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Gosport War Memorial Hospital patient deaths inquiry ‘buried evidence’

Whitehall investigators have launched an inquiry into allegations of serious misconduct during the official review of the Gosport hospital scandal. They are examining claims that civil servants working on the £13m inquiry bullied staff, buried evidence and went on taxpayer-funded “working retreats” to Spain.

An independent panel last year linked Dr Jane Barton to the premature deaths of up to 656 elderly people given opiate overdoses at Gosport War Memorial Hospital between 1989 and 2000.

Whistleblowers have alleged that the panel ignored concerns about the hospital’s culture and use of faulty medical equipment to deliver a “clean hit” and “draw a line under it all”.

The Department of Health said last night: “We take all and any allegations of wrongdoing very seriously. An investigation is being undertaken and it would be inappropriate to comment further until it is concluded.”

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Source: The Sunday Times, 11 August 2019

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What the US government should be doing – but isn’t – to guard against unsafe prescription drugs

Documents released in an Ohio court case last month, in a landmark, multi-district opioid lawsuit, gave new insight into an unparalleled opioid epidemic in the United States. It revealed that between 2006 and 2012, some 76 billion opioid pills were distributed in the United States — more than 200 pills for every man, woman and child.

It paints a damning picture of the tension between drug company profits and patient safety during the time opioid sales were climbing dramatically. In one 2009 exchange, a pharmaceutical company representative emailed a colleague at another company to alert him to a pill shipment. “Keep ’em comin’!” was the response. “Flyin’ out of there. It’s like people are addicted to these things or something. Oh, wait, people are.”

According to Charles L. Bennett et al. in an editorial published in the Los Angeles Times, the failings are at every point in the system, starting with drug approvals. But the authors believe there is a particularly serious problem with the mechanisms for identifying, monitoring and disseminating information about issues with a drug after its release.

They suggest a good starting point for reforming the system would be increased transparency about drugs already recognised as particularly dangerous. These drugs, currently numbering about 70 (including opioids), carry the FDA’s so-called 'black box warning,' intended to alert patients and their doctors to the high risks associated with the drugs. But that is not enough. The authors propose a 'black box' database or 'registry,' publicly available and simple to use, that would contain extensive information about where, by whom and for what purpose black box drugs are prescribed, as well as where and in what quantities such drugs are being distributed and sold. Information about adverse side effects, culled from the myriad of government databases that now collect them, would also be consolidated in an open form and format.

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Source: Los Angeles Times, 8 August 2019

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AI standards need to be created to protect patient safety, experts warn

Appropriate methods and standards around artificial intelligence (AI) need to be created to protect patient safety, experts have said. Responding to the Government’s pledge of £250 million for a National Artificial Intelligence (AI) Lab, Matthew Honeyman, researcher at The Kings Fund, said the NHS workforce needs to be equipped with digital skills for the benefits of new technologies to be realised.

“AI applications are in development for many different use cases – from screening, to treatment, to admin work – there needs to be appropriate methods and standards developed for safe deployment and evaluation of these solutions as they enter the health system,” he told Digital Health.

Adam Steventon, Director of Data Analytics at the Health Foundation, said the commitment was a “positive step” but that technology needs to be driven by patient need and “not just for technology’s sake”. “Robust evaluation therefore needs to be at the heart of any drive towards greater use of technology in the NHS, so that technologies that are shown to be effective can be spread further, and patients protected from any potential harm,” he said.

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Source: Digital Health, 9 August 2019

 

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Why women are more likely to have dodgy hip implants or other medical devices

The past year has seen wide concern about the safety of medical implants. Some of the worst scandals have involved devices for women, such as textured breast implants with links to cancer, and transvaginal mesh implants, which were the subject of the asenate inquiry. But women are harmed not only by 'women's devices' such as breast implants and vaginal mesh. Women are also more likely to be harmed by apparently gender-neutral devices, like joint replacements and heart implants according to Katrina Hutchison in a recent MENAFN article.

Bias starts with design and then lab testing: biological and social factors can affect how women present when injured or ill, and how well treatments work. Often, device designers do not take these differences into account. The lab tests used to make sure implants are safe often ignore the possibility women could have different reactions to materials, or their activities could place different loads on implants.

Bias continues with clinical trials. And then there's the doctor-patient relationship; the gender of the doctor and patient can make a difference to what women learn about their implant. 

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Source: MENAFN, 11 August 2019

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Life-saving selfie app tested by 8,500 people at Portsmouth hospital 'will benefit millions'

Researchers at Queen Alexandra Hospital in Cosham carried out a study on 8,585 patients and staff using the Lifelight app. Using a selfie taken on a smartphone, and the ambient light that bounces off the skin, the app carries out calculations and tells the user the resulting rates. Among the hundreds of people who took part in the Vision-D project, 1,295 were diagnosed with previously unidentified high blood pressure during what was the largest digital physiological study in history.

Developer Xim has brought the technology’s accuracy in line with current NHS equipment. It also measures a person’s respiratory rate. Hopes are high it will win approval from the National Institute for Health and Care Excellence (NICE) - paving the way for it to be used by health care providers and patients.

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Source: Portsmouth News, 30 July 2019

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Terminal cancer: A&E 'wrong place for dying patients'

Palliative and end-of-life care must become a priority in healthcare, a cancer charity has said. Macmillan Cancer Support said emergency departments were not the right places to care for terminally ill people. Their comments come after new research conducted by Macmillan and the NI Cancer Registry at Queen's University.

The report highlights the need for planning and communication around end-of-life care. It also found late diagnosis of cancer to be a problem. Among the research's findings is that three quarters of cancer patients who died in Northern Ireland in 2015 were admitted to A&E at least once in the last year of their lives.

"Emergency departments cannot provide the very specialist care needed by cancer patients", said Heather Monteverde, Macmillan's Head of Service.

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Source: BBC News, 8 August 2019

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Two-thirds of women with physical disabilities unable to attend cervical screenings

New research released by Jo's Cervical Cancer Trust has revealed the extent to which women who have physical disabilities are discriminated against when attempting to undergo cervical screenings. The charity surveyed 335 women for the investigation who have health conditions including spinal muscular atrophy, Ehlers-Danlos syndrome, paraplegia and cerebral palsy. According to the study's findings, 88% of the participants felt that it is more difficult for a women with a physical disability to attend a cervical screening and just under half of the participants said that they had purposely chosen not to attend a smear test because of a negative, past experience they'd had due to their disability.

Robert Music, Chief Executive of Jo's Cervical Cancer Trust, said: ""It is not acceptable that women with a physical disability are often faced with additional hurdles or even being denied access to this potentially lifesaving test."

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Source: Independent, 8 August 2019

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NHS to set up national AI lab

The NHS in England is setting up a national artificial intelligence (AI) laboratory to enhance care of patients and research. The Health Secretary, Matt Hancock, said AI had "enormous power" to improve care, save lives and ensure doctors had more time to spend with patients. He has announced £250m will be spent on boosting the role of AI within the health service. 

Clinical trials have proven AIs are as good as leading doctors at spotting lung cancer, skin cancer, and more than 50 eye conditions from scans. This has the potential to let doctors focus on the most urgent cases and rule out those that do not need treatment. Other tools have been developed that can predict ovarian cancer survival rates and help choose which treatment should be given. However, AI will pose new challenges, including protecting patient data.

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Source: BBC News, 8 August 2019

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Three quarters of NHS computers still running Windows 7 less than six months before support cut-off

The Department of Health and Social Care (DHSC) indicates that more than a million machines are still on the decade-old operating system with less than six months until Microsoft ceases support for Windows 7.

In answer to a written parliamentary question from shadow Cabinet Office Minister Jo Platt, former Department of Health and Social Care Minister Jackie Doyle-Price said that the NHS operates about 1.37 million PCs. As of the end of last month, some 1.05 million of these, equating to 76% of the overall total, still run on Windows 7, she added.

Platt – whose parliamentary question recently revealed that there are still 2,300 computers across the NHS running Windows XP, for which support ended five years ago – claimed that the widespread use of Windows 7 is “deeply concerning”. She added: “The WannaCry cyberattack two years ago starkly proved the dangers of operating outdated software. Unless the government swiftly acts and learns from their past mistakes, they are risking a repeat of WannaCry. Protecting public data and computer systems should be a highest priority of government...".

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Source: Public Technology.net, 30 July 2019

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Is WHO’s surgical safety checklist being hyped?

In a recent BMJ 'Head to head', the authors argue whether the World Health Organization's (WHO) surgery safety checklist saves lives.

Studies show that the WHO's surgery checklist saves lives around the world, say Alex Haynes and Atul Gawande. But David Urbach and Justin Dimick argue that there’s not enough evidence to say for sure.

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Source: BMJ, 5 August 2019

 

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NHS England launches independent review of teen death

A leading expert on learning disability services will work with the NHS to review the circumstances and lessons of the death of Oliver McGowan, a young teenager with learning disabilities. NHS England has announced that Dr Celia Ingham Clark, England’s Medical Director for Professional Leadership and Clinical Effectiveness, will oversee the completion of the learning disability mortality review (LeDeR) of Oliver’s death. 

Fiona Ritchie, an independent consultant, will chair the review which aims to ensure there is the necessary learning from deaths of people with a learning disability, working with the McGowan family. Ms Ritchie, the independent chair, will now take forward – with the family and Dr. Ingham Clark – finalising the terms of reference for review and overseeing the completion. Following agreement with Oliver’s family, further experts will join an oversight group, which will provide specialist clinical input and advice as needed to Ms Ritchie ensuring that the review process is thorough and the final findings are robust.

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Source: NHS England, 7 August 2019

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Cervical cancer test results in Ireland not sent to 4,000 women

More than 4,000 women in the Republic of Ireland were not told the results of cervical cancer smear tests due to an IT problem, a report has revealed.

It found in about 870 of the cases, results letters were not issued to the women or their GP. In the other 3,200 cases the results were issued to GPs, but not the women. The report concluded there was not proper due diligence and risk assessment in appointing a new lab as a cervical check test facility.

Quest Diagnostics Chantilly Laboratory was appointed in an effort to help clear a major backlog of cervical cancer test samples. This, the review said, was well intentioned but no testing took place to see if it could be seamlessly integrated into the way the system operated.

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Source: BBC News, 6 August 2019

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Burnout in healthcare: the case for organisational change

Burnout is an occupational phenomenon and we need to look beyond the individual to find effective solutions, argue Montgomery and colleagues in a recent BMJ article 

Burnout has become a big concern within healthcare and is associated with sleep deprivation, medical errors, poor quality of care and low ratings of patient satisfaction. Yet often initiatives to tackle burnout are focused on individuals rather than taking a systems approach to the problem. Evidence on the association of burnout with objective indicators of performance (as opposed to self report) is scarce in all occupations, including healthcare. But the few examples of studies using objective indicators of patient safety at a system level confirm the association between burnout and suboptimal care.

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Source: BMJ, 30 July 2019

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HSIB's online feedback form launched

The Healthcare Safety Investigation Branch (HSIB) has launched a new online feedback form so that anyone involved or interested in HSIB's healthcare safety investigations can "tell us what they think".

There are options to give feedback on national investigations in general, specific national investigations, maternity investigations and HSIB in general. 

The feedback form is available from the HSIB website

Source: HSIB, 1 August 2019

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Hospitals in England set to receive £850m

Twenty hospitals in England due to receive an extra £850m funding for upgrades to outdated facilities and new equipment have been revealed. Prime Minister Boris Johnson will formally announce the plans – part of NHS spending pledges totalling £1.8bn – at a Lincolnshire hospital today. Ahead of his visit to Lincolnshire, Mr Johnson said the new money – less than 1% of the annual NHS budget – would mean "more beds, new wards, and extra life-saving equipment".

But responding to the funding announcement, the Health Foundation said "years of under-investment in the NHS's infrastructure means this extra money risks being little more than a drop in the ocean". Ben Gershlick, from the charity, added that NHS facilities in England were "in major disrepair", with a £6bn maintenance backlog.

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Kidney condition detected in minutes by app

A mobile phone app has speeded up the detection of a potentially fatal kidney condition in hospital patients. Acute kidney injury is caused by serious health conditions, including sepsis, and affects one in five people admitted to hospital. It accounts for around 100,000 deaths every year in the UK.

During a trial at London's Royal Free Hospital, doctors and nurses received warning signals via a mobile phone app in an average of 14 minutes, when patients' blood tests indicated the condition. The new alerting system, known as Streams, developed by the Royal Free with technology firm DeepMind, sends results straight to front-line clinicians in the form of easy-to-read results and graphs.

This could could save the NHS an average of £2,000 per patient by alerting clinicians to acute kidney injury sooner. However, although the findings, published in the journal Nature Digital Medicine, led to earlier recognition, it did not lead to any improvements in the primary outcome measure (renal recovery) or in secondary outcomes, which included survival, length of stay in hospital, and admission to the intensive care unit.

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Source: BBC News, 1 August 2019

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Doctors reduce their hours to avoid punitive pension tax bills

About three quarters of GPs and hospital consultants have cut or are planning to cut their hours because of the doctors’ pensions crisis. About 42% of family doctors and 30 % of consultants have reduced their working times already, claiming that they are being financially penalised the more they work. A further 34% and 40 per cent respectively have confirmed that they plan to reduce their hours in the coming months because they fear losing out, according to a survey of more than 6,000 doctors by the British Medical Association.

The government has launched an urgent consultation over the issue, which is the result of changes to pension rules limiting the amount that those earning £110,000 or more can pay into their pensions before they are hit with a large tax bill.

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Source: The Times, 1 August 2019

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Freedom to Speak Up: guidance for NHS trust and NHS foundation trust boards

NHS Improvement's revised expectations of boards and board members in relation to Freedom to Speak Up plus supplementary resources and a self-review tool. 

Effective speaking up arrangements protect patients and improve the experience of NHS workers. NHS Improvement's guide contributes to the need, set out by Sir Robert Francis in his Freedom to Speak Up review, to develop a more open and supportive culture that encourages staff to speak up about any issues of patient care, quality or safety.

The importance of workers having the freedom to speak up and the role that executive directors play in this has been recently reaffirmed in the review of Liverpool Community Health NHS Trust, the Kark Report and the interim NHS People Plan. 

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Source: NHS Improvement, 31 July 2019

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Junior doctors win landmark case over rest breaks

Junior doctors have won a court case against a hospital trust over rest breaks which could have far-reaching implications for the NHS. The 21 doctors said Derby Hospitals NHS Foundation Trust failed to make sure they either took proper breaks or were paid extra for working. Lord Justice Bean said the trust's method of calculating breaks was "irrational" and a breach of contract.

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Source: HSJ, 31 July 2019

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Croydon Health Services NHS Trust launches pioneering app for increased staff engagement

Croydon Health Services NHS Trust has rolled out an app from Ryalto designed to improve the working and professional lives of its healthcare staff. Croydon NHS Trust is now offering all of its 3,800 workers access to Ryalto – a platform that enables healthcare professionals to manage their working day and acts as a safe and singular source of communication for all employees. Secretary of State for Health and Social Care, Matt Hancock, was present at the launch, and talked about the positive impact apps can have on the way health care staff manage their working lives.

Matthew Kershaw, interim CEO, Croydon Health Services NHS Trust, said: "The app is reflective of how we live our lives today – on mobiles, with flexibility and in real-time. It offers a key digital channel for us to communicate with each other instantly, through the chat and news feed features, increasing opportunities for engagement and fostering a closer working environment where we work together to provide the best care for our patients. 

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Source: Health Tech Digital

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Home births at risk as midwife service collapses

Hundreds of mothers-to-be have lost access to their midwives after a community service was forced to close. Women across the north-west of England and in Essex have been affected after One to One announced it was withdrawing the services it provided for the NHS. 

One to One specialises in home births, which means some women may have to give birth in hospital against their wishes. A spokesman for the NHS said emergency protocols had been put in place and women affected would be contacted by a dedicated team. He said the "priority" was ensuring those affected were provided with support, but he said he could not guarantee that they would be able to have a home birth.

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Source: BBC News, 31 July 2019

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Matt Morgan and Peter Brindley: Why it’s time we all woke up to the importance of sleep

For too long, medicine has been a cult that deifies workaholism and mocks those who “fuss” about sleep, say Matt Morgan, Honorary Senior Research Fellow at Cardiff University, Consultant in Intensive Care Medicine and Head of Research and Development at University Hospital of Wales, and Peter Brindley, Professor of Critical Care Medicine, Medical Ethics, Anesthesiology at the University of Alberta, Canada.  But we know that lack of sleep kills. Data have consistently shown how it kills slowly and silently by increasing the likelihood of cancer, heart disease, immunosuppression and weight gain. Poor sleep also kills suddenly and loudly through motor vehicle crashes and workplace trauma. More and better sleep is needed for all but the question is do we care enough to do the right thing? 

Regardless of whether insomnia is limited to medicine or is, instead, a society wide issue, we can likely all agree that we need a cultural shift. This starts by senior folks speaking up and standing side by side with junior colleagues. We should not, cannot, and need not stand by as doctors work hours that we would never condone for pilots or bus drivers. Lessons must be heeded. Fortunately, these are lessons that we have known for decades. Patient safety matters, and so does practitioner safety. 

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Source: BMJ Opinion, 28 July 2019

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Prosecutions against unsafe care homes and hospitals rise by one third

Prosecutions and other criminal enforcement actions against unsafe care homes and NHS hospitals have risen a third in a year, amid warnings of a growing crisis. Charities said older people were being put at risk by “a broken social care system and an overstretched NHS” as they urged ministers to act. Official figures show that last year, watch dogs enforced 211 criminal enforcement actions against failing providers - a rise from 159 the year before. The statistics from the Care Quality Commission, covering prosecutions, cautions and fixed penalty notices, come along side a sharp rise in civil actions taken against providers. There were 906 such cases in 2018/19, compared with 781 the year before. 

Caroline Abrahams, Charity Director at Age UK, said: “The fact that the CQC felt the need to use their enforcement powers a lot more often last year than the year before is a worry, and given all we know about the pressures in the system it is hard to avoid the conclusion that this reflects an overall decline in care standards, as providers struggle to make ends meet and the temptation to cut corners in terms of quality and safety inexorably grows.”

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Source: The Telegraph, 26 July 2019

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