A&E closures


Rescue plans to relieve pressure on A&Es have been ordered by NHS chiefs, amid confusion over whether extra cash is available to meet spiralling demand.

The move comes the day after David Prior, chair of the Care Quality Commission, said that pressure of admissions on A&E departments was “out of control” and “totally unsustainable”. He said too many patients were arriving as emergencies, when they should have been dealt with by GPs, social care or other services.

He urged widespread closure of hospital beds and investment in community care to keep the system from collapse, warning that he could not promise to avoid a repeat of the Mid Staffordshire scandal.

NHS England has said it would be creating urgent support plans for A&Es across the country, bringing together hospitals, GPs, care homes and others to find ways to reduce the pressure by improving other services.

However, bosses were unable to say whether extra money would be diverted from elsewhere in the NHS to tackle pressure on A&E. According to leaked emails, Jeremy Hunt, the health secretary, has asked officials to find up to £400 million to solve the crisis.

More than 750 patients have suffered severe preventable incidents in England’s hospitals over the last four years. These incidents are categorised by the Department of Health as “never incidents”, meaning that they are so serious they should never happen.

There were 322 cases of foreign objects left inside patients during operations; 214 cases of surgery on the wrong body part; 73 cases of tubes, which are used for feeding patients or for medication, being inserted into patients’ lungs; and 58 cases of wrong implants or prostheses being fitted. For example, the BBC interviewed a patient who had a seven-inch pair of forceps left inside her after an operation.

Hospitals have no incentive to report “never events” because they may have to reimburse the cost of the procedure to the NHS as well as paying for the patients’ long-term care. On average each year there are 4.6 million hospital admissions to the NHS in England that require surgery. The NHS says the risk of a “never event” happening to a patient is one in 20,000.

One case emerged with a similarity to that of Edward Maitland. An elderly patient was admitted to hospital after a stroke. Medical staff put a feeding tube into her lungs rather than her stomach. Nutritional fluids went into her lungs, she contracted pneumonia and died.

“You feel guilty because when she [was] talking to us she kept saying she wanted to come out, and we kept saying, ‘You can’t come out, mum, until you get better,” her daughter said.

“You feel angry after, because you think someone’s killed your mum. No, they probably didn’t do it on purpose but that’s how it feels. You feel that somebody’s killed her.”

Her daughter is still awaiting a date for an inquest. She thinks staff failed to follow basic procedure by omitting to give her mother an X-ray to check the tube’s location. NHS guidance says that, if in doubt, this should be done as a secondary test.

There is a gulf between public expectations for the NHS, particularly for urgent care, and what is actually delivered. And this despite the huge increase in funding over the last few years. There are too many basic failures and there’s too little capacity. Since the money has run out, the medical professions must do some serious thinking about how better to serve the public.

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