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Three-year wait for Essex girl, 8, to have tooth removed

An eight-year-old girl waiting three years to have three teeth removed has been left in "agony".

Ella Mann, from Dovercourt in Essex, first went to the dentist with an issue with a baby tooth in December 2019.

She was given a temporary filling and told it needed to be removed but has still not had the NHS procedure.

The youngster has now been placed on an NHS waiting list for the tooth extraction.

Ella's dad Charlie Mann, 54, said his daughter was sometimes in "agony".

Healthwatch England last year warned of people struggling to get dental treatment as increasing practices closed to new patients.

A BBC investigation identified cases of people driving hundreds of miles in search of treatment and pulling out their own teeth without anaesthesia.

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Source: BBC News, 23 March 2023

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Four-day junior doctor strike set for April

Junior doctors are to stage a four-day walkout in April in their fight to get a 35% pay rise in England.

Members of the British Medical Association (BMA) will take strike action from 11 April to 15 April.

Last week's walkout led to the cancellation of 175,000 treatments and appointments, with consultants brought in to provide cover in emergency care.

Hospitals bosses said the fallout from the strike would last weeks given the huge number of bookings that have to be rescheduled.

The new walkout of both planned and emergency care comes directly after the Easter weekend, which tends to be a busy period for the NHS.

Saffron Cordery, of NHS Providers, the membership organisation for NHS trusts in England, said demand would have built up over the bank holiday weekend.

"This threatens the biggest disruption from NHS walkouts so far," she said, adding: "There should be no doubt about the scale of the impact on patients, staff and the NHS."

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Source: BBC News, 23 April 2023

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‘It is not right to normalise the current GP workload’, says RCGP chair

It is ‘not right to normalise’ the current workload in general practice as numbers of GPs and practices goes down, the RCGP chair told delegates at Pulse Live this week. 

Professor Kamila Hawthorne highlighted the pressure GPs are under with general practice appointments increasing most last year, compared to A&E and outpatients. 

She also said her priority from a new GP contract would be better resourcing for GPs working in deprived areas. 

Her speech looked at the challenges facing general practice and imagined what the future could look like, including what the college can do to bring about change.

Professor Hawthorne said: ‘The workload that we’re facing – it’s not right to normalise it. The sort of work days that we have in general practice, it is not right to normalise this.

‘The number of GPs is going down because they’re leaving the profession faster than they’re entering it. The number of practices in England is going down, and compared with affluent areas, GPs in deprived areas earn less but see more patients with more chronic illness.’ 

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Source: Pulse, 21 March 2023

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Man died of sepsis after being sent home from Milton Keynes Hospital A&E

A father-of-two died of sepsis three days after being sent home from A&E with antibiotics for a suspected urinary tract infection, an inquest heard.

Alex Blewitt, 48, died in July 2022 after suffering a cardiac arrest caused by a perforated bowel and sepsis.

Senior coroner for Milton Keynes, Dr Sean Cummings, said Mr Blewitt's death was avoidable.

The coroner recorded a narrative conclusion and said he intended to issue a prevention of future deaths report.

Mr Cummings said: "The doctor, who saw and assessed Mr Blewitt in the emergency department, did not read the Urgent Care Centre communication that was provided and did not record important factual information in the clinical note.

"Mr Blewitt was discharged, but returned two days later when suffering with sepsis due to a previously undiagnosed bowel perforation."

Mr Blewitt's widow, Amy Blewitt, said: "Alex was in such pain and kept asking the hospital for help, but they sent him home.

"My plea to the hospital is please, please don't let this type of mistake ever happen to anyone else ever again."

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Source: BBC News, 22 March 2023

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Stretched A&E staff ‘rarely saw exec team’, review finds

Trust executives and senior managers have been criticised by a former national director for their lack of support for an under-pressure A&E.

An independent review described York Hospital as “reluctant” to trigger internal escalation processes, and suggested it should be quicker to admit extra patients to inpatient wards during busy periods.

Professor Matthew Cooke, a former national clinical director for emergency care who conducted the review, said that during his two-day visit to the department he witnessed a 60-hour delay for a patient to be admitted: “I was surprised not to see any senior managers or executives in the ED, despite such long delays. ED staff reported they rarely saw the executive team.”

Professor Cooke also warned of uncertainty over escalation processes, including for reducing pressure in the emergency department by “boarding” patients on wards beyond normal capacity.

He said: “On the second morning, there were multiple patients on oxygen in ordinary seats in majors waiting room, cared for by a single nurse. I find it difficult to understand how this is safer than boarding one extra patient on several wards.”

“Staff perceived that the organisation was reluctant to move to higher escalation levels and I sensed this meant staff no longer pushed for such actions.”

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Source: HSJ, 23 March 2023

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Self-harm hospital admissions up 22% for children aged eight to 17

Self-harm hospital admissions for children aged eight to 17 in the UK jumped 22% in one year.

The age group is now the largest for self-harm admissions, with all others seeing a drop, according to NHS data.

Charities say early access to support is vital, but high thresholds and long waiting lists mean more young people are ending up in hospital.

Emily Nuttal, 29, first struggled with self-harm when she was 12. At 13, she was first admitted to A&E.

At that time, she was struggling with changes at school, bullying and troubles at home.

Over the years, she said she had had varied experiences in accident and emergency departments.

"It's been times where it's been really empathetic and passionate people, understanding, supportive. And there's been times where there's been that stigma and judgement."

She said being labelled as "attention-seeking" was really difficult and made it harder to reach out for help again.

"I would then only go if I was forced upon by the crisis service, or if somebody else noticed, and they got people involved," she said.

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Source: BBC News, 23 March 2023

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Watchdog calls for review of menopause link to poor mental health after woman’s suicide

The link between menopause and poor mental health should be reviewed, the health watchdog has said, after an inquiry into a woman’s suicide found staff lack training to spot the risks.

Frances Wellburn, 56, took her own life in 2020 after she was incorrectly assessed as being a “medium risk” of suicide by Tees, Esk and Wear NHS Trust (TEWV).

A national study by the Health and Safety Investigation Branch (HSIB), prompted by her death, warned that this was a national problem, with funding and capacity problems driving staff to use ineffective “checklist” tools when assessing suicidal patients.

HSIB also found staff were not trained to spot mental health risks associated with menopause, and menopause is not routinely considered a contributing factor among women with low mood who need help.

It said that women are often prescribed antidepressants when hormone replacement therapy (HRT) would be more appropriate.

In Ms Wellburn’s case, HSIB found TEWV staff had failed to take into account that she was going through menopause when they assessed her as being at medium risk of self-harm. This went against national guidance, which states scales should not be used to predict future suicide or self-harm.

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Source: The Independent, 23 March 2023

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Mum was given her baby's remains in supermarket carrier bag

A terminally ill mother says she was "horrified" after she was handed her baby's remains in a supermarket carrier bag by NHS officials.

Lydia Reid's son Gary was a week old when he died in 1975. She later discovered his organs had been removed for tests without her permission and only received them last month after almost 50 years of campaigning.

The 74-year-old, told BBC Scotland she was visited last month by the head of NHS Lothian as well as another senior NHS official.

"I thought they were coming to help me sign some papers. When they arrived I noticed one of them was carrying a Sainsbury's carrier bag," Ms Reid said.

"Then they said they wanted to complete the list of body parts in case anything had been missed out. She handed me the Sainsbury's bag and said she wanted me to check them now."

Inside the carrier bag was a six-inch box containing body parts preserved in wax.

"I was so shocked and said 'How dare you. That is the only parts of my son and you want to hand them to me in a carrier bag.

"I was absolutely horrified. She said she didn't realise it would be a problem."

Tracey Gillies, medical director for NHS Lothian said: "I would like to repeat publicly the apology we made to Ms Reid in person for the upset and distress this has caused.

Ms Reid has been a leading figure in the Scottish campaign to expose how hospitals unlawfully retained dead children's body parts for research.

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Source: BBC News, 23 March 2023

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‘Fifth of UK hospitals cancelled operations’ during three days of 2022 heatwave

A fifth of UK hospitals were forced to cancel operations during the three days in July last year when temperatures soared, research suggests.

The findings, published in a letter to the British Journal of Surgery, are based on surveys from surgeons, anaesthetists and critical care doctors working during the heatwave from July 16-19 2022, when temperatures reached as high as 40C in some parts of the country.

The researchers received 271 responses from 140 UK hospitals – with one in five (18.5%) reporting elective surgeries being cancelled due to the heatwave.

The respondents also said surgical services were poorly prepared for heatwaves, with 41% of operating theatres having no means to control ambient temperature, while more than a third (35.4%) reported making changes to maintain routine surgical activity during the period.

These include delayed discharge of high-risk patients, changes to surgical teams, selecting lower-risk patients to have surgery, and restricting surgical activity to day cases.

Other measures included longer staff breaks, extra fluids to patients, and surgeries earlier in the morning when temperatures were lower.

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Source: The Independent, 23 March 2023

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‘I worry my young patients will die’: UK’s eating disorder services not fit, say GPs

Young people with eating disorders are coming to harm and ending up in A&E because they are being denied care and forced to endure long waits for treatment, GPs have revealed.

NHS eating disorders services are so overwhelmed by a post-Covid surge in problems such as anorexia that they are telling under-19s to rely on charities, their parents or self-help instead.

The “truly shocking” findings about the help available to young people with often very fragile mental health emerged in a survey of 1,004 family doctors across the UK by the youth mental health charity stem4.

The shortage of beds for children and young people with eating disorders is so serious that some are being sent hundreds of miles from home or ending up on adult psychiatric wards, GPs say.

“The provision is awful and I worry my young patients may die,” one GP in the south-east of England told stem4. Another described the specialist NHS services available in their area as “virtually non-existent and not fit for purpose”.

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Source: The Guardian, 22 March 2023

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Polio vaccine catch-up push to launch in London

London primary-school pupils not fully vaccinated against polio are to be offered catch-up jabs after Easter.

The disease, common in the UK in the 1950s, was eliminated by 2003. But poliovirus traces were found in north and east London sewage in early 2022.

An emergency vaccination-booster campaign in London last summer reached more than 370,000 children.

And in early November, the latest tests found less of the virus - but officials say there is no room for complacency.

Dr Vanessa Saliba, from the UK Heath Security Agency, told BBC News: "We have early signs that there's less spread of poliovirus in London - but we will need 12 months of no detections before the World Health Organization could declare that the UK is no longer an infected country."

Polio causes paralysis in a very small number of cases where the virus attacks the nerves in the spine and base of the brain - but most are asymptomatic.

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Source: BBC News, 23 March 2023

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Candida auris: deadly fungal infections spreading across US at ‘worrisome’ rate

Potentially deadly fungal infections with Candida auris are spreading rapidly in US healthcare facilities, with cases nearly doubling between 2020 and 2021, the US Centers for Disease Control and Prevention has said.

The number of cases rose by 44% to 476 in 2019, up from 330 in 2018, and subsequently by 59% to 756 in 2020 and by an additional 95% to 1,471 in 2021, the agency’s researchers reported on Monday in Annals of Internal Medicine.

Also concerning was a tripling in 2021 of the number of cases that were resistant to echinocandins, the class of drugs most often recommended for treatment of the disease.

The most common Candida auris symptoms include a high fever and chills that do not improve after antibiotic treatment for suspected bacterial infections, according to guidelines from the CDC. Additional symptoms can develop if the infection spreads.

Dr Waleed Javaid – an epidemiologist, infectious disease expert and director of infection prevention and control at New York’s Mount Sinai Downtown – told NBC News that the new findings were “worrisome”.

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Source: The Guardian, 21 March 2023

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Bristol children must be in crisis before autism referral, say parents

Children must now be in crisis before they can be referred for an autism diagnosis, parents claim.

The strict new eligibility criteria in the Bristol region comes after a 350% rise in the number waiting more than two years for assessment.

Changes made by the NHS mean children will only be referred with "severe and enduring" mental health issues.

The Integrated Care Board (ICB) said it meant resources could now focus on those with "the highest clinical need".

Some parents have launched the campaign Assess for Autism in protest against the rule change.

An Assess for Autism spokesperson said children would now have to be at crisis point before being referred, describing the policy as "deeply concerning" and "regressive".

However, healthcare provider Sirona, which provides autism diagnosis services, and the Integrated Care Board (ICB), which formally approved the new policy, insist it is necessary because families are waiting too long.

They said resources can now be focused on those with the "highest clinical need or are the most vulnerable".

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Source: BBC News, 22 March 2023

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Unregulated ‘eating disorder coaches’ putting people at risk, say experts

Vulnerable mental health patients are being put at risk by unregulated “eating disorder coaches” who do not have the necessary qualifications, experts have said.

As demand for eating disorder support soars – hospital admissions for eating disorders increased by 84% in the last five years – more people are filling gaps in NHS care.

So-called eating disorder coaches, who tend to be personal trainers or dietitians recovering from the illness themselves, are charging as much as £1,000 a month for sessions to offer support to others despite having little or no training and expertise.

The Guardian has found that many coaches cite short courses, which are intended as professional development for psychologists, as a qualification to practise.

The National Centre for Eating Disorders (NCED) offers a number of professional training courses, accredited by the British Psychological Society (BPS). The Guardian found a number of coaches were using these courses to claim they were qualified to offer professional services to people with eating disorders.

Agnes Ayton, chair of the Royal College of Psychiatrists’ eating disorders faculty, said she was “amazed” to see people “advertising themselves as experts after going on one course”.

“Eating disorders sit between physical and mental health so the risks associated with eating disorders can be physically debilitating and potentially fatal,” Ayton said. “I don’t know why there is not better regulation on that because there is lots of regulation for a medical professional – but therapy is the first line of treatment for eating disorders, and if it is not delivered properly, it can be harmful or misleading.”

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Source: The Guardian, 21 March 2023

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UK GPs have the highest stress levels, finds survey of 10 countries’ doctors

GPs in the UK have some of the highest stress levels and lowest job satisfaction among family doctors, a 10-country survey has found.

British GPs suffer from high levels of burnout, have a worse work/life balance and spend less time with patients during appointments than their peers in many other places.

Heavy workloads, seemingly endless paperwork and feelings of emotional distress are prompting many GPs to stop seeing patients regularly or even retire altogether, the research found.

Seven in 10 (71%) NHS family doctors find their job “extremely” or “very stressful”, the joint-highest number alongside GPs in Germany among the countries analysed.

The Health Foundation, which undertook the survey, said its “grim” findings showed that the “unsustainable” pressures on GPs and number of them quitting pose a threat to the NHS’s future.

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Thousands of English NHS 999 calls answered in Wales

Thousands of 999 calls are being transferred to the Welsh Ambulance Service because they are taking more than five minutes to answer in England, HSJ can reveal.

More than 50,000 calls – 1.2% of all made – were sent to a different ambulance service than the one intended between October and the middle of February, under a new system of routing unanswered calls was introduced.

It automatically diverts calls which have not been answered after five minutes, rerouting them to services with current capacity, while a BT operator remains on the line until the call is answered.

The Welsh Ambulance Service explained it records details from the transferred caller, prioritises the response level and provides lifesaving instructions if required, including having access to a national database of defibrillators.

However, it is unable to despatch ambulances outside its area and does not provide clinical assessment. Instead the details are transferred electronically into the “home” trust’s computer-aided despatch system.

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Source: HSJ, 21 March 2023

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Specialist NHS centres aim to halve maternity deaths in England

Women at risk of dying in pregnancy or childbirth will be treated at a network of specialist NHS centres under a national drive to halve maternal deaths.

For the first time, women in England with conditions such as heart disease, epilepsy or cancer will have access to specialist care from doctors trained to treat medical problems in pregnancy.

Two thirds of maternal deaths in the UK are due to medical conditions that pre-date or develop during pregnancy, rather than direct complications of birth. Previously there was no dedicated national service for these women.

The 17 NHS centres, covering every region of the country, aim to prevent these deaths by bringing together specialist doctors, obstetricians, midwives and nurses under one roof.

GPs and A&E staff will also be trained to identify “red flag” symptoms of illnesses in pregnant women and refer patients directly to the centres, where they can be assessed and receive medication or procedures.

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Source: The Times, 20 March 2023

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Warnings against 'reckless' weight loss surgery abroad

Seven British patients who travelled to Turkey for weight loss surgery died after operations there, a BBC investigation into the trend has found.

Others have returned home with serious health issues after having had gastric sleeve operations, during which more than 70% of the stomach is removed.

The operations, used to treat morbid obesity, are carried out in the UK, but, because it can take years to get one through the NHS, some people are looking abroad for treatment.

British doctors say that they're treating an increasing number of patients who have travelled to Turkey and returned with serious complications.

Dr Ahmed Ahmed, a leading surgeon and member of council at the British Obesity and Metabolic Surgery Society, says he's treated patients returning from Turkey who have had an entirely different operation to the one they understood they had paid for.

The BBC has also been told that some people are being accepted for surgery who do not have a medical need for it. The BBC contacted 27 Turkish clinics to see if they would accept someone for treatment who was considered to have a normal BMI. Six of the clinics we approached were happy to accept someone with a BMI of 24.5 for extreme weight loss surgery.

Separately, the BBC also found that some clinics who refused the treatment actually then encouraged patients to put on weight, to enable them to be accepted for surgery.

One said: "You need to gain 6.7kg to have sleeve surgery. I think you can easily eat some food and then lose weight easily." Another asked: "How soon can you gain weight?"

Dr Ahmed says the practices are "reckless" and "unethical".

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Source: BBC News, 21 March 2023

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Hundreds left with lost or damaged eyesight after NHS delays

Hundreds of patients have lost their eyesight or had it irreparably damaged because of NHS backlogs, new research suggests.

NHS England clinicians have filed 551 reports of patients who lost their sight as a result of delayed appointments since 2019, with 219 resulting in “moderate or severe harm”, according to an FoI request by the Association of Optometrists, which believes that hundreds more cases are unreported.

Its chief executive, Adam Sampson, said sight loss was a “health emergency”, and urged ministers to introduce a national eye health strategy to enable high street and community optometrists to ease some of the burden on hospitals.

He said: “There are good treatments available for common age-related eye conditions like macular degeneration but many hospital trusts simply do not have the capacity to deliver services.

“Optometry is ideally placed to take away some of that burden – optometrists are already qualified to provide many of the extended services needed and are available on every high street, so patients can be treated closer to home. It’s incomprehensible and absolutely tragic that patients are waiting, losing their vision, in many parts of the country because of the way eye healthcare is commissioned.”

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Source: The Guardian, 21 March 2023

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Conference highlights racial disparity in UK maternal healthcare

Unconscious bias in the UK healthcare system is contributing to the stark racial disparity in maternal healthcare outcomes, a conference has heard.

The Black Maternal Health Conference UK, also heard that black women not being listened to by healthcare professionals was also a contributing factor.

The conference, organised by The Motherhood Group, was arranged to highlight the racial inequality in maternal healthcare and the disparity in maternal mortality between white, ethnic minority and black women in the UK.

Black women in the UK are four times more likely to die in pregnancy and childbirth than white women, according to a report published by MBRRACE-UK. Asian women are twice as likely to die in pregnancy or childbirth.

Sandra Igwe, who founded the NGO The Motherhood Group in 2016 after the traumatic birth of her daughter, told the PA Media that the event was an opportunity to “bridge the community, stakeholders, professionals, [and] government”, de-stigmatise mental health and bring about change to improve black maternal health.

“There are so many stats – so why wouldn’t we have a whole day’s conference dedicated to addressing these, just scratching the surface of some of the stats?”

Charities and activists have been raising alarm bells about the dangerous consequences of unconscious bias in maternal healthcare for many years. Igwe co-chaired the Birthrights inquiry, a year-long investigation into racial injustice in the UK maternity services, which heard testimony from women, birthing people, healthcare professionals and lawyers and concluded that “systemic racism exists in the UK and in public services”.

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Source: The Guardian, 20 March 2023

Sandra Igwe is our hub topic lead for Black Maternal Health. Read our recent interview with Sandra.

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Trust told to pay more than £200k over dementia patient’s death

A hospital trust has been told to pay almost a quarter of a million pounds after pleading guilty to failing to provide safe care to a patient with advanced dementia who fatally injured himself. 

The Care Quality Commission (CQC) brought the prosecution against University Hospitals of Derby and Burton Foundation Trust after an incident in July 2019, when a patient died after absconding from the hospital.

Peter Mullis – who had advanced dementia – was admitted to Queen’s Hospital Burton emergency department and absconded twice. When he tried to a third time, he was followed by trust staff.

The CQC described how, despite being followed, Mr Mullis was able to climb over a barrier, fall down a grass bank and hit his head on concrete at the bottom. He was airlifted to the local trauma centre, but died of multiple traumatic injuries.

The CQC said UHDB did not take “reasonable steps” to ensure safe care was provided and that failure exposed Mr Mullis to “significant risk of avoidable harm”.

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‘Insufficiently curious’ leaders ‘tolerated’ safety failures

Leaders at a mental health trust tolerated high levels of safety incidents and accepted verbal assurance with ‘insufficient professional curiosity’, a critical report has found.

An NHS England-commissioned review into governance at Tees, Esk and Wear Valleys Foundation Trust has been published, reviewing the organisation’s response to serious safety concerns flagged at the former West Lane Hospital in Middlesbrough.

It follows separate reports identifying “systemic failures” over the deaths of inpatients Christie Harnett, Nadia Sharif and Emily Moore.

The new report, conducted by Niche Consulting, criticises board and service leaders’ handling of concerns about the regular occurrence of restraint and self-harm.

More than a dozen incidents of inappropriate restraint, some seeing patients dragged along the floor, were identified in November 2018, resulting in multiple staff suspensions and some dismissals. 

Niche found there was a “lack of accountable leadership at all levels” and lack of evidence for decisions in response to the November 2018 incidents.

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Source: HSJ, 21 March 2023

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Children getting ‘conveyor belt’ care due to waiting list pressure

The pressure to tackle long waiting lists in children’s community services is impacting care quality, clinical leaders have warned.

It comes after community health services waiting list figures were published for the first time by NHS England last week.

They revealed more than 200,000 children were waiting, of whom 12,000 had been waiting more than a year, and 65,000 more than 18 weeks. While adult community services lists have been coming down fairly steadily since the autumn, children’s services are failing to make progress.

The children’s services with the longest lists are community paediatrics (which mostly deals with neurological development issues such as autism and ADHD), speech and language therapy, and children’s occupational therapy.

Specialists in those areas told HSJ it was the result of staffing gaps, rising and more complex demand, Covid backlog, and years of underfunding.

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Source: HSJ, 20 March 2023

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Why US mothers are more likely to die in childbirth

The United States remains one of the most dangerous wealthy nations for a woman to give birth.

Maternal mortality rose by 40% at the height of the pandemic, according to new data released by the US Centers for Disease Control and Prevention.

In 2021, 33 women died out of every 100,000 live births in the US, up from 23.8 in 2020. That rate was more than double for black women, who were nearly three times more likely to die than white women, according to the CDC.

Compared to other countries, the maternal mortality rate was twice as high in the US than in the UK, Germany and France; and three times higher than in Spain, Italy, Japan and several other countries, according to the most recent global comparison data kept by the World Bank.

"Clearly the US is an outlier," said Joan Costa-i-Font, a professor of health economics at the London School of Economics. "Covid has made [maternal mortality] worse, but it was already a major issue in the US."

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Source: BBC News, 18 March 2023

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No one kept data on Tavistock children — it’s a monumental scandal

Twenty years ago, David Freedman helped to conduct an audit of the first 124 young people referred to the gender clinic, now he discovers it was never followed up.

David Freedman, 73, helped to conduct a clinical audit of the first 124 young people referred to the Gender Identity Development Service (Gids) from its inception in 1989. The London-based service, part of the Tavistock and Portman NHS Foundation Trust, is the only dedicated NHS clinic for transgender children.

When he discovered his clinical audit from two decades ago remained the only one conducted by the service, Freedman said he was “gobsmacked”, adding: “This was a service that was sailing into uncharted territory with vulnerable children and adolescents, where one has an extra duty of care, and the failure to collect any data in a coherent form to look at what they were doing . . . it’s pretty mind-boggling.”

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Source: The Times, 19 March 2023

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