficient social care in the community. One view of this problem is that if NHSE were serious about the ambulance delays it would invest its money in providing social care. The counter view is that £30million won’t go far with social care given the scale of the social sector’s staff shortages, but it will energise more demands from the sector for more funding. This is something the Treasury dislikes. It is better for the NHS to provide cosmetic solutions rather than seek curative ones if it wants to keep on the good side of the Money Mandarins.
Source: Alison Moore NHSE tenders £30m deal for emergency ‘surge’ support HSJ 12 May 2022
A waiting game
How long are A&E patients waiting for admission actually waiting? It all depends on when waiting starts. The official statistics (published by NHSE) record a time period from ‘decision to admit’ to admission. The hours spent in A&E prior to the decision to admit being made are discounted (although the NHS captures these as internal statistics). The table below shows the different totals for ‘long waiters’, depending on the basic definition.
The situation in A&E is likely to be worse than the official statistics suggest. This matters because differences in mortality rate become visible at end-to-end waits of 5 hours. Waits of 8-12 hours have a number needed to harm of about 72 which means that an extra death is associated with every 72 arrivals waiting 8-12 hours. Since the mortality rises for every hour longer than 5, it is likely that waits of 12 hours have even higher mortality.
February 2022 |
March 2022 |
|
Official statistics - waiting 12+ hours for admission following decision to admit |
16,500 cases |
22,500 cases |
Internal statistics - waiting 12+ hours for admission following arrival in A&E |
71,000 cases (21% of admissions) |
87,000 cases (23% of admissions) |
Sources: Matt Discombe Revealed: Secret stats show A&E crisis four times worse than reported HSJ 13 May 2022 and https://emj.bmj.com/content/39/3/168
Community vision
Inventing new organisations is not a privilege enjoyed only by the public sector. Founded in 2012, Community Health and Eye Care (CHEC) has worked with optometrists (opticians) to deliver a shared care partnership model and is now one of the largest providers of community-based ophthalmology services in the UK. Ophthalmology services in the NHS face significant backlogs with over half a million people currently waiting for assessment or treatment.
CHEC clinics bring together optometrists and ophthalmic specialists to provide a service that deals with a range of eye disorders, from seemingly minor eye symptoms to surgery for cataracts or ‘wet’ macular degeneration. CHEC is badged as providing NHS services, and is presented as a solution to the appointment backlog in many hospital-based eye services. It has units in New Cross, Slough, Coventry, Nottingham, Bridge End, Leicester, Northampton, Newcastle & Gateshead, and three sites in Dorset.
Many high street opticians have long been collectivised within larger retail chains where they complement pharmacy services. The acquisition of opticians Dolland & Aitchison by Boots is an example. The CHEC model is different because it brings opticians and ophthalmic surgeons together under one convenient and accessible roof.
Is it privatisation? No more than general practice is. It is a form of contracting out that mirrors the longstanding relationship between GPs and the NHS. Will it work? Quite possibly. Throwing resources at innovative community services can be very effective.
Source: https://www.communityeyecare.uk/our-story/
Great Expectations
The Northern Care Alliance is setting up one of the UK’s biggest virtual wards using medical technology provided by Dignio to monitor more than 500 patients in their own homes. The virtual ward project will cover a large part of the Greater Manchester area and the virtual beds will be available to patients with a variety of different conditions.
The new 500 bed virtual ward will see patients being given access to the app to record their vital signs. The data can be reviewed and monitored by the healthcare team and thresholds for alerts set on an individual patient basis.
Preliminary findings of a pilot study suggested that the virtual ward reduced hospital admissions by 30 per cent. If true, this is biggest effect ever seen with a community-based intervention. More likely, say NfN boffins, is that before and after measures were used to measure the impact. Such measures are notorious for over-estimating the size of effects.
Source: chloeb@highland-marketing.com
Read more News from Nowhere and articles on the NHS in ERA 3 at http://www.healthmatters.org.uk/