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Contraception shortage 'causing utter chaos'

A shortage of contraception is causing chaos and risks unplanned pregnancies and abortions, doctors are warning.

Leading sexual health experts have written to ministers warning that the supply shortage of contraceptives is beginning to lead to serious problems across the UK.

A number of daily pills and a long-acting injectable contraceptive are thought to be affected, including Noriday, Norimin and Synphase. The problem follows a shortage of hormone replacement therapy for menopausal women last year.

It is unclear how many women use these types of contraception - overall around three million women take daily pills, and more than 500,000 use long-acting contraception, such as coils, implants and injections.

The Royal College of GPs said its members were doing their best to help women find alternatives - there are many different types of daily pill available.

Faculty president Dr Asha Kasliwal said; "We are aware that women are sent away with prescriptions for unavailable products and end up lost in a system. This is causing utter chaos."

The faculty has teamed up with the Royal College of Obstetricians and Gynaecologists and the British Menopause Society to write to ministers, asking them to set up a working group to address the problems. The letter warns women are becoming distressed by having to find alternative products that might not necessarily suit them or go without contraception altogether.

It said this was affecting the "physical and mental wellbeing of girls and women" and could lead to a "rise in unplanned pregnancies and abortions".

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Source: BBC News, 7 February 2020

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Report highlights ‘toxic’ risk of beta blocker to prevent overdose deaths

The toxicity of a commonly prescribed beta blocker needs better recognition across the NHS to prevent deaths from overdose, a new report warns today.

The Healthcare and Safety Investigation Branch (HSIB) report focuses on propranolol, a cardiac drug that is now predominately used to treat migraine and anxiety symptoms. It is highly toxic when taken in large quantities and patients deteriorate quickly, making it difficult to treat. The investigation highlighted that these risks aren’t known widely enough by medical staff across the health service, whether issuing prescriptions to at risk patients, responding to overdose calls or carrying out emergency treatment.

Dr Stephen Drage, ICU consultant and HSIB’s Director of Investigations, said: “Propranolol is a powerful and safe drug, benefitting patients across the country. However, what our investigation has highlighted is just how potent it can be in overdose. This safety risk spans every area of healthcare – from the GPs that initially prescribe the drug, to ambulance staff who respond to those urgent calls and the clinicians that administer emergency treatment."

The report also emphasises that there is a link between anxiety, depression and migraine, and that more research is needed to understand the interactions between antidepressants and propranolol in overdose.

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Source: HSIB, 6 February 2020

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NHS England urgently appeals to GPs to staff triage service

A key element in the new covid-19 response service run by NHS 111 urgently needs more doctors, NHS England has said.

The national covid-19 clinical assessment service, or CCAS, serves a cohort of patients with coronavirus symptoms deemed by 111 as needing a clinical assessment over the phone or online.

An email to GPs from NHSE’s primary care directors on Friday evening said: “We urgently need more GPs help to staff this service, especially as covid-19 cases increase over coming days, because of your expertise and experience.”

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Source: HSJ, 6 April 2020

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‘Culture of blame’ found at troubled health trust

The former police chief who investigated mental health services in a crisis-hit health board was “shocked” by the poor working relationships and “blame shifting” he uncovered.

David Strang, who led the independent inquiry into the issues in NHS Tayside, said staff felt isolated and unsupported and people complained about each other’s practices without coming together to sort the issues out.

He described asking staff questions based on information he had received and being met with the response: “Who told you?” He added: “A lot of staff felt there was a real blame culture and that risk and blame fell to the front line.”

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Source: 6 February 2020, The Times

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Mental health: 'Urgent action needed over epidemic'

The new executive must act urgently if it is to "divert the current mental health epidemic among young people", Northern Ireland's children's commissioner has said.

Koulla Yiasouma said progress in implementing recommendations in a report on children and young people's mental health services, produced 12 months ago, had been "too slow". 

The stark read captured the scale of youth mental health problems in Northern Ireland. The report found that young people are waiting too long to ask for help and even longer to access the right support.

Health Minister Robin Swann said his aim was that young people do not wait longer than nine weeks to see a CAMHS (child and adolescent mental health services) professional."I take the mental health and wellbeing of our children and young people very seriously and I am committed to working with my colleagues in a new executive working group on mental well-being, resilience and suicide prevention," he said.

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Source: 6 February 2020

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Hospital whistleblower raised alarm over doctor seen injecting himself

A whistleblower raised the alarm over patient safety at West Suffolk Hospital because of concerns about the behaviour of a doctor who had been seen injecting himself with drugs, the Guardian has revealed.

The incident had already prompted internal complaints from senior staff at West Suffolk hospital, but the whistleblower decided to take matters a step further when the same doctor was later involved in a potentially botched operation. The whistleblower then wrote to relatives of a dead patient and urged them to ask questions about the conduct of the doctor and his background.

When they did this, the hospital launched a widely criticised “witch-hunt” in an attempt to find out the identity of the leaker.

The doctor’s drug use, which the trust has never acknowledged until now, helps explain why it demanded fingerprint and handwriting samples from staff – tactics which the NHS regulator roundly condemned in a hard-hitting report last week.

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Source: Guardian, 5 February 2020

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Coronavirus: Every hospital in England must create secure zones for patients

All NHS hospitals in England have been ordered to create secure areas for coronavirus testing to “avoid a surge in emergency departments”, according to a leaked NHS letter.

Hospitals have been told to create “coronavirus priority assessment pods”, where people will be checked for the virus, which will need to be decontaminated each time they are used.

The letter, seen by The Independent and dated 31 January, instructs all chief executives and medical directors to have the pods up and running no later than Friday 7 February.

It comes as the global death toll from the virus has reached 565 with around 28,000 infected.

One hospital chief executive told The Independent he believed the requirement was “an overreaction”, adding: “I think we should be sending teams out to swab in patients homes as the advice is to stay at home and self-manage as with any other flu".

In the letter, Professor Keith Willett, who is leading the NHS’s response to coronavirus, told NHS bosses: “Plans have been developed to avoid a surge in emergency departments due to coronavirus. “Although the risk level in this country remains moderate, and so far there have been only two confirmed cases, the NHS is putting in place appropriate measures to ensure business as usual services remain unaffected by any further cases or tests of coronavirus.”

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Source: 5 February 2020

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Paterson scandal: Is the NHS learning from mistakes?

Shipman, Mid Staffordshire, Morecambe Bay, and now Ian Paterson, the breast surgeon that performed botched and unnecessary operations on hundreds of women. The list of NHS-related scandals has got longer. It's tempting to say the health service has not learned lessons even after a string of revelations and reviews. But is that fair? asks BBC Health Editor Hugh Pym.

The inquiry, chaired by Bishop Graham James, makes clear there were failings at every level of a dysfunctional health system when it came to patient safety.

The public and private health systems did not compare notes about suspicious behaviour by a consultant. Staff working with Paterson thought that his surgical methods were unusual but, perhaps cowed by being ignored after raising concerns, kept their heads down. Add to that the power and status of a surgeon in the medical world and, in the words of the report, Paterson was "hiding in plain sight".

So could it happen again?

James says it's clearly impossible to eliminate the activities of determined criminals in any profession. He acknowledges that some improvements have been made on policing. But he says that a decade on from the Paterson scandal, he is not convinced that medical regulators, with a combined budget of half a billion pounds a year, are doing enough collectively or collaboratively to make the system safe for patients.

The review chair notes tellingly that while regulators spoke of major improvements which should identify another Paterson, some doctors and nurses had told the inquiry that it was "entirely possible that something similar could happen now".

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Source: BBC News, 4 February 2020

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Scotland's A&E waiting times hit record high

A&E waiting times have hit a record high, as more than 1,000 people waited at least 12 hours to be seen by a doctor for the first time since records began.

Official statistics released yesterday show the proportion of people left waiting more than eight and 12 hours in December were at the worst level for a single month since records started in 2007. Patients who were seen within the four-hour waiting time target also reached the lowest level on record.

Scottish Conservatives health spokesman Miles Briggs described the figures as "an utter disaster".

Mr Briggs said: "Patients are waiting in pain, discomfort and distress which in turn significantly affects staff."

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Source: The Telegraph, 4 February 2020

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The Chinese doctor who tried to warn others about coronavirus

In early January, authorities in the Chinese city of Wuhan were trying to keep news of a new coronavirus under wraps. When one doctor tried to warn fellow medics about the outbreak, police paid him a visit and told him to stop. A month later he has been hailed as a hero, after he posted his story from a hospital bed.

It's a stunning insight into the botched response by local authorities in Wuhan in the early weeks of the coronavirus outbreak.

Dr Li was working at the centre of the outbreak in December when he noticed seven cases of a virus that he thought looked like SARS - the virus that led to a global epidemic in 2003. On 30 December he sent a message to fellow doctors in a chat group warning them about the outbreak and advising they wear protective clothing to avoid infection. What Dr Li didn't know then was that the disease that had been discovered was an entirely new coronavirus.

Four days later he was summoned to the Public Security Bureau where he was told to sign a letter. In the letter he was accused of "making false comments" that had "severely disturbed the social order". "We solemnly warn you: If you keep being stubborn, with such impertinence, and continue this illegal activity, you will be brought to justice - is that understood?" 

He was one of eight people who police said were being investigated for "spreading rumours".

At the end of January, Dr Li published a copy of the letter on Weibo and explained what had happened. In the meantime, local authorities had apologised to him but that apology came too late.

For the first few weeks of January officials in Wuhan were insisting that only those who came into contact with infected animals could catch the virus. No guidance was issued to protect doctors.

"A safer public health environment… requires tens of millions of Li Wenliang," said one reader of Dr Li's post.

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Source: BBC News, 4 February 2020

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Ian Paterson: Surgeon wounded hundreds amid 'culture of denial'

A culture of "avoidance and denial" allowed a breast surgeon to perform botched and unnecessary operations on hundreds of women, an independent inquiry has found.

The independent inquiry into Ian Paterson's malpractice has recommended the recall of his 11,000 patients for their surgery to be assessed.

Paterson is serving a 20-year jail term for 17 counts of wounding with intent. One of Paterson's colleagues has been referred to police and five more to health watchdogs by the inquiry.

The disgraced breast surgeon worked with cancer patients at NHS and private hospitals in the West Midlands over 14 years.

His unregulated "cleavage-sparing" mastectomies, in which breast tissue was left behind, meant the disease returned in many of his patients. Others had surgery they did not need - some even finding out years later they did not have cancer.

Patients were let down by the healthcare system "at every level" said the inquiry chair, Bishop of Norwich the Rt Revd Graham James, who identified "multiple individual and organisational failures".

One of the key recommendations from the report is that the Government should make patient safety a the top priority, given the ineffectiveness of the system identified in this Inquiry. 

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Source: BBC News, 4 February 2020

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Surrey hospital trust becomes first in country to appoint nurse to prevent patient falls

A Surrey hospital trust has become the first in the country to appoint a nurse dedicated to preventing patient falls and medication mix-ups.

The consultant nurse has been appointed by Ashford and St Peter's (ASP) Hospital NHS Foundation Trust to reduce the number of patients who are injured while being treated at its sites.

This includes looking at ways to reduce the amount of people who fall over, suffer with venous thromboembolism or experience tissue damage while in hospitals in north west Surrey.

The trust says the harms prevention nurse will be the first in the country hired for such a role and will also work with the team who look at incidents of medication mix-ups and mistakes.

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Source: Surrey Live, 4 February 2020

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Doctors in row with HSE over claims children's transgender care is 'unsafe'

A number of doctors have claimed a service under which adolescents with gender dysphoria can be given puberty-suppressing hormone blockers is "unsafe" and must be immediately stopped, but their concerns were suppressed.

The service is provided in Ireland by flying in two clinicians from an NHS trust in London to run clinics at Crumlin Children's Hospital. But the Irish Independent has learned at least three doctors working in the gender area expressed grave concerns over the service provided by the Tavistock and Portman NHS Foundation Trust at Crumlin.

The concerns over standards of clinical care and governance were raised at a meeting of doctors and hospital officials in Crumlin last March. These included that children had been started on hormone treatment when they did not appear to be suitable. However, the issues raised and calls by the doctors for the service to be "terminated with immediate effect" were omitted from draft minutes of the meeting.

News of their concerns comes days after it emerged a lawsuit was being taken by a former nurse, a parent, and a former patient against the trust in the London High Court. The action is challenging the clinic's practice of prescribing hormone blockers and cross-sex hormones to children under the age of 18.

The trust has also been hit by a series of resignations by psychologists amid disquiet about the alleged "over-diagnosis" of gender dysphoria.

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Source: Irish Independent, 3 February 2020

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Prime Minister urged to give NHS 100 new hospitals plus an extra £7bn a year

NHS leaders have urged Boris Johnson’s government to build 100 new hospitals and give the service an extra £7bn a year for new facilities and equipment. They want the Prime Minister to commit to far more than the 40 new hospitals over the next decade that the Conservatives pledged during the general election.

So many hospitals, clinics and mental health units are dilapidated after years of underinvestment in the NHS’s capital budget that a spending splurge on new buildings is needed, bosses say. Too many facilities are cramped and growing numbers are unsafe for patients and staff, they claim.

Johnson has promised £2.7bn to rebuild six existing hospitals and pledged to build 40 in total and upgrade 20 others, although has been criticised for a lack of detail on the latter two pledges.

The call has come from NHS Providers, which represents the bosses of the 240 NHS trusts in England that provide acute, mental health, ambulance and community-based services.

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Source: The Guardian, 3 February 2020

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NHS hospitals bring in sleep pods to help tired staff take a break

Help is arriving for overworked NHS staff as a growing number of hospitals bring in sleep pods for doctors and nurses to grab power naps during their shifts.

Pods have been installed or are being trialled by a dozen hospitals in England. Royal Wolverhampton NHS trust was the first to try them, in June 2018. “Too many staff end up exhausted because they have long, busy, sometimes stressful shifts, often with little chance to grab a break because pressure on the NHS is so intense,” said Prof Steve Field, the trust’s chair.

“We know that doctors provide better, safer care when they are fresh and alert. We have found [the pods] to be very popular with staff and also very effective in helping them get more rest,” said Field, a former GP.

Dr Mike Farquhar, a consultant in sleep medicine at the Evelina children’s hospital in London, who has persuaded NHS chiefs to take staff slumber more seriously, said hospitals were finally taking practical action.

“Air traffic controllers are only allowed to work for two hours and then they must take a 30-minute break, because if they were tired and made a mistake, bad things could happen,” he said. “But in the NHS, where the pressure is often high and sustained, the problem is that the people delivering care will usually choose to prioritise everything else – especially patients – over themselves and sacrifice things like breaks and sleep.”

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Source: The Guardian, 3 February 2020

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'My baby died of sepsis - we can stop more deaths'

New monitors that can detect the deadly blood condition sepsis are being fitted at a Scottish children's hospital. The equipment will be installed at the Royal Hospital for Children in Glasgow.

Charlotte Cooper, who lost her nine-month-old daughter Heidi to sepsis last year, said she had "no doubt" the monitors would help save babies' lives. She told BBC Scotland: "You don't have time to come to terms with the fact that someone you love is dying from sepsis because it happens so quickly."

Ms Cooper now wants to see the monitors installed in every paediatric ward in Scotland. "We need to do whatever we can to stop preventable deaths from sepsis in Scotland," she said.

The monitors record and track changes in heart rate, temperature and blood pressure, and can pick up early sepsis symptoms. The machines, which have been installed in a critical care area, use the  Paediatric Early Warning Scores to monitor the children for any signs of deterioration in their condition.

Sepsis Research said early warning of the changes would mean sepsis being diagnosed and treated faster.

The monitors were accepted on behalf of the hospital by senior staff nurse Sharon Pate, who said: "In a very busy paediatric word it is vital all our patients are monitored regularly and closely for signs of deterioration. The addition of these new monitors will greatly improve our ability to monitor patients and provide vital care."

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Source: BBC News, 4 February 2020

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Pregnant women must be respected by medics, says regulator

Mothers-to-be must be respected and listened to by medics, regulators have said, after warnings that pleas for pain relief in labour have been ignored. The intervention by the Nursing and Midwifery Council (NMC) follows an investigation by The Sunday Telegraph.

Last week it was revealed that six NHS trusts were in breach of medical guidance which says pain relief should be provided at any point of labour if it is requested. Women said they were told “‘It’s not called labour for nothing, it’s meant to be hard work” as doctors refused their pleas.

The findings prompted the Health Secretary to order an investigation. 

Today Andrea Sutcliffe, Chief Executive of the NMC, which regulates nurses and midwives said such actions should not be tolerated. In a letter to The Telegraph she said: "As the regulator for nursing and midwifery professionals, we know that all women deserve to have their views, preferences and decisions respected during pregnancy and birth."

The watchdog recently published updated standards for midwives, which she said underlined this point. 

"Enabling women to make safe, informed decisions about the care they receive, including choices about pain relief during birth, is at the heart of our new Future Midwife Standards," the Chief Executive continued. 

Ms Sutcliffe said midwives should work "in partnership" with women in labour. "While midwives don’t administer epidurals, they do play a key role in helping women to make informed choices and advocating on their behalf to make sure those choices are understood and respected by the wider care team," she said.

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Source: The Telegraph, 2 February 2020

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NHS Trusts spent £20 million battling whistleblowers, workplace discrimination claims and employment disputes

NHS Trusts have spent nearly £20 million in four years battling whistleblowers, defending claims of workplace discrimination and fighting employment disputes, the Sunday Telegraph can disclose.

Data obtained through Freedom of Information (FOI) has revealed that a minority of healthcare trusts, often advised by the same law firms, are repeatedly running up huge legal bills.

Former health minister Sir Norman Lamb said some of the NHS employment cases he has witnessed in the last eighteen months involved ‘scandalous’ uses of public money. “It is not all NHS trusts in the country, but there are a small number where the culture is clearly wrong,” said Sir Norman.

Commenting on the findings, Tim Farron, former leader of the Liberal Democrats, who has fought for whistleblowers in his own constituency,  said: “Millions of pounds of tax payers’ money is being spent across our health service by NHS Trusts defending their actions in employment tribunals in cases of discrimination and unfair dismissal. It is only right that questions are being asked."

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Source: The Telegraph, 1 February 2020

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Inquiry into rogue breast surgeon to call for changes to private hospital safety

An independent inquiry is expected to call for major changes in the way private hospitals supervise doctors after hundreds of women were put through unnecessary operations by a rogue breast surgeon.

Ian Paterson was jailed for 20 years in 2017 after being convicted of 13 counts of wounding with intent and three counts of unlawful wounding. But his surgical malpractice may have harmed more than 750 women over more than a decade.

He carried out unnecessary surgery for breast cancer on women who did not have the disease, and put other women who did at risk by using his own unofficial technique, which left behind partial breast tissue.

On Tuesday an inquiry chaired by the Bishop of Norwich, the Right Reverend Graham James, will be published and is expected to make recommendations about how doctors are allowed to work across both the NHS and private sector with minimal supervision and oversight.

One key area of focus is expected to be a process known as “practising privileges”, where private hospitals allow clinicians to carry out their own activities within the hospital, similar to self-employed contractors. They effectively rent the hospital space for their work.

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Source: The Independent, 2 February 2020

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CQC calls for NHSE to publish 'safety test' of triage apps amid warnings of variation

Healthcare apps that triage patients should be put through a ‘fair test of clinical performance’ published by NHS England to ensure their safety, according to the Care Quality Commission (CQC).

In addition, the Department of Health and Social Care should look into whether ‘safety-netting’ advice should be available to the public about how to use symptom checkers, said the CQC.

The CQC made the recommendations as part of work to shape its approach to regulating healthcare apps. It found digital triage tools are currently not fully clinically validated or tested by product regulators and discovered ‘there is great variation in their clinical performance’.

NHS England and other bodies should assess where people have been wrongly escalated, resulting in undue anxiety, as well as where tools have failed to address people’s ill health, said the CQC.

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Source: PULSE, 30 January 2020

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Nurse died from cervical cancer after catalogue of errors

A nurse from South Gloucestershire died after doctors missed signs of her cervical cancer amid a series of "gross" failings, a coroner has ruled.

Julie O’Connor’s cancer was not picked up by North Bristol NHS Foundation Trust despite abnormalities in a smear test in 2014 and a biopsy in 2015. She went for multiple further checks for gynaecological problems in 2016 and 2017 and was referred three times to specialists. However, Ms O'Conner only received a cancer diagnosis once she decided to seek private treatment at Spire Hospital in Bristol.

An inquest into her death was held in Flax Bourton, Somerset, this week.

Maria Voisin, Senior Coroner for the Avon area, found the cause of Ms O’Connor’s death to be of “natural causes contributed to by neglect". She recorded three instances of "gross failures" including the inaccurate smear test as well as mistakes in two further assessments.

Deputy medical director Tim Whittlestone said: “We accept the findings of the coroner and support her actions to build on our correspondence with the Royal College of Obstetricians and Gynaecologists."

“...I would like to reaffirm that North Bristol has investigated these errors and more importantly that we have learnt lessons from our mistakes."

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Source: Nursing Times, 31 January 2020

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Two coronavirus cases confirmed in UK

Two people have tested positive for coronavirus in the UK, the Chief Medical Officer for England has announced.

They are both members of the same family and are receiving specialist NHS care. No more details are being released about their identity or where they are being treated.

At least 213 people in the China have died from the virus, mostly in Hubei, with almost 10,000 cases nationally. There have been 98 cases of the virus in another 18 countries.

Prof Chris Whitty, Chief Medical Officer for England said: "The NHS is extremely well-prepared and used to managing infections and we are already working rapidly to identify any contacts the patients had, to prevent further spread. "We have been preparing for UK cases of novel coronavirus and we have robust infection control measures in place to respond immediately," he added.

Prof Whitty said the UK was working closely with the World Health Organization (WHO) and the international community as the outbreak in China develops "to ensure we are ready for all eventualities".

The new coronavirus was declared a global emergency yesterday by the World Health Organization, as the outbreak continues to spread outside China.

"The main reason for this declaration is not what is happening in China but what is happening in other countries," said WHO Chief Tedros Adhanom Ghebreyesus.

The concern is that it could spread to countries with weaker health systems.

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Source: BBC News, 31 January 2020

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‘Inherently risky’ children’s cancer service to be overhauled

Children’s cancer services in south London are to be reconfigured after a new review confirmed they represented an “inherent geographical risk to patient safety” — following HSJ revelations last year of how serious concerns had been “buried” by senior leaders.

Sir Mike Richards’ independent review was commissioned after HSJ revealed a 2015 report linking fragmented London services to poor quality care had not been addressed, and clinicians were facing pressure to soften recommendations which would have required them to change.

The review, published in conjunction with Thursday’s NHS England board meeting, recommended services at two sites should be redesigned as soon as possible to improve patient experience.

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Source: HSJ, 31 January 2020

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Number of self-harm incidents in prisons reaches record high

Levels of self-harm in prisons have hit a new high, with more than 60,000 incidents in a year, official figures show.

The number of self-harm incidents was up 16% to 61,461 in the 12 months to September 2019, when there were 53,076, according to data released by the Ministry of Justice (MoJ).

Prison reform campaigners have criticised the government for failing to respond effectively to serious mental health problems and called Thursday’s figures a “national scandal”.

Deborah Coles, the Director of the charity Inquest, said: “Despite investment and scrutiny, the historical context shows that still more people are dying in prison than ever before. A slight recent reduction in the number of deaths comes alongside unprecedented levels of self-harm, while repeated recommendations of coroners, the prison ombudsman and inspectorate are systematically ignored."

"This is a national scandal and reflects the despair and neglect in prisons. Despite this, the health and safety of people in prison appears to be very low on the agenda of the new government."

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Source: 30 January 2020

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Report reveals the impact of Freedom to Speak Up

A new report published by the National Guardian’s Office reveals that the perception of the speaking up culture in health is improving.

An annual survey, conducted by the National Guardian’s Office, asked Freedom to Speak Up Guardians, and those in a supporting role, about how speaking up is being implemented in their organisation. The results reveal details about the network’s demographics and their perceptions of the impact of their role.

Headlines from the survey include a measure of whether those in speaking up roles think their work is making a difference, with 76 per cent agreeing or strongly agreeing – compared to 68 per cent last year. They also reported that awareness of the guardian role is improving.

“It’s really important we listen to guardians in order to understand the impact Freedom to Speak Up is making,” said Dr Henrietta Hughes OBE, National Guardian for the NHS. “The report we are publishing today will help organisations better understand how to work with their guardians to improve their speaking up cultures.”

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Source: National Freedom to Speak Up, 30 January 2020

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