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‘Unacceptable’ cancer and elective waiting times are ‘risking patients’ lives’

A report has warned that the impact of delays on patients isn’t being taken seriously enough.

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Only one in three trusts are meeting cancer waiting time targets.

Patients are facing “unacceptable” and “agonising” delays for both elective and cancer treatment, claims a new report.

The report by the Public Accounts Committee accuses health bodies of “a lack of curiosity” and warns that increasingly long waiting times “risk patients’ lives”.

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It reveals that less than half of NHS trusts are meeting the 18-week waiting times standard for elective treatment, and only 38% are meeting the 62-day standard from referral to treatment for cancer patients.

The report goes on to warn that the impact of delays on patients isn’t being taken seriously enough and urgent action is needed.

NHS England and NHS Improvement have both been asked to evaluate and report back to the Committee on how they plan to ensure patient demand is met in both the long and short term.

‘Unacceptable’

Meg Hillier MP, who chairs the committee, said that it was unacceptable that the proportion of patients being treated within NHS waiting times was continuing to spiral downwards

“The impact on individuals of protracted waiting times cannot be ignored. As one charity told us, the wait for cancer testing is “agonising… it is essential that a definitive answer is given as soon as possible, to either provide peace of mind or to allow treatment to begin at the earliest stage.”

“In a high-pressured healthcare environment in which patient numbers are rising and demand is increasing, we were troubled by the Department’s and NHS England’s approach to waiting times which seems to be characterised by gaps in understanding of: patient harm, hospital capacity and what is driving demand.

“It is no surprise then that we see such variation of waiting times across local areas and, therefore, why it has proved impossible for local trusts to properly map services and deliver sufficient provision.

‘Not enough staff’.

The Royal College of Nursing (RCN) says the failure to meeting targets is down to a lack of nursing staff.

Dame Donna Kinnair, Chief Executive and General Secretary of the RCN, said: “This report echoes calls the RCN has made for some time about the need to focus on the impact of the NHS’s failure to meet targets on patients themselves, who often seem to get forgotten in complicated debates about how waiting time statistics are calculated.

“At the heart of this failure to meet the targets for elective and cancer care is the fact that we simply do not have enough nursing and other clinical staff for patients to get their treatment within the target times. We need Ministers and NHS leaders in England to focus urgently on producing a comprehensive and costed strategy for increasing the nursing workforce – as a first step, the RCN is calling for at least £1 billion to be invested into nurse higher education in order to increase the number of students taking nursing degrees.

‘The impact is not taken seriously’.

Nigel Edwards, Chief Executive of the Nuffield Trust, said: “It’s no secret that the NHS has been missing most key waiting times targets for years. This report warns the impact on patients isn’t being taken seriously enough. The strong focus on A&E waiting times has been in danger of obscuring the fact that some patients waiting for planned care are suffering greatly from serious conditions and need help.

“I’m afraid I’m not convinced that just issuing new ultimatums to NHS England will resolve these problems. It’s all well and good for different parts of Government to demand things of each other, but without enough staff and beds the NHS won’t be meeting the old or new targets any time soon.

“The new targets suggest some promising ideas but we need to be honest that there will be some winners and losers when it comes to who has to wait the longest. The NHS will need to have a careful look at who these people are as the targets get tested out and be flexible if they’re not serving patients well.”

Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.

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Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.

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Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 

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Observations

A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.

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Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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