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NHS waiting list hits record high of almost 7.8m

The NHS waiting list in England has hit a new record high, with almost 7.8 million people waiting for treatment, data shows.

An estimated 7.75 million people were waiting to start treatment at the end of August, up from 7.68 million in July. It is the highest number since records began in August 2007.

The waiting list for treatment has been growing for much of the last decade, passing three million in 2014, four million in 2017, five million in 2021 and seven million in 2022.

As the NHS waiting list grows A&E pressures are “ running red hot”, a major think tank has warned, with new figures showing 123,000 patients waited more than 12 hours in emergency departments last month.

Some 8,998 people in England are estimated to have been waiting more than 18 months to start routine hospital treatment at the end of August, up from 7,289 at the end of July, according to data.

A total of 396,643 people in England had been waiting more than 52 weeks to start routine hospital treatment at the end of August, up from 389,952 at the end of July.

The Government and NHS England have set the ambition of eliminating all waits of more than a year by March 2025.

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Source: The Independent, 12 October 2023

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Patients put ‘at risk’ by NHSE plans to cut follow-ups

NHS England plans to reduce follow-up appointments is leading to patient safety risks and causing waiting lists to grow, an acute trust has warned.

The NHSE plans were set out in the 2023-24 planning guidance which says trusts must cut outpatient follow-ups by 25% against 2019-20 levels by March, to increase capacity for new patients.

But North Cumbria Integrated Care Foundation Trust has raised concerns that adhering to the policy will “exacerbate” its follow-up backlogs, warning that the delays “potentially… pose a risk of harm to patients whose condition may deteriorate when follow-up is late”.

NHS Confederation told HSJ it thought the policy “has risks” because it could mean that patients needing follow-ups will wait for longer, although the organisation also saw benefits. It said hospital leaders had “mixed feelings” about the policy.

The Patients Association also raised concerns that cancelling follow-ups for some patients “will exacerbate health inequalities”.

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Source: HSJ, 12 October 2023

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Agency profits growing due to ‘acute shortage of staff’

Two companies supplying staff to the NHS saw large growth in income and profits last year, annual accounts reveal.

Independent Clinical Services, owned by a Canadian private equity firm, saw a growth in turnover of more than 40%, with income growing from £273m to £399m, year on year.

A smaller company specialising in recruiting overseas healthcare staff to the UK also saw a bumper year, according to data released last month.

Your World Recruitment Ltd’s income increased by nearly a third, going from £50.5m to £66.8m (up 32%), with a similar rise in profits.

The company’s strategic report said: “Demand for agency staff and healthcare services in the first half of 2023 has remained strong principally due to staff shortages in the NHS and high waiting lists.

“The board expects the challenging market conditions to continue for the remainder of 2023, although demand is expected to remain due to an acute shortage of healthcare workers in the UK and worldwide.” The NHS has been pushing hard for increased overseas recruitment in recent years, to fill domestic gaps."

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Source: HSJ, 10 October 2023

 

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Patient died and 30 harmed after new IT system launch

A trust saw nearly 1,000 safety reports filed after introducing a new electronic patient record (EPR) – including one where a patient died and 30 others where they suffered harm.

The Royal Surrey Foundation Trust and Ashford and St Peter’s Hospital Foundation Trust installed a new joint EPR system in the middle of last year.

But Royal Surrey’s board was told there had been 927 Datix reports — which are used to raise safety concerns — related to the introduction of the “Surrey Safe Care” system, running up until mid September this year.

The catastrophic harm involved a patient death which the trust says was not “directly linked to technical problems” with the EPR, as “human factors” were involved, including inexperience or unfamiliarity with the electronic prescribing system.

Louise Stead, chief executive of Royal Surrey, said: “Implementing an electronic patient record is a huge shift for any workforce and we experienced some issues with the functionality of the system and getting users sufficiently trained and confident in using it correctly. We have worked hard to address these issues as quickly and responsibly as possible.

“Our fundamental aim is for ‘zero harm’ and any harm caused to a patient is taken extremely seriously and investigated. In the case of these Datix incidents the vast majority (over 99%) resulted in low or no harm to patients.

“However, one case resulted in the tragic death of a patient and we have been working closely with their family to be transparent and learn every possible lesson. This case was not directly linked to technical problems with the electronic patient record system and human factors did contribute. We are sincerely sorry for the failure in their care and devastating impact upon this person’s family.”

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Source: HSJ, 11 October 2023

 

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News SAS and LE doctors need targeted support, says GMC

The UK’s rapidly growing number of specialist, associate specialist, and specialty (SAS) doctors and “locally employed” (LE) doctors need targeted and specific support to make the most of their expertise, the General Medical Council has said.

SAS and LE doctors are the fastest growing part of the medical workforce, increasing by 40% in four years, from 45 578 in 2017 to 63 740 in 2021, said the regulator.1 This was largely driven by doctors from overseas coming to work in UK hospitals.

SAS doctors are specialty and specialist grade doctors with at least four years of postgraduate training, including two in a specialty relevant to their area of work.

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Source: BMJ, 9 October 2023

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More hips replaced in private hospitals than in NHS

The number of NHS-funded hip replacements carried out last year remained well below pre-covid levels, while the total funded privately nearly doubled to cover the shortfall, new data reveals.

The National Joint Registry annual report, which tracks orthopaedic activity across the NHS, showed the number of NHS-funded elective hip replacements carried out at NHS facilities in 2022 was at its lowest level since 2007.

However, the number of procedures performed in independent hospitals – both funded by the NHS and funded privately – has increased sharply. 

Orthopaedics is the biggest single elective specialty, with 847,000 of the current waiting list of 7.7 million on a trauma and orthopaedics pathway. As of July, 43% of these patients had been waiting longer than 18 weeks. 

The NJR report said: “The independent sector provision has increased hugely [since 2007] particularly in the last few years of covid recovery and there are now more hip replacements carried out in the independent sector than in the NHS.

“Despite the cost-of-living crisis the number of hip replacements paid for privately has almost doubled since 2019.”

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Source: HSJ, 10 October 2023

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Over 17 000 serious incidents reported in mental healthcare last year

The UK’s largest mental health charity, Mind, has published previously unseen data laying bare the full scale of the emergency in mental healthcare, with staff reporting 17,340 serious incidents in 12 months.

The Care Quality Commission (CQC) figures shows mental healthcare staff across England reported an incident two times every hour in the last year, where people are treated for issues including self-harm, eating disorders and psychosis.

Incidents included:

  • injuries to patients that caused likely long term sensory, movement or brain damage, or physically damaged their body
  • prolonged physical pain or psychological harm, or shortened life expectancy
  • cases of abuse, including those involving the police
  • injuries for which the patient needed treatment to prevent them dying.

All of these incidents involved care providers raising concerns with the CQC under their statutory duty under Regulation 18.

Dr Sarah Hughes, Chief Executive of Mind, says: “It is deeply worrying that healthcare staff across the country are so concerned about the situation in mental health settings that they are reporting a serious incident once every half an hour. We knew this was a crisis – now we know the scale of this crisis. People seek mental healthcare to get well, not to endure harm. Families are being let down by a system that’s supposed to protect their loved ones when they are most sick. The consequences can be and have been fatal".

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Source: Mind, 10 October 2023

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Would you want to be treated by a 'medic' with just two years' training?

Peter Marshall was delighted when he finally got an appointment after calling his GP surgery for several days.

On the day, he saw a young medic who said his excruciating stomach pain was caused by irritable bowel syndrome (IBS) and suggested over-the-counter peppermint tablets to ease the discomfort.

And off the 69-year-old retired IT specialist went, happy to have a diagnosis and treatment.

In fact, Peter hadn't had an appointment with a GP — he had been seen by a physician associate (PA).

This is a type of healthcare worker whose numbers are about to soar in the NHS in order to reduce the pressure on doctors so that they can concentrate on the most complex and seriously ill patients.

It all sounds like a great idea. Indeed, PAs are now being employed across areas that are particularly stretched, with around a third of PAs working in GP surgeries and 10% in A&E departments, according to the latest census by the Royal College of Physicians. But they are actually spread across 46 NHS specialties, from urology and surgery to cardiology and mental health.

In this role, they are permitted to carry out a range of medical tasks, from performing physical examinations, diagnosing patients and analysing test results to running clinics and performing minor procedures — as well as doing home visits — all under the supervision of a doctor.

However, in the case of Peter Marshall, although he was reassured by his diagnosis, his symptoms were, in fact, a sign of bowel cancer — and he died nine months later, in January this year.

His sister, who has told Good Health his story, says: 'My brother had no idea that he had seen a PA and not a qualified doctor — he didn't know the word physician associate even existed, no one does.'

The family, from London, later received an apology from the PA. 'Patients are so desperate to get an appointment with their GP, you are grateful to see anyone and whatever they say, you accept,' she says.

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Source: Daily Mail, 9 October 2023

 

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Hospital chief quits in protest at ‘cover-up’ over baby deaths

An NHS hospital has been accused of posing a continuing risk to patients by “covering up” leadership failures, including not properly investigating the deaths of two babies.

Dr Max Mclean, chairman of Bradford Teaching Hospitals trust, has quit in protest at the conduct of the trust’s chief executive, Professor Mel Pickup, after no action was taken over serious concerns about her performance.

In a blistering resignation letter, Mclean said he “cannot, in good conscience, work with a CEO who has fallen so short of the standards expected of her role that there is a genuine safety risk to patients and colleagues”. He is calling for senior national NHS figures to establish new leadership at the trust, and has written to the head of NHS England to share his concerns about Pickup, who has been in post since 2019.

Mclean told The Times there were parallels with the Lucy Letby scandal, when management ignored the concerns of whistleblowers. “Patients are at risk, babies are at risk, and there could be avoidable deaths unless there is a change of leadership,” he said.

The former detective chief superintendent who has chaired the trust since 2019, raised nine serious issues about Pickup’s performance, which he said were confirmed by an independent investigation that concluded last month.

However, the trust’s board met on October 2 and decided there would be no further action against Pickup, leaving Mclean with “no option” but to resign and speak publicly.

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Source: The Times, 10 October 2023

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Rise in A&E visits for hiccups and earaches add to strain on NHS

The NHS in England is facing mounting pressure amid a surge in patients attending A&E departments with minor ailments, health bosses have said.

Emergency departments, which are designed for serious injuries and life-threatening emergencies only, are seeing an increase in people attending with sore throats, insomnia, coughs and earache.

Data analysed by the Press Association news agency also shows more people going to A&E with complaints such as hiccups, nasal congestion, backache and nausea.

Cases where sore throat was the chief complaint rose by 77% between 2021-22 and 2022-23, from 191,900 cases to 340,441. Patients going to A&E with coughs rose by 47%, from 219,388 to 322,500, while attendances for nosebleeds rose by a fifth, from 47,285 cases to 56,546.

Miriam Deakin, the director of policy and strategy at NHS Providers, said: “The rise in A&E admissions is piling even more pressure on to an already stretched NHS. Persistent strain on primary care services, including GPs and dentists, means patients often resort to A&E when they cannot access timely care elsewhere.

“Minor ailments such as coughs, earache, fever, nausea and hiccups can and should be managed through more appropriate services such as pharmacies and NHS 111 online. This could ease pressure on emergency departments, whose priority is to deliver urgent care for those most in need. Boosting capacity of staff, beds and equipment in these settings would also significantly help. However, this requires proper funding and support from the government.”

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Source: The Guardian, 10 October 2023

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Cervical cancer: 17,500 women to have smear tests re-checked

About 17,500 women in Northern Ireland are to have their smear tests re-checked as part of a major review of cervical screening dating back to 2008.

Some of these women will be recalled to have new smear tests carried out, BBC News NI can reveal.

The Southern Trust said that the women affected should receive letters by post from Tuesday.

It follows a highly critical report commissioned by the Royal College of Pathologists (RCPath).

It found:

  • Several cytology staff were "significantly underperforming".
  • Mechanisms to check their work were flawed.
  • Action taken by management was inadequate over many years.
  • While a majority of negative results issued by the laboratory were correct, a "significant number" of these would likely have been identified as "potentially abnormal" by other laboratories.

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Source: BBC News, 9 October 2023

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Mental healthcare in England is a national emergency, say hospital bosses

Mental healthcare in England has become “a national emergency”, with “overwhelmed” services unable to cope with a big post-Covid surge in people needing help, NHS bosses say.

Care is so stretched that thousands of people undergoing a mental health crisis are having to be admitted every year to acute hospitals, even though they are not set up to deal with them.

Hospital bosses claim mental health in England has been “forgotten” by ministers who are giving priority to tackling the record 7.7m-strong care backlog, access to GPs and ongoing NHS strikes.

“Mental health has slipped down the government’s set of priorities and patients and services are being forgotten. This is a national emergency which is now having serious consequences across the board, not least for those patients in crisis,” said Matthew Taylor, the chief executive of the NHS Confederation.

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Source: The Guardian, 9 October 2023

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Physician associates told they must not call themselves doctors

Staff without medical training who fill gaps in the NHS workforce must tell patients they are “not a doctor” when introducing themselves, under new guidance.

The advice has been issued to “physician associates” (PAs), a type of clinical role that requires less training than doctors receive, amid a row over their use in the NHS.

PAs complete a two-year postgraduate qualification, but no medical degree, and can diagnose and treat patients. They can work in A&E or GP surgeries.

NHS England has set out plans to expand the number of PAs to deal with staff shortages, with a workforce of 10,000 PAs wanted over the next decade. The plan has been met with opposition from doctors’ leaders, who say the growing use of PAs instead of fully qualified doctors is leading to missed diagnoses and deaths.

Guidance published by the Faculty of Physician Associates, a part of the Royal College of Physicians, said that PAs must not mislead patients into thinking they are doctors.

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Source: The Times, 6 October 2023

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NHS trust and ward manager appear in court charged with manslaughter of mental health patient

An NHS trust and ward manager have appeared in court charged with the manslaughter of a 22-year-old mental health patient who died in hospital in July 2015.

Alice Figueiredo was found dead at Goodmayes Hospital in east London, and an investigation into her death was opened in April 2016. 

The Crown Prosecution Service (CPS) authorised the Met Police to charge North East London NHS Foundation Trust (NELFT) with corporate manslaughter last month following a five-year investigation.

It is just the second NHS Trust to face manslaughter charges. The Trust is additionally charged with an offence under section three of the Health and Safety at Work Act in connection with mental health patient Ms Figueiredo's death.

Ward manager Benjamin Aninakwa also faces a charge of gross negligence manslaughter and an offence under section seven of the Health and Safety at Work act.

NELFT is just the second ever NHS Trust believed to have been charged with corporate manslaughter, after Maidstone and Tunbridge Wells Trust was charged over the death of a woman who underwent an emergency Caesarean in 2015.

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Source: Mail Online, 6 October 2023

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How is the ADHD medication shortage in the UK affecting people?

ADHD patients around the UK are finding they can't get hold of medication since a national shortage was announced.

Three different medicines are affected, and the government says some supply issues could last until December.

The Department for Health and Social Care (DHSC) says "increased global demand and manufacturing issues" are behind the shortages.

Medication helps to manage symptoms, which can include difficulty concentrating and focusing, hyperactivity and impulsiveness.

Dr Saadia Arshad, a consultant psychiatrist, who specialises in diagnosing and treating people with ADHD.

She says the shortage of medication is "not a new issue, but it's a recurring one".

Dr Saadia says suddenly stopping meds can lead to patients "feeling jittery, finding it difficult to pay attention, staying focused and feeling restless".

Even though she understands the shortage can be worrying, Dr Saadia says it's important that people don't take measures into their own hands.

"These medicines can be quite potent and the response to medication for two individuals is not the same," she says.

"So please do not take any action without discussing it with your clinician."

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Source: BBC News, 6 October 2023

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Seven trusts relegated to NHSE’s poorest performers group

Seven trusts have been added to NHS England’s list of providers with the worst elective and cancer problems, putting the number of organisations in the ‘tier 1’ group back into double figures – and five leaving it, HSJ has learned.

Since last summer, NHS England has put trusts considered most “at risk” of missing recovery trajectories into “tiers” for either elective or cancer performance, or both.

The list has changed significantly for quarter three of this year, despite only a few months passing since the last rankings were revealed in August.

HSJ understands this is due to system-level agreements and some national factors, including the impact of ongoing industrial action on elective activity.

The number of trusts in the most challenged “tier 1” group for both elective and cancer performance has increased from eight to 11, with seven new providers entering this tier and five leaving.
Read full storySource: HSJ, 9 October 2023 

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Concern over severe food allergy prescriptions

Only 60% of patients who have had hospital treatment for food anaphylaxis were prescribed medicine to tackle another reaction, a study has found.

The study of some 130,000 NHS records where food allergy was mentioned showed 3,589 patients received "unplanned hospital treatment" for anaphylaxis.

Of those, only 2,152 were prescribed adrenaline auto-injectors (AAI) at least once.

Two leading allergy specialists have produced guidance to raise awareness.

Clinical scientist Dr Paul Turner from the National Heart & Lung Institute at Imperial College London, who carried out the study, and Prof Adam Fox, consultant paediatric allergist at Evelina London Children's Hospital, said they hoped the leaflet they have produced would save lives.

It is designed to help patients, parents, families, grandparents, friends and nannies so they feel empowered and more confident when looking after a person with food allergies.

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Source: BBC News, 6 October 2023

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Trust boss accuses private provider of ‘overpromising and underdelivering’

The boss of a large acute trust has accused a private provider of ‘overpromising and underdelivering’ after significant problems emerged with a local arrangement which have piled further pressure on its waiting list.

Mid and South Essex Foundation Trust recently discovered at least 1,000 cases were being returned to the trust from independent provider Omnes Healthcare following “complications” with a pathway for ear, nose and throat patients.

CEO Matthew Hopkins told a board meeting last Thursday: “I think other parts of the country, like us, are seeing independent sector providers in some cases overpromising and underdelivering. The consequence of that is what we’ve seen in the ENT example.”

The contract is managed by Mid and South Essex Integrated Care Board, which told HSJ it was “very sorry that some patients may have been waiting longer than they should have been” because of the problems.

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Source: HSJ, 6 October 2023

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Messages revealed healthcare workers were drugging patients

Two healthcare workers who exchanged vile texts while needless drugging sick people to ‘keep them quiet’ have been found guilty of ill-treating patients.

Senior nurse Catherine Hudson, 54, was found to have regularly tranquillised patients unnecessarily for her own amusement and to have an ‘easy’ shift.

While Charlotte Wilmot, 48, an assistant practitioner, wrote vile texts encouraging her to carry out the dangerous acts, with complete disregard for the consequences.

Preston Crown Court heard the pair worked on the stroke unit at Blackpool Victoria Hospital and had carried out needless sedations between 2017 and 2018.

Restrictions on prescription drugs were so lax in the stroke unit that staff would help themselves and self-medicate or steal drugs to supply to others, the court heard.

Drugs such as Zopiclone, a powerful medicine used to treat insomnia, were often stolen and used to drug multiple patients.

Police launched an investigation in November 2018 after a student nurse raised concerns about the treatment of patients in the stroke unit.

A number of staff members were arrested during the course of the investigation and their mobile devices were seized.

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Source: The Independent, 6 October 2023

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NHS ombudsman calls on trust chief to withdraw ‘not accurate’ remarks

The NHS ombudsman has told a health trust chief to withdraw “not accurate” remarks about him amid an alleged attempt to play down up to 1,000 avoidable patient deaths.

Rob Behrens wrote to Stuart Richardson, the head of the Norfolk and Suffolk mental health NHS trust, over remarks he made about him to Norfolk county council’s health scrutiny committee.

The councillors on the committee were questioning Richardson over claims reported by the BBC’s Newsnight programme that his trust had “watered down” a report into what are thought to be the avoidable deaths of up to 1,000 patients.

The changes between different versions of the document toned down criticism of the trust’s leadership, a move that drew criticism from Behrens and bereaved relatives.

For example, the auditors, Grant Thornton, removed references included in the first version to the trust’s governance being “poor, … weak [and] inadequate”, after discussions with trust bosses. The trust and Grant Thornton said the changes were part of a normal factchecking process.

Referring to the changes, Behrens had told Newsnight that “the differences in the texts at key points are so huge that this is not just a bureaucratic drafting issue”.

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Source: The Guardian, 5 October 2023

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Ambulance sector vows to improve sexual safety

The ambulance sector has signed up to a consensus statement in a bid to tackle misogyny and improve sexual safety for its staff and patients.

The statement – which chief allied health professions officer for England Suzanne Rastrick launched at this week’s Ambulance Leadership Forum – commits the service to a “cultural transformation”.

Several ambulance trusts have been criticised for a culture which includes “highly sexualised banter” in recent years, with reports highlighting sexual harassment, often of younger female staff.

The statement’s guiding principles include: a focus on protecting staff from misogyny and inappropriate sexual behaviour; removing barriers to speaking up and supporting those affected; and working towards an inclusive culture where staff understand misogyny and come to work feeling “sexually safe”.

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Source: HSJ, 5 October 2023

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Doctors urged to ask patients about gambling in new NHS mental health guidance

People who seek help for mental health issues should be asked about problem gambling in the same way they are asked about drugs, smoking and alcohol, new guidance has suggested.

According to the National Institute for Health and Care Excellence (NICE), those who visit an NHS health professional in England for depression, anxiety or thoughts about self-harm or suicide because of a possible addiction, such as alcohol or drugs, could be at a greater risk of harm from gambling.

NICE said questions should be asked about patients’ gambling habits to ensure they could cope with their thoughts and urges. In new draft guidance, it suggested patients should be encouraged to assess the severity of their gambling by using a questionnaire available on the NHS website. Those who scored eight or higher should seek support and treatment from gambling services.

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Source: The Guardian, 5 October 2023

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Women at greater risk of heart attack death due to medical sexism

Women are a third less likely to receive lifesaving treatment for heart attacks due to sexism in medicine, research shows.

Research led by the University of Leeds and the British Heart Foundation (BHF) pooled NHS data from previous studies looking at common heart conditions over the past two decades.

It investigated how care varied according to age and sex, finding that women were significantly less likely to receive treatment for heart attacks and heart failure.

Following the most severe type of heart attack — a Stemi — women were one third less likely to receive a potentially lifesaving diagnostic procedure called a coronary angiogram.

Women were significantly more likely to die after being admitted to hospital with a severe heart attack. They were also less likely to be prescribed preventative drugs that can help to protect against future heart attacks, such as statins or beta-blockers.

Dr Sonya Babu-Narayan, associate medical director at the BHF and a consultant cardiologist said: “This review adds to existing evidence showing that the odds are stacked against women when it comes to their heart care. Deep-rooted inequalities mean women are underdiagnosed, undertreated, and underserved by today’s healthcare system."

“The underrepresentation of women in research could jeopardise the effectiveness of new tests and treatment, posing a threat to women’s health in the long-term,” she added.

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Source: The Times, 5 October 2023

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Reliance on physician associates risks patient safety, doctors say

The use of non-medics in clinical roles is leading to deaths and missed diagnoses, senior doctors have warned.

Hundreds of doctors have signed an open letter to the leadership of the Royal College of Physicians (RCP), urging them to take a stand over the rollout of physician associates (PAs).

PAs are a newer type of medical role that involves significantly less training than doctors receive. The NHS has used PAs since 2003 but concerns have emerged in recent months about them taking on more advanced work than is appropriate.

NHS England set out plans earlier this year to expand their numbers significantly amid ongoing staff shortages.

Now an open letter to the RCP’s council, to date signed by 46 fellows of the college and 194 other doctors, sets out concerns ranging from patient safety and liability to the fact that newly qualified PAs can earn more than newly qualified doctors.

They say: “There have been several high-profile incidents in which serious illness was missed by a PA when undertaking a role that would normally be filled by a doctor. In some cases, avoidable deaths have resulted.

“Given that some of these conditions required more advanced training than the PA had received, the implication is that rare avoidable deaths are a price society must pay for the replacement of medical staff with non-medical staff. We believe this trade-off must be debated widely not just by doctors but also by the lay public.”

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Source: The Times, 5 October 2023

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GP burnout: 'I was left feeling like a husk of a human'

The number of doctors seeking help for mental health issues has risen by more than three quarters within two years, according to figures from a specialist treatment service for NHS staff. For one GP, the relentless stress of the job led to him taking three months off work with burnout.

David Triska is no stranger to high-pressure situations. As an army medic, he served two tours of Afghanistan.

But mounting workloads at his village GP surgery left him feeling "hollowed out and spent". Simple tasks, like unlocking his car or making a meal, became a challenge - an experience he describes as leaving him feeling "like a husk of a human".

"At that extreme point, I couldn't see why I needed to be here anymore," Dr Triska said.

He is not alone. Since the year ending March 2021, there has been a 77% rise in the number of doctors seeking help for mental health issues, according to figures shared with the BBC by a confidential support service for NHS staff.

More than 5,600 doctors used the NHS Practitioner Health programme in England in 2022/23, with about a third having thought about taking their own lives.

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Source: BBC News, 5 October 2023

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