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NHS admin: how does it affect patient experience?

At one time or another, most of us have experienced feeling frustrated by bureaucratic processes, outdated IT systems or unsatisfactory interactions with administrative staff. 

As in many other parts of our lives, when the administrative aspects of a service seem poor (and when they seem good) it can have a significant impact on how we feel about our experience of using it overall. In the case of healthcare, this often comes at a time when we are already feeling anxious. In some cases, administration can also have an impact on the care we receive – for example, if an appointment is delayed. For these reasons alone (though there are many others) NHS administration is important.

Despite this, there has been very little research into NHS administration and its impact on service users, and it is not routinely captured in NHS data. The King’s Fund are kicking off a project to explore patients’ experiences of NHS administration in more detail. As a first step, they reviewed a random sample of over 300 comments written on the Care Opinion website between 2016 and 2018.

This analysis is just the beginning. Over the next few months, The King's Fund will speak to patients and NHS staff to understand the issues around NHS administration in more detail. For more information, see their project page.

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Source: The King's Fund, 13 September 2019

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Cancer survival in the UK improving, but lagging behind

Cancer survival in the UK is on the up, but is still lagging behind other high-income countries, analysis suggests.

Five-year survival rates for rectal and colon cancer improved the most since 1995, and pancreatic cancer the least. Advances in treatment and surgery are thought to be behind the UK's progress.

But the UK still performed worse than Australia, Canada, Denmark, Ireland, New Zealand and Norway, the study in Lancet Oncology found. Cancer Research UK said the UK could do better and called for more "investment in the NHS and the systems and innovations that support it".

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Source: BBC News, 12 September 2019

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Pregnancy-related deaths are rising in the US. Geisinger among 30 health systems testing digital tools to stop the trend

Pregnancy-related deaths and maternal morbidity continue to rise in the US. A major factor is large areas of the country, 'maternity deserts' have little or no proper maternity care, officials say.

So 30 health systems are teaming up to implement digital tools and new care models to help close gaps in care for mothers and infants. Those digital solutions include screening tools to identify pregnant women with comorbidities like diabetes and hypertension to intervene earlier and using telehealth to connect expectant mothers to doulas. 

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Source: FierceHealthcare, 12 September 2019

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Member of EEAST staff shares sepsis story

To raise awareness of an illness estimated to kill 30 million people a year globally – and up to 44,000 people a year in the UK – East of England Ambulance Service NHS Trust (EEAST) is encouraging people to learn to spot the signs of sepsis – and know what to do.

As part of World Sepsis Day, EEAST staff have been sharing stories about how they have been affected by sepsis in their families.

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Source: East of England Ambulance Service NHS Trust, 13 September 2019

 

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Northwest Ambulance Service case review published

The National Guardian’s Office (NGO) has published a 'Summary of speaking up learning and actions' in response to the referrals made from the review into the handling of two speaking up cases at Northwest Ambulance Service NHS Trust (NWAS). The review is the product of the NGO’s engagement process, the central feature of which is the actions the trust will take to address the issues highlighted.

These include explaining the scope of the role of the Freedom to Speak Up Guardians and the issues they can support workers to raise. The trust has also committed to consider their approach to the independence, timeliness and handling of investigations into speaking up matters. They also recognised the need to address perceived attitudes towards female workers.

“The trust has outlined significant steps it is making to ensure these issues are taken seriously, and the learning is embedded in effective improvement actions,” explained Dr Henrietta Hughes, National Guardian for the NHS.

Daren Mochrie, NWAS’ Chief Executive, said, “It’s really important for us to give our staff the confidence to be able to share any concerns and observations safely and confidentially. This creates an open and honest reporting culture within the trust. We welcome the findings of the report and are now putting the learning from this into action to even further improve our reporting system.”

Source: National Guardian's Office, 12 September 2019

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Foundation trust to seek merger to avoid ‘patient safety risks’

A mental health trust is preparing to seek a merger or acquisition by another provider in a bid to address its financial challenges, HSJ has learned. 

In a message to staff, North West Boroughs Healthcare Foundation Trust said growing financial pressures were “likely to put the quality and safety of patients at risk”.

It said various options were discussed by governors and the trust board at a meeting yesterday, and it was agreed to pursue a “merger or acquisition of the whole organisation with one or more provider trusts”.

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Source: HSJ, 12 September

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Don’t charge migrants for maternity care, say midwives

Midwives have called on the government to end the policy of charging some migrants for maternity care, saying it undermines trust and creates a climate of fear among vulnerable pregnant women.

A report by Maternity Action, backed by the Royal College of Midwives, says some women were seeking maternity care late in pregnancy, missing tests and treatments, or completely avoiding antenatal care for fear of charges and Home Office sanctions.

“Midwives should not act as gatekeepers to maternity services,” said Gill Walton, chief executive and general secretary of the Royal College of Midwives.

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Source: BMJ, 9 September 2019

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Improving safety in care homes

A new report from the AHSN Network is shining a light on ways we can do more to improve safety for residents of care homes.

The publication showcases over 30 examples of projects delivered by England’s 15 Patient Safety Collaboratives (PSCs) and the Academic Health Science Networks (AHSNs) which host them. They include case studies in medicines safety, dementia, monitoring and screening, and workforce development.

AHSN Network Patient Safety Director Dr Cheryl Crocker, said:

“Many residents have complex healthcare needs, reflecting multiple long-term conditions, significant disability and advanced frailty. All these factors make caring for residents an incredibly difficult job for care homes and their staff.

“Given this operating landscape, there are some fantastic examples of care, safety and quality improvement in care homes. The aim of this summary is to share good practice supported by the AHSN Network, and we are actively encouraging readers to get in touch with those who have shared their work for this report and discuss how we can have even greater impact on patient safety and improvement in care homes.”

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Hundreds of thousands of people in England are getting hooked on prescription drugs

Hundreds of thousands of people in England are getting hooked on prescription drugs, health chiefs fear. 

A Public Health England (PHE) review looked at the use of strong painkillers, antidepressants and sleeping tablets - used by a quarter of adults every year. It found that at the end of March 2018, half of people using these drugs had been on them for at least 12 months. Officials said long-term use on such a scale could not be justified and was a sign of patients becoming dependent.

PHE medical director Prof Paul Cosford said he was worried. "These medicines have many vital clinical uses and can make a big difference to people's quality of life." But he added there were too many cases where patients were using them for longer than "clinically" appropriate - where the drugs would have simply stopped working effectively or where the risks could outweigh the benefits.

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Source: BBC News, 10 September 2019

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When parents of sick children don't get to decide

The parents of five-year-old Tafida Raqeeb, who is on life support, are going to the High Court to challenge an NHS decision which is preventing them from taking her abroad. 

Tafida Raqeeb suffered a traumatic brain injury in February as a result of a rare condition, arteriovenous malformation, where a tangle of blood vessels causes blood to bypass the brain tissue. Tafida's mother and father want to seek treatment in Italy. But the Royal London Hospital, which is caring for their daughter, says releasing her is not in her best interests.

A spokesperson for Barts Health NHS Trust, which runs the hospital, said that its clinicians and independent medical experts had found "further medical treatment would not improve her condition".

In England and Wales the concept of parental responsibility is set out in law, in the Children Act 1989. This gives parents the responsibility broadly to decide what happens to their child, including the right to consent to medical treatment. But this right is not absolute. If a public body considers that a parent's choices are not in the best interests of their child, and an agreement cannot be reached, it can challenge these choices by going to court. It comes down to a judge to make the final decision, based on the evidence available.

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Source: BBC News, 2 September

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AHSN's 'Patient Safety in Partnership' plan

The Academic Health Science Network (AHSN) has published their plan for a safer future: 'Patient Safety in partnership: Our plan for a safer future 2019-2025' . Their plan supports the NHS Patient Safety Strategy and sets out how England’s 15 AHSNs, and the Patient Safety Collaboratives (PSCs) they host, will work more closely with their local health and care organisations to improve safety both in hospitals and community-based services such as care homes.

AHSN's "ambition is to support the delivery of the NHS Patient Safety Strategy and therefore our vision is aligned to the national strategy: ‘for the NHS to continuously improve patient safety'.’'

Patient Safety Learning is delighted to be working with The AHSN and Patient Safety Collaboratives and welcomes their Patient Safety in Partnership plan:

"We believe that it will make a difference for patient safety and represents a step forward from the good work that AHSNs are already doing. We believe that there is opportunity for even more to be achieved with the resources, scale and capability within the AHSN networks. We absolutely applaud the statement that patient safety is a central priority and guiding principle for all AHSNs, and we recognise the AHSNs’ distinct role as orchestrators across the healthcare system. We think that AHSNs, with PSCs, can reinforce this position by taking a powerful role in bringing, enabling and supporting systems thinking for patient safety across healthcare."

Patient Safety Learning will be sharing details of the innovation and improvement programmes on the hub.

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Seven in 10 hospital trusts failing to meet safety standards

Patient safety is frequently at risk in NHS hospital trusts in England, with 70% of them failing to meet national safety standards, according to an Observer analysis of inspection reports, with staff shortages the biggest problem. 

Reports by the Care Quality Commission (CQC) reveal that managers at one trust failed to act on staff reports of abuse and violence, while a shortage of critical beds at another trust led to three serious incidents resulting in patient harm. Of 148 acute and general hospital trusts, safety standards at 96 are rated as “requires improvement” by the CQC; six are rated inadequate, the lowest category. The others are rated good, with none outstanding.

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Source: Guardian, 8 September 2019

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Postnatal checks for new mothers need to be properly funded, charity tells government

Almost half (47%) of new mothers get less than three minutes or no time to discuss their mental and physical health at the routine six week postnatal check-up, according to a survey by the National Childbirth Trust (NCT).

The charity is calling on the government to provide funding for a full postnatal check-up so that GPs have sufficient time to talk to a new mother about her health and wellbeing.

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Source: BMJ, 5 September 2019

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Significant failings in care by Great Ormond Street Hospital

The coroner looking into the death of Scottish teenager Amy Allan has found significant failings in her care by Great Ormond Street Hospital.

Amy, from Dalry in North Ayrshire, was 14 when she died in September last year following surgery on her spine. Coroner Edwyn Buckett outlined poor planning and support from the hospital. But he said he "was not able to make a firm conclusion" that those omissions "had caused or materially contributed to her death." The coroner is however likely to issue a prevention of future deaths report.

Great Ormond Street Hospital admitted Amy's care "fell short of the high standards" it should be meeting but said it had made changes to the way it worked.

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Source: BBC News, 5 September 2019

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Nottingham's Queen's Medical Centre failings led to girl's sepsis death

A series of hospital failings contributed to the death of a five-year-old girl who died from toxic shock syndrome, an inquest jury has found. Ava Macfarlane died on 15 December 2017 after being treated at Nottingham's Queen's Medical Centre.  

Prescribing antibiotics earlier could have "given her chances of survival", Nottingham Coroner's Court heard. Returning a narrative conclusion the jury said there had been "missed opportunities" to diagnose sepsis.

Dr Keith Girling, medical director at Nottingham University Hospitals NHS Trust, apologised for the "significant shortcomings" in its care.

He said a number of changes had been made following Ava's death and greater awareness of sepsis, in relation to children with complex medical conditions, had been raised.

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Source: BBC News, 4 September

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An open letter to MPs on the impact of a no deal Brexit on health and care

In an open letter to MPs, The King's Fund, the Health Foundation and Nuffield Trust have summarised the four major areas where the impact of a no deal Brexit could be felt most sharply in health and care. 

There is a very real risk that leaving the EU without an agreement could exacerbate the workforce crisis in health and care, drive up demand for already hard-pressed services, hinder the supply of medicines and other vital supplies, and stretch the public finances which pay for healthcare.

They conclude that a no deal Brexit could cause significant harm to health and social care services and the people who rely on them.

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Source: The King's Fund, 3 September 2019

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Isle of Wight NHS Trust 'no longer inadequate or unsafe'

An NHS Trust, rated inadequate for more than two years, has been awarded an improved grade by inspectors.

Isle of Wight NHS Trust has made "improvements in most areas" and is no longer unsafe overall, the Care Quality Commission (CQC) said. Although it recommended the trust should remain in special measures, the CQC gave the trust a rating of "requires improvement".

The trust said it welcomed the change and was committed to improving further.

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Source: BBC News, 4 September 2019

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First ‘digital’ baby born at West Cumberland Hospital

The first baby born using entirely digital maternity notes in north Cumbria has been born at West Cumberland Hospital in Whitehaven. The new digital system replaces the traditional paper-based system with notes being held digitally for staff and linking to a phone app so women no longer need to carry their notes to appointments.

The app which expectant and new mothers can use is called ‘Maternity Notes’. It helps women track their pregnancy journey and contains lots of information about the baby’s development as they move through their pregnancy, and up to six weeks post-birth. The new system is safer too, with women no longer needing to carry paper maternity notes.

Since going live on 1 April, 100% of women registering a new pregnancy have signed up to the app.

North Cumbria University Hospitals NHS Trust is one of only 14 Trusts across the country to implement electronic maternity notes.

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Source: Health Tech Digital, 2 September 2019

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Almost half of consultant anaesthetists have had a car accident or near miss on their commute home because of fatigue

A survey of consultants in anaesthesia and paediatric intensive care working in the UK and Ireland found that most had experienced work related fatigue.

The survey, published in Anaesthesia, received 3847 responses from consultants working in the UK and the Republic of Ireland. Most (91%) said that they had experienced work related fatigue and 72% said that this had a moderate or significant negative impact on their social and family life.

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Source: BMJ, 3 September 2019

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High street heart checks on the NHS

Pharmacists are set to offer rapid detection and help for killer conditions like heart disease as part of a major revamp of high street pharmacy services. The high street heart checks are part of an ambitious target the NHS in England has set itself as part of its Long Term Plan to prevent tens of thousands of strokes and heart attacks over the next ten years.

Plans are underway for both GPs and community pharmacists to lead the fight against common conditions that cause cardiovascular disease (CVD) and stroke, building on successful pilots which have reduced strokes by a quarter.

From 1 October 2019, as part of their new £13 billion five-year contract, community pharmacists will start to develop and test an early detection service to identify people who may have undiagnosed high-risk conditions like high blood pressure for referral for further testing and treatment. If successful this could be rolled out to all community pharmacies in 2021-22.

Professor Stephen Powis, NHS national medical director, said: “Heart disease and strokes dramatically cut short lives, and leave thousands of people disabled every year, so rapid detection of killer conditions through High street heart checks will be a game-changer."

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Source: NHS England, 2 September 2019

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Girl died after sepsis guidelines ignored

A five-year-old girl who died due to sepsis complications could have been saved if clinical guidelines had been followed, an inquest heard.

Ava Macfarlane died of toxic shock caused by a bacterial infection on 15 December 2017. She had presented with symptoms when she first went to hospital two days earlier but they were not picked up. Nottingham Coroner's Court heard she was given Calpol and ibuprofen before doctors allowed her to go home.

Dr Shearn admitted Ava had been showing at least two "red flags" of sepsis and if he had followed guidelines from the National Institute for Health Care and Excellence and the Sepsis Trust, then the infection would have been picked up earlier. When asked by Assistant Coroner Laurinda Bower whether the "failure to follow the Sepsis 6 Pathway contributed to her death", he replied "it probably did".

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Source: BBC News, 2 September 2019

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Addenbrooke's surgeon suspended after performing wrong operation

An orthopaedic surgeon falsified records and lied to a patient after he performed the wrong operation on her. 

Alan Norrish admitted performing the wrong type of partial knee replacement on his patient in January 2018 at the Nuffield Hospital in Cambridge. Having realised his mistake the former Addenbrooke's consultant tried to cover it up by falsifying records and doing "revision" surgery six days later.

Mr Norrish has been suspended for a year following a medical tribunal. He told the hearing of the Medical Practitioners Tribunal Service (MPTS) he was "shocked" and "upset" when he realised his mistake. It was found he had lied in a letter to a hospital matron about the reason for the second operation, which was carried out on 25 January 2018.

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Source: BBC News, 30 August 2019

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