in patients waiting for A&E care. The






Duncan, D. C. a. P., 2017. NHS figures show sharp rise in
patients waiting for A&E care. The Guardian, 21 December.

Campbell, D., 2015. Overcrowded hospital ‘Killed 500’ last
year, claims top A&E Doctor. The Guardian, 15 January.

Comptroller and Audit General, 2016. Discharging older
patients from hospital, s.l.: National Audit Office.

Comptroller and Audit General, 2016. Discharging older
patients from hospital, s.l.: National Audit Office.


Word count 726

Delayed discharge is clearly a major issue within the NHS
and it is clear that things need to change at quite rapid speed. For accident
and emergency departs to have to close their doors temporarily, although
through no fault of their own, is not good care for people in need of medical
assistance. For other departments to have forced closure shows that the delayed
discharge is having an effect on other departments. For patients to have to
stay in the hospital for no reason other
than they have nowhere else to go is not
good for patient moral or NHS funding. It is blatantly apparent that more needs
to be done with regards assessments of patients on arrival, this will help with
their needs when the time comes for them to leave the hospital. If Local authorities were able to get the funding that
they need then this will help in facilitating the needs of the patients needing
to leave the hospital.

With the NHS already under financial strain, delayed
discharge is on intensifying these issues. For each patient that is
unnecessarily still using a hospital bed costs the NHS money. Funding for staff
wages, for medication that they are receiving while in hospital care, hot meals
and the cost of the general running. “The NHS spends around £820 million a year
treating older patients who no longer need to be there.” (Comptroller and Audit General,

With wards been full to capacity,
it is having a knock-on effect on other areas of the hospital. One area that
it is currently having major effects on is the accident and emergency
department. “Up to 500
patients died last year as a direct result of harm they suffered when hospitals
became dangerously overcrowded, Britain’s A doctors have warned” (Campbell, 2015). Waiting times are at an all-time high and after patients have been
seen, there are even longer waiting times for patients to be sent to the ward, this is leading to patients being left in corridors on stretchers. It is
also causing patients that are suffering
from an ailment who would usually be sent
onto a ward are being sent home, this is unacceptable on behalf of the NHS but
unfortunately in many cases, the doctors
and nurses have no choice. It is becoming more and more common that hospital
accident and emergency departments are having to close their doors as a
temporary as they no longer have the space for any further patients and for
those patients to be getting safe and effective treatment. “the number of times A units had to temporarily divert patients
elsewhere because they could not cope with the demand for care rose from 25 the
previous week to 30″ (Duncan, 2017).

One of the key issues that the NHS is currently facing is
that the vast majority of patients are medically fit to leave the hospital but
unfortunately they are not able due to reasons beyond their control. Many
patients that are unable to leave the hospital are elderly, with the growing
age in population it is becoming more apparent that they hold the highest
percentage of the people awaiting discharge.”62%
of hospital bed days occupied by older patients (those aged 65 or over) in
2014-15” (Comptroller and Audit General, 2016) Although
patients may be ready to leave hospital this does not mean they are necessarily
ready to return straight home without support. This could be for a number of
reasons, their home may not to adequate enough for them, for example, handrails may need to be installed to aid in
the individual getting up and down the stairs safely. Some patients may be
ready to leave the hospital but have no one at home to help them in their
recovery, so the arrangement of a home care worker may need to be put in place
or it may be necessary for them to be placed on a stepdown ward or temporarily
be placed in a care home facility. At this point,
the local authority and the hospitals need to work together in finding
somewhere safe and comfortable for the patients to go after discharge. Early
identification is essential when patients are admitted to the ward so that the
assistance they may need on discharge is already in place. This is so social
services are able to put into place the measures that they need to. Unfortunately, this is not always happening. “Only a minority of hospitals (42%) were
undertaking early geriatric assessments” (Comptroller and Audit General, 2016). To help with
delayed discharge from hospital NHS digital have developed a new system with
£1.4 in funding to work directly with adult social care “Applications are now open for pioneering local authorities with adult
social care responsibilities to work with at least one of their NHS partners,
to create integrated digital assessment, discharge and withdrawal notices” (NHS, 2017).

Delayed-discharge, more commonly known as ‘bed-blocking’ is
one of NHS’s most heard about issues at this present time. Delayed-discharge
can happen for a number of reasons but it does not change the fact that is
causing hospitals do not have enough beds
for their patients.



2013. Antimicrobial Resistance – Why irresponsible use of antibiotics in
agriculture must stop, s.l.: s.n.

D. R., 2015. Behaviour change and antibiotic prescribing in healthcare
settings, s.l.: PHE Publications .

Health Organization, 2017. Antibiotic Resistance. Online
Available at:
Accessed 5 January 2018.

Health Organization, 2017. Antibiotic Resistance. Online
Available at:
Accessed 5 January 2018.


Word count – 685

Many factors contribute to the growing antibiotic
resistance but each one of the factors is aware of it and all know that the end
goal is to act now to help reduce it. Each sector has new guidelines that they need to adhere too, if each sector is to stick to these then the growing
antibiotic resistance might begin to stall in vast spreading.

The agriculture sector is not an area most people think of
with regards antibiotic resistance but they play more of a part than first
thought. Agricultural workers are using antibiotics as a preventative measure
with their livestock. This is been done so that livestock are not becoming ill,
this happens for more than one reason, one of which is that animals live in
such close proximity to one another, that if one animal was to contract an
infection then it is highly likely to pass on to another. Another is that
animals that have not been infected before results in the farmer been able to
gain more money from them. While a person may be able to see the logic in what
they are doing it is having consequences in the form of the meat that we are
eating. “Antibiotic-resistant bacteria
pass between humans, between animals and between humans and animals in both
directions much more frequently than once realised.” (Alliance, 2013). Although
animals receiving antibiotics routinely is not the only cause of antibiotic
resistance it is still part of the ‘bigger picture’. Recommendations have been
made as a way to improve usage and animal overall health so that there would
not be a reason to use antibiotics as a
preventative measure. “New legislation
should be introduced as part of an EU-wide antimicrobials strategy aimed at
improving animal health and welfare and ensuring that farm animals are kept in
less-intensive conditions with, wherever possible, access to the outdoors.” (Alliance,

Health professionals can also factor in the resistance,
prescribing the wrong antibiotic for the infection, prescribing antibiotics for
viruses. “Antibiotic resistance is one of the
most significant threats to patients’ safety in Europe. It is driven by
overusing antibiotics and prescribing them inappropriately” (NHS England, 2015). Healthcare professionals need to push the importance of
only prescribing antibiotics when they are really needed and how important it
is that they are taken correctly could play a crucial part in managing the
antibiotic resistance and making sure that they only
prescribe antibiotics for a bacterial infection and not a virus. Unfortunately, some prescribers feel that they
need to prescribe antibiotics even when they are aware that they should not be,
in some cases this can stem from a degree of bullying from the patients but another
crucial reason is anxiety in what might happen to the patient if they do not
prescribe them. “The anxiety relates to
what might happen to the patient if an antibiotic prescription is not issued –
both in clinical terms as well as general dissatisfaction caused by
disappointment.” (Pinder, 2015)

Individuals are extremely likely to misuse antibiotics,
some may not even be aware that they have done this. Taking antibiotics and not
finishing the course, taking antibiotics but not following the instructions
given and taking antibiotics that belong to someone else. These are key
problems with individual users, they are
major factors that help the antibiotic resistance develop and spread, thus
making it a lot harder for a health professional
in the future. In the vast majority of illnesses,
antibiotics aren’t actually needed,  Self-care measures have been developed for
colds, runny nose or flu. Local pharmacists are available for advice and they
can possibly suggest some over the counter medicine. If upon doing all of these
and symptoms do not improve then a GP appointment may help. If a GP advises
that antibiotics are still not needed then taking their advice is crucial.

Since the development of antibiotics by Alexander Flemming in 1928, antibiotics have come a long
way. Without them, a lot of the
population would very possibly succumb to
deaths over the simplest of illnesses. Since 1928 many antibiotics have been
developed, different antibiotics to treat different strains of bacteria. Unfortunately, this has led to antibiotic resistance, this is where the bacteria that infect the human body has become immune to the antibiotics that
would be used to treat the particular infection. This can have major
consequences for health and healthcare as
we know it, for example, a simple chest
infection could develop into something a lot more serious and lead to a
hospital stay so that the correct treatment
can be found. It is also possible that with antibiotics not working it could lead
to fatalities. “Antibiotic resistance
leads to higher medical costs, prolonged hospital stays, and increased
mortality” (World Health Organization, 2017). The development
of antibiotic resistance is not just being caused
by one element but several, Individual misuse, Health professionals/Healthcare
industry, and Agricultural section.

1.1./2.1 Antibiotics



Boseley, S., 2016. The History of Heart surgery Failures. The
Guardian, 3 March, p. 75.
Bulter, P., 2002. Patients and the public should be more
involved in decisions about their treatment and care. The Guardian, 17
Care Quality Commission, 2017. How we do our job. Online

Available at:
Accessed 30 november 2017.
Carersuk, n.d. Care standards and CQC. Online
Available at:
Accessed 17 December 2017.
Cuckoo Lane. 2017. Film Directed by NHS England. England: NHS
Kennedy, P. I., 2001. Learning from Bristol, s.l.:

Word Count – 697

In the above two cases,
there is a clear difference in the ethos
of care, at Cuckoo Lane practice their main priority was the care of their patients. They clearly showed that they were
willing to change the way that the practice was run so that both staff and
patients we happy about the level of care that they were giving. This had taken
the practice time and effort to do and clearly showed that this would not be an
inconvenience to them. In regards to the surgeon at Bristol Royal Infirmary,
they did not show the ethos in good quality care. For so many fatalities to
happen would have had devastating consequences for both the hospital and the
families. The care given by the surgeon was dissatisfactory as these fatalities
did not happen out of an accident, they
had happened because of a surgeon unable to perform
surgery with the adequate knowledge base and neglected to tell hierarchy.

Worries that this could happen again meant that Sir Ian
Kennedy demanded measures so that this was less likely to happen again. These
were as follows  “The introduction of appraisal, continuing professional development, and revalidation for all healthcare
professionals to ensure they keep their skills up to scratch. Changes to the
consultant contract to make them more accountable to the trust hospital that
employs them” (Bulter, 2002) and “An independent
external monitoring service to identify good and failing hospitals” (Bulter, 2002)



Unfortunately, care failings do happen. These are unacceptable, not
following codes of conduct and following policies can create a bad working
environment but more importantly, it can
lead to fatalities. A major care failing happened at the children’s heart
surgery unit at Bristol Royal Infirmary
between 1984 – 1995. In which a number of children under the age of 1 died. A
public inquiry was conducted between
October 1998 and July 2001. “Bristol had
a significantly higher mortality rate for open-heart surgery on children under
1 than that of other centres in England” (Kennedy,
These deaths could have been avoidable if the surgeon that was performing the operations would have admitted
that although he was a heart surgeon he was not able to perform such complex
surgery on such tiny hearts. “tragedies
born of arrogance, not malpractice” (Boseley, 2016)

The practice showed that they were willing to change
policies and take time to address the issues that the practice had. This was so
they had the ability to provide the best care that they could to their
patients. The meetings were effectively run by the leadership Nurse, she would
address any issues that had occurred so that every member was informed but the
meeting also allowed for other nurses and staff within the practice to voice
any concerns they had. It showed that they were still holding policies such as
the 6c’s to a high standard and wanted the best treatment for patients and the
most comfortable working environment possible for staff.

Nurses from within Cuckoo Lane, a nurse-run GP practice; noticed that they had unwarranted variation in communication with staff in the
practice. After they identified the issue, which stemmed from complaints and
concerns from patients via feedback. They
also noticed that there was a pattern with part-time
staff not being informed of crucial information that occurred at the time of their absence. The Leadership practice Nurse introduced a system
in which there was a 5-minute meeting,
twice a day. All staff was to attend and
issues from clinical to operational were to be addressed. After this policy had
been introduced the number of complaints reduced and the feedback from patients
began to become more positive, comments included that the practice was
knowledgeable, timely and organised (Cuckoo Lane, 2017). 

The care quality commission (CQC) runs the care services in
England. CQC regulate, monitor and inspects organisations
that are providing care, this is to make sure that all standards of care are
being met. The standards of care that CQC says
every person should have are, Person-centered care, Dignity, and respect, consent, safety, safeguarding from
abuse, Food and drink, Premises and equipment, complaints, good governance,
staffing, fit and proper staff, the duty
of candour and display of ratings.

For the running of any care unit, be it a care home,
doctors surgery, home care or even a hospital, they need to have an ethos of
good quality care. Most care professionals within these environments work by
the 6c’s, this is effectively an ethical code of conduct which was first
launched in December 2012 after the mid-Staffordshire
hospital inquiry. They were put into
place so that nurses and other professionals could care for their patients in
the best way possible, they are as follows; care, compassion, competence,
communication, courage, and commitment.