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NHS plans new elective target after April deadline missed

System leaders are discussing pushing back the NHS’s target to virtually eliminate 78-week breaches from the waiting list by this month to ‘June or July’, HSJ understands.

The discussions come after the service missed its original targeted trajectory of clearing the backlog by this month, as first proposed in NHS England’s elective recovery plan last February, despite a steep reduction over the past 18 months.

Internal NHS forecasts suggest there will be around just over 10,000 long waiters still on the waiting list by the end of April, as HSJ first revealed last month. Senior sources said this week that this figure remained a likely position for the end of the month.

HSJ understands there has not been any official communication to trusts about pushing back the 78-week target, and it was not yet clear when the centre’s expectations would be finalised.

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Source: HSJ, 21 April 2023

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USA: Rising focus on patient safety and regulatory compliance driving growth in medical device complaint management market

The medical device complaint management market is experiencing significant growth due to the increasing focus on patient safety and regulatory compliance. As medical devices become more complex and the regulations governing them become more stringent, it has become essential for manufacturers to have effective complaint management systems in place to ensure the safety and satisfaction of their customers.

The global medical device complaint management market is expected to grow at a CAGR of 6.3% from 2021 to 2026. 

One of the key factors driving the growth of the medical device complaint management market is the increasing emphasis on patient safety. In recent years, there has been a growing awareness of the potential risks associated with medical devices, and patients are increasingly demanding higher levels of safety and quality. This has led to a greater focus on complaint management among medical device manufacturers, who are now investing in advanced complaint handling systems to ensure that they are able to identify and address issues before they become major problems.

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Source: Digital Journal, 20 April 2023

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‘National improvement board’ to be set up by NHS England

NHS England has launched a new framework for quality improvement and delivery, including a national board that will pick a “small number of shared national priorities”.

The new document says NHSE will “establish a national improvement board, to agree the small number of shared national priorities on which NHS England, with providers and systems, will focus our improvement-led delivery work”.

The review says NHSE will, among other actions: 

  • Create a “national improvement board” to “agree a small number of shared national priorities and oversee the development and quality assure the impact of the NHS improvement approach”.
  • Set an expectation that all NHS providers, working in partnership with integrated care boards, will embed a quality improvement method aligned with the NHS improvement approach”.
  • Incentivise a universal focus on embedding and sustaining improvement practice”, including with “regulatory incentives alongside clearer and more timely offers of support.
  • Work with the [Care Quality Commission] to align the revised CQC well-led [inspection method] with the improvement approach.

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Source: HSJ, 21 April 2023

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Herpes deaths: NHS trust lied about virus links, inquest hears

The mother of a young woman who died with herpes said she was "disgusted" with an NHS trust which "lied" about the potential cause of the virus.

Kim Sampson and Samantha Mulcahy died with herpes after the same obstetrician at the East Kent Hospitals University NHS Trust carried out their caesareans.

Yvette Sampson's daughter had been "fit and healthy" until she gave birth on 3 May 2018, an inquest has heard.

She said the trust had lied about links between the two mothers' deaths.

They were treated by the same surgeon and midwife six weeks apart, neither of whom were tested for herpes, the inquest in Maidstone was told.

Ms Sampson said her daughter had been "in agony" from 3 May when she gave birth to her second child, until she died on 22 May.

She told the inquest she had received "poor treatment" by midwives at the Queen Elizabeth the Queen Mother Hospital (QEQM) in Margate, which she felt also "contributed" to her daughter's death.

Ms Sampson was initially denied a Caesarean and instead told to push for almost three hours, despite repeatedly telling midwives that "something wasn't right" and "clinging to the bed in agony", her mother said.

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Source: BBC News, 20 April 2023

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NHS threatens legal action to block second day of nurses’ strike

The NHS has launched a legal challenge that could end in the high court to block the second day of an upcoming strike by tens of thousands of nurses.

Officials at NHS Employers wrote to the Royal College of Nursing (RCN) on Wednesday saying the union’s plans for a two-day strike were unlawful.

In response, it is understood the RCN has said it will “forcibly resist” employers’ attempts to seek a high court injunction designed to block the strike, which they insist is lawful.

The threat raises the possibility of a high court clash between NHS lawyers backed by the government and those of the nursing union. It also highlights the increasingly bitter relationship between the government and those representing workers on the frontline of the health service.

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Source: The Guardian, 20 April 2023

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Millions wait more than a fortnight to see a GP in England

Nearly five million patients each month in England wait more than a fortnight for a GP appointment, NHS figures show, which Labour is calling "unacceptable".

The government says it expects all patients needing a GP appointment to be seen within two weeks.

The Royal College of GPs says 85% of appointments happen within two weeks and nearly half on the same day.

Those taking longer than two weeks may be routine ones for which the wait is therefore appropriate, it says.

Prof Kamila Hawthorne, who chairs the Royal College of GPs, said: "GPs and our teams are working tirelessly to deliver safe, timely and appropriate care and to give patients the choice of appointment they want.

"We share our patients' frustration when they struggle to access our care. However, this is not down to GPs and their hard-working teams, but due to decades of underfunding and poor resource planning."

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Source: BBC News, 21 April 2023

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Child health checks failed to recover after covid, figures show

Inadequate health visiting provision has led to gaps in care for children and heaped pressure on acute services, senior clinicians have told HSJ. 

Government data suggests that a fifth of infants are not receiving one or more of their five mandatory health visiting reviews across the first two years of life, with rates still substantially below pre-covid levels.

Meanwhile, nationally about 1 in 10 children are still being seen virtually, contrary to the government’s delivery model and despite clinicians saying in-person contact is vital to spotting problems. Senior figures in children’s services told HSJ that in some areas a much higher rate was still being carried out with no in-person contact.

Clinicians said the reasons were ongoing funding and staffing constraints, and that the problems were leading to parents turning to emergency departments and GPs instead.

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Source: HSJ, 20 April 2023

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Mifepristone: US Supreme Court delays abortion pill access decision

The US Supreme Court has extended until Friday a temporary block on limits to access of a popular abortion pill.

A Texas judge suspended approval of abortion drug mifepristone on 7 April, questioning its safety.

Parts of that decision were upheld on appeal, prompting the Biden administration to make an emergency request to the Supreme Court.

It's the most significant such case since the Supreme Court last year ended the nationwide right to abortion.

The pill - used in more than half of abortions in the US - was first approved by the Food and Drug Administration (FDA) more than two decades ago. 

Critics say that by overriding the FDA's approval, the court in Texas has usurped the federal health agency's remit to regulate food, medicine, and medical devices. Legal experts warn the ruling opens the door for challenges to other approved medicines in the US and could also stifle development of future drugs.

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Source: BBC News, 20 April 2023

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Top scientists warn ‘the next pandemic is coming and we’re not ready’

The UK is not ready for the next global pandemic because public services are being dismantled and key research is being defunded, experts have claimed.

More than three years after the global outbreak of coronavirus, top scientists have warned that the UK is no better prepared for a pandemic than it was in 2020.

They say another epidemic on the scale of Covid-19 is inevitable, but that disinvestment in infection-monitoring services, dismantling of key infrastructure, and the state of the NHS mean the country is “losing ground”.

Sir John Bell, a leading immunologist and a member of the UK’s Covid vaccine taskforce during the pandemic, said it was too easy to dismiss Covid-19 as a “once in a generation crisis”.

Writing in The Independent, he warned that it is “a question of when, not if, another pandemic strikes”, adding that the nation needs to adopt an “always on” approach that includes building a more resilient healthcare system, carrying out better surveillance, and identifying future threats.

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Source: The Independent, 18 April 2023

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Medical leaders call for arbitration to resolve junior doctors’ dispute

Medical leaders have called for third-party arbitration to break the impasse on a pay dispute between junior doctors and the government after hundreds of thousands of procedures and appointments were cancelled as a result of last week’s strike in England.

The “colossal impact” of the four-day stoppage compounded by a health service already stretched by the coronavirus pandemic and facing workplace shortages has led the Academy of Medical Royal Colleges (AoMRC) to intervene and urge both parties to engage with an independent organisation.

The AoMRC, the membership body for the UK and Ireland’s 24 medical royal colleges and faculties, said in a statement it was “concerned that a solution has not yet been reached and about the anticipated impact on NHS services and patients that will potentially follow any future action”.

It added: “Both parties need to rapidly engage with an independent organisation to work out how the deadlock can be broken for the sake of patients and the wider NHS.”

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Source: The Guardian, 20 April 2023

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Forty trusts are set elective target less ambitious than last year

NHS trusts have been given targets to increase elective activity that range from 103% of pre-pandemic levels to nearly 130%, internal data seen by HSJ reveals.

The wide gap between the targets, which are based on past performance and reflect the value of activity carried out, indicate the slow pace of recovery at many trusts last year.

Forty trusts have been set the least ambitious target, to deliver 103% of pre-covid activity levels in 2023-24, including Leeds Teaching Hospitals, Barts Health, and University Hospitals Birmingham.

All providers were supposed to deliver at least 104% of pre-covid activity last year, but few managed to achieve this, with emergency pressures, the impact of covid and flu, and workforce problems hampering efforts to ramp up activity.

Amanda Pritchard has previously admitted the health service would have to “re-profile” the trajectory to achieving 130% of pre-covid activity levels by 2025.

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Source: HSJ, 20 April 2023

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National ambitions for use of NHS App undermined by plateauing performance

Take-up and usage of the NHS App in England has begun to plateau, after covid drove huge growth, figures seen by HSJ suggest.

This can be seen in the percentage of GP appointments booked or cancelled using the app; the number of records viewed; and the number of times it has been downloaded.

Rapid uptake was driven during covid restrictions, when travel and other activities often required a covid vaccination pass. Government has said it wants the growth to continue.

The number of GP appointments booked or cancelled using the app fell for a third consecutive month in March to 212,954, representing a decrease of 15% since January and 28% on October 2022, when usage peaked.

The NHS app is central to government’s plan for digital health and care, published last year, billed as the “digital front door” to the NHS which would aid the recovery of services post-pandemic.

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Source: HSJ, 19 April 2023

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Kettering hospital ward accused of failing children rated inadequate

The safety of a ward accused of failing children has been rated as inadequate by inspectors.

The care regulator warned Kettering General Hospital (KGH) in Northamptonshire over its children's and young people's services.

Inspectors' worries include sepsis treatment, staff numbers, dirt levels and not having an "open culture" where concerns can be raised without fear.

Since the BBC's first report in February highlighting the concerns of parents with children who died or became seriously ill at KGH, dozens more families have come forward, bringing the number to 50 to date.

Inspectors found that "staff did not always effectively identify and quickly act upon patients at risk of deterioration".

They said there were sometimes "delays in medical reviews being undertaken outside of normal working hours", highlighting one case where a seemingly deteriorating patient was not seen until three hours after being escalated to the on-call team.

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Source: BBC News, 20 April 2023

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NHS Ayrshire & Arran team hailed for Parkinson's medication breakthrough

A team from NHS Ayrshire & Arran has successfully created a system to ensure that people with Parkinson’s get their medication on time while they are in hospital.

Parkinson’s nurse specialist Nick Bryden, who led the team, explains: “The timely administration of medication is hugely important in helping to control symptoms in people with Parkinson’s.

"Guidance states that Parkinson’s medication should be administered within 30 minutes, either side, of the prescribed time which can be challenging within a busy hospital ward environment."

Nick, who works out of Biggart Hospital in Prestwick, added: “When we initially worked with our digital pharmacist, Richard Cottrell, it was to develop a system that would alert us to when a Parkinson’s patient was admitted to hospital.

"It then became clear that we could take the system a step further and use it to monitor if people are on the right medication and whether or not it is being administered at the right time.”

The team worked to develop a further system of clear visual prompts with NHS Digital services, which appear alongside relevant patient details on wards’ electronic whiteboards.

Every patient prescribed Parkinson’s medication has a tulip symbol beside their name which changes colour and flashes when it’s close to the time to administer the medication. The system was initially piloted in a couple of wards and, due to its success, has now been rolled out to almost every ward in Ayrshire and Arran.

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Source: The Herald, 19 April 2023

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Up to one in 20 new diabetes cases could be linked to Covid, study suggests

Up to one in 20 new diabetes cases could be related to Covid infection, data suggests.

The research adds to mounting evidence the pandemic may be contributing to a rapidly escalating diabetes crisis, with individuals who have experienced more severe Covid at greatest risk.

However, lifestyle factors such as being overweight or obese continue to be the main driver for the increase, with 4.3 million officially diagnosed cases in the UK alone.

Although previous research has hinted that Sars-CoV-2 infection may increase the risk of developing diabetes – possibly by damaging insulin-producing cells in the pancreas – these studies were either relatively small or limited to specific groups of individuals, such as US military veterans, who may not represent the general population.

To delve deeper, Prof Naveed Janjua at the University of British Columbia in Vancouver, Canada, and his colleagues turned to the British Columbia Covid-19 Cohort, a surveillance platform that links data on Covid infections and vaccinations with sociodemographic and administrative health data.

They examined records from 629,935 people who took a PCR test for Covid and found those who tested positive were significantly more likely to experience a new diagnosis of type 1 or type 2 diabetes in the following weeks and months – with 3-5% of new diabetes cases attributable to Covid overall.

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Source: The Guardian, 18 April 2023

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Hundreds of British people are needlessly going blind. Why?

The backlog for ophthalmology appointments in England is the second-largest in the NHS, with UK eye doctors concerned about the number of patients losing sight unnecessarily. Their shock is palpable.

How this could be happening in a rich country such as Britain? There are treatments for common blindness-causing conditions such as macular degeneration, but to get them patients must be able to access the service. And right now the NHS doesn’t have the capacity to deliver them in a timely way.

As junior doctors’ unions – and possibly those of consultants and nurses – proceed with strike action, it’s easy to attack medical professionals with the question: “How many people are dying because of your actions?” The truth is that the entire system has been struggling, and people have been dying anyway because of system failures. Now add to this people living with disabilities that were preventable, such as going blind.

When Labour was in power, it made a real effort, including with financial allocation, to reduce waiting-list times for non-emergency care. But since the Tories were elected in 2010, years of austerity and public-sector neglect – and the shifting of resources and wealthy patients into a lucrative and growing private sector – has meant that the NHS has been transformed from a robust, preventive healthcare service into an acute one. Its basic offering is now: “If you’re dying, we will save you.”

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Source: The Guardian, 19 April 2023

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‘They didn’t believe I was in labour’ says Black mother ‘ignored’ by midwives

The Women and Equalities Committee in a recent report has challenged the government over failures to address inequalities in maternity care which have led to Black women dying at four times the rate of white women.

Tinuke Awe, 31, was left ‘traumatised’ and forced to go without pain relief after midwives didn’t believe she was in labour.

Ms Awe, was induced after experiencing late pre-eclampsia while pregnant with her first child in 2017. She said:  “Pre-eclampsia can be life-threatening for mum and baby, and it could’ve been fatal if I wasn’t treated. I was told I couldn’t leave the hospital and had to be induced".

“They said the hormones could take 24 hours to work, but my labour happened really quickly and when I told the midwife she didn’t even believe I was in labour.”

“I felt so overlooked and it was horrible how nobody listened to me,” she added. “I ended up having to have an assisted delivery which isn’t what I wanted, but it could’ve been avoided if someone had acknowledged I was in labour rather than ignore me. I just felt so unimportant.”

Ms Aew alongside Clotilde Abe set up the charity Five X More. The organisation helps give advice and empower Black women to make informed choices during pregnancy and after childbirth.

Five X More hope that the testimonials of the women they support can be used to show that better outcomes are possible with their ‘five steps for self-advocacy‘ being used to encourage women to ask for things like a second opinion.

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Source: The Independent, 18 April 2023

Read our interview with Tinuke Awe on the hub: Five X More campaign: Improving maternal mortality rates and health outcomes for black women

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Northern Ireland new model of care for pregnant women launching

Anew model of care which the Public Health Agency (PHA) say will 'improve maternity services for women and babies in Northern Ireland' is being launched.

The new model, which will see women receive support from the same midwifery team during pregnancy, birth and in the early days after birth, is being rolled out across all Health and Social Care (HSC) Trusts in the coming months.

‘Continuity of Midwifery Carer’ (CoMC) is a new model of care for women throughout their childbirth journey "that will provide positive clinical outcomes and higher care satisfaction", the PHA said.

Chief Nursing Officer for Northern Ireland, Maria McIlgorm said: “This is a very positive development for maternity services in Northern Ireland. There is a clear evidence base behind the Continuity of Midwifery Carer model which shows that when a woman knows their midwife it can make a significant difference to their experience and outcome.

“This woman and family-centred model of care will mean that women across Northern Ireland using our maternity services will receive support from the same dedicated midwifery team throughout their pregnancy, birth and postnatal period.”

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Source: Belfast Live, 12 April 2023

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NHS criticised for sending patients to children’s hospital despite 1,600 ‘sexual safety incidents’

The NHS has been criticised for sending vulnerable patients to a children’s hospital despite receiving reports of more than 1,600 “sexual safety incidents” at the 59-bed unit.

A series of investigations by The Independent have exposed allegations of systemic abuse across a group of children’s hospitals run by the former Huntercombe Group. The latest revealed that a total of 1,643 “sexual safety incidents” had been reported in four years at its hospital in Maidenhead – accounting for more than half of all sex-related investigations reported in the 209 children’s mental health units across the country since 2019.

Despite the majority of these reports being made prior to 2022-23, the NHS did not take any action and only stopped using the hospital, also known as Taplow Manor, this year.

Gemma Byrne, head of health policy and campaigns at Mind, said in response to The Independent report on sexual incidents: “These horrific reports reveal the systemic scale of abuse and neglect in inpatient mental health settings. Even when patients bravely came forward to share their stories, some of which took place more than 10 years ago, young people continued to be sent to a unit which was known to have catastrophic failings in physical and sexual safety.”

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Source: The Independent, 18 April 2023

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Cancer survivors may be at heightened risk of cardiovascular disease

People who survive cancer may be at heightened risk of cardiovascular disease in subsequent years, data suggests.

However, heart scans may identify early heart damage, potentially opening the door to more tailored follow-up care for cancer survivors.

Although previous studies have suggested that people who have been treated for cancer may be at greater risk of future cardiovascular problems such as stroke or heart failure, these have mainly focused on the first year after a cancer diagnosis. Few have looked at longer term risks or included cardiovascular imaging to pinpoint damage that has not yet resulted in symptoms.

To plug these gaps, Dr Zahra Raisi-Estabragh at Queen Mary University of London and her colleagues assessed the cardiovascular health of 18,714 UK Biobank participants with a previous diagnosis of lung, breast, prostate, blood, womb or bowel cancer, and compared them with an equal number of participants with no cancer history, tracking their cardiovascular health for nearly 12 years.

Almost a third of cancer survivors developed a cardiovascular problem during the study period, compared with a quarter of people in the control group.

“This study adds to existing knowledge about the impact of some cancer treatments on cardiovascular disease in cancer survivors,” said Martin Ledwick, the head information nurse at Cancer Research UK.

“It may help to inform strategies for how some cancer survivors need to be monitored long-term, especially in situations where they have been discharged from cancer follow-up to the care of their GPs.”

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Source: The Guardian, 18 April 2023

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Patients left waiting on trolleys for four days due to ‘unsafe’ staffing levels, report finds

Patients were left on trolleys for up to four days at a major NHS hospital where whistleblowers raised concerns over “unsafe” staffing levels, it has emerged.

In a scathing report, the NHS safety watchdog said it found patients waiting on trolleys, in corridors and outside nursing bays at Good Hope and Heartlands hospital, run by the scandal-hit University Hospitals Birmingham NHS Foundation Trust.

In one incident flagged by the Care Quality Commission (CQC), a patient’s skin ulcers had grown significantly worse while they waited for four days on a trolley without an appropriate mattress. At the time of the inspection, most patients had been waiting for more than two days on trolleys, according to the CQC.

The inspection took place in December, after concerns were raised by patients and families over care. The CQC said staff told inspectors they’d been left in “unsafe situations” due to poor staffing.

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Source: The Independent, 19 April 2023

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Coroner calls for allergies tsar after 17-year-old dies from anaesthetic reaction

A senior coroner has warned that more allergy sufferers will die due to a “lack of national leadership” following the death of a 17-year-old aspiring doctor.

Heidi Connor said the “tragic” case of Alexandra Briess was “not new territory”, citing three recent cases where people had died from anaphylaxis.

She has now written to the Government saying lives are at risk without better funding and research into the condition and calling for the appointment of an allergies tsar.

The Berkshire coroner’s warning comes after an inquest into the death of “bright and well loved” Alexandra, who died from a reaction to a common anaesthetic.

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Source: The Times, 18 April 2023

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USA: A silent crisis in men’s health gets worse

A silent crisis in men’s health is shortening the life spans of fathers, husbands, brothers and sons.

For years, the conventional wisdom has been that a lack of sex-specific health research mainly hurts women and gender minorities. While those concerns are real, a closer look at longevity data tells a more complicated story.

Across the life span — from infancy to the teen years, midlife and old age — the risk of death at every age is higher for boys and men than for girls and women:

  • Men are at a greater risk of dying from covid-19 than women, a gap that cannot be explained by rates of infection or preexisting conditions. 
  • More men die of diabetes than women. 
  • The cancer mortality rate is higher among men — 189.5 per 100,000 — compared with 135.7 per 100,000 for women. 
  • Men die by suicide nearly four times more often than women, based on 2020 data from the Centers for Disease Control and Prevention. 

“Some people think health care is a zero sum gain and one dollar to men’s health is taking something away from women,” said Ronald Henry, president and co-founder of the Men’s Health Network, an advocacy group. “That’s wrong. We are fully supportive of women’s health efforts and improving quality of life for women.”

"But by viewing men as the privileged default, health experts are ignoring important sex differences that could illuminate health issues across gender and minority groups."

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Source: The Washington Post, 17 April 2023

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Dr Michael Watt tribunal was 'unlawful corner-cutting exercise'

A tribunal which allowed a doctor's voluntary removal from the medical register was an "unlawful corner-cutting exercise", a judge has said.

Neurologist Michael Watt was at the centre of Northern Ireland's biggest recall of patients.

The Medical Practitioners Tribunal Service (MPTS) allowed him to voluntarily remove himself in 2021. It meant he would not face a public hearing about any fitness to practice issues.

More 2,500 patients who were in his care had their cases reviewed - with around one in five having their diagnosis changed.

Having already quashed the decision to grant removal, Mr Justice McAlinden delivered a scathing assessment of how the application was handled on Monday.

In Belfast's High Court, he described the process where Dr Watt's request was heard without the necessary jurisdiction as a "fiasco".

The court also heard how Dr Watt appeared to have a "get out of jail free card" where patients were denied public scrutiny of their medical care.

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Source: BBC News, 17 April 2023

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NHS Scotland calls 13,000 women for smear tests after error

Thousands of women are to be called for smear tests after errors in Scotland's cervical screening programme.

In June 2021 it was discovered that several women had died from cervical cancer after being wrongly excluded from NHS Scotland's screening list.

Now a further review expects to find 13,000 patients who have had a hysterectomy will need further tests.

MSPs were told two years ago that a small number had died from cervical cancer after wrongful exclusion from the programme, and that further incorrect exclusions were possible.

The most common reason for exclusion was after a total hysterectomy, where the entire cervix has been removed, meaning there was no need for cervical screening. But some were recorded as having had this procedure where there was only a sub-total or partial hysterectomy, meaning cervical screening was still needed.

An urgent audit followed and all affected women were invited for follow-up examination. Now, a wider audit of 150,000 women who have had subtotal hysterectomies has been launched.

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Source: BBC News, 17 April 2023

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