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NHS hospitals in England record worst ever A&E performance

Only 77.1% of patients were dealt with within four hours in January, well short of 95% target

A&E at Queen’s Medical Centre in Nottingham in January


A&E at Queen’s Medical Centre in Nottingham in January. Photograph: David Sillitoe for the Guardian

Hospitals recorded their worst performance against the four-hour A&E treatment target last month as the NHS came under unprecedented strain because of winter and the flu outbreak.

A&E units based at hospitals managed to treat and then admit, transfer or discharge just 77.1% of arrivals within the politically important four-hour target in January. That compared with 77.3% in December, which was also a new record low at that time.

The figures reveal just how far away the NHS is from meeting the requirement for hospital A&Es, walk-in centres and urgent care centres to deal with 95% of patients within four hours.

A&E waiting times

They are a setback for Jeremy Hunt, the health and social care secretary, who has ordered the NHS to improve its performance against the best-known of the various NHS-wide waiting time targets.

The latest set of performance data published by NHS England also shows that patients due to have planned surgery in hospital have been waiting longer and longer for their operations, and hospitals have been struggling to cope with the seasonal surge in illness.

Hospital emergency departments have now had to divert patients elsewhere 287 times since the NHS began recording winter performance data on 20 November. It happened 36 times last week, of which 17 were at the Worcestershire Royal Acute trust in the West Midlands.

The trust, which runs hospitals in Worcester and Redditch, has had to take that action a total of 65 times this winter, far more than any other trust, although it pointed out that it tended to divert patients from one of its two A&Es to the other, rather than to other nearby hospitals.

Q&A

Why is the NHS winter crisis so bad in 2017-18?

A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied.

NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”.

Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine.

The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries.

Read a full Q&A on the NHS winter crisis

Dr Nick Scriven, the president of the Society for Acute Medicine, said: “The last six weeks have seen the acute services of the NHS under a sustained period of stress due to ‘normal’ winter pressures along with a surge in influenza. Neither of these were unpredictable, but both have combined to cause the issues that have been widely reported across the country.

“Last year we coined the phrase ‘eternal winter’, but the last month-and-a-half has shown an even steeper decline in performance as demonstrated by all the data available, particularly around ambulance delays, the four-hour emergency target and bed occupancy both in acute beds and critical care.”

Scriven said Theresa May and Hunt’s repeated insistence that the NHS was the best prepared it had ever been to deal with the rigours of winter was not being borne out by events, and many frontline NHS did not believe it.

Thursday’s new data also revealed that:

  • 138,463 patients have waited at least 30 minutes in the back of an ambulance or a hospital corridor before being handed over to A&E staff this winter, despite NHS bosses telling hospitals that no patient should have to wait more than 15 minutes with an ambulance crew.
  • 31,306 of those patients endured a wait of at least an hour.
  • 81,003 patients had to wait on a trolley in an A&E unit in January for more than four hours, of whom a record 1,043 waited more than 12 hours – again an event which hospitals were told to ensure never happened this winter.
  • Bed occupancy levels in hospitals are running at 95%, far above the 85% limit that doctors and health experts should be the maximum, in order to prevent the spread of infections such as MRSA and C dificile and ensure patient safety.
  • NHS England stressed that the proportion of patients receiving A&E-type care at all types of settings, including walk-in and urgent care centres, rose slightly to 85.3% in January from 85.1% in December 2017. However, that was still the third worst-ever performance by that, their preferred measure of progress against the A&E target.

“Today’s figures provide hard evidence on just how bad a winter the NHS is having: over 80,000 patients waited on trolleys for more than four hours at A&E in January, of whom over 1,000 were waiting for over 12 hours. These are the highest numbers since records began,” said Prof John Appleby, chief economist at the Nuffield Trust health thinktank.

“A year ago we warned that corridors had become the new emergency wards. It is deeply concerning that 12 months on the position has worsened, with many harrowing reports of patients being treated in busy corridors by stressed and overworked staff.”

Patients awaiting non-urgent surgery such as cataract removal or a hip or knee replacement are facing lengthening delays and are now the longest for nine years. The NHS is meant to treat 92% of such patients within 18 weeks under the Referral to Treatment (RTT) scheme.

Yet that target is increasingly being breached as well. At the end of December 92% of people on the waiting list had waited an average of 21.3 weeks, up from 20.2 weeks just a month earlier.

Dr Rob Findlay, a doctor and expert in NHS performance, said: “The increase in waiting times from 20.2 weeks to 21.3 weeks is a shocking deterioration in performance and the worst monthly rise since December 2010.”

Of the 3.76 million people on the RTT waiting-list, in all 445,360 had been waiting for more than 18 weeks. Hospitals cancelled tens of thousands of operations in December and January, in part because NHS England told them to do so to free up beds to accommodate emergency arrivals over the winter.

NHS hospitals in England record worst ever A&E performance

Only 77.1% of patients were dealt with within four hours in January, well short of 95% target

A&E at Queen’s Medical Centre in Nottingham in January


A&E at Queen’s Medical Centre in Nottingham in January. Photograph: David Sillitoe for the Guardian

Hospitals recorded their worst performance against the four-hour A&E treatment target last month as the NHS came under unprecedented strain because of winter and the flu outbreak.

A&E units based at hospitals managed to treat and then admit, transfer or discharge just 77.1% of arrivals within the politically important four-hour target in January. That compared with 77.3% in December, which was also a new record low at that time.

The figures reveal just how far away the NHS is from meeting the requirement for hospital A&Es, walk-in centres and urgent care centres to deal with 95% of patients within four hours.

A&E waiting times

They are a setback for Jeremy Hunt, the health and social care secretary, who has ordered the NHS to improve its performance against the best-known of the various NHS-wide waiting time targets.

The latest set of performance data published by NHS England also shows that patients due to have planned surgery in hospital have been waiting longer and longer for their operations, and hospitals have been struggling to cope with the seasonal surge in illness.

Hospital emergency departments have now had to divert patients elsewhere 287 times since the NHS began recording winter performance data on 20 November. It happened 36 times last week, of which 17 were at the Worcestershire Royal Acute trust in the West Midlands.

The trust, which runs hospitals in Worcester and Redditch, has had to take that action a total of 65 times this winter, far more than any other trust, although it pointed out that it tended to divert patients from one of its two A&Es to the other, rather than to other nearby hospitals.

Q&A

Why is the NHS winter crisis so bad in 2017-18?

A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied.

NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”.

Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine.

The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries.

Read a full Q&A on the NHS winter crisis

Dr Nick Scriven, the president of the Society for Acute Medicine, said: “The last six weeks have seen the acute services of the NHS under a sustained period of stress due to ‘normal’ winter pressures along with a surge in influenza. Neither of these were unpredictable, but both have combined to cause the issues that have been widely reported across the country.

“Last year we coined the phrase ‘eternal winter’, but the last month-and-a-half has shown an even steeper decline in performance as demonstrated by all the data available, particularly around ambulance delays, the four-hour emergency target and bed occupancy both in acute beds and critical care.”

Scriven said Theresa May and Hunt’s repeated insistence that the NHS was the best prepared it had ever been to deal with the rigours of winter was not being borne out by events, and many frontline NHS did not believe it.

Thursday’s new data also revealed that:

  • 138,463 patients have waited at least 30 minutes in the back of an ambulance or a hospital corridor before being handed over to A&E staff this winter, despite NHS bosses telling hospitals that no patient should have to wait more than 15 minutes with an ambulance crew.
  • 31,306 of those patients endured a wait of at least an hour.
  • 81,003 patients had to wait on a trolley in an A&E unit in January for more than four hours, of whom a record 1,043 waited more than 12 hours – again an event which hospitals were told to ensure never happened this winter.
  • Bed occupancy levels in hospitals are running at 95%, far above the 85% limit that doctors and health experts should be the maximum, in order to prevent the spread of infections such as MRSA and C dificile and ensure patient safety.
  • NHS England stressed that the proportion of patients receiving A&E-type care at all types of settings, including walk-in and urgent care centres, rose slightly to 85.3% in January from 85.1% in December 2017. However, that was still the third worst-ever performance by that, their preferred measure of progress against the A&E target.

“Today’s figures provide hard evidence on just how bad a winter the NHS is having: over 80,000 patients waited on trolleys for more than four hours at A&E in January, of whom over 1,000 were waiting for over 12 hours. These are the highest numbers since records began,” said Prof John Appleby, chief economist at the Nuffield Trust health thinktank.

“A year ago we warned that corridors had become the new emergency wards. It is deeply concerning that 12 months on the position has worsened, with many harrowing reports of patients being treated in busy corridors by stressed and overworked staff.”

Patients awaiting non-urgent surgery such as cataract removal or a hip or knee replacement are facing lengthening delays and are now the longest for nine years. The NHS is meant to treat 92% of such patients within 18 weeks under the Referral to Treatment (RTT) scheme.

Yet that target is increasingly being breached as well. At the end of December 92% of people on the waiting list had waited an average of 21.3 weeks, up from 20.2 weeks just a month earlier.

Dr Rob Findlay, a doctor and expert in NHS performance, said: “The increase in waiting times from 20.2 weeks to 21.3 weeks is a shocking deterioration in performance and the worst monthly rise since December 2010.”

Of the 3.76 million people on the RTT waiting-list, in all 445,360 had been waiting for more than 18 weeks. Hospitals cancelled tens of thousands of operations in December and January, in part because NHS England told them to do so to free up beds to accommodate emergency arrivals over the winter.

NHS hospitals in England record worst ever A&E performance

Only 77.1% of patients were dealt with within four hours in January

A&E at Queen’s Medical Centre in Nottingham in January.


A&E at Queen’s Medical Centre in Nottingham in January. Photograph: David Sillitoe for the Guardian

Hospitals recorded their worst performance against the four-hour A&E treatment target last month as the NHS came under unprecedented strain because of winter and the flu outbreak.

A&E units based at hospitals managed to treat and then admit, transfer or discharge just 77.1% of arrivals within the politically important four-hour target in January. That was a further, although small, decline on the 77.3% figure they recorded in December, which was also a new record low at that time.

The figures reveal just how far away the NHS is from meeting the requirement on hospital A&Es, walk-in centres and urgent care centres to deal with 95% of patients within four hours.

A&E waiting times

They are a setback for Jeremy Hunt, the health and social care secretary, who has ordered the NHS to improve its performance against the best-known of the various NHS-wide waiting time targets.

Thursday’s latest set of performance data published by NHS England also showed that patients due to have planned surgery in hospital were waiting longer and longer for their operations, and hospitals across England were struggling to cope with the seasonal surge in illness.

Hospital emergency departments have now had to divert patients elsewhere no fewer than 287 times since the NHS began recording winter performance data on 20 November. That happened 36 times again last week, of which 17 were at the Worcestershire Royal Acute trust in the West Midlands.

The trust, which runs hospitals in Worcester and Reddich, has had to take that action a total of 65 times this winter – far more than any other trust – although it pointed out that it tended to divert patients from one of its two A&Es to the other, rather than to nearby other hospitals.

“The last six weeks have seen the acute services of the NHS under a sustained period of stress due to ‘normal’ winter pressures along with a surge in influenza. Neither of these were unpredictable, but both have combined to cause the issues that have been widely reported across the country,” said Dr Nick Scriven, the president of the Society for Acute Medicine.

“Last year we coined the phrase ‘eternal winter’, but the last month and a half has shown an even steeper decline in performance as demonstrated by all the data available, particularly around ambulance delays, the four-hour emergency target and bed occupancy both in acute beds and critical care.”

Scriven added that Theresa May and Hunt’s repeated insistence that the NHS was the best prepared it had ever been to deal with the rigours of winter was not being borne out by events, and many frontline NHS did not believe it.

Yemen’s cholera outbreak now the worst in history as millionth case looms

The cholera epidemic in Yemen has become the largest and fastest-spreading outbreak of the disease in modern history, with a million cases expected by the end of the year and at least 600,000 children likely to be affected.

The World Health Organization has reported more than 815,000 suspected cases of the disease in Yemen and 2,156 deaths. About 4,000 suspected cases are being reported daily, more than half of which are among children under five, who account for a quarter of all cases.

The spread of the outbreak, which has quickly surpassed Haiti as the biggest since modern records began in 1949, has been exacerbated by hunger and malnutrition. While there were 815,000 cases of cholera in Haiti between 2010 and 2017, Yemen has exceeded that number in just six months.

Save the Children has warned that, at the current rate of infection, the number of cases will reach seven figures before the turn of the year, 60% of which will be among children. In July, the International Committee of the Red Cross predicted there would be 600,000 suspected cholera cases in the country by the end of the year.

Tamer Kirolos, Save the Children’s country director for Yemen, said an outbreak of this scale and speed is “what you get when a country is brought to its knees by conflict, when a healthcare system is on the brink of collapse, when its children are starving, and when its people are blocked from getting the medical treatment they need”.

Kirolos said: “There’s no doubt this is a man-made crisis. Cholera only rears its head when there’s a complete and total breakdown in sanitation. All parties to the conflict must take responsibility for the health emergency we find ourselves in.”

More than two years of fighting between the Saudi-led coalition and Houthi rebels has crippled the country, causing widespread internal displacement, the collapse of the public health system, and leaving millions on the brink of famine.


When I see a mother lose her baby because of cholera, it makes me so angry

Dr Mariam Aldogani, Save the Children

The crisis was exacerbated when sanitation workers whose salaries had gone unpaid went on strike. This meant garbage was left on the streets, which was then washed into the water supply. It is estimated that 19.3 million Yemenis – more than two-thirds of the population – do not have access to clean water and sanitation.

The government stopped funding the public health department in 2016, meaning many doctors and hospital staff have not received salaries for more than a year. Healthcare has since been provided mainly by international organisations, the efforts of whom have been hampered by the conflict.

The spread of the disease has nonetheless slowed. At the beginning of the most recent outbreak, in May this year, between 5,000 and 6,000 new cases were detected daily. That rate has since dropped to just under 4,000 a day. The mortality rate has also declined, from 1% at the beginning of the outbreak to 0.26% now.

“Whatever decline we’re seeing now is due to the heroic efforts of workers at the scene,” said Sherin Varkey, the officiating representative of Unicef Yemen.

Varkey said the situation would not be solved until there was peace in the country.

“There are no signals that give us any reason for optimism. We know that both parties to the conflict are continuing with their blatant disregard of the rights of children,” he said. “We’re at a cliff and we’re staring down and it is bottomless. There seems to be no hope.”

A worker is pictured in a government hospital’s drug store in Sana’a, Yemen


A worker is seen at a government hospital’s drug store in Sana’a, Yemen. Photograph: Khaled Abdullah/Reuters

Cholera should be easily treatable with oral rehydration salts and access to clean water. But Mariam Aldogani, Save the Children’s health adviser for the city of Hodeidah, said conditions in the country had made this very difficult.

Aldogani said: “All the NGOs are trying to increase the knowledge of how to prevent the disease, because it’s preventable, you have to boil the water. But if you don’t have money to buy gas, and you have to walk a long way to get the wood, how can you boil the water?”

Aldogani, who has been a doctor since 2010, said witnessing the suffering of her patients was deeply painful. “I saw one young man, he had cholera and severe dehydration. He was in a coma and he died in front of his mother. We tried our best, but he came too late and she was crying, and I cried. It makes me angry. When I see a mother lose her baby, especially a stillbirth, she waits for this baby for a long time and then she loses it because of cholera, it makes me so angry.

“The war is a big problem for us, it’s a wound. But with the cholera, you have the wound and you put salt in the wound. It hurts. I hope this war can be stopped. We need peace for the children of Yemen. Our situation before the war was not good, but it was not like this.”

Suicide and self-harm in prisons hit worst ever levels

Prisons have “struggled to cope” with record rates of suicide and self-harm among inmates following cuts to funding and staff numbers, the public spending watchdog has said. The National Audit Office said it remains unclear how the authorities will meet aims for improving prisoners’ mental health or get value for money because of a lack of relevant data.

Auditors said that self-harm incidents increased by 73% between 2012 and 2016 to 40,161, while the 120 self-inflicted deaths in prison in 2016 was the highest figure on record and almost double that for 2012. Since 2010, when David Cameron became prime minister, funding of offender management has been reduced by 13%, while staff numbers have been cut by 30%, the report said.

Self-harm

“Prisons have struggled to cope with reduced resources. When prisons are short-staffed, governors run restricted regimes where prisoners spend more of the day in their cells, making it more challenging for prisoners to access mental health services,” the report concluded.

The report covered prisons in England and Wales, although issues around healthcare are devolved, so the NAO examined only health services provided in England.

NAO chief Sir Amyas Morse said: “Improving the mental health of those in prison will require a step change in effort and resources. The quality of clinical care is generally good for those who can access it, but the rise in prisoner suicide and self-harm suggests a decline in mental health and wellbeing overall.

“The data on how many people in prison have mental health problems and how much government is spending to address this is poor. Consequently, government do not know the base they are starting from, what they need to improve, or how realistic it is for them to meet their objectives. Without this understanding, it is hard to see how government can be achieving value for money.”

The report noted that the prison system was “under considerable pressure, making it more difficult to manage prisoners’ mental wellbeing”, but acknowledged that the government had promised an “ambitious reform programme” to address this.

The National Offender Management Service (Noms), which was replaced by HM Prison and Probation Service (HMPPS) in April, had suffered funding cuts of 13% from 2009 to 2017, the NAO said, with a 30% fall in staff numbers in jails over the same period.

Staff numbers

Responsibility for mentally unwell prisoners should fall upon the Ministry of Justice, HMPPS, Department of Health, NHS England and Public Health England, the report said. The NAO also noted delays in transferring inmates to secure hospitals for treatment; just 34% of eligible prisoners were transferred within the 14-day target in 2016-17.

Peter Dawson, director of the Prison Reform Trust, said the report showed a familiar tale of admirable policy objectives not being delivered on the ground. “This report makes horribly clear that our prisons are holding very many people who will suffer disproportionate and unnecessary harm because of the prison environment.”

Lib Dem health spokesman Norman Lamb called for a legal maximum time between diagnosis and transfer for prisoners who need hospital treatment. He said: “The mental health crisis is threatening the very fabric of our prisons. Too many prisoners with serious mental health problems are being allowed to slip through the cracks, often with tragic consequences.”

Self-inflicted death

A government spokesperson said support available to vulnerable offenders had increased, including investment in specialist mental health training for prison officers. “We’re putting more funding into prison safety and have launched a suicide and self-harm reduction project to address the increase in self-inflicted deaths and self-harm in our prisons.

“But we recognise that more can be done and continue to work in partnership with HMPPS, NHS England and Public Health England to improve mental health services for offenders at all points of the criminal justice system,” the spokesperson said.

For professional advice on suicide prevention in young people, or if you are concerned about someone who may be suicidal, or are at risk yourself, contact Papyrus on 0800 068 4141 or text 07786 209 697 or email pat@papyrus-uk.org. In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here

Suicide and self-harm in prisons hit worst ever levels

Prisons have “struggled to cope” with record rates of suicide and self-harm among inmates following cuts to funding and staff numbers, the public spending watchdog has said. The National Audit Office said it remains unclear how the authorities will meet aims for improving prisoners’ mental health or get value for money because of a lack of relevant data.

Auditors said that self-harm incidents increased by 73% between 2012 and 2016 to 40,161, while the 120 self-inflicted deaths in prison in 2016 was the highest figure on record and almost double that for 2012. Since 2010, when David Cameron became prime minister, funding of offender management has been reduced by 13%, while staff numbers have been cut by 30%, the report said.

Self-harm

“Prisons have struggled to cope with reduced resources. When prisons are short-staffed, governors run restricted regimes where prisoners spend more of the day in their cells, making it more challenging for prisoners to access mental health services,” the report concluded.

The report covered prisons in England and Wales, although issues around healthcare are devolved, so the NAO examined only health services provided in England.

NAO chief Sir Amyas Morse said: “Improving the mental health of those in prison will require a step change in effort and resources. The quality of clinical care is generally good for those who can access it, but the rise in prisoner suicide and self-harm suggests a decline in mental health and wellbeing overall.

“The data on how many people in prison have mental health problems and how much government is spending to address this is poor. Consequently, government do not know the base they are starting from, what they need to improve, or how realistic it is for them to meet their objectives. Without this understanding, it is hard to see how government can be achieving value for money.”

The report noted that the prison system was “under considerable pressure, making it more difficult to manage prisoners’ mental wellbeing”, but acknowledged that the government had promised an “ambitious reform programme” to address this.

The National Offender Management Service (Noms), which was replaced by HM Prison and Probation Service (HMPPS) in April, had suffered funding cuts of 13% from 2009 to 2017, the NAO said, with a 30% fall in staff numbers in jails over the same period.

Staff numbers

Responsibility for mentally unwell prisoners should fall upon the Ministry of Justice, HMPPS, Department of Health, NHS England and Public Health England, the report said. The NAO also noted delays in transferring inmates to secure hospitals for treatment; just 34% of eligible prisoners were transferred within the 14-day target in 2016-17.

Peter Dawson, director of the Prison Reform Trust, said the report showed a familiar tale of admirable policy objectives not being delivered on the ground. “This report makes horribly clear that our prisons are holding very many people who will suffer disproportionate and unnecessary harm because of the prison environment.”

Lib Dem health spokesman Norman Lamb called for a legal maximum time between diagnosis and transfer for prisoners who need hospital treatment. He said: “The mental health crisis is threatening the very fabric of our prisons. Too many prisoners with serious mental health problems are being allowed to slip through the cracks, often with tragic consequences.”

Self-inflicted death

A government spokesperson said support available to vulnerable offenders had increased, including investment in specialist mental health training for prison officers. “We’re putting more funding into prison safety and have launched a suicide and self-harm reduction project to address the increase in self-inflicted deaths and self-harm in our prisons.

“But we recognise that more can be done and continue to work in partnership with HMPPS, NHS England and Public Health England to improve mental health services for offenders at all points of the criminal justice system,” the spokesperson said.

For professional advice on suicide prevention in young people, or if you are concerned about someone who may be suicidal, or are at risk yourself, contact Papyrus on 0800 068 4141 or text 07786 209 697 or email pat@papyrus-uk.org. In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here

Suicide and self-harm in prisons hit worst ever levels

Prisons have “struggled to cope” with record rates of suicide and self-harm among inmates following cuts to funding and staff numbers, the public spending watchdog has said. The National Audit Office said it remains unclear how the authorities will meet aims for improving prisoners’ mental health or get value for money because of a lack of relevant data.

Auditors said that self-harm incidents increased by 73% between 2012 and 2016 to 40,161, while the 120 self-inflicted deaths in prison in 2016 was the highest figure on record and almost double that for 2012. Since 2010, when David Cameron became prime minister, funding of offender management has been reduced by 13%, while staff numbers have been cut by 30%, the report said.

Self-harm

“Prisons have struggled to cope with reduced resources. When prisons are short-staffed, governors run restricted regimes where prisoners spend more of the day in their cells, making it more challenging for prisoners to access mental health services,” the report concluded.

The report covered prisons in England and Wales, although issues around healthcare are devolved, so the NAO examined only health services provided in England.

NAO chief Sir Amyas Morse said: “Improving the mental health of those in prison will require a step change in effort and resources. The quality of clinical care is generally good for those who can access it, but the rise in prisoner suicide and self-harm suggests a decline in mental health and wellbeing overall.

“The data on how many people in prison have mental health problems and how much government is spending to address this is poor. Consequently, government do not know the base they are starting from, what they need to improve, or how realistic it is for them to meet their objectives. Without this understanding, it is hard to see how government can be achieving value for money.”

The report noted that the prison system was “under considerable pressure, making it more difficult to manage prisoners’ mental wellbeing”, but acknowledged that the government had promised an “ambitious reform programme” to address this.

The National Offender Management Service (Noms), which was replaced by HM Prison and Probation Service (HMPPS) in April, had suffered funding cuts of 13% from 2009 to 2017, the NAO said, with a 30% fall in staff numbers in jails over the same period.

Staff numbers

Responsibility for mentally unwell prisoners should fall upon the Ministry of Justice, HMPPS, Department of Health, NHS England and Public Health England, the report said. The NAO also noted delays in transferring inmates to secure hospitals for treatment; just 34% of eligible prisoners were transferred within the 14-day target in 2016-17.

Peter Dawson, director of the Prison Reform Trust, said the report showed a familiar tale of admirable policy objectives not being delivered on the ground. “This report makes horribly clear that our prisons are holding very many people who will suffer disproportionate and unnecessary harm because of the prison environment.”

Lib Dem health spokesman Norman Lamb called for a legal maximum time between diagnosis and transfer for prisoners who need hospital treatment. He said: “The mental health crisis is threatening the very fabric of our prisons. Too many prisoners with serious mental health problems are being allowed to slip through the cracks, often with tragic consequences.”

Self-inflicted death

A government spokesperson said support available to vulnerable offenders had increased, including investment in specialist mental health training for prison officers. “We’re putting more funding into prison safety and have launched a suicide and self-harm reduction project to address the increase in self-inflicted deaths and self-harm in our prisons.

“But we recognise that more can be done and continue to work in partnership with HMPPS, NHS England and Public Health England to improve mental health services for offenders at all points of the criminal justice system,” the spokesperson said.

For professional advice on suicide prevention in young people, or if you are concerned about someone who may be suicidal, or are at risk yourself, contact Papyrus on 0800 068 4141 or text 07786 209 697 or email pat@papyrus-uk.org. In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here

Suicide and self-harm in prisons hit worst ever levels

Prisons have “struggled to cope” with record rates of suicide and self-harm among inmates following cuts to funding and staff numbers, the public spending watchdog has said. The National Audit Office said it remains unclear how the authorities will meet aims for improving prisoners’ mental health or get value for money because of a lack of relevant data.

Auditors said that self-harm incidents increased by 73% between 2012 and 2016 to 40,161, while the 120 self-inflicted deaths in prison in 2016 was the highest figure on record and almost double that for 2012. Since 2010, when David Cameron became prime minister, funding of offender management has been reduced by 13%, while staff numbers have been cut by 30%, the report said.

Self-harm

“Prisons have struggled to cope with reduced resources. When prisons are short-staffed, governors run restricted regimes where prisoners spend more of the day in their cells, making it more challenging for prisoners to access mental health services,” the report concluded.

The report covered prisons in England and Wales, although issues around healthcare are devolved, so the NAO examined only health services provided in England.

NAO chief Sir Amyas Morse said: “Improving the mental health of those in prison will require a step change in effort and resources. The quality of clinical care is generally good for those who can access it, but the rise in prisoner suicide and self-harm suggests a decline in mental health and wellbeing overall.

“The data on how many people in prison have mental health problems and how much government is spending to address this is poor. Consequently, government do not know the base they are starting from, what they need to improve, or how realistic it is for them to meet their objectives. Without this understanding, it is hard to see how government can be achieving value for money.”

The report noted that the prison system was “under considerable pressure, making it more difficult to manage prisoners’ mental wellbeing”, but acknowledged that the government had promised an “ambitious reform programme” to address this.

The National Offender Management Service (Noms), which was replaced by HM Prison and Probation Service (HMPPS) in April, had suffered funding cuts of 13% from 2009 to 2017, the NAO said, with a 30% fall in staff numbers in jails over the same period.

Staff numbers

Responsibility for mentally unwell prisoners should fall upon the Ministry of Justice, HMPPS, Department of Health, NHS England and Public Health England, the report said. The NAO also noted delays in transferring inmates to secure hospitals for treatment; just 34% of eligible prisoners were transferred within the 14-day target in 2016-17.

Peter Dawson, director of the Prison Reform Trust, said the report showed a familiar tale of admirable policy objectives not being delivered on the ground. “This report makes horribly clear that our prisons are holding very many people who will suffer disproportionate and unnecessary harm because of the prison environment.”

Lib Dem health spokesman Norman Lamb called for a legal maximum time between diagnosis and transfer for prisoners who need hospital treatment. He said: “The mental health crisis is threatening the very fabric of our prisons. Too many prisoners with serious mental health problems are being allowed to slip through the cracks, often with tragic consequences.”

Self-inflicted death

A government spokesperson said support available to vulnerable offenders had increased, including investment in specialist mental health training for prison officers. “We’re putting more funding into prison safety and have launched a suicide and self-harm reduction project to address the increase in self-inflicted deaths and self-harm in our prisons.

“But we recognise that more can be done and continue to work in partnership with HMPPS, NHS England and Public Health England to improve mental health services for offenders at all points of the criminal justice system,” the spokesperson said.

For professional advice on suicide prevention in young people, or if you are concerned about someone who may be suicidal, or are at risk yourself, contact Papyrus on 0800 068 4141 or text 07786 209 697 or email pat@papyrus-uk.org. In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here

Suicide and self-harm in prisons hit worst ever levels

Prisons have “struggled to cope” with record rates of suicide and self-harm among inmates following cuts to funding and staff numbers, the public spending watchdog has said. The National Audit Office said it remains unclear how the authorities will meet aims for improving prisoners’ mental health or get value for money because of a lack of relevant data.

Auditors said that self-harm incidents increased by 73% between 2012 and 2016 to 40,161, while the 120 self-inflicted deaths in prison in 2016 was the highest figure on record and almost double that for 2012. Since 2010, when David Cameron became prime minister, funding of offender management has been reduced by 13%, while staff numbers have been cut by 30%, the report said.

Self-harm

“Prisons have struggled to cope with reduced resources. When prisons are short-staffed, governors run restricted regimes where prisoners spend more of the day in their cells, making it more challenging for prisoners to access mental health services,” the report concluded.

The report covered prisons in England and Wales, although issues around healthcare are devolved, so the NAO examined only health services provided in England.

NAO chief Sir Amyas Morse said: “Improving the mental health of those in prison will require a step change in effort and resources. The quality of clinical care is generally good for those who can access it, but the rise in prisoner suicide and self-harm suggests a decline in mental health and wellbeing overall.

“The data on how many people in prison have mental health problems and how much government is spending to address this is poor. Consequently, government do not know the base they are starting from, what they need to improve, or how realistic it is for them to meet their objectives. Without this understanding, it is hard to see how government can be achieving value for money.”

The report noted that the prison system was “under considerable pressure, making it more difficult to manage prisoners’ mental wellbeing”, but acknowledged that the government had promised an “ambitious reform programme” to address this.

The National Offender Management Service (Noms), which was replaced by HM Prison and Probation Service (HMPPS) in April, had suffered funding cuts of 13% from 2009 to 2017, the NAO said, with a 30% fall in staff numbers in jails over the same period.

Staff numbers

Responsibility for mentally unwell prisoners should fall upon the Ministry of Justice, HMPPS, Department of Health, NHS England and Public Health England, the report said. The NAO also noted delays in transferring inmates to secure hospitals for treatment; just 34% of eligible prisoners were transferred within the 14-day target in 2016-17.

Peter Dawson, director of the Prison Reform Trust, said the report showed a familiar tale of admirable policy objectives not being delivered on the ground. “This report makes horribly clear that our prisons are holding very many people who will suffer disproportionate and unnecessary harm because of the prison environment.”

Lib Dem health spokesman Norman Lamb called for a legal maximum time between diagnosis and transfer for prisoners who need hospital treatment. He said: “The mental health crisis is threatening the very fabric of our prisons. Too many prisoners with serious mental health problems are being allowed to slip through the cracks, often with tragic consequences.”

Self-inflicted death

A government spokesperson said support available to vulnerable offenders had increased, including investment in specialist mental health training for prison officers. “We’re putting more funding into prison safety and have launched a suicide and self-harm reduction project to address the increase in self-inflicted deaths and self-harm in our prisons.

“But we recognise that more can be done and continue to work in partnership with HMPPS, NHS England and Public Health England to improve mental health services for offenders at all points of the criminal justice system,” the spokesperson said.

For professional advice on suicide prevention in young people, or if you are concerned about someone who may be suicidal, or are at risk yourself, contact Papyrus on 0800 068 4141 or text 07786 209 697 or email pat@papyrus-uk.org. In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here

Suicide and self-harm in prisons hit worst ever levels

Prisons have “struggled to cope” with record rates of suicide and self-harm among inmates following cuts to funding and staff numbers, the public spending watchdog has said. The National Audit Office said it remains unclear how the authorities will meet aims for improving prisoners’ mental health or get value for money because of a lack of relevant data.

Auditors said that self-harm incidents increased by 73% between 2012 and 2016 to 40,161, while the 120 self-inflicted deaths in prison in 2016 was the highest figure on record and almost double that for 2012. Since 2010, when David Cameron became prime minister, funding of offender management has been reduced by 13%, while staff numbers have been cut by 30%, the report said.

Self-harm

“Prisons have struggled to cope with reduced resources. When prisons are short-staffed, governors run restricted regimes where prisoners spend more of the day in their cells, making it more challenging for prisoners to access mental health services,” the report concluded.

The report covered prisons in England and Wales, although issues around healthcare are devolved, so the NAO examined only health services provided in England.

NAO chief Sir Amyas Morse said: “Improving the mental health of those in prison will require a step change in effort and resources. The quality of clinical care is generally good for those who can access it, but the rise in prisoner suicide and self-harm suggests a decline in mental health and wellbeing overall.

“The data on how many people in prison have mental health problems and how much government is spending to address this is poor. Consequently, government do not know the base they are starting from, what they need to improve, or how realistic it is for them to meet their objectives. Without this understanding, it is hard to see how government can be achieving value for money.”

The report noted that the prison system was “under considerable pressure, making it more difficult to manage prisoners’ mental wellbeing”, but acknowledged that the government had promised an “ambitious reform programme” to address this.

The National Offender Management Service (Noms), which was replaced by HM Prison and Probation Service (HMPPS) in April, had suffered funding cuts of 13% from 2009 to 2017, the NAO said, with a 30% fall in staff numbers in jails over the same period.

Staff numbers

Responsibility for mentally unwell prisoners should fall upon the Ministry of Justice, HMPPS, Department of Health, NHS England and Public Health England, the report said. The NAO also noted delays in transferring inmates to secure hospitals for treatment; just 34% of eligible prisoners were transferred within the 14-day target in 2016-17.

Peter Dawson, director of the Prison Reform Trust, said the report showed a familiar tale of admirable policy objectives not being delivered on the ground. “This report makes horribly clear that our prisons are holding very many people who will suffer disproportionate and unnecessary harm because of the prison environment.”

Lib Dem health spokesman Norman Lamb called for a legal maximum time between diagnosis and transfer for prisoners who need hospital treatment. He said: “The mental health crisis is threatening the very fabric of our prisons. Too many prisoners with serious mental health problems are being allowed to slip through the cracks, often with tragic consequences.”

Self-inflicted death

A government spokesperson said support available to vulnerable offenders had increased, including investment in specialist mental health training for prison officers. “We’re putting more funding into prison safety and have launched a suicide and self-harm reduction project to address the increase in self-inflicted deaths and self-harm in our prisons.

“But we recognise that more can be done and continue to work in partnership with HMPPS, NHS England and Public Health England to improve mental health services for offenders at all points of the criminal justice system,” the spokesperson said.

For professional advice on suicide prevention in young people, or if you are concerned about someone who may be suicidal, or are at risk yourself, contact Papyrus on 0800 068 4141 or text 07786 209 697 or email pat@papyrus-uk.org. In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here