Prioritise Improvements to Imaging as NHS Recovers from Pandemic, Urges Ombudsman

August 4, 2021

The Parliamentary and Health Service Ombudsman (PHSO) has written to the Government urging it to prioritise improvements to NHS imaging services as part of the health sector’s recovery from the COVID-19 pandemic.

The letter highlights findings from the Ombudsman’s report that shows recurrent failings in the way X-rays and scans are reported on and followed up across NHS services.

The Parliamentary and Health Service Ombudsman (PHSO) has written to the Government urging it to prioritise improvements to NHS imaging services as part of the health sector's recovery from the COVID-19 pandemic.

PHSO’s casework shows the devastating impact these failings have had on patients and their families. In several cases, signs of cancer in X-rays and scans were not reported, which led to delayed diagnoses and poorer outcomes for the patients. In one case, an 18-month delay in diagnosing pancreatic cancer meant a patient missed out on getting earlier treatment that could have prolonged their life. In another case, a patient was not told that their cancer was terminal until it was too late for them to get their affairs in order and see their son before they died.

Another common failing was inefficient handovers between departments and services. Investigations also found that trusts did not learn from previous errors related to imaging, which meant they repeated the mistakes.

In his report, Ombudsman Rob Behrens stresses that failings related to imaging are found across the NHS, in both primary and secondary care services, and not solely in imaging departments. He calls on the Government to commit to a system-wide programme of improvements for more effective and timely management of X-rays and scans.

Ombudsman Rob Behrens, said:

‘X-ray and scan results are key to diagnosis and treatment for many people. Yet the failings outlined in this report show that without a concerted effort to improve imaging, patient safety continues to be at risk.

‘Now, as the NHS recovers from the devastating impact of the pandemic, we have a vital opportunity to learn from the failings and embed system-wide changes to improve imaging in the health service.

‘The evidence-led recommendations I have set out should be implemented swiftly, with collaboration across government and the health sector to strengthen the NHS’s recovery.’

For many of the 5 million people currently waiting for hospital treatment, imaging will be a crucial part of their care. Effective diagnosis will be an essential first step in tackling the backlog caused by the pandemic, further highlighting the need for rapid action on improvements.

Peter Walsh from the patient safety charity Action against Medical Accidents, said:

‘We very much welcome this report, which underlines the urgency of improving radiology services across the board, including recognition, reporting and acting on imaging results.

‘We see in our own work how vital diagnostic services are, and the awful effect on people’s lives when they go wrong. There have now been a raft of reports and recommendations about improving radiology services.

‘This is a major patient safety issue, and we need to see the various recommendations implemented as a matter of urgency.’

Lessons UK Healthcare Systems Can Learn from the Pandemic

June 17, 2021

New report from the Royal College of Anaesthetists

Effective workforce planning and investment, staff wellbeing, and increased critical care capacity remain vital to the recovery of the NHS

The Royal College of Anaesthetists has launched a report identifying 10 lessons the UK healthcare system can learn from the pandemic. The College is calling for the findings to be implemented in order to support the recovery and build back a stronger and more resilient NHS. The College will work with senior stakeholders to promote the application of these lessons across the healthcare sector.  

The risk of new COVID-19 variants coinciding with annual winter pressures and recurring peaks of infection from flu and respiratory diseases threatens to overwhelm healthcare services.  If critical care is once again pushed beyond capacity, this will jeopardise the NHS recovery. Our report outlines how the NHS must be better prepared for potential additional COVID-19 surges, with consideration of supply of PPE, pandemic skills maintenance, and the need for staff to be protected from burnout and given the opportunity to recover. The report also highlights the importance of innovation and new ways of delivering care, including the expansion of perioperative and enhanced care to optimise surgical activity.

Over the next few years, the biggest challenge for the healthcare service will be to tackle the backlog in planned surgery built up prior to and during the pandemic. With data from the College census1 showing at least one consultant vacancy in 90 per cent of all anaesthetic departments, we argue that any recovery plans must be underpinned by an investment in staff and long-term workforce planning.

The RCoA’s 10 lessons learnt from the pandemic:

  1. the wellbeing of NHS staff is paramount
  2. staff shortages must not persist, now is the time to invest in workforce
  3. we need increased critical care capacity across the UK
  4. appropriate and timely supply of PPE is key
  5. perioperative care has a critical role to play in the NHS recovery and beyond
  6. we should maintain pandemic skills
  7. collaboration and information sharing are critical for a successful pandemic response
  8. local decision-making works
  9. the healthcare system must be better prepared for future pandemics
  10. there is huge potential for digital innovations

Professor Ravi Mahajan, President of the Royal College of Anaesthetists said:

“Anaesthetists, alongside other healthcare professionals, have adapted incredibly well during the pandemic to look after the sickest COVID-19 patients. Over half2 of our members said they had acquired new, transferrable skills, and it is now crucial that staff are supported to maintain the knowledge gained so we can build a pool of ‘reservists’ who can quickly step up to support ICUs when needed.

“Alongside the positive lessons, the pandemic has shone a light on the underinvestment in critical care services which has contributed to the suspension of elective activity and a significant increase in waiting lists. While investment in facilities such as protected elective surgical units are part of the solution, without the workforce capacity to staff them we will never be able to make full use of any additional resources.

“Now is the time to invest in increasing training places for anaesthetists, surgeons, nurses, and others as they look towards tackling the extensive backlog. It is also vital that the NHS appreciates and retains the staff currently working in the system and provides them with the best physical and psychological support as they begin their journey to build back the NHS.

“The fortitude, dedication and adaptability of the NHS staff during the pandemic has demonstrated what they and the NHS are capable of when under pressure. There must be a commitment from the UK government to continue the move towards a more innovative and solutions-focused healthcare system. The NHS must not be left to return to business as usual. The government and the NHS must grab this opportunity to embed what has been learnt so far and continue to learn and improve so we can build a truly sustainable health service.”

Dawn Chamberlain, Director of Clinical Improvement, NHS England and NHS Improvement said:

“The way that the NHS has adapted in response to the pandemic has been phenomenal. We have seen changes to the way we work within our teams, across organisational boundaries and how we interact with our patients, carers and citizens. We must learn lessons from the pandemic to ensure that future generations benefit from these changes. I welcome the learning from the Royal College of Anaesthetists report to support the recovery of the NHS.”

References:

  1. RCoA Medical Workforce Census Report 2020
  2. COVID-19 Winter Survey. February 2021

PDF of the report:  Royal College of Anaesthetists – 10 lessons learnt from COVID-19.pdf

Link to the report: 10 lessons learnt from COVID-19

Royal College of Anaesthetists’ President Writes to Secretary of State on Behalf of Anaesthetists in Training

May 21, 2021

The Royal College of Anaesthetists is continuing to work closely with the Department of Health and Social Care, Health Education England and other devolved nation stakeholders to negotiate a solution to ST3 recruitment.

The Royal College of Anaesthetists

College President, Professor Ravi Mahajan, has written to the Secretary of State for Health and Social Care, suggesting the following short-and-long term solutions:

  • to divert some of the additional funding allocated to tackling the surgical backlog to create additional Trust grade posts for anaesthetists in training who have been unsuccessful in this year’s recruitment round, so that they can continue to provide much needed anaesthetic cover for surgical procedures
  • to ensure that any workforce experience that anaesthetists in training gain outside of recognised training programmes is appropriately recognised as part of their anaesthetic training. The College is writing to all deaneries and Heads of Schools to ensure that they follow our equivalent training guidance
  • to consider an essential increase in anaesthetic training numbers in light of the fact that, even after the end of this year’s recruitment round, it is likely that a considerable number of anaesthetists in training will have been unsuccessful in securing a place. The current situation offers an excellent opportunity for a one-off increase in Higher Specialty Training recruitment that would provide significant mitigation for the current and future shortfall in consultant numbers after just four years rather than the usual seven-year programme.

Professor Ravi Mahajan, President of the Royal College of Anaesthetists said:

“Anaesthetists in training have worked tirelessly to support the response to the COVID-19 pandemic and in doing so, many have experienced significant disruption to their training. This has been compounded by the disappointing situation where many will have been unsuccessful in their recent applications for higher training posts. I was therefore pleased to see the announcement from Health Education and Improvement Wales that an increase in the number of anaesthetic training posts in that nation is being delivered for August 2021. I hope to see similar decisions being made across the devolved nations and I look forward to working with the Department of Health, Health Education England and the other Statutory Education Bodies to help make this happen.”

As negotiations continue, the College will provide updates to its anaesthetists in training and wider membership, where substantial progress is made.

If anaesthetists in training have further questions about their recruitment, or the introduction of the 2021 Anaesthetics Curriculum, please speak with your College Tutor, Regional Advisor Anaesthesia or Training Programme Director.

Alternatively, the College Training Team can be reached at 2021cct@rcoa.ac.uk, or the Chair and Deputy Chair of the Anaesthetists in Training Committee can be reached via trainee@rcoa.ac.uk.

Ysbyty Gwynedd Becomes First Hospital in Wales to Receive Prestigious Royal College of Anaesthetists Award

April 7, 2021

The Anaesthetic department at Ysbyty Gwynedd in Bangor has been recognised for providing the highest quality of care to their patients.

Royal College of Anaesthetists (RCoA)

The hospital has become the first in Wales to be awarded the prestigious Anaesthesia Clinical Services Accreditation (ACSA) from the Royal College of Anaesthetists (RCoA).

The ACSA accreditation is the RCoA’s peer-reviewed scheme that promotes quality improvement and the highest professional standards of anaesthetic service. To receive accreditation, anaesthetic departments are expected to demonstrate high standards in areas such as patient experience, patient safety and clinical leadership.

The Anaesthetic teamwork across the hospital and provide anaesthesia services for all types of surgery, labour delivery suites, pre-operative assessments, pain services and are in charge of the Intensive Care Unit that looks after the most critically unwell patients in the hospital.

Dr Tony Shambrook, Consultant Anaesthetist and ACSA Lead at Ysbyty Gwynedd, said:

“We are extremely proud and honoured to be the first hospital in Wales to receive ACSA accreditation.

“It has been a long process over two years to meet all 145 standards to achieve this award. A great deal of work has gone on behind the scenes, from investing in new equipment to updating policies and guidelines to ensure we achieved it.

“Our main focus is putting our patients first and ensuring patient safety is at the heart of everything we do. The ACSA process has helped to highlight how we can improve as a department to ensure we are delivering safer patient care and better patient experience.

“I would like to say a special thank you to my colleagues Dr Ian Johnson, Dr Jason Walker and Dr Linda Warnock for their assistance with coordinating this project.”

Dr Abrie Theron, Chair of the Welsh Board, Royal College of Anaesthetists, said:

“I would like to offer my personal congratulations to the entire anaesthetic team at Ysbyty Gwynedd in Bangor for their ACSA accreditation. Receiving this award is a significant achievement, and I am delighted that we have our first Welsh department accredited under the scheme. It is richly deserved and demonstrates their commitment to providing the best possible care for their patients.

“Patient safety is at the heart of what we do as a Medical Royal College. The quality improvement demonstrated during the accreditation process has helped the department manage the immense tasks presented to them by COVID-19 and the resumption of normal services.  

“Ysbyty Gwynedd has worked hard to keep patients as the primary focus and deliver excellent flexibility to match patient’s needs. Many innovative practices are taking place at this hospital.

“As well as meeting the standards, the department demonstrated many areas of excellent advanced practice that have now been highlighted for sharing through the ACSA network.”

Dr Karen Mottart, Consultant Anaesthetist and Ysbyty Gwynedd Medical Director said:

“Achieving this accreditation is a testament to the hard work of the Anaesthetic Department here at Ysbyty Gwynedd.

“This is a huge achievement in a time of challenge and evidence that a District General Hospital can deliver high quality patient care.  

“We are very proud to be the first hospital in Wales to achieve this award and we will continue to work with the RCoA to maintain these standards.”

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