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Sepsis killing too many as lessons not learned, warns NHS watchdog

Sepsis is still killing too many patients due to the same hospital failings that occurred a decade ago, a damning report by the NHS ombudsman has warned.

Avoidable mistakes include delays in spotting and treating the condition, poor communication between health staff, sub-standard record keeping and missed opportunities for follow-up care, according to Rob Behrens, the parliamentary and health service ombudsman (PHSO).

Despite some progress since a previous report on sepsis by the ombudsman in 2013, lessons are not being learned and repeated mistakes are putting people at risk, Behrens said. Major improvements are urgently needed to avoid more fatalities, he added.

“I’ve heard some harrowing stories about sepsis through our investigations, and it frustrates and saddens me that the same mistakes we highlighted 10 years ago are still occurring,” said Behrens. “It is clear that lessons are not being learned. Losing a life through sepsis should not be an inevitability.”

Melissa Mead, whose one-year-old son, William, died from sepsis in 2014 after concerns were dismissed by doctors, said: “I think this report, nine years on from William’s death, really lays bare the incidences of sepsis cases.”

Mead, who peer-reviewed the study, added: “Too many lives are being lost in preventable circumstances.”

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Source: The Guardian, 25 October 2023

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Government progress against recommendations on patient safety in the NHS to be evaluated

The Health and Social Care Select Committee have commissioned an Expert Panel to consider the Government’s progress against accepted recommendations from public inquiries and reviews on patient safety.

The Panel will consider a range of recommendations made by public inquiries and reviews on both patient safety and whistleblowing and subsequently select a number of these for evaluation. The Panel will in its final report provide a rating of the Government’s progress against each of these recommendations.

Panel members are:

  • Professor Dame Jane Dacre (Chair).
  • Sir Robert Francis KC
  • Anita Charlesworth
  • Professor Stephen Peckham
  • Sir David Pearson
  • Professor Emma Cave

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Source: House of Commons Health and Social Care Select Committee, 24 October 2023

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Plan to pump 10,000 fake doctors into the NHS is insane and dangerous

You might not have heard of a ‘physician associate’ - and that’s not your fault. They probably won’t tell you. A physician associate walks and talks like a doctor, but they are no replacement for one.

To become a physician associate you need to complete a two-year postgraduate course or three-year apprenticeship. But despite much less learning than the five years a junior doctor must undergo to be qualified, they are often paid more than them.

Which is why the government’s plan to flood the NHS with 10,000 more of them over the next 15 years doesn’t make any sense. There’s certainly no money-saving aspect. This is simply another corner-cutting exercise to quickly plug gaps in a struggling NHS that will put patients at risk.

Far from saving doctors work (their original purpose), they often create more. Physician associates are unregulated so cannot be held accountable for their mistakes, meaning doctors must recheck any critical decisions they make. Critical decisions are made quite frequently in hospitals.

But they’re not just overstretching doctors and creating more work; they’re harming patients. A recent Daily Mail investigation has found brain bleeds misdiagnosed as inconsequential headaches and lung disease mistaken for a chest infection.

Doctors say they are “increasingly concerned” by this.

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Source: LBC, 16 October 2023

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Crumbling concrete: Raac found in 18 more hospitals in England

Eighteen more hospitals in England contain potentially crumbling concrete, bring the total affected to 42, the Department of Health and Social Care has confirmed.

The reinforced autoclaved aerated concrete (Raac) has also been found in 214 schools and colleges in England as well as thousands of other buildings.

NHS Providers, which represents hospitals, said the concrete "puts patients and staff at risk".

Full structural surveys are taking place at all newly confirmed sites.

The government said it was committed to eradicating Raac from NHS buildings completely by 2035.

Seven of the worst-affected hospitals will be replaced by 2030 as part of the programme to build 40 new hospitals in England, it added.

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Source: BBC News, 21 October 2023

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Whistleblower raises alarm over ‘inadequate’ investigation into 60 suicides

A trust pressured into commissioning an external review of dozens of suicides faces fresh criticism and questions about the probe’s credibility after it emerged the investigation will not investigate each case but instead look to ‘identify themes’.

Cambridgeshire and Peterborough Foundation Trust originally said it would carry out the review of more than 60 patient suicides internally. But following criticism, it U-turned on this decision and last month agreed to an externally-led process.

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Source: HSJ

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As RSV cases tick up, CDC warns that a key drug to keep babies safe is in short supply

The Centers for Disease Control and Prevention alerted doctors nationwide Monday about a limited availability of certain doses of a newly approved antibody drug given to infants to prevent RSV infection.

Cases of RSV, or respiratory syncytial virus, have started to rise as cold and flu season begins.

"RSV season is here," said Dr. Buddy Creech, a pediatric infectious disease doctor at Vanderbilt University Medical Center in Nashville, Tennessee. "We are seeing a substantial increase in the amount of RSV such that in many areas, it has become the most commonly identified respiratory virus causing disease in children.

"This is one of the reasons why there's probably a lot of scrambling going on," he said, "to identify those babies at highest risk and to try to prioritize them, since it's such a limited resource right now."

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Source: NBC News, 23 October 2023

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Welsh Ambulance Service declares extraordinary incident due to delays

An ambulance spent 28 hours outside a hospital after an "extraordinary incident" was declared due to delays.

The Welsh Ambulance Service said 16 ambulances had waited outside the emergency department at Morriston Hospital, Swansea, at one time.

It said multiple sites across Wales were affected.

The extraordinary incident, which asked people to only call 990 if their emergency was "life or limb threatening", is now over.

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Source: BBC News, 23 October 2023

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Thousands of men miss out on life-extending prostate cancer drug

Thousands of patients in England and Northern Ireland are missing out on a life-extending prostate cancer drug that is more widely available on the NHS in Scotland and Wales, say experts.

Charity Prostate Cancer UK said it was "unacceptable" that men in parts of the UK were facing a postcode lottery.

Although not a cure, abiraterone can help stop prostate cancer spreading to other parts of the body.

NHS England said it would review the drug's use for more men next year.

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Source: BBC News, 23 October 2023

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Man who died after heart problem was dismissed as anxiety was seen by physician’s associate

A 25-year-old who died from a heart haemorrhage after being diagnosed with a panic attack had been seen by a non-medical school trained physician associate (PA) but not a doctor, it has emerged.

Ben Peters, 25, attended the emergency department at Manchester Royal Infirmary on the morning of 11 Nov 2022 with chest pain, arm ache, a sore throat and shortness of breath.

While waiting, he endured a “severe episode of vomiting”.

Peters was diagnosed with a panic attack and gastric inflammation by the PA and sent home with two medications, after a supervising consultant, who the coroner found never reviewed the patient in person, agreed with the diagnosis.

Less than 24 hours later, Peters died from a rare complication of the heart that had resulted in a tear of the heart’s major artery, known as aortic dissection, and led to a fatal haemorrhage.

The Aortic Dissection Charitable Trust (TADCT) says around 2,000 people in Britain die from the condition each year, which can be “reliably diagnosed or excluded” using a CT scan, but “misdiagnosis affects one-third of patients”.

A prevention of future deaths notice issued by Chris Morris, the area coroner for Greater Manchester South, written to Manchester University Foundation Trust, said: “It is a matter of concern that despite the patient’s reported symptoms, in view of his age and extensive family history of cardiac problems, Mr Peters was discharged from the Ambulatory Care Unit without being examined or reviewed in person by a doctor."

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Source: The Telegraph, 21 October 2023

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Welsh Ambulance Service declares extraordinary incident due to delays

An ambulance spent 28 hours outside a hospital after an "extraordinary incident" was declared due to delays.

The Welsh Ambulance Service said 16 ambulances had waited outside the emergency department at Morriston Hospital, Swansea, at one time.

It said multiple sites across Wales were affected, "specifically" in the Swansea Bay health board area.

Lee Brooks, director of operations, told BBC Radio Wales Breakfast the situation was "heart-breaking".

The service said people should only call 999 if their emergency was "life or limb threatening".

Judith Bryce, assistant director of operations at the Welsh Ambulance Service, said on Sunday the service was experiencing "patient handover delays outside of emergency departments. This is taking its toll on our ability to respond within the community."

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Source: BBC News, 23 October 2023

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Finance directors ‘incensed’ at comments by safety watchdog

The Health Services Safety Investigation Branch has been accused of taking “divisive potshots” at NHS finance directors.

Speaking at an event to mark the watchdog becoming an independent body, HSSIB chief investigator Rosie Benneyworth said: “We need a position where finance directors in every organisation are as responsible for safety as the person leading the safety agenda and vice versa… Often you see the finance director and safety lead don’t work effectively together and we need to change that.”

Dr Benneyworth said progress on safety would not be made unless it was tackled “in the same breath” as operational and financial matters.

In response, the Healthcare Financial Management Association said Ms Bennyworth’s views had “incensed” its members.

Commenting below the story, HFMA chief executive Mark Knight said: “I have been contacted by a number of finance directors who are incensed by the comments in this article. To gain a fuller picture of the views of the newly created HSSIB we will be asking for a meeting with Dr Benneyworth and [HSSIB chair Ted] Baker. The HFMA would like to understand the evidence on which the assertions in the article are based, which are completely at odds with how I know the vast majority of finance directors and their teams behave.”

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Source: HSJ, 23 October 2023

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Reliance on private hospitals being ‘hard wired’ into NHS elective care

The drive to cut NHS waiting lists are becoming ‘disproportionately reliant’ on the private sector, experts have warned, as new data suggests rapid growth in the elective activity carried out by non-NHS providers.

Internal figures for activity commissioned by integrated care boards and NHS England, seen by HSJ, suggests the value-weighted activity carried out by private providers has increased by around 30 per cent on pre-covid levels. The value-weighted elective activity carried out by NHS providers rose by just three per cent over the same three-month period, from April to June 2023.

The figures relate to activity measured under the “elective recovery fund”, which accounts for the bulk of elective activity. NHSE said it was right to make use of “all available capacity” to treat long-waiters. However, experts said the NHS would struggle to bring down waiting lists without significantly increasing the amount of elective work it did.

Waiting list analyst Rob Findlay said independent sector outsourcing was “not genuine backlog clearance, but a way of plugging some of the recurring shortfall in core NHS capacity.”

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Source: HSJ, 23 October 2023

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Gaza’s collapsing health system shows struggles of medical care in war

The Gaza Strip’s health-care system stands on the brink of collapse as bombings damage hospitals and ambulances and as generators run out of fuel, highlighting how quality medical care is a casualty of war.

Dire scenarios await Gaza’s medical professionals. They face dwindling basic resources such as power, water and anesthesia, compelling doctors to confront wrenching decisions on whose lives to save. The growing humanitarian crisis is plunging health-care workers into the critical emergency planning that follows both human-made and natural disasters — assessing staffing and other resources, managing existing health needs on top of gruesome new ones, and looking out for their own welfare.

“When we are in a disaster setting or conflict, we usually have more patients than resources. We have to be very creative to be able to provide the best care for the most number of people,” said Lindsey Ryan Martin, who is director of global disaster response and humanitarian action at Massachusetts General Hospital in Boston and has been monitoring the situation in Gaza.

The health-care crisis extends beyond Tuesday’s deadly blast at al-Ahli Hospital in Gaza City. Aid organizations say the war continues to imperil an already beleaguered health-care system.

Gaza’s Health Ministry said five hospitals were out of service as of Thursday and an additional 14 health facilities have closed because they lack fuel and electricity.

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Source: The Washington Post, 19 October 2023

 

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Mental health help for under-fives overlooked - report

More support is needed to prevent babies and young children developing mental health problems in later life, leading doctors say.

Their report shows there is growing evidence that intervening very early on - from conception to the age of five - may help stop conditions arising or worsening. The Royal College of Psychiatrists is calling for more specialist services. The government says the mental health of children and parents is paramount.

Officials say they are investing more in expanding NHS services, alongside funding programmes designed to support children and caregivers.

NHS data shows about 5% of two to four-year-olds struggle with anxiety, behavioural disorders and neurodevelopmental conditions including ADHD.

The Royal College of Psychiatrists' report suggests half of mental health conditions arise by the age of 14, and many start to develop in the first years of life, making early action "vital".

Dr Trudi Seneviratne, from the Royal College of Psychiatrists (RCPsych), said the majority of under-fives with mental health conditions were not receiving the level of support needed "to help them become productive, functioning adults and reach their full potential. The period from conception to five is essential in securing the healthy development of children into adulthood. Unfortunately, these years are often not given the importance they should be, and many people are unaware of what signs they should be looking out for. Parents, carers and society as a whole have a critical role to play. This includes securing positive relationships and a nurturing environment that supports the building blocks of a child's social, emotional and cognitive development."

Read the RCPsych report Infant and early childhood mental health: the case for action

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Source: BBC News, 21 October 2023

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Woman told she had ‘postnatal depression’ diagnosed with stage four bowel cancer

A mother of two prescribed antidepressants after complaining of fatigue was devastated when she learned she had stage four bowel cancer and had just nine months to live.

Helen Canning complained of anaemia and low energy for more than a year, but as a 37-year-old with two children under the age of five, her symptoms were put down to prolonged postnatal depression and work stress.

“At the end of the school day, I’d sit at my desk and lose half an hour of my time just sitting and staring,” the A-level science teacher from Suffolk said. “I was so tired. Then I would get even more stressed because I was getting behind on my work.”

She went to the GP because she was concerned about her symptoms. Despite being told her iron was low, she said she was never offered a blood test to investigate this further. As well as prescribing antidepressants, the GP referred her to a gynaecologist for an ultrasound scan on her left side in December 2020, but the scan did not detect anything.

But less than a year later in August 2021, she was diagnosed with bowel cancer after she was rushed into A&E with a “crippling, stabbing pain” and violent vomiting, the night before her ninth wedding anniversary. She was told she had advanced colorectal cancer, a primary tumour in the right side of her colon, with secondary growths on her ovaries, liver, and peritoneum.

Though Mrs Canning was given only nine months to live after her diagnosis, the mother of two leaned on her family for strength as she started chemotherapy. It has now been over two years and she continues to fight. Now she is determined to raise awareness of the common signs and symptoms of bowel cancer, and urges people to “know their own ‘normal’ and not be afraid to keep pushing for further testing and answers when doctors don’t”.

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Source: Independent, 22 October 2023

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Crumbling concrete: Raac found in 18 more hospitals in England

Eighteen more hospitals in England contain potentially crumbling concrete, bring the total affected to 42, the Department of Health has confirmed.

The reinforced autoclaved aerated concrete (Raac) has also been found in 214 schools and colleges in England as well as thousands of other buildings. NHS Providers, which represents hospitals, said the concrete "puts patients and staff at risk".

Full structural surveys are taking place at all newly confirmed sites. The government said it was committed to eradicating Raac from NHS buildings completely by 2035. Seven of the worst-affected hospitals will be replaced by 2030 as part of the programme to build 40 new hospitals in England, it added.

Sir Julian Hartley, chief executive of NHS Providers, said there had been fears that more of the material would be found following surveys of NHS buildings. "Trusts are doing everything they can, at huge cost, to keep patients safe where this concrete is found," he said.

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Source: BBC News, 21 October 2023

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East Kent NHS Trust: Lessons not learned at maternity trust, mum says

Lessons still have not been learned at a Kent hospital trust which was criticised in a damning report, a mother has said.

Dr Bill Kirkup's review found at least 45 babies might have survived with better care at East Kent NHS hospitals.

Victoria, whose six-year-old daughter needs 24-hour support, said: "I've had no contact from anyone from the trust."

Her case was one of 202 that were examined by Dr Kirkup in his report, which was published exactly a year ago.

Victoria, whose daughter is living with the consequences of failings in her care during her birth, said: "Our children have become unwell because of what has happened to them.

"I don't feel lessons have been learned whatsoever.

"Treatment hadn't been made available as easily as it should have done for children that are still living this experience every day."

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Source: BBC News, 19 October 2023

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Children waiting years for autism and cerebral palsy treatment as NHS chiefs slam government inaction

Children are waiting years for autism and cerebral palsy treatments as NHS leaders accuse the government of ignoring warnings of a crisis in community care.

The number of patients waiting for NHS community services hit more than one million in August and a new analysis has revealed one in five of those patients are children. 

The waits are so bad in some areas of England that a 12-year-old needing treatment might not get it until they are 16, the NHS Community Services Network warned.

The analysis, by NHS Confederation and NHS Providers, also found 34,000 children have been waiting more than 18 weeks for diagnosis and care, which is the maximum time anyone should be waiting, with the backlogs growing quickly in spinal and eye care.

Matthew Taylor, chief executive for NHS Confederation, which represents hospitals, community service providers and primary care, told The Independent that long waits can impact children more severely than adults because delays in treatment can have a knock-on effect on communication skills, social development and educational as well as mental wellbeing.

“We have a real and growing problem with long waits in community services, but despite repeated warnings that neglect of these vital services is having a detrimental impact on patients, these warnings seem to be met with a shoulder shrug from the government. Leaders are working incredibly hard to deliver these important services for patients but are fighting a rising tide and need help,” he said.

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Source: The Independent, 20 October 2023

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NHS ombudsman warns Sciensus that patients ‘should not be ignored’

The boss of Britain’s biggest medicines courier has been told to urgently improve its complaints system by the NHS ombudsman amid concerns patients let down by missing deliveries are repeatedly ignored.

In a highly unusual development, Darryn Gibson, the chief executive of Sciensus, has received a written warning from Rob Behrens, the parliamentary and health service ombudsman (PHSO). It says patients “should not be ignored” and must be “listened to and taken seriously” or he will consider taking further action.

The PHSO investigates complaints that have not been resolved by the NHS or by private providers of NHS care. Sciensus is the single largest provider of homecare medicines services to the NHS and has contracts worth millions of pounds.

In an email seen by the Guardian, Behrens told Gibson he had been unable to investigate most reports received about Sciensus because patients had not been able to complete the company’s complaints process. “That is not acceptable or fair to complainants,” Behrens wrote.

In a statement, Sciensus said it worked “very hard” to ensure NHS patients received their medicines on time. Its services had “a 95% satisfaction rating”, it added.

The move follows a Guardian investigation that exposed how Sciensus put NHS patients at risk of harm with delayed, missed or botched deliveries of medicines for conditions including cancer, heart disease, diabetes, dementia and HIV.

It also uncovered how patients’ alarm at vital drugs and medical devices not arriving at their home was often compounded by a struggle to reach Sciensus to complain and fix the problems.

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Source: The Guardian, 19 October 2023

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Two-thirds of England’s maternity units dangerously substandard, says CQC

Almost two-thirds of maternity units provide dangerously substandard care that puts women and babies at risk, the NHS watchdog has said in a damning report.

The Care Quality Commission (CQC) has rated 65% of maternity services in England as either “inadequate” or “requires improvement” for the safety of care – up from 54% last year.

Services are beset by a host of problems, including serious staff shortages and internal tensions, which mean that too many mothers and their babies receive care that is not good enough, it said.

Women too often face delays in accessing care, do not receive the one-to-one care from a midwife to which they are entitled or experience communication problems with staff looking after them, including being shouted at by midwives.

The CQC judged overall quality of care to be inadequate or require improvement at 85 maternity units, almost as many at which it rated it to be either good or outstanding – 87. The number of units offering substandard care has soared by 30 in the last year, from 55 to 85.

It said that, having inspected 73% of all maternity units, “the overarching picture is one of a service and staff under huge pressure. People have described staff going above and beyond for women and other people using maternity services and their families in the face of this pressure.

“However, many are still not receiving the safe, high-quality care that they deserve.”

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Source: The Guardian, 20 October 2023

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Finance directors need to do more to keep patients safe, warns watchdog

Financial directors need to take responsibility for safety, which should be at the core of how the NHS runs services, the leadership of the Health Services Safety Investigations Body (HSSIB) said at its launch Wednesday.

The Healthcare Safety Investigation Branch is now an independent body – and has been renamed HSSIB – although maternity investigations are hosted by the Care Quality Commission.

Questioning how many finance directors across the NHS take responsibility for safety, HSSIB’s interim chief investigator Rosie Benneyworth said: “We need a position where finance directors in every organisation are as responsible for safety as the person leading the safety agenda and vice versa, the safety person works with the finance agenda to support them.

“Often you see the finance director and safety lead don’t work effectively together and we need to change that.”

Dr Benneyworth said progress will not be made unless operational delivery, financial delivery and safety are tackled “in the same breath”.

HSSIB’s new chair Ted Baker also called for safety to become a core part of running services “in the way running the accounts is”, as it is currently still seen “as an add-on”.

He stressed that safety “drives efficiencies, enables innovation and saves costs”.

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Source: HSJ, 19 October 2023

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Birmingham NHS trust sacks staff after sexual harassment claims

A hospital trust has dismissed three members of staff following complaints of sexual harassment.

The sackings by University Hospitals Birmingham (UHB) NHS Trust were revealed at the launch of its sexual safety charter on Monday.

Sexual safety was one of the areas highlighted in a review of the trust's culture.

UHB said sexism, misogyny and sexual harassment would not be tolerated in the workplace.

The trust has been subject to three enquiries following a BBC investigation into its culture.

The second of these investigations, by Prof Mike Bewick, identified a new line of inquiry into allegations of misogynistic behaviour and sexual harassment.

Prof Bewick said the trust had begun formal investigations and there was a widening of the scope of the enquiry to accommodate the sensitive nature of these concerns.

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Source: BBC News, 19 October 2023

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ADHD ‘not over-diagnosed’ despite surge in Ritalin prescriptions

Children are not being over-diagnosed with ADHD despite concerns about a spike in prescriptions of powerful stimulant drugs, a leading psychiatrist has said.

NHS statistics show 125,000 children and teenagers in England are taking drugs such as Ritalin for symptoms such as poor concentration, up by a quarter since before the Covid pandemic.

Isobel Heyman, a consultant child and adolescent psychiatrist at Great Ormond Street Hospital and lead for child mental health at Cambridge Children’s Hospital, said that on the whole ADHD remained “under-treated” and that this was driving high levels of mental illness in young people.

Speaking to the Times Health Commission, Heyman said: “My understanding is that the increase in prescribing is largely related to increased diagnosis and increased recognition … We are still overall slightly under-treating [rather] than over-treating.

“There is a problem about over-medicalisation of ordinary distress, ordinary ebullience and over-enthusiasm in young people.”

She said the public should be reassured that ADHD diagnoses follow a “very stringent” process. However, she said private adult ADHD clinics may be less “rigorous” in providing a diagnosis.

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Source: The Times, 18 October 2023

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Woman's 'complete shock' at skin cancer misdiagnosis

A woman has spoken of her "complete shock" at being misdiagnosed with cancer and undergoing surgery when she never had the condition at all.

Megan Royle, 33, from East Yorkshire, was diagnosed with skin cancer in 2019.

As part of her treatment, she underwent immunotherapy and her eggs were frozen due to the risk to her fertility.

But after she was given the all-clear in 2021, a review showed she never had cancer and she has now won compensation from the two NHS trusts involved.

Ms Royle, from Beverley, said: "You just can't really believe something like this can happen, and still to this day I've not had an explanation as to how and why it happened.

"I spent two years believing I had cancer, went through all the treatment, and then was told there had been no cancer at all."

"You'd think the immediate emotion would be relief and, in some sense, it was - but I'd say the greater emotions were frustration and anger."

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Source: BBC News, 18 October 2023

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Naga Munchetty: I was failed and gaslit by NHS despite debilitating periods

Naga Munchetty has said she spent decades being failed, gaslit and “never taken seriously” by doctors, despite suffering debilitatingly heavy periods, repeated vomiting and pain so severe that she would lose consciousness.

The BBC presenter, newsreader and journalist told the Commons women and equalities committee on Wednesday that she was “deemed normal” and told to “suck it up” by NHS GPs and doctors during the 35 years she sought help for her symptoms.

Munchetty was finally diagnosed with adenomyosis, a condition where the lining of the womb starts growing into the muscle in its walls, in November last year.

She said she was consistently told by doctors that “everyone goes through this”.

“I was especially told this by male doctors who have never experienced a period but also by female doctors who hadn’t experienced period pain,” said Munchetty.

Munchetty’s diagnosis came after she had bled heavily for two weeks and experienced pain so severe she asked her husband to call an ambulance. Only then was she taken seriously, seeing a GP who specialised in women’s reproductive health. That GP advised her to use private healthcare to avoid lengthy NHS waiting lists.

Munchetty and Vicky Pattison, a television and media personality, were giving evidence as part of the committee’s inquiry into the challenges that women face being diagnosed and treated for gynaecological and reproductive conditions.

The committee is also considering any disparities that exist in diagnosis and treatment, and the impact of women’s experiences on their health and lives.

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Source: The Guardian, 19 October 2023

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