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Long covid: Damage to multiple organs presents in young, low risk patients

Young, low risk patients with ongoing symptoms of COVID-19 had signs of damage to multiple organs four months after initially being infected, a preprint study has suggested.

Initial data from 201 patients suggest that almost 70% had impairments in one or more organs four months after their initial symptoms of SARS-CoV-2 infection.

The results emerged as the NHS announced plans to establish a network of more than 40 long covid specialist clinics across England this month to help patients with long term symptoms of infection.

The prospective Coverscan study examined the impact of long covid (persistent symptoms three months post infection) across multiple organs in low risk people who are relatively young and had no major underlying health problems. 

The research has not yet been peer reviewed and could not establish a causal link between organ impairment and infection. But the authors said the results had “implications not only for [the] burden of long covid but also public health approaches which have assumed low risk in young people with no comorbidities.”

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Source: BMJ, 17 November 2020

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Long Covid: overlap emerges with ME – including debate over treatment

As more people suffer lasting symptoms from Covid including fatigue, ME patient advocates fear they will get bad advice,

Based on current estimates, about 10% of COVID-19 patients develop lasting symptoms, one of the most common being fatigue. The underlying mechanism is still unclear, but possible explanations include reduced oxygen supply to tissues caused by heart or lung damage, or muscle weakness from prolonged bed rest.

However, some doctors are increasingly concerned about the overlap between long Covid and another largely virus-triggered illness: “It’s extraordinary how many people have a postviral syndrome that’s very strikingly similar to myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS),” said the US’s top public health official, Dr Anthony Fauci, in July. “They just don’t get back to normal energy or normal feeling of good health.”

Like people with ME/CFS, many long-Covid patients report headaches, brain fog, sleep problems, a racing heart, joint and muscle pain and fatigue. Some also experience a relapse of fever, muscle pain and exhaustion, known as “post-exertional malaise”, if they exercise beyond their capabilities.

“There are so many similarities between long Covid and ME/CFS it leads me to believe the underlying pathology is probably the same – except that long Covid is presenting as an epidemic, whereas ME/CFS has presented in a very sporadic way, and by no means in such large numbers in such a short space of time,” said Dr William Weir, a consultant in infectious diseases with a special interest in ME.

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Source: The Guardian, 19 November 2020

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Rheumatoid arthritis drug appears to help Covid patients in ICU

A drug used to treat rheumatoid arthritis appears to help patients who are admitted to intensive care with the most severe coronavirus infections, researchers say.

Tocilizumab, a medicine that dampens down inflammation, improved outcomes for critically ill patients, according to early results from an international trial investigating whether the drug and others like it boost survival rates and reduce the amount of time patients spend in intensive care.

The findings have not been peer-reviewed or published in a journal, but if confirmed by more trial data, the drug will be on track to become only the second effective therapy for the sickest Covid patients, following positive results for the steroid dexamethasone earlier this year.

“We think these are very exciting results, we are encouraged by them,” said Prof Anthony Gordon, of Imperial College London, the UK’s chief investigator on the REMAP-CAP trial. “It could become the standard of care once we have all the data reviewed by guidelines groups, and also drug regulators.”

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Source: The Guardian, 20 November 2020

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Free flu jab offered to all over 50s in England

People aged 50 to 64 in England will be able to get a free flu jab from 1 December in an attempt to fight the "twin threats" of flu and COVID-19.

The group has been added to a list of people who are already eligible for a flu jab in England, such as those over 65 and health and social care workers.

Thirty million people are being offered the vaccine in England's largest flu-immunisation programme to date.

Health Secretary Matt Hancock said it was a winter "like no other".

"We have to worry about the twin threats of flu and COVID-19," he said, adding that the coronavirus pandemic meant it was "more important than ever" that people got their flu jabs.

Mr Hancock told BBC Breakfast that all over 50s would be able to get the vaccine by January.

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Source: BBC News, 20 November 2020

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NHS going into winter with 5,500 fewer beds than last year

The NHS is going into this winter with 5,500 fewer general acute beds than last year, NHS England data has revealed.

The numbers of general and acute beds open overnight from July to September this year was 94,787 compared with 100,370 for the same period in 2019, a fall of 5.6% or 5,583 beds. 

The reduction in bed numbers is thought to be partly because of covid infection control measures, such as creating more distance between beds. HSJ reported this week that Cambridge University Hospitals Foundation Trust had taken nearly 100 beds out of use to allow for better social distancing.

The figures showed significant regional differences. London had 8% fewer beds available compared with last year, while the East of England and the North East only had 3.4% fewer. The North West, which has been badly affected by the second wave of covid, had 6.6% fewer beds than last year. 

NHS Providers deputy chief executive Saffron Cordery said: “We have been arguing for some time that the NHS is short of beds as we head into winter… This is a real problem as trusts deal with pressures posed by the virus, growing demand for urgent and emergency care and the work to recover the backlog of routine operations.”

Nuffield Trust deputy director of research Sarah Scobie said: “This drop in the number of beds available bears out our warning that infection control will mean a loss of capacity even between waves of the virus. Many of these will have been beds too close to others for physical distancing. This is why it will be so difficult to return to previous rates of activity while the virus remains at large, worsening waiting times and forcing difficult decisions about who gets priority."

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Source: HSJ, 19 November 2020

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Children’s hospital ‘covered up mistakes that led to toddler’s death’

A world-leading children’s hospital has been accused of a “concerted effort” to cover up the mistakes that led to the death of a toddler.

Jasmine Hughes died at London’s Great Ormond Street Hospital aged 20 months after suffering acute disseminated encephalomyelitis (ADEM), a condition in which the brain and spinal cord are inflamed following a viral infection.

Doctors said that her death in February 2011 had been caused by complications of ADEM. But an analysis of detailed hospital computer records shows the toddler died after her blood pressure was mismanaged – spiking when she was treated with steroids then allowed to fall too fast. Experts say this led to catastrophic brain damage. 

Although the detailed computer records were supplied to the coroner who carried out Jasmine’s inquest, crucial information concerning her blood pressure was not included in official medical records that should hold the patient’s entire clinical history.  

Dr Malcolm Coulthard, who specialises in child blood pressure and medical records examination, carried out the analysis of the files, comprising more than 350 pages of spreadsheets. Dr Stephen Playfor, a paediatric intensive care consultant, examined the computer records and came to the same conclusion as Dr Coulthard, that mismanagement of Jasmine’s blood pressure by Great Ormond Street and Lister Hospital, in Stevenage, was responsible for her death.

Dr Coulthard told The Independent: “As a specialist paediatrician, it is with great regret and disappointment that I have concluded that the doctors' records in Jasmine Hughes’ medical notes fail to reflect the truth about her diagnosis and treatment.”

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Source: The Independent, 20 November 2020

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Patients eight times more likely to die following major surgery at outlier hospitals

Death rates for a major emergency abdominal surgery are almost eight times higher at some outlier hospitals compared with top performers, a national report has found.

A review of emergency laparotomies in England and Wales has identified six hospitals as having much higher-than-average 30-day mortality rates for the surgery between December 2018 and November 2019.

Hospitals identified by the annual National Emergency Laparotomy Audit as having the best outcomes, such as Stepping Hill Hospital and Salford Royal Hospital, had mortality rates of around 2.5%.

But the review, published this month, found some hospitals, such as George Eliot Hospital, had 30-day mortality rates for emergency laparotomies as high as 19.6%

The national 30-day mortality rate for emergency laparotomies in England and Wales was 9.3% last year and has fallen consistently since the review started in 2013.

Some trusts told HSJ that data collection issues were partly to blame for the high mortality rates recorded in the review.

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Source: HSJ, 20 November 2020

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Support for Long COVID patients visiting their GP

PRESS RELEASE

 (London, UK, 19 November 2020) – The charity Patient Safety Learning and the Royal College of GPs have published new guidance to help patients with post COVID-19 syndrome (also known as Long COVID) understand the support they can expect from their GP.

 This guidance draws on the RCGP's recent summary and top tips for GPs caring for patients with post COVID-19 syndrome. Both these documents have been produced in advance of more detailed national guidance being developed by the National Institute of Health and Care Excellence (NICE), the Scottish Intercollegiate Guidelines Network (SIGN) and the Royal College of GPs, due to be published in December 2020.

 Helen Hughes, Chief Executive of Patient Safety Learning, said:

 “We have used the RCGP’s guidance to produce a simple patient-friendly guide to help support people living with Long COVID in the interim period before more detailed guidance is produced by NICE.

 We hope that this guidance will empower and inform patients, providing them with an evidence-based document that can be shared with those around them. We believe that this will also help raise awareness of the health challenges these patients are facing so that their health and recovery needs can be better met.”

 Professor Martin Marshall, Chair of the Royal College of GPs, said:

 “It’s important that patients experiencing debilitating prolonged effects of Covid-19, which we know affect a small but significant number of people who have had the virus, feel that they have the understanding and support of the GPs and other healthcare professionals delivering their care. To this end we hope this guidance is helpful for them. The RCGP is working  hard to ensure that the long term effects of Covid-19 are recognised, especially in those who were never admitted to hospital, and that our GP members have interim guidance whilst waiting for formal national guidance, currently being developed by NICE, SIGN and the College, to be published.”

 Notes to editors:

 1.     The new Patient Safety Learning and RCGP guidance can be found here: Post COVID-19 syndrome: What support can patients expect from their GP?

 2.     Patient Safety Learning is a charity and independent voice for improving patient safety. We harness the knowledge, insights, enthusiasm and commitment of health and social care organisations, professionals and patients for system-wide change and the reduction of avoidable harm. We believe patient safety is not just another priority; it is a core purpose of health and social care. Patient safety should not be negotiable.

 3.     The RCGP guidance for GPs can be found here: RCGP, Management of the long term effects of COVID-19. The RCGP response and top tips for caring for our patients, V1 30 October 2020.

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Maternity unit rated ‘inadequate’ as trust faces scrutiny over horrific stillbirth

An Essex maternity department has been served with further warnings by the Care Quality Commission (CQC) and again rated “inadequate”.

Serious concerns were raised about the services at Basildon University Hospital in the summer, after several babies were found to have been starved of oxygen and put at risk of permanent brain damage.

Despite the CQC issuing warning notices to Mid and South Essex Foundation Trust in June 2020, a subsequent visit on 18 September found multiple problems had persisted.

The CQC’s findings at Basildon included:

  • the service was short-staffed and concerns were not escalated appropriately
  • multidisciplinary team working was “dysfunctional”, which sometimes led to safety incidents
  • doctors, midwives and other professionals did not support each other to provide good care.

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Source: HSJ, 19 November 2020

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Hospital trust accused of risking lives after raising patient-to-nurse ratio to dangerously high levels

A hospital trust in Bristol has been accused of risking lives after raising its patient-to-nurse ward ratio to dangerously high levels, having allegedly dismissed staff concerns and national guidance on safe staffing.

University Hospitals Bristol and Weston NHS Foundation Trust (UHBW) has introduced a blanket policy across its hospitals that assigns one nurse to 10 patients (1:10) for all general adult wards. This ratio, which previously stood at 1:6 or 1:8 depending on the ward, rises to 1:12 for nights shifts.

The new policy, which is applicable to Bristol Royal Infirmary (BRI) and Weston General Hospital, also extends to all specialist high-care wards, which treat patients with life-threatening conditions such as epilepsy and anaphylaxis.

Nurses at the trust have expressed their anger over the decision, saying they were never fully consulted by senior officials. Many are fearful that patient safety will be compromised as the second coronavirus wave intensifies, culminating in the unnecessary loss of life.

“Patients who would have extra nursing staff because they are very acutely unwell and need close observation I think are going to unnecessarily die,” one nurse at BRI told The Independent. 

“Or if they survive, they’ll suffer long-term conditions because things were missed as they don’t have the staff at their bed side to watch the deterioration.”

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Source: The Independent, 18 November 2020

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Private baby scans show 'incredibly poor practice'

BBC News investigation has uncovered failures in the diagnosis of serious medical issues during private baby scans.

More than 200 studios across the UK now sell ultrasound scans, with hundreds of thousands being carried out each year.

But the BBC has found evidence of women not being told about serious conditions and abnormalities.

The Care Quality Commission says there is good quality care in the industry but it has a "growing concern".

Private baby scanning studios offer a variety of services.

Some diagnose medical issues while others market themselves as providers of souvenir images or video of the ultrasound. Most sell packages providing a "reassurance scan" to expectant mums.

Many women BBC News spoke to said they had positive experiences at private studios, but we have also learned of instances where women said they were failed.

Charlotte, from Manchester, attended a scan in Salford with one of the biggest franchises, Window to the Womb, to record her baby's sex for a party and check its wellbeing.

BBC News has learned the sonographer identified a serious abnormality that meant the baby could not survive, where part or all of its head is missing, called anencephaly.

But rather than refer her immediately to hospital and provide a medical report, Charlotte was told the baby's head could not be fully seen and recommended to book an NHS anomaly scan.

She was also given a gender reveal cannon and a teddy bear containing a recording of its heartbeat as a present for her daughter.

"I was distraught," Charlotte said. "You've bonded with that baby."

"It's like a deep cut feeling," she added. "All of it could have just been avoided, we could have processed the news all together as a family because I was with my mum and dad, I would have had the support there."

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Source: BBC News, 18 November 2020

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Delays to Covid-only care home plan could strand patients, warn England health chiefs

Covid patients could be left to languish in hospital and block NHS beds amid delays in setting up “hot” care homes dedicated to receiving them, health chiefs have warned.

A plan to reduce care home coronavirus outbreaks by setting up “hot homes” to receive infected people discharged from hospital is running late after dozens of councils missed a government deadline to nominate locations.

By the end of October every area of England was supposed to have at least one facility approved for Covid-positive discharges, the government pledged last month. It was part of an attempt to prevent a repeat of the spring pandemic, which killed more than 18,000 residents after thousands of patients were discharged into care homes without tests.

But as hospital admissions with Covid continue to rise, only 67 out of 151 local authorities have one set up, according to figures from the Care Quality Commission (CQC).

NHS Providers, which represents NHS trusts, said the delays were adding to discharge problems, causing increasing patient stays and a growing number of “super-stranded” patients.

“While the new discharge requirements are well-intentioned and aimed at protecting the most vulnerable in care homes, the challenge of implementing the changes has created blockages across mental health, acute and community beds,” said Miriam Deakin, the director of policy and strategy at NHS Providers.

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Source: The Guardian, 18 November 2020

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Baby dies after ‘excessive force’ during forceps delivery

A coroner has urged ministers to revisit plans to make it possible to hold inquests into babies that are stillborn after a baby died due to “excessive force” during an attempted forceps delivery.

Senior coroner Caroline Beasley-Murray has written to the Ministry of Justice after she was forced to stop hearing evidence into the death of baby Frederick Terry, known as Freddie, who died under the care of the Mid and South Essex Hospitals Trust on 16 November, last year.

An inquest into his death was started in September where Freddie was found to have died after suffering hypovolaemic shock as a result of losing a fifth of his blood when his skull was fractured during a traumatic birth attempt. In a report on the case the coroner said: “Baby Frederick Joseph Terry was delivered by caesarean section, after a failed forceps attempted delivery on 16 November 2019 and death was confirmed after 40 minutes of resuscitation attempts."

"The evidence showed that baby Freddie's very serious scalp and brain injuries were sustained during the failed forceps attempted delivery and, but for these, baby Freddie would have survived as a perfectly formed, healthy baby."

The coroner said the injuries he sustained implied “an excessive degree of force” in the application of the forceps, which are curved metal instruments that fit around a baby’s head and are designed to help deliver the baby.

The inquest had to be stopped from hearing any more evidence because coroners are not able to investigate stillborn babies.

As part of her report, the coroner said: “It would have been helpful for there to have been, during the course of the inquest, an exploration, in the course of evidence, of the treatment and care provided to baby Freddie and his parents at the time of delivery.

"Currently there is no legislation to cover the holding of a coroner’s inquest into a stillbirth. In March 2019, the Government issued a consultation on coronial investigations of stillbirths It would be helpful for this important topic to be progressed, whatever the ultimate jurisdictional decisions.”

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Source: The Independent, 17 November 2020

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Top teaching trust blames surge in long A&E waits on covid measures

A top teaching hospital has blamed covid measures for a dramatic rise in the number of trolley waits in its accident and emergency department.

In October, 111 patients at Cambridge University Hospitals (CUH) Foundation Trust, which runs Addenbrooke’s Hospital, waited more than 12 hours for admission, despite the region’s relatively low covid rates. 

CUH recorded just nine 12-hour waits in September and 27 in August. It had no 12-hour waits in either June or July this year, and in October 2019, it had only one. 

The trust also had 761 patients who waited more than four hours from the decision to admit to admission last month, out of a total of 2,998 emergency admissions. 

CUH director of operations Holly Sutherland said: “We have had to reorganise the hospital to meet infection control requirements and to reduce the risk of covid-19 transmission. With limited side room availability due to the age of our facilities, this has reduced the number of beds in the hospital by around 100 and has impacted on patient flow from the emergency department."

“We would like to apologise to anyone affected by this, and to reassure our patients that their safety is our utmost priority and we are doing everything we can to treat them as quickly as possible.”

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Source: HSJ, 18 November 2020

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Coronavirus: Doctors spell out how to exit England's lockdown

Lifting lockdown must be handled better this time round to avoid a surge in Covid that could overwhelm the NHS, doctors say.

The British Medical Association has published a blueprint for how it thinks England should proceed with any easing. It includes replacing the "rule of six" with a two-households restriction to reduce social mixing and banning travel between different local lockdown tiers.

Government has yet to say if or exactly how England will exit on 2 December.

It will decide next week, based on whether cases have fallen enough and how much strain hospitals are under.

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Source: BBC News, 18 November 2020

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Energy drinks increase stillbirth risk but pregnant women’s caffeine guidance is confusing

Expectant mothers are being warned about potentially confusing guidance on consuming caffeine while pregnant, as research suggests energy drinks could have potentially deadly consequences for their babies.

A new report by Tommy’s Maternal and Fetal Health Research Centre claims to have established a 27 per cent rise in the risk of stillbirth for each 100mg of caffeine consumed.

Researchers compared stillbirths to ongoing pregnancies among 1,000 women across 41 hospitals from 2014 to 2016 as well as interviewing women about their consumption of caffeinated drinks. They adjusted for demographic and behavioural factors, such as age and alcohol consumption, to determine whether stillbirth was linked to caffeine.

One in 20 women were found to have increased their caffeine intake while pregnant in spite of evidence some caffeinated drinks put babies lives at risk. However, experts say that calculating precise intake can be difficult, and guidance on limiting caffeine is not consistent

The NHS recommends pregnant women keep their daily caffeine intake below 200mg whereas the World Health Organization stipulates 300mg as the safe amount to consume.

Tommy’s, a leading baby charity, called for both the NHS and the World Health Organisation to rethink such guidelines, but refused to outline a specific limit - saying it was the NHS and World Health Organisation’s responsibility to decide the recommendations in light of their new study.

Professor Alexander Heazell, an author of the study, said: “Caffeine has been in our diets for a long time, and, as with many things we like to eat and drink, large amounts can be harmful – especially during pregnancy. It’s a relatively small risk, so people shouldn’t be worried about the occasional cup of coffee, but it’s a risk this research suggests many aren’t aware of."

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Source: The Independent, 18 November 2020

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Physician predicts 'unprecedented surge' in US COVID-19 cases after Thanksgiving

Coronavirus cases in the US will spike after Thanksgiving, further stressing health care systems and prompting new restrictions, an emergency physician said Saturday, as states continued to report soaring numbers of new cases, hospitalizations and deaths.

Dr. James Phillips, chief of disaster medicine at George Washington University Hospital, told CNN's Erica Hill he is "terrified" about what's going to happen this holiday season.

"We're going to see an unprecedented surge of cases following Thanksgiving this year, and if people don't learn from Thanksgiving, we're going to see it after Christmas as well," Phillips said.

Already, grim indicators offer a glimpse of what's to come. A little more than a week after the US first topped 100,000 daily infections, it reported a record of more than 184,000 new cases Friday. Hospitalisations also hit a new high – for the fourth consecutive day – with more than 68,500 COVID-19 patients nationwide, according to the COVID Tracking Project. And the country's daily death toll has topped 1,300 at least three times this week.

"Things are going to get much, much worse," said Dr. Leana Wen, a CNN medical analyst and former Baltimore Health Commissioner. She expressed concern over the impact on the already-strained health care system when the new cases added in recent days are reflected in hospitalisations.

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Source: CNN, 15 November 2020

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Mothers needlessly separated from babies under UK hospital Covid rules

Mothers are being needlessly separated from their babies under strict hospital restrictions introduced to stop the spread of COVID-19, doctors and charities have warned.

The measures preventing UK parents from staying with their babies when one or both require hospital treatment are causing trauma and increasing the risk of physical and mental health problems, it is claimed.

Some parents of sick babies are also being barred from seeing their child in neonatal units, which is causing distress and preventing bonding.

Campaigners have written to the health secretary, Matt Hancock, to raise their concerns. They want hospitals to review these policies urgently and have called for a working group to draw up national standards to meet families’ needs during pregnancy, birth and breastfeeding.

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Source: The Guardian, 16 November 2020

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Labour demands new NHS investment as patients wait longer for surgery

Labour is demanding new investment for the NHS as part of the government’s spending review next week, after analysis shows hundreds of thousands of patients are waiting for life-changing operations.

The party’s shadow health secretary, Jonathan Ashworth, will challenge Matt Hancock in Parliament on today over the latest NHS data, which reveal almost 500,000 patients are waiting for surgery on their hips, knees and other bones.

Last week, NHS England published new data showing more than 1.7 million people were waiting longer than the NHS target of 18-weeks for treatment. The target was last met in February 2016.

An analysis of NHS England data reveal which specialities have been hardest hit by the growing backlog of operations, which has soared since the first wave of coronavirus caused widespread hospital cancellations earlier this year.

There were 4.3 million patients on NHS waiting lists for hospital treatments in September. Labour said this included 477,250 waiting for trauma and orthopaedic surgery, with 252,247 patients waiting over 18 weeks.

The next worst specialty was ophthalmology, which treats eye disorders, with 444,828 patients on waiting lists, 233,425 of whom have waited more than 18 weeks.

There were six figure waiting lists over 18 weeks for other specialties including gynaecology, urology, general surgery, and ear, nose and throat patients.

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Source: 17 November 2020

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'Diabetes burnout': The mental health impact of diagnosis

"It's a full-time job that you can't quit. It's a massive burden that you didn't ask for, didn't expect."

Diagnosed with type 1 diabetes at the age of 19, Naomi, now 33, says she reached a point where she simply could not handle "the physical or mental challenges of diabetes any more", a condition known as "diabetes burnout".

About 250,000 people in England have type 1 diabetes, which means the body cannot produce insulin, the hormone that controls blood sugar levels. It can lead to organ damage, eyesight problems and - in extreme cases - limb amputation. But for many there is also a significant psychological impact of learning to manage the condition.

Naomi felt she could no longer bear testing her blood sugar levels many times each day to calculate how much insulin she needed to inject, even though she knew she was risking her long-term health and putting herself in extreme danger, at risk of developing diabetic ketoacidosis (DKA), which can lead to a coma. She became so ill she was admitted to an eating disorder unit even though she was not struggling to eat.

The head of the unit, Dr Carla Figueirdo, says of her diabetes patients: "These people are seriously unwell, seriously unwell. They are putting themselves at harm every day of their lives if they don't take their insulin."

Naomi's consultant at the Royal Bournemouth Hospital, Dr Helen Partridge, says the psychological impact of a diabetes diagnosis should not be underestimated. 

The hospital is hosting one of two NHS England pilot projects looking at how to treat type 1 diabetes patients whose chronic illness affects their mental health.

NHS England diabetes lead Prof Partha Kar says: "The NHS long-term plan commits strongly on getting mental and physical health together. If we do tackle these two together, it will help improve outcomes."

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Source: BBC News, 16 November 2020

 
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CQC to inspect hospitals on food standards after patient deaths

Hospital food standards are set to be put on a statutory footing, with trusts held to account by the Care Quality Commission, according to the chair of a government-commissioned review.

Philip Shelley, who led the review into hospital food following seven patient deaths from listeria last year, told HSJ the incident was an “absolute condemnation” and that trusts must use the review to improve food standards.

The review, published last month, also calls for capital investment to refurbish hospital kitchens and replace old and inefficient equipment, which is likely to cost several hundreds of millions of pounds.

The government has accepted the recommendations and Mr Shelley will lead a group of experts to oversee the review’s implementation across the NHS during the next three years.

Among the review’s recommendations is the “enhanced role” for the CQC when it inspects NHS trusts.

The review states there is currently “very little evidence to prove that food and drink standards are being monitored closely enough” and it therefore recommends placing the standards on a statutory footing from which the CQC can hold trusts to account.

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Source: HSJ, 17 November 2020

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Patients harmed amid ‘internecine squabbles’ and cover-up claims

Several patients were harmed after leaders at an acute trust failed to act on multiple concerns being raised about a surgeon, documents obtained by HSJ suggest.

The documents reveal a catalogue of governance and safety concerns over the trauma and orthopaedics department at University Hospitals of Morecambe Bay Foundation Trust in the last three years.

They include an external review which described the process for investigating clinical incidents as akin to “marking your own homework” and found the T&O department at Royal Lancaster Infirmary driven by “internecine squabbles”.

It comes as the trust, which is widely known for a patient safety scandal within its maternity department, also faces a major investigation into whistleblowing concerns over its urology services.

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Source: HSJ, 17 November 2020

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Major delays for new NHS England covid service

A key expansion of services for patients recovering from coronavirus has been delayed by several months, HSJ has learned.

In July, NHS England hailed a “ground breaking” new service with the launch of a website with information for patients on how to recover from covid following hospital discharge. It promised a second phase of the service would allow patients to be connected with health professionals for more tailored support, to be launched “later this summer”.

But in a memo sent to professional bodies on 30 October, NHSE said the national roll-out was delayed until at least January 2021, with no date confirmed for the launch beyond that.

Documents on the website itself said a “first cohort of patients from Leicester will begin to work through the programme” in November, with a further rollout scheduled for early December, followed by a “refresh” in January 2021 and a “full national rollout accessible across the country” at an unspecified date beyond that.

The second phase is seen as vital for ensuring that people with covid receive personalised support to help them recover from its debilitating effects, especially as a separate face-to-face rehabilitation programme was scrapped due to costs.

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Source: HSJ, 16 November 2020

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More than 75% of NHS midwives think staffing levels unsafe, says RCM

More than three-quarters of midwives think staffing levels in their NHS trust or board are unsafe, according to a survey by the Royal College of Midwives (RCM).

The RCM said services were at breaking point, with 42% of midwives reporting that shifts were understaffed and a third saying there were “very significant gaps” in most shifts.

Midwives were under enormous pressure and had been “pushed to the edge” by the failure of successive governments to invest in maternity services, said Gill Walton, the chief executive of the RCM.

“Maternity staff are exhausted, they’re demoralised and some of them are looking for the door. For the safety of every pregnant woman and every baby, this cannot be allowed to continue,” she said.

“Midwives and maternity support workers come into the profession to provide safe, high-quality care. The legacy of underfunding and underinvestment is robbing them of that – and worse still, it’s putting those women and families at risk.”

RCM press release

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Source: The Guardian, 16 November 2020

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How to overcome COVID-19 fatigue

Eight months after phrases such as “stay at home,” “flatten the curve” and “social distancing” started to become part of our daily vocabulary, people are experiencing a type of burnout experts call COVID-19 fatigue.

“By this point, we know people are tired — tired of missing family and friends, tired of not having a routine, of not going into the office,” said Jeanne Marrazzo, M.D., director of the University of Alabama at Birmingham (UAB) Division of Infectious Diseases. “Whatever disruptions to a person’s normal life have occurred, there is no denying the mental, physical and emotional toll people are experiencing. What we’ve learned — and what we keep learning — is how to combat burnout in safe ways that minimize the spread of the virus and enable us to feel some sense of normalcy.”

Figuring out how to safely navigate the new normal is more important than ever, explain UAB experts, particularly heading into more vulnerable and trying winter months that present unique challenges.

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Source: University of Alabama at Birmingham, USA, 6 November 2020

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