Ambulance target sickness fears

 The Welsh Ambulance Service NHS Trust said it was reducing sickness rates year on year and has plans in place to manage absences

The high number of staff off sick is affecting the ability of the Welsh Ambulance Service to reach life-threatening emergency calls.

That is the verdict by the service itself in a document seen by BBC Wales.

It also says the the service is having to incur "significant additional costs" in providing cover at overtime rates.

The Welsh Ambulance Service NHS Trust said it was reducing sickness rates year on year and has plans in place to manage absences.

Despite hitting target times for the eighth month in a row, the service's own risk assessment shows concerns about the high levels of staff absent due to long and short term sickness.

The problem was categorised as being almost certain to have "major consequences" which means it could lead to "major injury leading to long-term disability" to patients.

The service received more than 29,000 calls in September - with nearly 70% of responses to "life-threatening" calls arriving within eight minutes. The All-Wales target is 65%.

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Our sickness absence rates are reducing year on year, however we recognise more work is needed and are committed... to bring this down even further”

End Quote Ambulance Service NHS Trust Recent official statistics reveal that the ambulance service has the highest sickness rates in the NHS in Wales.

As of March this year 7.3% of their staff were absent due to illness.

By the end of September that figure had reduced to 6.6% but was still higher than the average within the NHS in Wales of 5.2%.

A spokesperson for the Welsh ambulance service said: "Our sickness absence rates are reducing year on year, however we recognise more work is needed and are committed, with the support of our trade union colleagues, to bring this down even further.

"Some of the initiatives we are introducing to address this issue include setting up a health and wellbeing group, a staff support service and absence management training."

'Lot of stress'

The spokesperson said they were also reviewing occupational health arrangements and sickness absence policy.

"With these plans in place, we have reduced the risk level in respect of achieving the target. This position is kept under continuous review."

Bleddyn Roberts, north Wales ambulance branch secretary of Unison said part of the reason for the sickness rates was the pressure staff were under.

"It can be very physical at times... there's a lot of stress involved as well.

"The workload has increased year on year and the number of staff within the service hasn't necessarily kept pace with that for various reasons."

Analysis: How one NHS hospital is turning around a £13m deficit

 Heart monitor in the hospital's catheter laboratory How are the tough decisions the NHS is having to make across England affecting individual hospitals and services?

That's the question I've set out to answer, by looking at how the nationwide drive for efficiency savings is playing out in Leicester.

The trust which runs the city's three hospitals had chalked up an overspend of £8m in July.

Since then, the deficit has gone up to £13m. But managers believe they are now turning the corner.

Management consultants have been brought in to give advice - this will result in a bill of around £500,000.

The trust says the price is worth paying, because the consultants are helping with future plans, as well as the recent problems.

Like everywhere else in the NHS, staff are finding ways of doing their work more efficiently.

Closing theatres

There are 46 operating theatres in Leicester - but that number will reduce to 36 in the next three years. Eleven jobs have already gone.

The appropriately numbered Theatre Zero was the first to close last month.

Community pharmacists want to continue carrying out health checks

Equipment is still in the room, so it could be pressed into action if needed, but currently the only activity is the drone of the ventilation system.

Incredibly, closing the theatre has not resulted in fewer operations being performed. That's because surgery now starts on time.

The nursing leader behind the project, Elaine Ryan, explained: "Everybody used to have a different view on what the start time should be.

"Now we send for all the patients at 8am for the first list at 8.30am, and we send for the afternoon patients at 1pm for a 1.30pm start."

Another innovation has been DOSA - the Day Of Surgery Admissions area.

This is a peaceful room with individual bays, where patients are brought in a good time before surgery.

Again, valuable operating time has been made more efficient - because of cutting delays in waiting for porters to fetch patients.

Leicester's cardiology services are based at Glenfield Hospital, in a leafy area on the edge of the city.

Dr Doug Skehan said: "We have discovered that we have to do better in the way we code our activity. It's as simple as knowing that we send out the right bills.

"Many of our staff - including doctors and nurses - have not understood the true cost of healthcare as well as they might."

Delayed bid

Leicester's application for foundation trust status, which gives hospitals more financial freedom, is being delayed by up to a year.

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Let's devise a system and stick with it, because we know we can save tons of money.”

End Quote Mukesh Lad Community pharmacist The trust's chief executive, Malcolm Lowe-Lauri, is cautiously optimistic that the finances will balance by next April.

He said: "This is going to bite hard. It's a challenging period.

"But this is where you earn your corn - by delivering on behalf of the patient and the staff, but ultimately also the taxpayer who is forking out for the health service every year."

Big decisions are being made in primary care too, as structures reorganise and GPs prepare to take on more responsibility for commissioning decisions.

In inner city Rushey Mead, Mukesh Lad - a pharmacist who owns several stores - is unhappy that NHS work he started doing three years ago has been decommissioned.

The cholesterol checks on middle-aged customers, assessing their risk of heart attack or stroke, are being transferred to GPs.

'Short-minded'

NHS managers say they are preparing to invest £750,000 in a more ambitious programme, with targets that will encourage family doctors to screen greater numbers of patients.

But Mr Lad believes pharmacists are in a better position to do this work.

He said: "The average 45-year-old is very busy, running around in their day job.

"But we can catch them when they pop into the pharmacy. It takes 20-30 minutes and then they're away.

"Stopping this service is short-minded. Let's just devise a system and stick with it, because we know we can save tons of money."

NHS Leicestershire believes the new system will be better, because the results will be captured directly on to patients' records held by GPs.

But Nick Hunter, from the Local Pharmaceutical Committee, sees the decision as an example of decommissioning which is happening in other parts of England.

He said: "The Health Check programme in pharmacies had superb outcomes.

"We're also disappointed as businesses that we have lost out on a commercial opportunity.

"We're hearing similar stories from colleagues around the country - particularly in services connected with the prevention agenda."

'Devastating' quake health toll

 Many major cities lie on fault lines Earthquakes have a bigger impact on health than other natural disasters such as floods and hurricanes, US researchers say.

There are more than a million earthquakes, of varying severity, around the world each year.

As well as the immediate deaths, many people receive serious injuries which cannot be treated because of the quake damage to infrastructure.

The Lancet review says children are often at particularly high risk.

Many of the world's major cities are on fault lines, including Los Angeles, Tokyo, New York, Delhi and Shanghai, putting millions of people at risk from earthquakes.

In the past decade, earthquakes have caused more than 780,000 deaths - almost 60% of all disaster-related mortality. Other disasters, such as floods and hurricanes typically cause many deaths from drowning, but fewer injuries.

It is estimated that for every person killed in an earthquake, three others are injured.

Suicides

Depression can also be common after earthquakes - affecting up to 72% of the population.

Following the 1999 Turkey earthquake, 17% of the population had suicidal thoughts.

Children are often at higher risk of injury and death during earthquakes than adults. In Haiti in 2010, 53% of patients were younger than 20 years old and 25% were under five.

The team, led by Dr Susan Bartel of the Harvard Humanitarian Initiative in Boston, wrote in the Lancet: "Because earthquakes frequently affect populous urban areas with poor structural standards, they often result in high death rates and mass casualties with many traumatic injuries."