Paramedics spend 500,000 hours outside busy A&Es, say auditors

Paramedics last year spent 500,000 hours outside hospitals with a patient in the back of their ambulance because A&E staff were too busy to accept them, an official inquiry has revealed.

That was the equivalent of 41,000 12-hour ambulance shifts being taken up with waiting instead of crews being able to attend to other emergencies, according to a report by the National Audit Office.

Ambulance crews are meant to take no more than 15 minutes to hand over a patient to A&E staff and another 15 minutes to prepare their vehicle to get back on the road. “Each failure to meet this standard results in a poor experience for the patient and a delay in an ambulance crew being available for a new emergency call,” the report says.

Last year just 58% of ambulances transferred their patient within 15 minutes and 65% were ready to leave a quarter of an hour later.

All but one of the 10 NHS regional ambulance trusts are breaching 999 call response targets, services are desperately short of paramedics and funding has not kept pace with a surge in the number of patients who need an ambulance.

The NAO report says: “Ambulance services are finding it increasingly difficult to cope with rising demand for urgent and emergency services. Introducing new models of care has helped but there are signs of stress, including worsening performance against response time targets.”

Ambulances are meant to arrive at the scene of 75% of Red 1 and Red 2 calls within eight minutes. Red 1 calls involve life-threatening emergencies such as patients who have suffered a cardiac arrest, are not breathing and do not have a pulse. Red 2 calls are less immediately time-critical but involve events such as a heart attack or stroke. Green 1 calls have a target of 20 minutes.

In 2015-16 the West Midlands ambulance service was the only one of the 10 trusts in England to meet the three main targets, the NAO found.

The NAO flags up a 10% vacancy rate for paramedics, and ambulance trusts’ difficulties in retaining staff, as obstacles to tackling what it describes as “significant challenges”.

It says the ageing population, growing number of patients with alcohol or mental health problems and lack of health services outside hospitals all help to explain the rapidly growing demand for care. The number of calls to ambulance services and transfers from the NHS 111 telephone advice service rose from 7.9m in 2009-10 to 10.7m in 2015-16 – an average year-on-year increase of 5.2%.

Phil McCarvill, deputy director of analysis at the NHS Confederation, which represents NHS trusts including ambulance services, said underfunding elsewhere in the health and care system was a key reason ambulance trusts were under pressure.

“Our highly skilled and dedicated ambulance personnel are working incredibly hard to make sure people get the right care where and when they need it, but they are having to respond to unprecedented demand for health and care services,” he said.

“If we are to relieve the current pressures on ambulance services, we also need to see the right balance of resources going into community, primary care and social care.”

Norman Lamb, the Liberal Democrats’ health spokesman, said: “The health secretary says he wants to make the NHS the safest healthcare system in the world, but these figures show patient care and safety is being severely compromised.

“When thousands of patients are stuck outside A&E departments, ambulances can’t get to other emergencies on time. People suffering from serious conditions such as a stroke will be left with serious disabilities and other life-long problems, and there is a serious risk of lives being lost because emergency calls are delayed.”

Case studies

Rachel, Newcastle upon Tyne: “I was ordered an ambulance by NHS Direct due to a suspected brain haemorrhage. My boyfriend offered immediately to drive me to A&E but they insisted on sending an ambulance, and he was told to wait outside ready to receive the paramedics. Forty-five minutes later we were still waiting, and when we were able to speak to someone we were told that it was in the system but hadn’t been dispatched yet.

“We drove to hospital and were seen immediately. Given that we offered to drive from the outset, it was an unnecessary delay and, had the ambulance arrived, would have been an unnecessary journey.”

Paul Baggaley, Newark: “I came across a pedal cyclist lying in the road after falling off his bike on a slippery surface. A young carer stopped with us and called for an ambulance after five minutes of convincing him that he needed to be seen by hospital. He had injuries and a broken helmet after cracking his head on the road. After coming back to his senses he informed us of two spinal operations he had suffered so we didn’t move him. We kept him warm with blanket and kept him talking.

“After 20 to 30 minutes I rang 101 for police assistance to help with traffic. They arrived in 15 to 20 minutes. We stayed 20 minutes then had to leave. After we had done what we had to do, we came back past that way and still no ambulance. He was lying on the cold ground for over an hour.

“The East Midlands ambulance service is the poorest performing service in the country and things seem to be worst where we are because we are 23 miles from the nearest A&E and so ambulance service is continually stretched.”

Paramedics spend 500,000 hours outside busy A&Es, say auditors

Busy undertaking nothing? Fine by me

The daydream believer is extinct. New study by the University of Virginia has unveiled that we no longer have the capacity, as W H Davies put it, to stand and stare. When participants have been asked to stay in an empty area for 15 minutes and both do nothing at all or give themselves a mild electrical shock, several did the latter.

Yes that’s right: folks willingly stick their fingers in an electric socket rather than be left with their very own thoughts. Or at least guys did: two thirds gave themselves a shock, compared with a quarter of girls. A single guy gave himself 190 shocks, which, at one particular every four.7 seconds, suggests he shouldn’t be taking portion in a scientific experiment but be rapidly-tracked for treatment.

But why the gender divide? After an afternoon replicating the experiment at property, I can inform you. Fifteen minutes of solitude: no possibility. Every four.seven seconds there was a request to put on Frozen, fill the paddling pool, wipe a snotty nose, discover an vital toy, find my husband’s wallet… In retrospect, my only shock is that far more girls did not beg to remain longer in the experiment area.

Busy undertaking nothing? Fine by me

Tomato Sherpa Is Transforming Property Cooking For Busy People

In June of 2012 an report in the New York Occasions known as “The Hectic Trap” went viral, igniting a seemingly never-ending conversation about the issues connected with getting a culture that embraces “busy” as evidence of good results. A lot more recently, Cadillac’s controversial ad praising rich guys who function all the time (and Ford’s clever response) can make clear the subject is nevertheless a hotbed problem. An equally buzz-worthy topic of late is America’s broken food system, with expanding concern in excess of the extended-phrase effects that industrialized agriculture will have on our wellness, and our struggling healthcare system. Offered these two trends, it makes perfect sense to see an increased quantity of healthful meal kit delivery services cropping up, providing “generation busy” with an substitute to takeout following a lengthy day of work. 1 of these is Berkeley-primarily based Tomato Sherpa.

I very first grew to become conscious of Tomato Sherpa even though attending Presidio Graduate College – the company’s founder, Stacey Waldspurger, was a fellow classmate and the company idea was her team’s ultimate undertaking. But soon after graduating I did not hear anything about it, so figured every person on the group had decided to pursue other issues. Just in excess of one year later, the business launched with a bang and speedily began gaining traction. When asked about this (relatively atypical) delay, Waldspurger says she identified out she was pregnant with her second little one appropriate before stepping on stage to present Tomato Sherpa at Presidio’s Capstone Showcase and, no matter how passionate she was about taking the company forward, she convinced herself that the responsible point to do would be to seek out employment. But following six months of interviews that didn’t click, the external indicators became not possible to ignore.

In August of 2012 she gave birth to her son, and by September she was in conversations with a global HR consulting company about how Tomato Sherpa could differentiate itself in the marketplace by focusing on companies in the Bay Spot that embrace corporate responsibility and/or supply worker wellness applications. This way Waldspurger wouldn’t have to solely rely on expanding her customers base organically (pun intended) via word-of-mouth referrals, but instead could attain a massive quantity of likely clients at a single time by way of connecting with human resource departments, and turning them into advocates for her meal delivery service. Person employees would even now be responsible for ordering their meals on the web, but Tomato Sherpa would supply totally free delivery to partner locations, creating it straightforward for these folks to choose up their insulated tote bags filled with cooking elements and a recipe prior to heading home.

She started revising her team’s authentic organization plan, applying her background in technique and graphic design to generate visual mock-ups that obviously conveyed all of the moving elements, and in December she convinced her family members to invest $ a hundred,000. By March a beta launch was underway, and the full ordering platform went reside in August. The group now includes 7 complete-time workers and 5 portion-time contractors. All are compensated, but the quantity is modest with continued involvement largely driven by passion for the company’s mission – improved wellness for people, communities and ecology by means of cooking – a actuality that each inspires and motivates Waldspurger on a day-to-day basis. Although talks with the consulting firm proceed, Tomato Sherpa has independently produced corporate plans with LinkedIn, Pandora, IDEO, Workday, Zynga, Lyft, Effect Hub, and OpenDNS. Relationships with Utilized Resources and NetApp are set to launch this month.

Some have been swift to criticize these sorts of meal delivery solutions for currently being too upscale, a luxury comfort given other pressing meals concerns in our nation. For example, food deserts are a enormous problem, exactly where these residing in reduce earnings places are getting forced to subsist on processed meals offered at corner merchants because grocery retailers carrying fresh create and non-hormone-injected meat do not exist in their neighborhoods. But Tomato Sherpa’s pricing is relatively realistic, ranging from $ 17-$ 21 for a two portion meal, and they are purposely going right after men and women who have the indicates but speak themselves out of producing healthful meals alternatives. Furthermore, the company’s sourcing requirements are stringent and there is an educational part to their providing, where consumers are exposed to foods that they frequently have to track down at neighborhood famers markets to use once more, making a positive ripple result that Waldspurger says advantages modest farmers presently struggling to survive.

There’s another ripple effect at perform right here, when shifting from a “whatever, I’ll just grab food on my way home” mindset to deciding on to consider time to put together a wholesome meal. It feels very good to care, and invest in your very own well-getting, and this mindset spreads into other places of your life. It’s self-confidence building to understand you are not as clueless in the kitchen as you may possibly have considered, and that you could even be at least a little bit creative. You may well locate by yourself exploring other inventive pursuits that you previously employed the “busy” excuse to steer clear of striving. In addition, it can be meditative to adhere to a recipe and prepare a meal, permitting you to clear your thoughts of lingering to dos or obsessive mental loops and just focus on the process at hand. It’s a way to connect with oneself, with other individuals, and with a less complicated time. Am I getting too hippie dippie? Don’t solution that.

I desired to know how using Tomato Sherpa has changed the lives of their consumers, so I reached out to a couple of by email. Terry Vicencio is 47, functions total-time, and is married with one son at residence. She 1st subscribed in November of 2013, looking for more selection in the meals she was preparing for her household. She now receives 1 meal kit twice a week (deliveries take spot Tuesdays and Thursdays), and most appreciates the freshness of the substances, the ease, continually currently being introduced to new meals, and understanding new cooking tactics. One more loyal consumer, Kathy Bruin, is 52 and has been subscribing to the omnivore meal kits because final May. Presently a normal cook, she’s been surprised by how significantly her cooking has enhanced, loves the unique spices and ingredient combinations she’s been launched to, and appreciates that her 12-12 months-previous son usually joins in to aid her out.

William Crawford is 25, operates at a modest tech business in San Francisco, and makes use of Tomato Sherpa as a way to collect pals and share the knowledge of cooking and consuming with each other. He’s been subscribing for the past eight months, and says it will take the anxiety out of determining what to cook, and minimizes the meals waste created when acquiring in bulk. He’d previously experimented with Blue Apron and Plated, but prefers Tomato Sherpa and he also appreciates how the recipes teach him to cook utilizing uniquely flavorful meals he’d never heard of before. Every week he sends a text out to his friends to allow them know what he’ll be preparing, and asks who needs to chip in – the quantity nets out, on common, to about $ eight.50 per man or woman. His close friends that perform for more substantial technologies companies that provide a whole lot of free food rarely join in on the enjoyable, which he sees as a misplaced chance.

Waldspurger has finished two marathons, and says her knowledge as a extended-distance runner is proving to be valuable when it comes to the endurance and grit necessary to keep the course, and proceed scaling growth. She’s at present raising $ 500,000, which will permit the business to attain profitability by 12 months-end, and will then raise an official Series A in the fall, expanding into Los Angeles and 1 other market place by the finish of 2015. She stresses the value of each and every city obtaining its very own Sourcing Manager who will be responsible for establishing relationships with local famers and making certain Tomato Sherpa fulfills its mission of providing improved well being not just for its clients, but also the surrounding neighborhood and ecology.

Tomato Sherpa Is Transforming Property Cooking For Busy People

My Last Column Targeted On Digital Overall health - 4 Books To Hold You Busy

Given that 2011, I’ve written extensively about digital health in this column, motivated by my excitement for the subject and my conviction all around its possible.  Going forward, I anticipate creating far less about digital overall health – paradoxically, due to its quite growth.  I basically lack the bandwidth to carry on to stick to digital wellness developments while remaining gainfully employed in a part unrelated to this room.

I continue to be profoundly optimistic about the potential of digital wellness, and I am convinced it can play a transformative function in shaping the potential of healthcare.   I suspect we will come to find out that technology’s most essential part in healthcare lies not in changing people with computers, but rather by means of motivating, enhancing, and supporting important, well being-marketing relationships between folks.

Meanwhile, here are many just lately-published books that readers interested in digital health may want to verify out:

Huge Information: A Revolution That Will Transform How We Live, Function, And Feel

Authors:  Viktor Mayer-Schönberger (Oxford Professor) and Kenneth Cukier, Information Editor of The Economist.

One-liner: Massive information: how the planet alterations when you start to believe about N=all.

Why go through? Approachable and engaging overview of essential, typically-intimidating subject.

Caveat: Discussions of well being implications have a tendency to conflate promise with demonstrated benefits – however a little quibble in context of a superb read through.

Social Physics: How Ideas Spread—The Lessons From A New Science

Author: Sandy Pentland (MIT Professor) (disclosure: Pentland is an advisor to the MGH/MIT Center for Evaluation Engineering and Steady Well being [CATCH], of which I am a co-founder.)

A single-liner: The underappreciated energy and influence of social interactions.

Why go through: Learn why social media can share data (or misinformation), but modifying habits is most successfully mediated by close, in-man or woman relationships.

Caveat: Assessment of wellness implications may overstate benefits (at least in the short phrase – could really understate transformative prospective of this area of research in the longer phrase, a la Roy Amara).

Uncontrolled: The Surprising Payoff Off Trial-And-Error For Enterprise, Politics, and Society

Author: Jim Manzi (advisor and application entrepreneur – see also here).

A single-liner: Optimization will get harder as programs get progressively a lot more complicated rigorous empiricism can support – relatively.

Why study: Fascinating, deeply informative discussion of the origins of the scientific method, and the difficulties encountered when attempting to apply it to various business and social challenges in many contexts, profound, reproducible influence is difficult to attain, and probably unreasonable to assume.

My Last Column Targeted On Digital Overall health - 4 Books To Hold You Busy

Pay consultants more at busy A&Es, say MPs

Health minister Dan Poulter says the government is looking at making a career in A&E more attractive to consultants. Photograph: Felix Clay for the Guardian

Consultants working in struggling accident and emergency departments should be offered pay increases to halt a chronic shortage in qualified and experienced staff, according to a parliamentary report.

The public accounts committee, which scrutinises the use of public money, said A&E services finding it difficult to attract and retain permanent specialists should be allowed to offer improved terms and conditions.

The MPs made the suggestion in a report released on Tuesday which criticises both the Department of Health and NHS England for not having a “clear strategy for tackling the chronic shortage of A&E consultants”.

Dan Poulter, the health minister, said that the government is considering ways of making a consultants’ career in A&E more attractive and that the issue is being addressed as part of current negotiations.

“It takes six years to train an A&E consultant, and there is no easy fix – but our long-term plans are robust, increasing the number of training places by 75 next year, and planning for all trainee doctors to spend time in A&E. We are also looking at making an A&E career more attractive as part of our negotiations on the consultant contract,” he said.

A health source refused to be drawn on whether ministers were considering increasing consultants’ pay.

The report will make difficult reading for Jeremy Hunt, the health secretary, and Sir Bruce Keogh, NHS England’s medical director, who have faced pressure to review their plans to introduce changes in accident and emergency services.

Margaret Hodge, the committee’s chair, said that any attempt to improve emergency admissions services in the NHS is being stymied by the chronic shortage of specialist A&E consultants. Nearly a fifth of consultant posts in emergency departments were either vacant or filled by locums in 2012.

“With many hospitals struggling to fill vacant posts for A&E consultants, there is too much reliance on temporary staff to fill gaps. This is expensive and just does not offer the same quality of service.

“Struggling hospitals, such as those placed in special measures, find it even harder to attract and retain consultants. There are currently no incentive payments to make working in these hospitals a more attractive prospect. So we raised with the department the possibility of paying consultants more to work at struggling hospitals,” she said.

The committee’s report on emergency care suggested that doctors could be enticed to work at struggling hospitals if they were paid more.

Emergency admissions to hospitals have increased by 47% in the last 15 years, according to the report. But it is not clear who is actually accountable for the delivery of local A&E services, the report said.

A tripartite group comprising NHS England, Monitor and the Trust Development Authority is intended to oversee the performance of the emergency care system. However, it is unclear under what circumstances the tripartite group would intervene at a local level, the MPs said.

The MPs welcomed government plans to provide 24/7 consultant cover in hospitals but said they were concerned about the slow pace of implementation.

Hunt’s department also drew criticism for £250m injected into the NHS last winter to help 53 struggling departments as well as a further payment of £150m. The committee said that it was not convinced the money was used to best effect.

Dr Paul Flynn, chair of the British Medical Association (BMA) consultants committee, said that consultants working in emergency medicine faced increasingly challenging, high-pressured and stressful work environments. “The government needs to urgently address issues such as workload pressures, resourcing, and work-life balance if the NHS is to attract doctors in training and the consultant numbers that are needed, not least because spending large amounts on locum doctors is not financially sustainable in the long run.”

In November, Hunt announced plans to establish a two tier accident and emergency services across Britain, with some hospitals top be downgraded as either “emergency centres”, which would assess patients and start treatment, and “major emergency centres”, which would provide specialist care such as for strokes or heart attacks.

Pay consultants more at busy A&Es, say MPs