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People who wait longer for NHS treatment are significantly more likely to seek emergency care in the months after eventually receiving it, compared with those who are seen quickly.

People treated within 18 weeks of being on the waiting list made 18% fewer A&E visits per week in the three months following their treatment, compared to how often they visited A&E while waiting for treatment.

In contrast, people who waited over a year ended up making 31% more A&E visits in the three months following their care.

The Health Foundation, which carried out the research and shared the findings with the Sky News Data and Forensics Unit, say that the fact people need more emergency care after long waits for treatment “may indicate additional aftercare needs or decreased effectiveness of treatment following a longer wait”.

They analysed detailed patient-level data that had previously not been available for research use.

It complements new NHS data published last week which revealed the make-up of the waiting list for the first time, in terms of the gender, age, ethnicity and deprivation status of the patients on it.

Government targets being missed

One of the targets most commonly highlighted by the government is to ensure that, by the end of this parliament, fewer than 8% of patients wait longer than 18 weeks for treatment.

Currently, almost five times as many patients in England wait longer than that, with significant differences depending on where you live.

It’s the same in emergency care. The target is that fewer than 5% of people should wait longer than four hours at A&E. As it stands, one in four people wait longer than that.

The Health Foundation explained that, as well as patients having to live with the “consequences of debilitating conditions for longer”, long waits can also lead to “more complex, difficult and expensive treatment” being required.

They also “significantly increase consumption of pain relief medication”. In some cases, while waiting, conditions for the patient become permanent and untreatable.

The NHS has paid out more than £8.3bn in compensation claims for injury and deaths caused by delays in care since 2010, in addition to the extra cost to the NHS of more A&E and GP attendances.

Dr Hilary Williams, incoming clinical vice president of the Royal College of Physicians, told Sky News: “People’s health clearly deteriorates overall as they wait for treatment. For example, waiting for heart or knee treatment can lead to increased risk of worsening health due to inactivity.

“When patients are then waiting too long, their conditions can worsen and complications can occur, meaning people may end up needing emergency care even after their planned treatment. In other words, the issue with long waits isn’t just the delay itself, but the lasting health impacts that those longest waits can cause.

“Not only does this significantly impact individual patients, but it also adds further avoidable strain to an already overstretched workforce.”

Shorter waits for wealthier people, white people and men

Data released by the NHS for the first time last week also shows that women, Asian people, and those in more deprived areas are more likely to experience longer waits for NHS treatment, compared with men, white people and the least deprived.

The differences are not extreme – less than two percentage points between the top and bottom groups – but they are statistically significant.

Health Foundation analysis also reveals that Asian people are more likely to wait longer even after accounting for the age, frailty and deprivation level of patients.

The research addresses the reasons why people left the waiting list – fewer than half of people removed from the waiting list did so because they actually started treatment.

A third of people had a “decision not to treat”. This is a broad category that includes people who dropped off the NHS list to receive private care. It also includes cases where a clinician has decided that the patient’s condition can be treated in primary care.

About one in 12 people went on to “active monitoring” instead of treatment, meaning their symptoms are monitored by specialists but they are not due for further clinical intervention or diagnostics procedures.

In about one in 20 cases the patient declines treatment themselves. In about one in 200 cases, equivalent to 30,000 people on a waiting list of over six million, the patient dies while waiting for care.

A similar number are taken off the waiting list because they have missed appointments, although this figure is higher among people from more deprived areas.

Longest waits for oral surgery, shortest for elderly services

There are significant differences in wait time depending on what you’re waiting for.

More than half of patients waiting for mouth or jaw surgery wait longer than 18 weeks for treatment, compared with fewer than a third of patients referred for heart and lung or eye appointments.

The Health Foundation said that conditions that are less likely to lead to death, for example many of those associated with gynaecology or ear, nose and throat problems, had been de-prioritised as part of efforts to increase access to care after the pandemic.

They said that some treatments that typically required overnight stays had longer wait times, as capacity was more limited. In some cases, waits were longer because there was a shortage of specialists for that specific condition.

Discussing the findings of the research, Charles Tallack, Director of Research and Analysis at the Health Foundation, told Sky News: “Reducing the elective care waiting list is rightly a major government priority. But while long waits continue, it’s vital to understand the impact of those waits. The NHS should consider how to better support people on waiting lists who have higher needs and longer waiting times.

“To enable informed decisions, the NHS must make better use of the rich data already available on elective care. That includes improving the quality of data to answer questions like why people leave a waiting list – which is essential for truly understanding and addressing the backlog.”

Health and Social Care Secretary Wes Streeting said: “We inherited an NHS which after years of neglect had left all patients worse off – but some more than others.

“Sunlight is the best disinfectant. Only by being upfront and shining a light on inequalities can we begin to tackle the problem. We will give all patients the care they need when they need it as part of our Plan for Change.”

See how waits in your trust differ for cancer treatment, elective operations and emergency care with our table:


The Data and Forensics team is a multi-skilled unit dedicated to providing transparent journalism from Sky News. We gather, analyse and visualise data to tell data-driven stories. We combine traditional reporting skills with advanced analysis of satellite images, social media and other open source information. Through multimedia storytelling we aim to better explain the world while also showing how our journalism is done.

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Inflation: Cost of living challenges require bold decisions

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Inflation: Cost of living challenges require bold decisions

You know bad economic news is looming when a Chancellor of the Exchequer tries to get their retaliation in first.

Treasury guidance on Tuesday afternoon that Rachel Reeves has prioritised easing the cost of living had to be seen in the light of inflation figures, published this morning, and widely expected to rise above 4% for the first time since the aftermath of the energy crisis.

In that context the fact consumer price inflation in September remained level at 3.8% counts as qualified good news for the Treasury, if not consumers.

Money latest: What inflation hike means for state pension and rail fare increases

The figure remains almost double the Bank of England target of 2%, the rate when Labour took office, but economists at the Bank and beyond do expect this month to mark the peak of this inflationary cycle.

That’s largely because the impact of higher energy prices last year will drop out of calculations next month.

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Inflation sticks at 3.8%

The small surprise to the upside has also improved the chances of an interest rate cut before the end of the year, with markets almost fully pricing expectations of a reduction to 3.75% by December, though rate-setters may hold off at their next meeting early next month.

September’s figure also sets the uplift in benefits from next April so this figure may improve the internal Treasury forecast, but at more than double the rate a year ago it will still add billions to the bill due in the new year.

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Minister ‘not happy with inflation’

For consumers there was good news and bad, and no comfort at all from the knowledge that they face the highest price increases in Europe.

Fuel prices rose but there was welcome relief from the rate of food inflation, which fell to 4.5% from 5.1% in August, still well above the headline rate and an unavoidable cost increase for every household.

Read more from Sky News:
Beef market in turmoil and affecting farmers and consumers
Rachel Reeves looking at cutting energy bills in budget

The chancellor will convene a meeting of cabinet ministers on Thursday to discuss ways to ease the cost of living and has signalled that cutting energy bills is a priority.

The easiest lever for her to pull is to cut the VAT rate on gas and electricity from 5% to zero, which would reduce average bills by around £80 but cost £2.5bn.

More fundamental reform of energy prices, which remain the second-highest in Europe for domestic bill payers and the highest for industrial users, may be required to bring down inflation fast and stimulate growth.

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Schools must be ‘brave enough’ to talk about knives – as Harvey Willgoose’s killer is sentenced

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Schools must be 'brave enough' to talk about knives - as Harvey Willgoose's killer is sentenced

Schools need to be “brave enough” to talk about knives, Sky News has been told, as the killer of Sheffield teenager Harvey Willgoose is sentenced today.

The 15-year-old was stabbed outside the school canteen at All Saints Catholic high school by a fellow pupil in February this year.

His killer, who was also 15 and cannot be identified for legal reasons, had brought a 13cm hunting knife into school.

Harvey Willgoose. Pic: Sophie Willgoose
Image:
Harvey Willgoose. Pic: Sophie Willgoose

Following Harvey’s murder, his parents Caroline and Mark Willgoose told Sky News they wanted to see knife arches in “all secondary schools and colleges”.

“It’s 100% a conversation, I think, that we need to be empowered and brave enough to have,” says Katie Crook, associate vice principal of Penistone Grammar School.

The school, which teaches 2,000 pupils, is just a few miles away from where Harvey was killed.

After being contacted by the Willgoose family, it has decided to install a knife arch.

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The arch – essentially a walk-through metal detector – has been described as a “reassuring tool” and “real success” by school leaders.

“We’re really lucky here that we don’t have a knife crime problem – but we are on the forefront with safeguarding initiatives,” says Mrs Crook.

“I didn’t really think we needed one at first,” says Izzy, 14. “But then I guess at Harvey’s school they wouldn’t think that either and then it did actually happen.”

Joe, 15, says he did find the knife arch “intimidating” at first.

“But after using it a couple of times,” he says, “it’s just like walking through a doorway”.

“And it’s that extra layer of, like, you feel secure in school.”

After Harvey’s death, then home secretary Yvette Cooper said that she would support schools in the use of knife arches.

But there remains no official government policy or national guidance on their use.

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Some headteachers who spoke with Sky News feel knife arches aren’t the answer – saying the issue required a societal approach.

Others said knife arches themselves were a significant expense to schools.

But Mrs Crook says they are “well worth the funding” if they prevent “a student making a catastrophic decision”.

“I’m a parent and, of course, my focus every day is keeping our students safe, just as I want my son to be kept safe in his setting and his school.”

Mrs Crook says she thinks schools would “welcome” a discussion at “national level” about the use of knife arches and other knife-related deterrents in schools.

“It’s sad, though that this is what it’s come to, that we’re having lockdown drills in the UK, in our school settings.

“But I suppose some might argue that has been needed for a long time.”

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Shrinking herds and rising costs: The beef market is in turmoil – and inflation is spiralling

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Shrinking herds and rising costs: The beef market is in turmoil - and inflation is spiralling

If you eat beef, and ever stop to wonder where and how it’s produced, Jonathan Chapman’s farm in the Chiltern Hills west of London is what you might imagine. 

A small native herd, eating only the pasture beneath their hooves in a meadow fringed by beech trees, their leaves turning to match the copper coats of the Ruby Red Devons, selected for slaughter only after fattening naturally during a contented if short existence.

But this bucolic scene belies the turmoil in the beef market, where herds are shrinking, costs are rising, and even the promise of the highest prices in years, driven by the steepest price increase of any foodstuff, is not enough to tempt many farmers to invest.

For centuries, a symbolic staple of the British lunch table, beef now tells us a story about spiralling inflation and structural decline in agriculture.

Mr Chapman has been raising beef for just over a decade. A former champion eventing rider with a livery yard near Chalfont St Giles, the main challenge when he shifted his attention from horses to cows was that prices were too low.

“Ten years ago, the deadweight carcass price for beef was £3.60 a kilo. We might clear £60 a head of cattle,” he says. “The only way we could make the sums add up was to process and sell the meat ourselves.”

Processing a carcass doubles the revenue, from around £2,000 at today’s prices to £4,000. That insight saw his farm sprout a butchery and farm shop under the Native Beef brand. Today, they process two animals a week and sell or store every cut on site, from fillet to dripping.

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Today, farmgate prices are nearly double what they were in 2015 at £6.50 a kilo, down slightly from the April peak of almost £7, but still up around 25% in a year.

For consumers that has made paying more than £5 for a pack of mince the norm. For farmers, rising prices reflect rising costs, long-term trends, and structural changes to the subsidy regime since Brexit.

“Supply and demand is the short answer,” says Mr Chapman.

“Cow numbers have been falling roughly 3% a year for the last decade, probably in this country. Since Brexit, there is virtually no direct support for food in this country. Well over 50% of the beef supply would have come from the dairy herd, but that’s been reducing because farmers just couldn’t make money.”

Political, environmental and economic forces

Beef farmers also face the same costs of trading as every other business. The rise in employers’ national insurance and the minimum wage have increased labour costs, and energy prices remain above the long-term average.

Then there is the weather, the inescapable variable in agriculture that this year delivered a historically dry summer, leaving pastures dormant, reducing hay and silage yields and forcing up feed costs.

Native Beef is not immune to these forces. Mr Chapman has reduced his suckler herd from 110 to 90, culling older cows to reduce costs this winter. If repeated nationally, the full impact of that reduction will only be fully clear in three years’ time, when fewer calves will reach maturity for sale, potentially keeping prices high.

That lag demonstrates one of the challenges in bringing prices down.

Basic economics says high prices ought to provide an opportunity and prompt increased supply, but there is no quick fix. Calves take nine months to gestate and another 20 to 24 months to reach maturity, and without certainty about price, there is greater risk.

There is another long-term issue weighing on farmers of all kinds: inheritance tax. The ending of the exemption for agriculture, announced in the last budget and due to be imposed from next April, has undermined confidence.

Neil Shand of the National Beef Association cites farmers who are spending what available capital they have on expensive life insurance to protect their estates, rather than expanding their herds.

“The farmgate price is such that we should be in an environment that we should be in a great place to expand, there is a market there that wants the product,” he says. “But the inheritance tax challenge has made everyone terrified to invest in something that will be more heavily taxed in the future.”

While some of the issues are domestic, the UK is not alone.

Beef prices are rising in the US and Europe too, but that is small consolation to the consumer, and none at all to the cow.

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