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Almost one in three doctors investigated by GMC ‘have suicidal thoughts’

Almost one in three UK doctors investigated by the General Medical Council (GMC) think about taking their own life, a survey has found.

Many doctors under investigation feel they are treated as “guilty until proven innocent” and face “devastating” consequences, the Medical Protection Society (MPS) said.

Its survey of 197 doctors investigated by the GMC over the last five years found:

  • 31% said they had suicidal thoughts.
  • 8% had quit medicine and another 29% had thought about doing so.
  • 78% said the investigation damaged their mental health.
  • 91% said it triggered stress and anxiety.

The MPS, which represents doctors accused of wrongdoing, accused the GMC of lacking compassion, being heavy-handed and failing to appreciate its impact on doctors.

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Source: The Guardian, 27 April 2023

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Hospital to send hundreds of births elsewhere

The trust at the centre of a maternity scandal is trying to reduce the number of births at its main maternity units by 650 a year following a highly critical Care Quality Commission (CQC) visit.

East Kent Hospitals University Foundation Trust is looking at ways to reduce pressure on staff at the William Harvey Hospital in Ashford, including stopping bookings from women who are “out of area”. The unit currently has around 3,600 births a year, of which 200 are out-of-area bookings. The trust is also seeking to send more births to its other site, in Thanet.

It comes after the CQC used enforcement powers to order immediate improvements at the unit, following a visit in January, when it had “significant concerns about the ongoing wider risk of harm to patients”. 

Earlier this year, the trust’s new chief executive, Tracey Fletcher, held what board papers describe as an “emotional” meeting with 135 midwives, other staff and senior Royal College of Midwives representatives. She was told by staff that the service at the WHH was not felt to be safe due to a lack of substantive staff, high acuity of patients and the level of activity.

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Source: HSJ, 28 April 2023

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Nurses' strike in England to be cut short after court ruling

A 48-hour strike by nurses in England over the Bank Holiday weekend will be cut short by a day after a High Court judge ruled it was partly unlawful.

The walkout in a row over pay by the Royal College of Nursing, due to start on Sunday, will now end on Monday.

RCN chief Pat Cullen said this was "the darkest day" of the dispute so far and the government needed to negotiate.

Downing Street said it was "regrettable" the government had to go to court and it had tried to avoid it.

Health Secretary Steve Barclay took legal action after NHS Employers said the last day of the planned strike was not covered by the mandate as the ballots closed on 2 November at midday.

The judge Mr Justice Linden ordered the RCN to pay the costs of the hearing, saying the union had showed "a high degree of unreasonableness", the outcome was "inevitable" and "instead of grasping the nettle and conceding" it had forced the case to court.

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Source: BBC News, 27 April 2023

 

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Whorlton Hall: Four guilty of ill-treating hospital patients

Four carers have been found guilty of ill-treating patients at a secure hospital, following a BBC Panorama investigation.

Nine former staff at Whorlton Hall, near Barnard Castle, County Durham, had faced a total of 27 charges. Five of those on trial have been cleared.

Jurors heard vulnerable patients were mocked and treated with "contempt".

Lawyers for the defendants argued their clients had been doing their best in very challenging circumstances.

The men found guilty have been bailed and will be sentenced at Teesside Crown Court in July.

Speaking after the verdicts, Christopher Atkinson, of the Crown Prosecution Service, said the four men had a "duty of care for patients who, due to significant mental health issues, were wholly dependent on their support every day of their lives".

He said it was "clear" there were times when the care provided was "not only devoid of the appropriate respect and kindness required but also crossed the line into criminal offending".

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Source: BBC News, 27 April 2023

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UK on verge of new dawn for dementia treatments, says taskforce chair

Today’s generation of elderly people could be the last to face the spectre of untreatable Alzheimer’s disease, according to the co-chair of the government’s new dementia mission.

Hilary Evans, the chief executive of Alzheimer’s Research UK, appointed by ministers last month, said the world was “on the cusp of a new dawn” for dementia treatments that meant devastating neurodegenerative illness would no longer be regarded as an inevitable part of old age.

However, she warned that an overhaul of NHS dementia care was required to ensure that patients could access the first effective Alzheimer’s drugs, which could be approved in the UK as soon as next year.

Evans was appointed last month to co-chair the UK government’s national dementia initiative, which aims to draw lessons from the Covid vaccine taskforce to accelerate dementia research and comes with a commitment to double funding for dementia research to £160m a year by 2024–2025.

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Source: The Guardian, 26 April 2023

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NHS warned over writing to patients in English after child dies

Patient safety investigators have issued a warning to the NHS over writing to patients only in English after a Romanian child died following missed cancer scans.

The three-year-old, of Romanian ethnicity, had an MRI scan delayed after they were found to have eaten food beforehand.

When the appointment for the child’s MRI scan was made by the radiology booking team, a standard letter was produced by the NHS booking system in English asking the child not to eat before the scan, despite the family’s first language being Romanian. Staff at the trust had hand-written on the patient’s MRI request sheet that an interpreter was required.

“The family recognised key details in the written information, including the time, date and location of the scan,” the report said.

“However, they were not able to understand the instructions about the child not eating or drinking (fasting) for a certain amount of time before the scan.”

The Healthcare Safety Investigation Branch (HSIB) has urged NHS England to develop and implement new rules on supplying written appointment information in languages other than English.

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Source: The Independent, 27 April 2023

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Outcome of the expert review of the safety of isotretinoin

Following an in-depth expert safety review of the acne drug isotretinoin (commonly known by brand names Roaccutane and Reticutan), the Commission on Human Medicines (CHM) has agreed to a number of recommendations to strengthen the safe use of the treatment.

Isotretinoin is used to treat severe forms of acne, especially if there is a risk of permanent scarring. This medicine is an extremely effective last-line treatment for severe acne. However, patients and members of the public have raised concerns about suspected side effects associated with isotretinoin, including psychiatric (mental health) and sexual side effects that sometimes continue after treatment with isotretinoin has been stopped.

Key recommendations include:

  • Better information for patients and their families about the risks of isotretinoin so that they can make an informed decision before using this medicine.
  • Consistent monitoring of a patient’s psychiatric and sexual health so that any problems are spotted earlier and there are defined routes for patients to receive help.
  • Tighter controls on first prescribing isotretinoin to young people (aged 12 to 18) so that it is only started when doctors agree the acne is severe enough to justify it and that other standard treatments have been sufficiently tried and haven’t worked.

Patient Safety Commissioner, Henrietta Hughes tweeted last night: "I welcome the new recommendations from @MHRAgovuk to strengthen the safe use of isotretinoin. Courageous patients and families have shared their experience with the review. It’s only by listening and acting that we can meet patients’ needs."

Read MHRA press release, 26 April 2023

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‘One nurse per ward’ warning over next week’s strike

A major acute trust has warned ahead of next week’s nursing strike that it will face ‘very severe staffing shortages’ in children’s A&E, with ‘as few as one nurse per ward’, much less critical care capacity, and fewer operating theatres open than on Christmas Day.

Cambridge University Hospitals Foundation Trust’s medical director said in a note, seen by HSJ,  that the hospital would only have 60 to 70% of its critical care beds open and that “it is not possible to guarantee patient safety on our wards over the forthcoming weekend” with severe staffing shortages in “almost all areas”. 

The Royal College of Nursing is planning no derogations (exceptions) to its planned 48-hour walkout, from 8pm on Sunday until 8pm on Tuesday, whereas its previous action has exempted emergency care. 

There have been national warnings about the significant safety threat posed, but the CUH message, sent to all staff by medical director Ashley Shaw, sets out a more stark picture of critical services scaled back.

It says: ”Our current information indicates there will be a severe shortage of nurses in almost all ward areas, with as few as 1 nurse per ward per shift."

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Source: HSJ, 26 April 2023

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'My daughter's Long Covid is not nonsense'

In September 2021 Caitlin Glasgow, then 10-years-old, was diagnosed with Covid. She never fully recovered.

"The rest of Caitlin's classmates all returned to school after isolating for 10 days, but she was still in bed after six weeks," recalls her mother Lorna.

Lorna believes her daughter has Long Covid. She is one of 175,000 people in Scotland who say they are still affected by the illness.

Lorna, who lives in Penicuik in Midlothian, said her local GP was helpful and concerned for Caitlin, but it has been difficult to understand why she hasn't recovered like her friends.

"She still gets pains in her legs, that's probably the worst thing along with the fatigue. There's breathlessness, chest and tummy pain, brain fog and she gets quite light-headed at times."

A report published by a Scottish government committee said tackling the stigma around long Covid needs "urgent" action.

The Covid-19 recovery committee has outlined a raft of measures to improve awareness of the condition among healthcare professionals.

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Source: BBC News, 26 April 2023

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Deficit trusts face ‘intimidating conversations’ and orders to hold down staffing

NHS England has told many trusts and systems they are not allowed to increase their staffing establishment in the next 12 months, HSJ has learned.

Trust leaders said NHS England and the government were treating money as the “first priority” and one director, speaking anonymously, said: “The tone of the conversation [with NHSE about finance] has become intimidating and I worry that this will lead boards to take unsafe risks, and head into Mid Staffs territory.”

Board papers seen by HSJ, and several senior sources, confirmed many trusts had been told by NHS England during the planning process that they were not permitted to increased their total number of planned posts, known as staffing “establishment”, for 2023-24. 

A chief nurse at one large acute provider said the pressure on staff numbers “doesn’t triangulate” with messages on safer staffing from regulators, including NHSE, such as the drive to increase midwife numbers over maternity safety concerns. It also contrasts with plans to expand clinical staff numbers in the promised national long-term workforce plan, the chief nurse said.

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Source: HSJ, 25 April 2023

 

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WHO issues alert over another India-made cough syrup

The World Health Organization (WHO) has said that a batch of contaminated India-made cough syrup has been found in the Marshall Islands and Micronesia.

The WHO said that the tested samples of Guaifenesin TG syrup, made by Punjab-based QP Pharmachem Ltd, showed "unacceptable amounts of diethylene glycol and ethylene glycol".

Both compounds are toxic to humans and could be fatal if consumed.

The WHO statement did not specify if anyone had fallen ill.

The latest alert comes months after the WHO linked other cough syrups made in India to child deaths in The Gambia and Uzbekistan.

Sudhir Pathak, managing director of QP Pharmachem, told the BBC that the company had exported the batch of 18,346 bottles to Cambodia after getting all due regulatory permissions. He said he didn't know how the product had reached the Marshall Islands and Micronesia.

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Source: BBC News, 26 April 2023

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Britain’s dental health desperately needs a check-up

“Nobody cares about me. Nobody wants to help me. I don’t want to be here anymore.” Difficult words to hear from a small child, but for Molly Tippetts, aged five with a nasty tooth infection, the outburst was the culmination of two years of pain – all because she couldn’t get an appointment to see a dentist.

Molly is just one example of the UK’s dental-health crisis. An increasing number of people cannot access dental care at all; others – including children and expectant mothers – find themselves on years-long waiting lists. Even though the pandemic is over, NHS practitioners admit the country is in a crisis that shows no sign of ending.

New research shows one in four people suffering from toothache put off going to the dentist because of the cost.

Dentistry is now the number one issue raised with Healthwatch, the independent statutory body representing NHS patients, with four in five people who contacted them saying they found it difficult to access dental care. 

The Royal College of Paediatrics and Child Health recently warned that even toothbrushes were a “luxury item” for some families, and that children’s dental health was a “national disgrace”.

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Source: The Telegraph, 25 April 2023

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Alternative to epidural recommended for women in labour

Women in labour should be offered an alternative to an epidural spinal block injection, say new draft guidelines for the NHS.

The National Institute for Health and Care Excellence (NICE) is recommending remifentanil, which is a fast-acting morphine-like drug given into a vein.

Women control the medication themselves, by pressing a button to get more of the drug for pain relief. A timer ensures the user cannot administer too much of it.

Women who decide to try remifentanil and do not like it could still decide to have an epidural instead if there is no medical reason why they should not.

They can use gas and air, also called Entonox, which is a mix of oxygen and nitrous oxide, at the same time.

NICE says having remifentanil as a treatment option has advantages - it might enable women to be more mobile than with an epidural, which makes the legs numb and weak, for example.

Evidence suggests fewer epidurals might mean fewer births using instruments like forceps and ventouse vacuum suction, says NICE.

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Source: BBC News, 25 April 2023

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Priory Group whistleblowers 'concerned for patient safety'

Two former senior managers at a large mental healthcare provider have told the BBC they had concerns about the safety of patients and staff.

The whistleblowers claim they felt pressure to cut costs and fill beds.

The Priory Group, which receives more than £600m of public money each year, is the biggest single private provider of mental health services to the NHS.

The company denies the claims and says it successfully treats tens of thousands of patients each year.

It adds its services "remain amongst the safest in the UK".

The former members of the Priory Group's senior management said that, when they were working for the company, they found it difficult to recruit or retain staff, due to poor pay and conditions.

They believe this resulted in patients being placed on wards that did not have staff equipped with the right skills to handle their conditions.

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Source: BBC News, 26 April 2023

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GP is struck off for “utterly deplorable” litany of treatment failures

A senior GP has been struck off the UK medical register for an “utterly deplorable” litany of treatment failures and for “reprehensible” professional conduct that included leaving patients in the care of unprepared trainee doctors and operating without adequate professional insurance.

At least two patients suffered “grave consequences” from inaction on the part of Surraiya Zia, including a man whose deteriorating condition was effectively ignored for six months, despite the fact that he “presented to Dr Zia frequently, sometimes up to three times within a week, with red flag symptoms,” said Samantha Gray, chairing the medical practitioners tribunal.

The patient was eventually persuaded to seek private magnetic resonance imaging by his family. This showed widespread stage IV lung cancer that took his life within weeks. 

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Source: BMJ, 21 April 2023

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'Care homes are being deprived of dental services'

A care home manager said it had become an "impossibility" to get NHS dentists to visit her elderly residents when they needed treatment.

Liz Wynn, of Southminster Residential Home, near Maldon in Essex, said she had battled for years for site visits.

It comes as a health watchdog revealed that 25% of care home providers said their patients were denied dental care.

NHS Mid and South Essex said it was considering a number of approaches to improve access for housebound patients.

Ms Wynn said the shortage of NHS community dentists available to come into the home to carry out check-ups and treatment had been an "on-going concern" for almost 10 years.

Ms Wynn said the home relied on its oral care home procedures - such as checking residents' mouths daily - to prevent problems from escalating. However, she said while its residents were "our family", conditions such as dementia made it difficult to spot when patients were in pain.

She also said poor dental hygiene in the elderly could result in a number of potentially life-threatening infections.

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Source: BBC News, 24 April 2023

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Ministers in legal move to cut nurse strike short

Health Secretary Steve Barclay is to ask judges to rule whether part of the next nurse strike is unlawful.

The government wants the High Court to assess whether Tuesday - the last day of the walkout in England - falls outside the Royal College of Nursing's six-month mandate for action.

It believes the mandate will have lapsed by Tuesday - the 48-hour strike is due to start at 20:00 BST on Sunday.

The RCN accused ministers of using "draconian anti-union legislation".

Mr Barclay's decision to take legal action follows a request from hospital bosses.

The RCN argues the strike falls within the required six-month period from when votes were cast in its ballot for industrial action.

But NHS Employers said it had legal advice that the action would be unlawful.

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Source: BBC News, 24 April 2023

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NHS 'hamstrung by red tape' as it takes 50 steps to release patients

Britain is hamstrung by red tape in the NHS and workers are blighted by regulation, Boris Johnson’s former cabinet secretary has said.

Lord Sedwill, who was head of the civil service for two years, said that the UK was “failing to fulfil its great potential” because of excessive regulation.

He made the comments in a foreword to a report by the Policy Exchange think-tank which also highlights examples of regulation “passing on significant costs” to customers.

Examples in the report include NHS rules instructing hospital staff to go through 50 separate steps to discharge patients, “leading to severe delays”.

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Source: The Telegraph, 23 April 2023

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Cover-ups and lies in maternity care keep happening, says Donna Ockenden

A week after Donna Ockenden published her damning report on the catastrophic failures in maternity services at Shrewsbury and Telford Hospital NHS Trust in March last year, she was contacted by families in Nottingham asking her to investigate how dozens of babies had died or been injured in their city hospitals.

Six months later, Ockenden — herself a senior midwife — was put in charge of another inquiry by the government and yet again she is finding a culture of cover-ups and lies in maternity care.

“Of the families that I have met in Nottingham to date, some of them have expressed concerns to me that the trust were not truthful in discussions around their cases,” she tells the Times Health Commission.

“We have all the systems and structures in place that should be able to spot maternity services in difficulty and here we are again. Families are having to fight to get answers.”

The woman who has done more than anyone to highlight the problems with maternity care is reluctant to use the word “crisis” but she warns: “I think that without urgent and rapid action, from central government downwards — on funding and workforce and training — mothers and their babies are not going to be able to receive the safe, personalised maternity care that they deserve and should expect".

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Source: The Times, 21 April 2023

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Who is being hit hardest by the NHS' waiting list of 7 million people?

Seven million people in England are currently waiting for treatment on the NHS.

That's more than the entire populations of some countries, including Denmark and New Zealand.

Just under half of those referred to a specialist will have been in the queue for longer than 18 weeks — the maximum target set in 2004 by the Government. And more than 360,000 of them will have been waiting a year or more.

It's a deeply troubling state of affairs that has been thrown into sharp focus by the impact of the junior doctors' strike.

However, 'treatment delays existed long before the doctors' strike — and also the Covid-19 pandemic,' Danielle Jefferies, a senior analyst with independent think-tank The King's Fund, told Good Health.

Indeed, while the impact of the virus may have worsened the bottlenecks, the problem of rising patient demand is of longer standing. And the potential consequences are terrifying.

Studies show that for each month patients with breast, bowel or head and neck cancers have their treatment delayed, the chances of them dying from the disease increase by 6 to 13%.

Meanwhile, eye specialists fear some people may suffer permanent sight loss because they cannot get to a specialist in time to prevent the worsening of serious conditions such as glaucoma, which affects around 700,000 people in Britain.

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Source: MailOnline, 19 April 2023

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Half of UK public fear family would not be well looked after in care homes

Trust in care homes has slumped, leaving half of the British public lacking confidence that friends or family would be well looked after.

Nationwide polling for the Guardian revealed 9 out of 10 older people believe there are not enough care staff, and half have lost confidence in the standard of care homes since the start of the pandemic.

The survey conducted by Ipsos this month follows a doubling in public dissatisfaction in the NHS and exposes deepening fears about the fitness of a social care sector that had its weaknesses exposed by Covid-19, which claimed 36,000 lives in care homes in England alone.

The Relatives and Residents Association (RRA) said the polling tallied with calls to its helpline about the “harm and anguish caused by poor care and frustration at the inconsistency in standards”.

“We must weed out the poor providers and invest in skills – care workers must become our most valued workers, not the least,” said Helen Wildbore, the RRA’s chief executive. “Tomorrow, any one of us could need them.”

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Source: The Guardian, 24 April 2023

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More teenagers unprotected from serious diseases as vaccine uptake falls

More teenagers are at risk of contracting rare but serious diseases due to a fall in immunisations as a result of the pandemic, according to a report.

The uptake of vaccines among teenagers in secondary schools that protect against meningococcal disease, diphtheria, tetanus and polio has dropped since COVID affected routine school immunisation programmes provided by the NHS.

The UK Health Security Agency (UKHSA) found that 69% of children in year nine, aged 13 and 14, had the MenACWY vaccine and the Td/IPV booster in 2021-22. This marked a 7% drop in coverage for both vaccines compared to the previous year.

The 3-in-1 Td/IPV booster helps provide teens with long-lasting protection against tetanus, diphtheria and polio, diseases that can result in serious illness or even death.

Doctor Vanessa Saliba, consultant epidemiologist at UKHSA said: "In recent years we have seen vaccine uptake fall due to the challenges posed by the pandemic.

"Many young people who missed out on their vaccinations have already been caught up, but more needs to be done to ensure all those eligible are vaccinated.

"These vaccines offer the best protection as young people start their journey into adulthood and mixing more widely - whether going to college, starting work, travelling or going to summer festivals."

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Source: Sky News, 24 April 2023

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Mental health services to face surprise spot-checks after series of abuse scandals, watchdog warns

Unannounced and out-of-hours spot-checks on mental health services are set to ramp up following a string of abuse scandals, The Independent can reveal.

The Care Quality Commission’s new mental health chief Chris Dzikiti said he was “saddened” by “unacceptable” scandals in the last six months, warning the regulator “will use the powers [it has] to hold people to account.”

He said the organisation will be carrying out more unannounced inspections of providers, including inspections launched out of normal hours, with the aim to have the “majority” of spot-checks carried out this way.

In his first interview since joining the regulator in November Mr Dzikiti, who is mental health nurse by background, said: “I talk to chief execs of mental health services, I talk about [how] as a regulator, we will use the power we have, when [we] see poor practice, we will definitely hold people to account.

“In our inspection programmes, we are also increasing the unannounced inspections out of hours inspections, because we need to try and get really deep into the culture of mental health services, especially those areas where we think there’s a higher risk of poor practice.

“I will not rest until we get people safe.”

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Source: The Independent, 24 April 2023

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Northern Ireland medical negligence costs double in a year

The amount of government money spent on medical negligence cases and legal fees in Northern Ireland doubled within a year.

Just over £20m was paid out during 2020-21 but that increased to more than £40m in the 2021-22 financial year.

Last year, £30.7m was paid out in damages, while £5.9m went on plaintiff costs and £3.7m in defence costs.

The increase in cost is being attributed to the coronavirus pandemic.

Last year, 3,987 clinical negligence cases were open. Almost half (1,813) of all cases open in 2021-22 related to four specialties:

  • Obstetrics - 564
  • Accident and emergency - 456
  • Neurology - 407
  • General surgery - 386

There has been a stark increase in the number of cases relating to neurology in the past five years from 23 in 2017-18 to 407 in 2021-22.

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Source: BBC News, 24 April 2023

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Sciensus: Chronically ill patients go without vital drugs amid delays by NHS-contracted firm

Chronically ill patients across the UK allege they've had to go without vital medication amid delays by a private company contracted by the NHS to deliver drugs.

In the last year alone, Sciensus was awarded NHS contracts worth more than £5 million, despite being placed into special measures by health regulators in 2021 following widespread delivery failings.

ITV News has revealed that the CQC is currently reviewing whether to take further regulatory action against Sciensus, having been made aware of concerns about the company’s performance.

The company, which is based in Burton-on-Trent and says it "works with every NHS Trust in the country", should provide a lifeline for those who rely on specialised medications.

These include those with long-term conditions - like cancer, HIV, and haemophilia - which often require drugs that can't be collected from high street or hospital pharmacies.

One new mother with rheumatoid arthritis said she was taken to A&E after Sciensus left her without medication for three weeks.

The 37-year-old, who wishes to remain anonymous, told ITV News: "I was unable walk with a small baby... it was such a chronic flare that I couldn't walk, which I've never, ever had before in my life."

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Source: ITV News, 21 April 2023

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