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Crumbling hospitals putting lives at risk, say NHS chiefs

Hospital patients’ safety is being put at risk by fires, floods and crumbling, overcrowded buildings caused by a £4 billion government squeeze on capital funding, NHS bosses are warning.

Hospitals say they do not have the funding to replace outdated scanners, fix leaking roofs and boilers, or remove ligature points that suicidal patients may attempt to use to try to end their lives.

Four out of five (82%) chief executives and chief finance officers at NHS trusts in England fear the lack of capital funding poses a medium or high risk to patient safety.

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Source: Guardian, 30 August 2019

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NHS faces legal action from ‘abandoned’ IV feed patients

The NHS and the national medical regulator could face legal action over the shortage of intravenous feed supplies for hundreds of UK patients, HSJ has learned. 

The law firm acting for more than a dozen patients affected by the shortage of feed supplies has confirmed to HSJ it has been instructed to take action against NHS England, the Department of Health and Social Care, the Medicines and Healthcare products Regulatory Agency and the company responsible for producing the feed, Calea. 

Since June, hundreds of patients who rely on IV feed known as total parenteral nutrition have gone without deliveries of their bespoke feed. More than 40 people have been admitted to hospital as a result.

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Source: HSJ, 29 August 2019

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Hospital deep clean as baby skin infection detected

A small number of babies at a Belfast hospital have been found to have pseudomonas on their skin. The infants involved were being treated in the neonatal unit of the Royal Jubilee Maternity Service. Although the bacteria was found on their skin, it does not mean the babies were infected. Staff have put in place infection prevention measures and carried out a deep clean of the unit.

A spokesperson for the Belfast Health Trust said while the issue was unfortunate it wanted to reassure patients, their families and the public that the situation was being managed appropriately.

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Source: BBC News, 29 August 2019

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CQC closes ‘inadequate’ children’s unit

An NHS children’s mental health unit has been closed down by the Care Quality Commission after being rated “inadequate” last week.

A child and adolescent mental health ward run by Tees, Esk and Wear Valley’s Foundation Trust has been closed after the CQC took enforcement action to protect the safety of patients.

In a statement today, a CQC spokesman said: ”[We have] taken urgent enforcement action at Tees, Esk and Wear Valley’s Foundation Trust which will lead to the closure of the child and adolescent mental health service units at West Lane Hospital. The Holly unit at West Park Hospital and Baysdale Unit at Roseberry Park are unaffected. The action follows continued concerns identified at earlier inspections in June and August, and the recent inspection on 20 and 21 August 2019."

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Source: HSJ, 23 August 2019

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Cardiologist who fitted wrong pacemaker and destroyed patient notes is struck off

A cardiologist has been struck off the UK medical register after he failed to check a patient’s medical notes before surgery, implanted the wrong type of pacemaker, and then destroyed the notes specifying the correct type.

Amer Chit, a locum consultant cardiologist at Royal Cornwall Hospitals NHS Trust, admitted to a trust investigation that, before implanting the pacemaker, he had looked at the operating list but not at the patient’s medical notes.

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Source: BMJ, 23 August 2019

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Brexit: Health leaders issue new no-deal warning

Health leaders have written to Boris Johnson issuing new warnings on the impact of a no-deal Brexit. In a letter to the Prime Minister, the heads of 17 royal colleges and health charities across the UK say clinicians are "unable to reassure patients" their health and care will not be affected. 

They go on to say they have "significant concerns about shortages of medical supplies". Government said it was working with the health sector on "robust preparations". 

The letter, co-ordinated by the Royal College of Physicians, is signed by the heads of organisations including the British Dental Association, the Royal Pharmaceutical Society, Kidney Care UK and the Royal College of Emergency Medicine. It calls for the Health and Social Care Secretary Matt Hancock to be put on the EU exit strategy committee chaired by Michael Gove, who is in charge of no-deal planning.

The signatories argue that - given the scale of the NHS - without sufficient planning, even the smallest of problems could have "huge consequences on the lives of millions of people".

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Source: BBC News, 21 August 2019

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Two million Britons are taking seven different prescription drugs

Two million pensioners are taking at least seven types of prescription drugs - putting them at risk of potentially lethal side-effects, a major report warns. 

Age UK said the rise of “polypharmacy” was putting lives at risk, with three quarters likely to suffer adverse reactions to at least one of their drugs. The research found that the number of emergency hospital admissions linked to such side-effects has risen by 53 per cent in seven years, with some cases proving fatal.

Experts said GPs were doling out too many drugs because they were too busy to properly consider complex health problems, and the risk of side-effects, and interactions between different drugs. 

Caroline Abrahams, Charity Director at Age UK, said: "We are incredibly fortunate to live at a time when there are so many effective drugs available to treat older people’s health conditions, but it’s a big potential problem if singly or in combination these drugs produce side effects that ultimately do an older person more harm than good.”

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Source: The Telegraph, 22 August 2019

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West Lane Hospital patients 'at high risk of avoidable harm'

A mental health unit for young people where two girls died in two months is not safe. The Care Quality Commission (CQC) rated West Lane Hospital in Middlesbrough inadequate and said patients were at high risk of "avoidable harm". It found staff did not store medicines safely, out-of-date medicines were still in use, and staff used non-approved restraint techniques.

Tees, Esk and Wear Valleys NHS Trust said it was taking "urgent action".

The inspection in June uncovered a catalogue of failings, including "substantial and frequent staff shortages" and employees not always "adequately assessing, monitoring or managing risks to patients".

The report said staff did not feel supported or valued, with morale low, and some told inspectors not all incidents were reported.

CQC report

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Source: BBC News, 21 August 2019

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Nurses in Wales leaving job due to stress, report says

Morale among community nurses is low and many are leaving the service due to stress and an increased workload, a report has claimed.

The report from a Welsh assembly committee said the changing nature of healthcare, in particular the move to provide more help in the home and the ageing population, made the role of community nurses increasingly important. But it said many community nurses feel they do not get the support they need and some see themselves as the “invisible service”.

One of the biggest issues raised by nurses in Wales during a committee inquiry was their inability to access to technology to enable them to do their job effectively.

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Source: The Guardian, 21 August 2019

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New NHS plan to help patients avoid long hospital stays

Action to help tens of thousands more people avoid lengthy spells in hospital is being rolled out nationwide as part of the NHS Long Term Plan.

NHS doctors, nurses and other staff are being encouraged to ask themselves ‘Why not home? Why not today?’ when planning care for patients recovering from an operation or illness, as part of a campaign – called ‘Where Best Next?’ – which aims to see around 140,000 people every year spared a hospital stay of three weeks or more.

The campaign will see posters and other information placed in hospitals aimed at different staff groups, encouraging them to take practical steps every day to help get patients closer to a safe discharge – whether to their own home or a more suitable alternative in the community.

Dr Taj Hassan, President of the Royal College of Emergency Medicine, said: “The ‘Why not home? Why not today?’ campaign is really important in helping staff to make sure patients are discharged promptly if it is medically appropriate... A greater length of stay increases the risk of hospital acquired infections and further illness. We know that extended stays in a hospital bed can lead to significant muscle loss, particularly in older people, so ensuring that patients do not stay any longer than they need really is vital."

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Source: NHS England, 19 August 2019

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Speaking up requires a supportive organisational culture to be effective

Frontline staff are well placed to identify failings in care, but speaking up requires a supportive organisational culture to be effective, say Russell Mannion and Huw Davies in a recent analysis published in the BMJ.

Concerns about care are raised and ignored, staff are denigrated or bullied, the situation escalates into whistleblowing to outside authorities, and eventually, often years later, a formal inquiry is set up to get to the bottom of things. The long line of inquiries in the UK and elsewhere highlights the sentinel role of staff “speaking up” when they see unsafe or poor quality care.  But exhortations to speak up (encapsulated by the statutory duty of candour introduced in the NHS after the Francis inquiries into failures at Mid Staffordshire NHS Trust) belie the complexity and ambiguity that it creates for staff.

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Source: BMJ, 19 August 2019

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The harm to hospitalised patients cost Ontarians more than $1 billion a year

A new study published in the Canadian Medical Association Journal has found that patients who suffered harm after being admitted in an Ontario hospital took longer to recover, spent more time in hospital, and required more healthcare to undo or mitigate the harm.

Tessier et al. studied the records of 610,979 patients admitted to Ontario hospitals over a one-year period ending in March 2016. Overall, 36,004 or six per cent of the patients were harmed during their hospital stay. As part of the study, the researchers categorised the kinds of harms experienced by patients. Just over half suffered harm due improper treatment. This included failing to make the correct diagnosis or making an incorrect diagnosis that led to incorrect treatment and harm caused by medications. 

The second biggest category (37%) was harm caused by an infection acquired during the hospital stay. The third leading cause (27.3%) was harm caused by a procedure, and the fourth (2.7%) was harm brought on by accidents such as falling off a hospital stretcher.

The current study is one of the first to use a new method that enables researchers to capture all of the care the patient received during their stay in hospital and following discharge from hospital, including home care.

In a commentary published alongside the study, Dr. Lauren Lapointe-Shaw and Dr. Chaim Bell wrote that reported rates of adverse events are widely considered to be the proverbial "tip of the iceberg."

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Source: CBC Radio Canada. 12 August 2019

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Hundreds of lives saved through new tech to spot sepsis

In a major nationwide push to tackle sepsis, including a one hour identification and treatment ambition, new ‘alert and action’ technology is being introduced which uses algorithms to read patients’ vital signs and alert medics to worsening conditions that are a warning sign of sepsis.

Three leading hospitals are using alerts to help identify sepsis and tell doctors when patients with the serious condition are getting worse, ahead of the measures being rolled out across England as part of the NHS Long Term Plan. 

In Liverpool, the hospital’s digital system brings together lab results and patient observations into one place to help staff diagnose and treat suspected sepsis, saving up to 200 lives a year. In Cambridge, deaths from sepsis have fallen consistently over the last three years, with at least 64 lives saved in the past year thanks to the innovative alert and action feature. In Berkshire since introducing a digital system, the Trust has increased screening rates by 70% with nine in 10 patients now consistently screened for sepsis during admission as opposed to two in ten beforehand, allowing doctors to spot more cases sooner.

The schemes are part of a national effort to push best practice and new technology across the NHS, to help hospitals learn from the success of others and spread use of the best technology further, faster.

Dr Ron Daniels BEM, CEO of the UK Sepsis Trust, and the hub's topic leader, said: “Any kind of technology which assists clinicians in making prompt decisions when the warning signs of sepsis are detected should be embraced; with every hour that passes before the right antibiotics are administered the risk of death increases".

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Source: NHS England, 18 August 2019

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Changes to NHS health checks must be evidence based and beneficial, say GPs

A review of NHS health checks, which will look at tailoring checks based on risk and increasing the range of checks offered, must involve a “rigorous evaluation” to ensure they are safe, accurate and of benefit to patients, GPs have warned. The Department of Health and Social Care announced the review in the prevention green paper last month and has now fleshed out its scope.

It says it will consider including additional checks to prevent musculoskeletal problems and hearing loss, as well as how the checks can be digitised and tailored so people are offered “personalised interventions” based on risk, location, predisposition to diseases and their DNA.

While some experts welcomed the more targeted approach, others said the current scheme still needs to be evaluated for cost effectiveness and questioned how GPs will take on the extra work.

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Source: BMJ, 16 August 2019

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Hospitals made money from scandal surgeon Ian Paterson

Private hospitals may have made more than £3 million from the actions of the disgraced breast surgeon Ian Paterson, a think tank has claimed.

Paterson was jailed in 2017 for carrying out unnecessary surgery on ten patients in private hospitals. However, it is believed he harmed about 750 patients, many of whom he wrongly led to believe they had cancer. He was paid each time he operated but the private hospitals would have received a separate payment for each operation, the Centre for Health and the Public Interest (CHPI) said. 

CHPI wants the inquiry set up by the government into Paterson’s actions to examine the financial incentives that could affect how private hospitals treat patients. David Rowland, director of CHPI, said: “The current financial incentives to over-treat patients weigh heavily against the weak measures which are in place to protect patients.”

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Source: The Times, 19 August 2019

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Women take legal action over breast implant cancer link

Twenty UK women are taking legal action after developing a rare form of cancer linked to their breast implants. More than 50 women have been diagnosed with the same condition in the UK, and hundreds more worldwide. A top surgeon said there were gaps in implant information and people were almost being "used as guinea pigs".

One manufacturer has issued a worldwide recall of some textured implants, which have been linked to most cases of breast implant-associated lymphoma. The Medicines and Healthcare products Regulatory Agency (MHRA), which regulates medical devices in the UK, is currently collecting data on women affected by breast implant associated-anaplastic large cell lymphoma (BIA-ALCL).

Tens of thousands of breast implant surgeries are thought to take place each year in the UK, mostly in private clinics.

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Source: BBC News, 16 August 2019

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Patients waiting for hip operations suffering 'pain worse than death'

Patients waiting for hip replacements are suffering pain "worse than death", a study by Edinburgh University suggests. The research recorded the health states of more than 2,000 people on waiting lists and found 19% were in extreme pain or discomfort.

The level is so poor it is defined by experts as "worse than death" - more painful than chronic health conditions such as diabetes, heart failure or lung diseases. Scientists who used the internationally approved EQ-5D measurement said the findings disprove perceptions that hip and knee arthritis only causes mild discomfort. Earlier this year research found that four in 10 clinical commissioning groups in England are rationing hip and knee operations.

The Royal College of Surgeons has described the restrictions are “alarming” and “arbitrary”.

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Source: The Telegraph, 15 August 2019

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What was found in the FDA’s "hidden" device database?

After two decades of keeping the public in the dark about millions of medical device malfunctions and injuries, the US Food and Drug Administration (FDA) has published the once hidden database online, revealing 5.7 million incidents publicly for the first time.

The newfound transparency follows a Kaiser Health News investigation that revealed device manufacturers, for the past two decades, had been sending reports of injuries or malfunctions to the little-known database, bypassing the public FDA database that’s pored over by doctors, researchers and patients. Millions of reports, related to everything from breast implants to surgical staplers, were sent to the agency as “alternative summary” reports instead.

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Source: Kaiser Health News, June 27 2019

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NHSE declares emergency over IV shortage

NHS England has declared a national emergency over shortage of feed for babies and disabled patients, with some patients being told to go to Accident & Emergency (A&E) departments.  Hundreds of NHS patients, including children, who depend on intravenous (IV) nutrition, have been experiencing delays in deliveries.

It follows an inspection by watchdogs which found manufacturers were failing to meet safety standards, and the presence of potentially fatal bacteria. The NHS National Patient Safety Director, Aiden Fowler, has written to all NHS hospital trusts, and affected patients, warning that the incident has been designated as an emergency incident, under the Civil Contingencies Act, at the highest level. 

British manufacturer Calea had already said the shortages could last up to four weeks. But the letter warns that the crisis could last far longer, outlining plans to ration the product to those most in need. 

Parents said the situation was “terrifying” with some told to go to A&E if vulnerable children were left too long without being fed. 

Hospitals have now been asked to review all patients receiving such IV feed to ensure only those deemed at high-risk are allocated the supplies, which are tailored to meet specific individual needs. Others will be allocated standard bags of nutrition, with extra supplements. 

In the letters from Dr Fowler, disclosed by the Health Service Journal, he warns that the NHS is facing a “difficult balance” between the risks caused by the shortages, and the dangers of allowing production to continue, without safety improvements. 

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Source: The Telegraph, 13 August 2019

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Australian junior doctors launch legal action against managers over working conditions

Registrars at an Australian hospital have launched legal action against its management amid claims that they are being worked beyond exhaustion while being denied their mandatory clinical training.

The alleged plight of the doctors at Melbourne’s Sunshine Hospital has become the latest instalment in a growing list of complaints among doctors in training over excessive workload pressures, exploitation, harassment, and bullying across the country’s public hospital system.

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Source: BMJ, 12 August 2019

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Digital GP service provider secures biggest ever deal with NHS

Nearly 2 million NHS patients are to be given access to video consultations with doctors employed by a digital healthcare supplier as a result of a series of deals signed with NHS commissioners.Nearly 2 million NHS patients are to be given access to video consultations with doctors employed by a digital healthcare supplier as a result of a series of deals signed with NHS commissioners.

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Source: HSJ, 12 August 2019

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