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HSJ has published an interactive map of local NHS waits around England in June 2023, showing the pressures, with links to all the details by organisation and specialty.
It shows the local picture on 18-week referral to treatment taken from the latest Referral to Treatment (RTT) waiting times data released by NHS England.
Read full story (paywalled)
Source: HSJ, 14 August 2023
At-home smear tests should be introduced in Wales, campaigners say. Love Your Period campaigners said self-sampling at home would encourage more people to have the tests.
For women aged 25 to 64 a smear test is an effective way of detecting human papillomavirus (HPV) and preventing cervical cancer. According to Public Health Wales data, cervical cancer is the most common cancer in women under the age of 35, with regular screening helping to reduce the risk of getting cervical cancer by 70%.
The Welsh government said it followed advice from the UK National Screening Committee (UKNSC), which is yet to make a recommendation on self-sampling. However, it said Public Health Wales (PHW) was considering how the tests could be implemented in Wales. Currently, women in Wales are invited for a screening to check for the presence of high-risk HPV every five years.
Campaigner Jess Moultrie said tests should be made available to those who have experienced trauma and find the process of in-hospital smears triggering. "Being able to do it at home gives you that power, you can be a little bit more relaxed, it's not as intimidating."
Source: BBC News, 14 August 2023
A Scottish research firm set up by a dementia expert who quit the NHS because of insufficient “infrastructure” has developed a blood test to allow doctors to identify Alzheimer’s disease earlier.
Scottish Brain Sciences, based in Edinburgh, announced it will collaborate with Roche Diagnostics on a series of projects, which the former’s founder, Craig Ritchie, said could have “big impacts”. Ritchie, who has led dozens of drug trials and pilots a European network on preventing Alzheimer’s, had been advocating the need to create new brain health centres across Scotland.
Read full story (paywalled)
Source: The Times, 14 August 2023
Medics have welcomed clarification from health officials over when the upcoming flu and Covid-19 vaccination programme will begin.
NHS England had been criticised for pushing back the start date a month with pharmacists saying the change of plan would likely “catch patients off guard”. While school-aged children will be able to receive the flu shot from 1 September, adults were not expected to start getting flu and Covid jabs until October, a month later than recent years.
Officials briefed that the later start time was so sites can co-administer both vaccines wherever possible, to make it more convenient, and to ensure protection in later winter months – typically when viruses are more likely to spread. But NHS England was criticised for a lack of transparency and communication, as healthcare teams had been preparing to provide the service as usual from September.
NHS England said to maximise and extend protection during the winter and through the period of greatest risk in December and early January 2024, care home residents and care home staff must start receiving their jabs from 2 October, and other eligible flu and Covid cohorts from 7 October. However, in updated guidance officials said that as some firm commitments and appointments have already been made, any patient wishing to receive their vaccination in September will be allowed to do so. Most people are still likely to have their vaccines in October, officials believe.
Responding to news that NHS England will, if needed, now allow practices to deliver both vaccination programmes from September rather than October, Dr Katie Bramall-Stainer, chair of GPC England at the British Medical Association (BMA), said: “This news is very welcome, coming after the BMA made clear yesterday to NHS England that shifting the entire programme at the last minute to October would not only cause widespread confusion, but also serious disruption as flu clinics would have to be rearranged to fit the new timetable."
Source: inews, 11 August 2023
Two-thirds of NHS cancer waiting time targets are expected to be scrapped in England, in a move the health service says aims to catch cancers earlier.
NHS bosses want to reduce the number of targets, most of which have been routinely missed in recent years, from nine to three. They say the plan is backed by leading cancer experts and will simplify the "outdated" standards.
But some are concerned about the move. Pat Price, oncologist, visiting professor at Imperial College London and Head of the charity Radiology UK, said current performance was "shockingly bad", and while too many targets could be disruptive, "the clear and simple truth is that we are not investing enough in cancer treatment capacity".
Source: BBC News, 14 August 2023
Making data on medical interventions easier to collect and collate would increase the odds of spotting patterns of harm, according to the panel of a recent HSJ webinar
When Baroness Julia Cumberlege was asked to review the avoidable harm caused by two medicines and one medical device, she encountered no shortage of data.
“We found that the NHS is awash with data, but it’s very fractured,” says Baroness Cumberlege, who chaired the Independent Medicines and Medical Devices Safety Review and now co-chairs the All-Party Parliamentary Group which raises awareness of and support for its findings.
And it is that fracturing that can make patterns of harm difficult to spot. The report concluded that many women and children experienced avoidable harm through use of the hormone pregnancy test Primodos, the epilepsy drug sodium valproate, and the medical device pelvic mesh – simply because it hadn’t been possible to connect the dots.
“It’s very hard to collect things together and to get an overall picture. And one of the things that we felt very strongly about was that data should be collected once, but used often,” said Baroness Cumberlege at a recent HSJ webinar. Run in association with GS1 UK, the event brought together a panel to consider how better data might help address patient safety challenges such as problems with implants.
“But the big problem was they couldn’t identify who had which implants. No doubt somebody somewhere had written this down with a fountain pen and then someone spilt the tea over it and the unique information was lost,” recalled Sir Terence Stephenson , now Nuffield professor of child health at Great Ormond Street Institute of Child Health and chair of the Health Research Authority for England.
The review he chaired therefore suggested establishing a concept of person, product place – “for everybody who had something implanted in them, we should have their name, the identifier of what had been put in, and where it had been put in. And one of my panel members said: ‘Well, how are we going to record this? We don’t want the fountain pen and the teacup.’”
Ultimately the answer suggested was barcode scanning. By scanning the wristband of a patient, that on the product being implanted, and one for the hospital theatre or department at which it was being implanted, the idea was to create an immediate and easy-to-create record.
For those long convinced of the virtues of barcode scanning in health, it is a welcome development
Two years later, the then Department of Health launched the Scan4Safety programme, in which six “demonstrator sites” implemented the use of scanning across the patient journey. At these organisations, barcodes produced to GS1 standards – meaning they are globally unique – are present on patient wristbands; on equipment used for care, including implantable medical devices; in locations; and sometimes on staff badges.
Link to full article here (paywalled)
A group of potent synthetic opioids called nitazenes have been linked to a rise in overdoses and deaths in people who use drugs, primarily heroin, in England over the past two months, drug regulators have warned.
The Office for Health Improvements and Disparities has issued a National Patient Safety Alert on potent synthetic opioids implicated in heroin overdoses and deaths.
In the past 8 weeks there has been an elevated number of overdoses (with some deaths) in people who use drugs, primarily heroin, in many parts of the country (reports are geographically widespread, with most regions affected but only a few cities or towns in each region).
Testing in some of these cases has found nitazenes, a group of potent synthetic opioids. Nitazenes have been identified previously in this country, but their use has been more common in the USA. Their potency and toxicity are uncertain but perhaps similar to, or more than fentanyl, which is about 100x morphine.
The National Patient Safety Alert provides further background and clinical information and actions for providers.
As junior doctors begin a four-day strike today with a two-day strike by consultants a fortnight later, Sir Julian Hartley, chief executive of NHS Providers, said:
"Trust leaders are very worried about six more days of severe disruption across the NHS this month.
"We could be close to a tipping point. Trusts and staff are pulling out all the stops to reduce waiting times for patients but with no end to strikes in sight the sheer volume of planned treatment being put back due to industrial action will make it almost impossible for trusts to cut waiting lists as much as the government wants.
"Waiting lists are now at a record high of 7.57 million, the pressure on urgent and emergency care services is relentless and an already stretched NHS is gearing up for another high-demand winter as pressure on tight budgets mounts.
"A string of strikes – which have led to more than 835,000 routine treatments and appointments being put back since December – is estimated to have cost the NHS around £1bn already including lost income and hiring expensive staff cover.
"The number of rescheduled appointments could be close to 1 million after this month's strikes and consultants have called another two-day strike in September. There will be a long-lasting effect on patients who have had treatment delayed and on already low staff morale.
"Concerns are mounting too over how patient safety will be maintained during August's strikes as many NHS services will be even more stretched as many staff are on much-needed summer holidays and cover is harder to secure.
"It's vital that the government and unions find a breakthrough urgently. Trust leaders understand the strength of feeling among striking staff and why they're taking action. Everyone in the NHS wants to concentrate on treating more patients more quickly rather than spend days making plans to cope with strikes.
"People can still rely on the NHS during strikes, calling 999 in an emergency. For less urgent cases people should use 111 online for help and advice."
Despite regular MRI scans at the Royal Preston Hospital showing that the tumour was growing, May Ashford was not offered surgery until five years later.
A woman died unnecessarily after doctors failed to operate soon enough on a growing brain tumour, according to the health complaints service.
May Ashford, from Blackpool, was diagnosed with a brain tumour in 2010 after experiencing headaches and seizures.
Despite regular MRI scans at the Royal Preston Hospital showing that the tumour was growing, she was not offered surgery until five years later.
An investigation by the Parliamentary and Health Service Ombudsman (PHSO) said the treatment was too late as medical staff had failed to monitor the scan results properly.
Medical experts said Mrs Ashford should have been operated on at least three years earlier, before the tumour had time to grow and affect the surrounding area of the brain.
She tragically died aged 71 from a stroke following surgery.
Link to full article here
The Care Quality Commission (CQC) has published a report on Stoke Mandeville Hospital, part of Buckinghamshire Healthcare NHS Trust following a recent inspection in June.
CQC carried out a focused inspection of the trusts children’s emergency department in response to concerns raised about the safety and quality of the service. Inspectors found children and young people received safe care. However, the trust needs to review its systems to make sure potential serious incidents are managed in a way that allows any lessons learned to be shared, to reduce the risk of them happening again.
Link to the full report (opens in a new browser window)
After generations of inaction and very few novel ideas, researchers and activists are hopeful a new path is being charted in understanding and treating the crippling chronic condition
“There’s an excitement at the moment,” says Andrew Horne. After decades of inaction, something is happening in endometriosis.
Now, says the professor of gynaecology and reproductive sciences at the University of Edinburgh, “I do think things are changing. There are more people working on it, so it’s bringing in people from different disciplines with new ideas.”
It’s hard to pinpoint the exact moment when despair turned to hope in the research and patient community. There was no single breakthrough. No one person responsible.
In March, the largest ever study on the genetics of endometriosis was published in Nature Genetics, which found genetic links to 11 other pain conditions as well as other inflammatory conditions. The study, involving DNA from more than 760,000 women, found ovarian endometriosis is genetically distinct from other types and indicated there may be a genetic predisposition to excessive inflammation in people with the condition. One of the researchers, Dr Nilufer Rahmioglu from the University of Oxford, described the data as a “treasure trove of new information”.
Weeks later on the other side of the world, researchers from Sydney’s Royal Hospital for Women attracted international attention after they grew tissue from different types of endometriosis and compared how each responded differently to treatments. Jason Abbott, professor of obstetrics and gynaecology at the hospital, likened the development to those made in the treatment of breast cancer three decades ago.
Two weeks on from the Australian discovery, Japanese researchers found a common form of bacteria may be contributing to the growth of endometriosis via inflammation.
The frisson was, by then, hard to miss.
Read the full article here: https://www.theguardian.com/society/2023/aug/10/its-really-only-the-beginning-are-we-on-the-cusp-of-a-breakthrough-in-endometriosis
Racism is a significant issue affecting recruitment, retention, and patient care. With this in mind, the Royal College of Psychiatrists launched the Act Against Racism campaign, offering guidance and actions to combat racism in the workplace for better staff well-being and patient care, writes Adrian James
In June, HSJ revealed that mental health trusts in England are among the biggest users of locum doctors in the NHS. With one in seven medical posts in mental health trusts vacant, many providers now rely on locum doctors to deliver essential services to patients.
Source: HSJ, 9 August 2023
Coroners have raised multiple warnings about the way a commonly-used medication is being prescribed to at-risk patients, HSJ has found.
HSJ has identified at least nine ‘prevention of future deaths’ reports issued by coroners since 2017 which highlighted the way the deceased’s prescription for sertraline was handled, with two of these issued since the start of 2023.
It comes as Open Prescribing data suggests sertraline prescriptions have increased by almost 40 per cent since 2019, which has led to concerns that GPs are struggling to meet the growing demand for follow-up checks.
Source: HSJ, 9 August 2023
A hospital maternity service has dropped two ratings to ‘inadequate’ after the Care Quality Commission warned of a ‘chaotic environment’, where leaders normalised poor practices and failed to act on safety concerns.
The Care Quality Commission inspected Hull Royal Infirmary’s maternity services earlier this year, and imposed urgent conditions on the service, requiring Hull University Teaching Hospitals Trust to make “rapid improvements” to keep people safe.
The overall maternity rating fell from “good” to “inadequate”, the CQC announced today, although it only reviewed the “safe” and “well led” domains. The inspection was part of an ongoing national CQC maternity inspection programme, which has downgraded numerous services to “inadequate” over the last year.
The regulator said the antenatal day unit and triage department was a “chaotic environment which was not fit for purpose”, and found some staff described “unkindness” from peers. Women and service users waited long periods without an offer of food or water, it said.
Significant concerns were raised about safeguarding, with staff unable to identify adults and children suffering or at risk of significant harm.
Source: HSJ, 9 August 2023
About one in seven people in the UK now take medication to treat depression but some say they are not being given appropriate advice about the potential side-effects of the drugs they have been prescribed.
Seonaid Stallan's son Dylan was a teenager when he began receiving treatment for body dysmorphia and depression.
"He was struggling with the way he felt about himself, the way he looked," Seonaid said.
"He was extremely anxious. He would be physically sick. He would be unable to leave the house."
Dylan, from Glasgow, was treated with the antidepressant Fluoxetine from the age of 16.
But when he turned 18, his medication was changed to Sertraline.
Within two months of his prescription change he had taken his own life.
Source: BBC, 9 August 2023
A ‘disappointingly slow’ transformation of community services means thousands of mental health patients are still presenting at emergency departments within weeks of being discharged from an inpatient facility.
Experts said an NHS England-led community transformation programme, launched in 2019 as part of a £2.3bn investment in mental health services, should have helped reduce readmission rates, but internal data seen by HSJ suggests the rates have actually increased since then.
The data reveals for the first time the proportion of patients discharged from inpatient care who then present to accident and emergency within two months.
The proportion of adult patients was 11 per cent in 2018-19, when the investment programme was launched, and had increased to 12 per cent by 2022-23, representing around 6,000 adult cases.
The situation appears worse for children, with an 18 per cent readmission rate within two months, up from 17 per cent in 2018-19.
Source: HSJ, 8 August 2023
Teens who have been bullied by their peers, or who have considered or attempted suicide, may be more likely to have more frequent headaches than teens who have not experienced any of these problems, according to a study published in the August 2, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology. The study does not prove that bullying or thoughts of suicide cause headaches; it only shows an association.
“Headaches are a common problem for teenagers, but our study looked beyond the biological factors to also consider the psychological and social factors that are associated with headaches,” said study author Serena L. Orr, MD, MSc, of the University of Calgary in Canada. “Our findings suggest that bullying and attempting or considering suicide may be linked to frequent headaches in teenagers, independent of mood and anxiety disorders.”
The study involved more than 2.2 million teens with an average age of 14 years.
Read the full article here: https://www.eurekalert.org/news-releases/997216
Videos circulating on the social media platform claim that castor oil can help to treat dryness, floaters, cataracts, poor vision and even glaucoma.
Doctors have issued a warning not to use castor oil as a way to treat vision problems following claims on TikTok.
Castor oil is a type of vegetable oil traditionally used to treat a range of issues like skin infections. It is even a common ingredient in some over-the-counter eye drops. But dozens of TikTok videos have gone one step further, claiming that by rubbing the oil over eyelids, eyelashes and under the eye, it helps to treat dryness, floaters, cataracts, poor vision and even glaucoma. One woman said that after two weeks of use, she doesn't need to wear reading glasses as often, while another said it prevented an eye infection from progressing.
Now, doctors in the US have said the oil is "not going to seep in and dissolve or fix anything". They warned that some unsterilised bottles on shop shelves may even cause irritation or infection if put directly into the eye. "Castor oil is not a cure-all. If you have concerns about your eyes, you need to see an optician," Dr Ashley Brissette, a spokesperson for the American Academy of Ophthalmology. She said they cannot make recommendations as studies that look at the effects of eye drops which contain castor oil on dry eyes and blepharitis are of low quality, involving small sample sizes and no control groups.
Dr Vicki Chan, a practising optician in Los Angeles added that castor oil has no effect on conditions that affect the inside of the eyeball. These include cataracts - an age-related condition that causes cloudy vision - floaters, and glaucoma, which occurs when fluid accumulates and damages the optic nerve. Dr Brissette added that ignoring early symptoms of glaucoma, or waiting to see it castor oil improves conditions such as cataract, can lead to permanent vision loss or complications with surgery. Instead, eating a healthy balanced diet; removing all make up before bed; wearing sunglasses outdoors and attending regular eye examinations are alternative ways to maintain eye health.
The Government has decided to cut the fee GPs are paid per Covid vaccination by a quarter, prompting BMA to issue a patient safety warning.
NHS England has published the new enhanced service specification for Covid vaccines to be delivered between 1 September and 31 March next year, setting out that GPs will be paid £7.54 for each vaccine administered – down from £10.06 – and continue to be paid £10 for each housebound patient.
The fee had already been reduced from £12.58 last year, when the BMA advised GPs to review whether they were still able to fulfil the ES commitments.
The new specification said that practices with ‘sufficient workforce capacity so as not to impact the delivery of essential services and appropriately trained and experienced staff’ must indicate their willingness to participate in the programme before 5pm on 29 August.
The Item of Service fee for flu remains £10.06 of each vaccine delivered, according to the new specification published last week.
But the BMA said that that NHS England’s decision to reduce the Covid fee ‘undervalues general practice and threatens the safety of vulnerable patients’.
Read the full article here: https://www.pulsetoday.co.uk/news/clinical-areas/respiratory/25-cut-to-covid-vaccine-ios-threat-to-patient-safety-bma-warns/
Steve Gulati, Associate Professor and Director of Healthcare Leadership at HSMC (University of Birmingham) discusses the concept of "time to care" within healthcare.
A UK-wide poll of healthcare workers revealed that most NHS staff think they have too little time to help patients and the quality of care that services provide is falling. This reported reduction in the time to care is perhaps inevitable after almost a decade of health funding failing to keep up with increases in demand, and is a cause for concern for all of us – patients, carers or those working in the NHS. Where does this fit in to the wider picture – and can anything be done about it?
It is not just NHS workers who are feeling the pinch – levels of public satisfaction with the NHS are at an all-time low. Interestingly, the two most cited reasons relate to access (difficulties or delays in getting appointments) and, tellingly, to staff shortages. Even against this gloomy backdrop, the collectivised funding model upon which the NHS is founded continues to find significant public support. All of this points towards a painful congruence – NHS staff feel that they do not have enough time to care, and the public is noticing.
Is ‘time to care’ an outdated concept, harking back to an age of long patient stays, a paternalistic bedside manner and unrealistic expectations? Both staff and patient experience suggest not. Although technology plays an increasing role in healthcare diagnostics, treatment and recovery, delivering care remains a deeply human phenomenon and is essentially a relational and personal task. Recognising that frontline healthcare workers need time to care is not a new phenomenon. Influenced by service improvement methodologies, the ‘productive ward’ initiative in the mid-2000s placed an explicit emphasis on using efficiency techniques for the express purpose of releasing nursing staff to have “time to care”. It was acknowledged that productivity was more than metrics around bed occupancy and throughput, for example, and that the driving purpose of service improvement was to time to care. Whilst research indicated a nuanced impact, the principle is long recognised.
If solutions to these problems were easy, they would have been implemented by now. There is no doubt that on one level, it really is a matter of resources – no system can carry a vacancy factor of around 10% for any length of time without there being an evident impact. However, even within an environment of constrained resources, choices are made every day by caregivers and leaders alike about what receives attention and what is allowed to move into the ‘important but not urgent’ category. That is in no way to blame the hard-pressed caregivers, but instead to indicate that even when it really does not feel like it, every individual has a level of agency.
Feeling as though one does not have time to do one’s job is, put simply, unpleasant for all workers but should especially concern us in care environments. The impact on clinical safety and quality is an obvious starting point, but it is also important to recognise the impacts on care workers themselves with regard to emotional labour and the impact on the psychological contract that working in a caring profession, when people feel that they don’t have enough time to care, must have. As eloquently stated by the Vice-President of the Royal College of Physicians in Wales, it is “…very clear that good clinicians, be they nurses, doctors, therapists or pharmacists, need time to train, time to care and time to rest”. Even in challenging times, self-care and compassionate, values driven leadership can make a difference. Caring is everyone’s business.
Link to original article: https://www.birmingham.ac.uk/news/2023/healthcare-workers-need-more-time-to-care
Almost three-quarters of babies born with a rare muscle-wasting disease are living longer thanks to advances in NHS treatment.
Spinal muscular atrophy (SMA) is a genetic condition that causes muscle weakness, along with progressive loss of movement and paralysis.
There are three types of this disease that impact children. SMA1 manifests in babies under the age of six months and is the most severe, while SMA2 and SMA3 are less severe. They develop between the ages of seven and 18 months, and after 18 months of age, respectively. According to the NHS, about 70 babies are born in the UK with SMA each year.
The NHS began rolling out new treatments in 2019, starting with injectable drug nurinersen – marketed as Spinraza – which targets the SMN2 gene in patients. Before 2019 there were no effective drugs for this condition.
A study by SMA Reach UK claims patients with untreated SMA1 historically had a 50% survival probability at eight to 10 months, reducing to 8% at 20 months of age. However, data from the SMA Reach UK database analysed by NHS England found 73% of babies with SMA1 are now living beyond two years and without permanent ventilatory support.
Source: Independent, 7 August 2023
One of the UK's most secretive centres of scientific research - Porton Down - is aiming to stop the next pandemic "in its tracks".
James Gallagher, Health and science correspondent, passed through the incredibly tight security at this remote facility to get rare access to its scientists.
They are based in the shiny new Vaccine Development and Evaluation Centre.
Their work builds on the response to Covid, and aims to save lives and minimise the need for lockdowns when a new disease next emerges.
Source: BBC 7 August 2023
Families of people with complex medical needs are warning the NHS system that funds their care at home is struggling to provide sufficient support.
Despite recent significant increases in spending on Continuing Healthcare, experts say staff shortages and rising prices mean families are lacking help.
Some say at times they are so exhausted from providing care, they worry about the safety of their relatives.
The government says it has invested billions into health and social care.
The BBC followed 24-year-old Declan Spencer for 10 months, witnessing how the repeated breakdown of his care has left his mother having to provide it by herself, day and night.
Source: BBC 7 August 2023
Older patients should walk around hospital wards and along corridors to prevent their muscles weakening, research suggests.
Lying in a hospital bed for several days can cause a sharp deterioration in strength, leaving some elderly patients struggling to walk or live independently when they are discharged.
New research shows this decline can be prevented if patients are helped to walk for at least 25 minutes a day while in hospital.
The best effect was observed when patients walked around the hospital for at least 50 minutes a day. The study suggested that a mixture of physical activity, such as 20 minutes working with resistance bands while seated and 20 minutes of walking, also helped.
The authors said patients who remained active during their stay in hospital were less likely to suffer “adverse events” after they were discharged.
Read full story (paywalled)
Source: The Times, 4 August 2023
A man died after A&E doctors sent him home from hospital and “told him to drink Lucozade” despite him vomiting 100 times in 24 hours.
Nick Rousseau died from an undiagnosed blocked bowel in 2019 after doctors at Milton Keynes Hospital failed to spot that he had the life-threatening condition.
The 47-year-old was sent home twice in three days and reassured he “would be alright” as doctors believed he had gastroenteritis, his “devastated” wife Kimberly White said.
But Mr Rousseau was actually suffering from an ischaemic bowel, a condition which blocks the arteries to the bowel. He had been to see his doctors several times and had lost three stones in weight over two years due to vomiting and diarrhoea but was never diagnosed.
His family, represented by Osbornes Law, received a six-figure payout in June from Milton Keynes University Hospital NHS Foundation Trust. While it did not admit negligence, it accepted that there were features of Mr Rousseau’s illness which could have justified admission, inpatient observation, and further tests, which could have given a definitive diagnosis.
Source: The Independent, 4 August 2023