RCEM Acute Insight Series: Emergency Medicine Workforce in England

RCEM – June 2023

This report found that:

• Emergency medicine trainee doctors make up 45% of the total emergency medicine workforce. Without a detailed plan to replenish and grow this cohort of the workforce, there is great risk to service provision, namely during out of hours, night and weekend shifts, and poor consequences for patient safety.
• 29% of our emergency medicine consultant members in England are over 50. As consultants approach this age, they may consider reducing their working hours. Furthermore, with a third of the workforce approaching retirement age at the same time, we may witness a mass exodus of experienced senior clinicians.
• There should be one whole-time equivalent consultant for every 4,000 annual attendances. At present, this ratio stands at 1:7052. This is further exacerbated by extreme long waits that are now commonplace in emergency departments.
• 2019 and 2022 saw a comparable number of attendances (0.15% difference), yet the number of care-hours per whole-time equivalent emergency medicine consultant and nurse respectively, almost doubled within this time frame.
  Unsurprisingly, the working conditions are making it difficult to retain staff in the specialty: retention of the staff we do have is of great concern. Burnout and low morale plague the specialty incentivising senior staff to retire early.
• This explainer found that in 15 years’ time, there will still be a shortfall of 600 WTE consultants in
  England. Planning and implementation must begin now if we are to sustainably secure the
  workforce of the future, and ensure emergency departments continue to be there for anyone and
  everyone at their time of need.

Read the Report – Emergency Medicine Workforce in England

UK Perinatal Deaths for Births from January to December 2021.

HQIP – 15th September

The Maternal, Newborn and Infant Clinical Outcome Review Programme, which is delivered by MBRRACE-UK, has published a report on UK Perinatal Deaths for Births from January to December 2021.

Overall, it found that perinatal mortality rates increased across the UK in 2021, with 3.54 stillbirths per 1,000 total births and 1.65 neonatal deaths per 1,000 live births (3.33 and 1.53 respectively in 2020). However, there was a wide variation in stillbirth and neonatal mortality rates across organisations, though these rates increased in almost all gestational age groups. It was also found that inequalities in mortality rates by deprivation and ethnicity remain, but the most common causes of stillbirth and neonatal death are unchanged (eg congenital anomalies continue to contribute to a significant proportion of perinatal deaths).

The report makes a number of recommendations, including calls to:

• Support external clinical input into the rigorous review of all stillbirths and neonatal deaths across the UK, to identify learning and common themes related to clinical care and service provision, delivery and organisation
• Ensure healthcare providers adopt and use the BAPM Perinatal Optimisation Pathway, to improve preterm outcomes
• Continue to develop and implement targeted action, at national and organisational levels, to support the reduction of direct and indirect health inequalities, and
• Review perinatal pathology services as a national priority, and ensure equity of access to all modalities of post-mortem examination.

Read the full report: UK Perinatal Deaths for Births from January to December 2021.

National Hip Fracture Database (NHFD): 15 years of quality improvement

HQIP – 14th September

This state-of-the-nation report from the National Hip Fracture Database (NHFD) focuses on 1 January to 31 December 2022, finding that the number of people who died in the month following a hip fracture now stands at 6.2%; down from 10.9% in 2007, when the NHFD was set up. However, the report also finds that it took longer for patients to reach a ward where a hip fracture team can work together (where there is the best chance of recovery) in 2022. It also states that fewer patients received prompt surgery to repair their broken hip by the day after they presented to hospital.

As such, this report calls for hospitals to improve how they move patients to the right ward, operate and get patients out of bed promptly, recommending that hip fracture teams:

1. Review the care provided in the Emergency Department (ED), so that patients are seen promptly, offered pain relief, and admitted to an appropriate specialist ward within four hours
2. Use the NHFD website to see why surgery is delayed, and work together so that this happens by the day after patients present with a hip fracture, and
3. Use the NHFD website to see what more can be done to avoid patients becoming confused in hospital and to ensure that they are well enough to get out of bed on the day after their operation.

Additionally, there was an improvement in how many people with hip fracture received bone strengthening medicines to avoid future fractures in 2022, but some hospitals continue to report that none of their patients receive such treatment.

Read the full report: National Hip Fracture Database (NHFD): 15 years of quality improvement

Our Annual Report and Accounts 2023 – British Heart Foundation

BHF – September 2023

This year’s annual report showcases our ongoing resilience in the wake of the pandemic and the incredible work of our BHF family to recover our income, support millions of families in their time of need, and make history by funding more ambitious research than ever before.

Read the Report – Our Annual Report and Accounts 2023 – British Heart Foundation

Rapid evaluation report: chronic obstructive pulmonary disease virtual ward enabled by technology

NHS England – 13th September 2023

A rapid evaluation conducted by Eastern Academic Health Science Network (AHSN) and Health Innovation Manchester, the AHSN for Greater Manchester, adds to emerging evidence of virtual wards enabled by technology offering positive, effective care that supports people to be at home rather than in hospital.

This report summarises the findings of the evaluation of a chronic obstructive pulmonary disease virtual ward managed by South and West Hertfordshire Health and Care Partnership and conducted on behalf of the national Innovation Collaborative for digital health.

Rapid evaluation report: chronic obstructive pulmonary disease virtual ward enabled by technology

How confident are people about accessing NHS healthcare?

Healthwatch England – September 2023

This research shows low public confidence in being able to access NHS services. It finds that a third of adults in England lack confidence that they can access timely care, including GP services, mental health support and hospital care. It also suggests that perceptions of access to NHS care is a health inequality issue, with some of the most vulnerable groups having the lowest confidence that they will get the care they need in a timely way.

Read the Research – How confident are people about accessing NHS healthcare?

A community-centred approach to musculoskeletal care

NHS Confederation – 11th September 2023

Sussex MSK Partnership has successfully developed a community-centred approach to musculoskeletal (MSK) care through the use of community appointment days (CADs). Over two days in different locations, the partnership delivered a personalised approach to care, increasing staff morale and improving outcomes for their patients.

Read the case study – A community-centred approach to musculoskeletal care

Quality and safety of maternity care (England)

House of Commons Library – 8th September 2023

This briefing details government and NHS policies on the quality and safety of maternity care in England.

Quality and safety of maternity care (England)

Digital and data strategy for health and social care in Wales

NHS Wales – 27th July 2023

Our system of delivering joined-up health and social care needs further development. Digital transformation is key to successful and improved health and social care outcomes. The refreshed ‘Digital and data strategy for health and social care in Wales‘ builds upon previous successes and sets out future ambitions. User-centred digital services built upon better digital skills, data and platforms are critical.    

The strategy identifies a series of priorities to be delivered through six missions.

• digital skills
• digital economy
• data and collaboration
• digital Infrastructure and connectivity
• user-centred services
• digital inclusion

We will place digital and data at the heart of our plans when developing health and social care services. This strategy reinforces our commitment to supporting citizens to lead longer, happier lives.

Read the Report – ‘Digital and data strategy for health and social care in Wales – Welsh Govt

Martha’s Rule: a new policy to amplify patient voice and improve safety in hospitals

Demos – September 2023

Martha Mills died aged 13 in the summer of 2021 and the inquest into her death heard that she would likely have survived the sepsis that killed her had consultants made a decision to move her to intensive care sooner. This report is a response to a call from Martha Mills’ parents to rebalance the power between patients and medics to improve patient safety. It outlines evidence that shows that failing to properly listen to patients and their families contributes to safety problems in the NHS, along with public awareness among citizens that the NHS can feel unresponsive at times.

Read the Report – Martha’s Rule: a new policy to amplify patient voice and improve safety in hospitals