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Subscribe Yahoo Finance's Morning Brief newsletter has been revamped! HP Inc. Currency in USD. Add to watchlist. Summary Company Outlook. Previous Close Volume 9,, Market Cap Trade prices are not sourced from all markets. Press Releases. American City Business Journals. Yahoo Small Business. All rights reserved. Data Disclaimer Help Suggestions. Since , eight vanguard areas of the country have been exploring new approaches to delivering urgent and emergency care services in line with these principles.

Patients admitted to hospital require a bed to be available. Figure 4, and our more detailed recent analysis , show that the number of hospital beds for overnight stays continues to decrease even as admissions continue to rise. Figure 5 shows that hospitals are routinely operating with bed-occupancy rates above 85 per cent — the level at which the Department of Health suggests that hospitals will struggle to deal with emergency admissions.

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Source: Bed Availability and Occupancy. In September there were more than , delayed days 2 in acute hospital care. The majority of delayed transfers 57 per cent in September can be attributed to delays within the NHS, when there is a delay in patients being transferred to receive care from a different NHS provider such as a community hospital. However, the proportion attributable to social care ie, patients waiting for care to be arranged at a residential or nursing home or for a care package at home to be developed has increased over recent years.

This reflects pressures faced by local councils, which have seen significant cuts to their budgets in recent years. Figure 6 shows the increase in recent years in the number of trolley waits of more than four hours and 12 hours. While this is a small proportion of the The Royal College of Emergency Medicine notes that emergency medicine has a high attrition rate from doctors in training, high early retirement rates for experienced clinicians, and significant reliance on temporary locum clinical staff.

In the most recent General Medical Council survey , doctors training in emergency medicine reported the highest level of workload pressures of any medical specialty. Between and the number of emergency medicine consultants increased by 7 per cent each year. However, it remains difficult to recruit and retain sufficient staff in emergency care and other key services.

The number of nurses employed by the NHS is falling , and shortages of senior staff are reported in mainstream specialties such as acute general medicine. The declining performance against this waiting time standard is a clear indication of the pressures the wider health and care system is under. While the latest version of this analysis is useful, there are some points where the conclusions are not stated strongly enough and others where useful additional analysis has been missed.

Here are a few examples. And the analysis says the major factor driving performance is admissions not attendances. This emphasis is important as rather too much policy effort has been devoted to trying to reduce attendance despite there being clear evidence that this will make no difference whatsoever. There are other reasons that lead to this conclusion. Hospitals need to see emergency flow as a system not as a fragmented bundle of independent hospital departments.

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And investment needs to be made in the parts of the system that will unblock the flow. Investing in the wrong place will waste money without leading to improvement. Here is a suggestion for a more insightful analysis of long waits. Don't look at the published 12hr trolley wait numbers: it is a game-able metric and very misleading. This is not gameable and is a far better indicator of how waits have deteriorated. This is a much more sensitive and more useful indicator of how bad things are than the discredited trolley-wait number.

Hedging the conclusions with too many caveats when the evidence is clear doesn't help. Be bold or the myths will resist and policy will continue to be ineffective. The number of patients waiting in any system is the most obvious and sensitive indicator of a System's performance. While we would all like to believe that 'lack of resources' staff, beds, machines is the cause, unfortunately all the research shows that the latter is the most common and more unpalatable reason. Most beds are storage for patients while they wait for someone to start the next step in their care.

So the number of beds in the system depends on the number of patients waiting for the flow resource. To prevent a queue, the flow resources need resilience capacity to cope with the variations in workload. While patient present with a variety of symptoms, the clinical process is very similar for many of them.

It involves taking a history, examining the patient, making a clinical differential diagnosis, diagnostic tests blood and other fluids, imaging making the definitive diagnosis, prognosis and plan and then implanting the plan, reviewing the patient's progress against the prognosis and then maintenance. So how long does each step take? This defines the clinical routing the patient requires and this is defined according to the longest step in the diagnostic part of the process - blood tests.

If no blood test required, the patient needs the 'quick' stream often referred to as 'minors', and if a blood test is needed - the routing is referred to as 'majors'. So now we can calculate how many man-hours are required to perform each task. And when we look at the resource available there are more than enough staff.


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So what's the problem? The policies: the policy of unwittingly designing the system to have a queue so we then have to reserve resource for the 'urgent patients', leaving others to wait, which further compromises the flow as the chart above suggests. Then there are 'prioritisation' policies at every stage GP receptionist prioritise patients calls, GPs do their home visits at lunchtime, the ambulance service prioritise, the hospital receptions staff prioritise, the doctors, nursing staff and porters prioritise, the labs prioritise, the imaging departments prioritise, and as a consequence the system is filled with queues at every stage.

As a consequence of all the delays and errors, the most senior and experienced staff can't provide the definitive diagnosis prognosis or plan until the next day. Many patients, particularly the elderly are whisked out into the next available bed without a diagnosis, prognosis or plan in order to 'hit the target'. Not only is this unsafe, but it causes massive rework and delays for patients and the staff downstream. So there are further delays the recovery and discharge where again priority occurs at every stage: discharges are done last after the ward rounds which may only occur 2x week as junior doctors focus on their sicker patients first, pharmacy batches and prioritises the prescriptions focusing on the inpatients first, as a result nurses can only organise relatives or other transport late in the afternoon or evening and the ambulance service prioritise the sick coming in over those going home.

And then there is the extraordinary process for assessing the elderly and infirm for continuing health or social are funding which may only happen once a month. A system is only as good as it's feedback loop Gregory Bateson and the feedback loop in the NHS is absent or at best delayed by months. Firstly the feedback occurs, if we are lucky, in retrospect once a month or quarter. Second the way the data is presented is by comparing one system with another rather than monitoring each system's performance continuously over time as doctors do for a System in a hospital bed.

Thirdly, the executive and senior mangers do not respond to the feedback signal. This is called Hubris and we, the public and press, collude in their Hubris by believing the yarn that the executive spin to hide their ineptitude. So what do we need to? Train our managers, or better still encourage managers to find and recognise the skills they need.

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Unfortunately the science of operations management is unheard of in the NHS - we refer to operational research by academic institutions which takes months and is aimed to improve an authors or academic institution's research ranking in the light of their peers, not solving the problem. This is a chart of a System that tipped into 'chaos' in I glanced through your long article, and as a person diabetic aged over 80 I wish to point out that you and most of the younger?

Strategic also because close to M11, train line, and Stansted airport. Local Councils, Government and the "organisation" of GPs surgeries themselves hence do hold so much of the blame for the current crisis. Who is the author of this article? Thanks for getting in touch. You will just need to put 'The King's Fund' as the author of this piece and include the publication date in your citation.

These times are calculated based on the average waiting times of patients in the previous four hour period. These times cannot be guaranteed and you may need to wait longer than the time shown. Figure 5: Occupancy rate for overnight general and acute beds, by quarter. Is a lack of staff increasing waiting times? Related content. Article What is happening to waiting times in the NHS?

We examine the big issues and recent NHS performance on waiting times. I am very fortunate to have amazing AE staff and a fantastic CD. Got a brilliant CEO and the Board. But AE middle grade doctors shortage and Consultant shortage is killing us and our performance. When there is a shortage quality of doctors drops and cost increases. Neighbouring Trusts are trying to pouch our consultants with more pay! Traditionally these are filled by non-EU doctors from Indian and African countries. With the immigration changes these doctors have stopped coming to UK. While we bust the myths let us also see what is the solution for acute shortage of AE doctors, why our trainees are happy to go to Australia but don't want to do their training in UK and let us learn lessons.

We owe it to our patients and also for our staff. If not quality will drop, cost will increase and both patients and staff will suffer. Reply Link to comment.

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Good afternoon I am very sad and also somewhat resentful that doctors are going to Australia. I am visiting my daughter in Melbourne very soon having been their for three and a half months in I was surprised to discover how much must be spent on admin in the Australian system. As a patient with Medicare I had to either pay the total amount and then claim a large percentage back via a Medicare office or fill in many forms or or if they bulk billed then I had to pay the percentage required at the surgery.

One young Australian said he would not take his children to A E in Melbourne as there would be too much blood?? WE do not hear of the problems in otherrcountries. I have a relation in Vancouver and she had to wait for three days on a trolley in a corridor as they did not have a bed to admit her. I intend doing some research whilst I am in Australia to find out just exactly how it works. I wish you all the very best. PS I was admitted to hospital as an emergency ,spent four days there and received surgery eight weeks later. Excellent all round.

This is an excellent paper. It is good to see a thoughtful and well set out analysis of reality addressing the myths that continue to be promoted by people who to be frank are either ill informed or manipulating the facts for political gain. Much of what is described in this paper is common sense when looking at the impact of policy decisions, investment, geographical pressures, training and recruitment issues and inescapable demographic changes and pressures.

My experience of working in primary, acute and ambulance services at a senior level and at a more remote strategic level tells me that the vast majority of all staff go to work and do a great job with what they have and that there are a great many who are innovative and creative. The simple fact is that this as your paper highlights a complex area with an incredible number of variables. It is important to be realistic and honest about what is not only affordable but what is achievable taking into account all the available resources.

Well done again. Keep up the great work - busting the myths and highlighting the issues. As a trainee about to embark on a career in the NHS, I am excited. In the coming years we have a fantastic opportunity to make the NHS even better than it already is as a fully-comprehensive health service, free at the point of delivery. We should be bold, and make the NHS as good as it can be, for everyone - it might look very different in years to come. The 'front door' issues make the headlines, but there are untold triumphs and issues lurking beneath that do not get the political and press coverage.

We have an opportunity as clinicians to work with all stakeholders at trust and strategic level to address these issues, with the patient at the centre of the whole scenario - the QIPP savings will follow!

I too enjoy reading the Kings Fund's measured take, on what can be at times a visceral discussion about the future of the NHS, inevitably tarnished with whatever political hue one would wish - a nessecary evil in a system borne by politicians. What does this statement actually mean - these people needed no treatment, no reassurance, nothing?

Please explain. So they could have consumed lots of activity before they were discharged, but with no further treatment required. So perhaps the true number of patients receiving no treatment is somewhere between the two. I do think however that we need to be careful about how we class 'guidance only'. Though it is likely that this advice could be given in other healthcare settings, we shouldn't discount its value to patients who felt they needed to see a healthcare professional at short notice. Those ED's not so well resourced would likely charge the Medicare rebate only. However Australain health care is based on user pays- we pay for scripts, always GP visits, unless you go you a bulk billing clinic.

This is the way it works. There is no NHS philosophy here for those who can pay and if you are fortunate enough to be able to afford to visit Oz -you pay. If you have a life threatening illness all bets are off and any ED will ignore all of the above and care for you- even top private ED's would not chase the dollar - if you needed heart surgery after a heart attack they would get on with it and suck it up.

This is not infrequent. TAC - transport accident commission would cover all costs if you are injured on our roads WC - work cover would cover all costs if you got injured at work DvA - would cover all costs if ever you out your life on the line for fellow countryman It's different to the UK but it's not a bad system. Do not travel and expect fish and chips- unfair. We would grill the fish and have salad and you would feel healthier afterwards. Enjoy Melbourne- my family have enjoyed my deflection to Oz 25 years ago and on their visits to Oz have needed to utilise the services occasionally and loved it - Advice.

You will need to pay a copayment at the GP as everyone does. Unless you go to a bulk billing clinic. As to why the registrars are coming- look at the case mix and skill base they get here. POHm's come here because the training model for ACEM is different and the lifestyle and attitude is wonderful for anyone. Don't moan that they come- find out what we offer and take it back to UK. It's not surprising that newly qualified A and E doctors go abroad- the working conditions here are dreadful.

Rotas are very hard, long days , maybe 9 days in a row. It's difficult to choose your area to be near your family. Holidays have to booked a year in advance, with poor HR support. Colleagues tell me how despairing they become Just reading with some skepticism the claim that lots of nurses and doctors from the UK are filling positions in Australia The reverse is true.

A number of representatives from UK hospitals and government agencies have been recruiting here for UK roles. The money is better in the UK and the bureaucracy problem is less. The issues we have are globally universal: Trauma doctors and experienced nurses are in short supply. Whats new? Every country has these problems.

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Doctors and nurses in Australia are paid roughly the same as in the UK if you analyse the higher living costs in Australia and purchasing power. Stephen Sydney Australia. To suggest they don't and only the Savience System is worthwhile is tendentious to say the least. How is healthcare delivered in the UK- what are the processes? Looking at the data and reports, I feel that there is.

What do think?