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Patient Safety Learning

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  1. Patient Safety Learning
    Public satisfaction with the NHS has dropped again, setting a new low recorded by the long-running British Social Attitudes survey.
    Just 24% said they were satisfied with the NHS in 2023, with waiting times and staff shortages the biggest concerns.
    That is five percentage points down on last year and a drop from the 2010 high of 70% satisfaction.
    The findings on the NHS, published by the Nuffield Trust and King's Fund think tanks, show once again that performance has deteriorated after a new record low was seen last year.
    In total, since 2020, satisfaction has fallen by 29 percentage points.
    Of the core services, the public was least satisfied with A&E and dentistry.
    The survey also showed satisfaction with social care had fallen to 13% - again the lowest since the survey began.
    The major reasons for dissatisfaction were long waiting times, staffing shortages and lack of funding.
    Read full story
    Source: BBC News, 27 March 2024
  2. Patient Safety Learning
    An ambulance trust is having to protect its staff from the effects of fumes – including potential cancer risk – as they are spending so long in their vehicles outside hospitals.
    South Western Ambulance Service Foundation Trust (SWASFT) has carried out a risk assessment of the impact of diesel engine emissions after following concerns from staff, many of whom are spending hours waiting to handover on each shift. The region has faced the worst handover delays to emergency departments in recent years.
    Ambulance engines normally have to be kept on while waiting, to keep essential equipment running, and sometimes for warmth. But with queues of a dozen or more ambulances at times, staff and patients can be exposed to substantial emissions for long periods.
    The trust’s risk assessment – which has been seen by HSJ – warns exposure to diesel emissions is associated with eye and upper respiratory tract irritation, while prolonged exposure can lead to coughing, increased sputum production and breathlessness.
    There is also “epidemiological evidence which indicates that sustained occupational exposure to diesel engine exhaust emissions may result in an increase in the risk of lung cancer”.
    It gives a risk rating of 20 – one of the highest possible – which, under the trust’s policies, indicates “activities must not proceed” until mitigations are in place.
    Read full story (paywalled)
    Source: HSJ, 27 March 2024
  3. Patient Safety Learning
    Government’s standards watchdog has launched a review into accountability in public bodies, warning that problems are too often not dealt with quickly and effectively.
    Over the next few months, the Committee on Standards in Public Life will look at “where public bodies should focus their attention to maximise the likelihood of problems being uncovered and addressed before issues escalate and lives are damaged”.
    In a letter to the prime minister about the review, CSPL chair Doug Chalmers said the committee had been “struck by how, when failures occur within public institutions, it repeatedly seems to be the case that indicators of emerging issues were present, but missed, with the result that the window to respond appropriately, before problems escalate, has often also been missed”.
    In its announcement of the review, CSPL said it had seen “several examples of major failures within public institutions” in recent years where “opportunities were missed to address issues before they escalated”.
    “We are asking, when things go wrong in public bodies, why does it take so long for problems to be recognised and the leadership to respond appropriately and, most importantly, what needs to change?”
    Rather than reinvestigating previous incidents, the committee will look at how to encourage more effective accountability within public bodies “so that problems are addressed before catastrophic failure”, Chalmers said.
    As part of the review, CSPL has opened a consultation today inviting members of the public to submit evidence on why public bodies might fail to act quickly when problems arise, along with suggestions on how to tackle problems better and examples of good practice. The consultation closes on 14 June.
    Read full story
    Source: Civil Service World, 25 March 2024
  4. Patient Safety Learning
    The US Supreme Court will hear oral arguments on whether to restrict access to mifepristone, a commonly used abortion pill.
    It is considered the most significant reproductive rights case since the court ended the nationwide right to abortion in June 2022.
    The Biden administration hopes the court will overturn a decision to limit access to the drug over safety concerns raised by anti-abortion groups.
    The pill has been legal since 2000.
    The current legal battle in the top US court began in November 2022 when the Alliance for Hippocratic Medicine, an umbrella group of anti-abortion doctors and activists, filed a lawsuit against the Food and Drug Administration, or FDA.
    The group claims that mifepristone is unsafe and further alleges that the federal agency unlawfully approved its use in September 2000 to medically terminate pregnancies through seven weeks gestation.
    Mifepristone is used in combination with another drug - misoprostol - for medical abortions, and it is now the most common way to have an abortion in the US.
    Medical abortions accounted for 63% of all abortions in 2023, up from 53% in 2020, according to the Guttmacher Institute.
    In total, more than five million US women have used mifepristone to terminate their pregnancies.
    Read full story
    Source: BBC News, 26 March 2024
  5. Patient Safety Learning
    Norah Bassett was hours old when she died in 2019, after multiple failings in her care. What can be learned from her heartbreaking loss?
    The maternity unit at the Royal Hampshire county hospital in Winchester was busy the evening when Charlotte Bassett gave birth. When the night shift came on duty, a midwife introduced.
    “She was very brusque,” Charlotte, 37, a data manager, remembers. “She said, ‘We’ve got too many people here. I’ve got this and this to do.’” Charlotte tried to breastfeed Norah, but she wasn’t latching. The midwife told Charlotte to cup feed her with formula. She didn’t stay to watch. Charlotte poured milk from a cup into Norah’s rosebud mouth. Blood came out. It was staining the muslin. The midwife didn’t seem concerned.
    “I was drowning my child, who was drowning in her own blood. And there was no one there to say: this isn’t normal,” Charlotte says.
    The Health Services Safety Investigations Body (now HSSIB but at the time known as HSIB), which investigates patient safety in English hospitals, produced a report into Norah’s care in 2020. One sentence leaped out to Charlotte and her husband James. “An upper airway event (such as occlusion of the baby’s airway during skin-to-skin) may have contributed to the baby’s collapse.” In other words, it was possible that Charlotte might have smothered her daughter.
    “So Charlotte spent four years in agony,” says James, “thinking it was her.”
    Dr Martyn Pitman remembers the night Norah died, because it was unusual. A crash call, for a baby born to a low-risk mother. It played on his mind, because eight days earlier, on 4 April 2019, Pitman, a consultant obstetrician and gynaecologist, had presented proposals for enhanced foetal monitoring to a meeting of the maternity unit’s doctors and senior midwives. Pitman, 57, who is an expert in foetal monitoring, felt the proposals would prevent more babies suffering brain injuries at birth. “We’re not that good at detecting the high-risk baby, in the low-risk mum,” he says.
    Another doctor would later characterise the meeting as “hideous … hands down the worst meeting I’ve ever been to. Martyn … was being set upon.” A midwife felt the animosity in the room was “personal towards Martyn”, and was “appalled” by the “unprofessionalism that I saw from my midwifery colleagues”.
    James and Charlotte join an unhappy club: a community of parents whose children died young, after receiving poor care, and were told their deaths were unavoidable, or felt blamed for them.
    “I’ve spoken to so many families,” says Donna Ockenden, who authored a 2022 report into Shrewsbury’s maternity services, “who have been blamed for the eventual poor outcome in their cases. This has included being blamed for their babies’ death.” She has also met the families of women blamed for their own deaths. “This never fails to shock me,” she says.
    Read full story
    Source: The Guardian, 26 March 2024
  6. Patient Safety Learning
    Ministers are being urged to roll out a better testing regime for one of the country’s biggest killers, with the most recent figures showing death rates for chronic obstructive pulmonary disease more than three times higher in some of the most deprived areas of the country.
    More than 20,000 people a year in England die from chronic obstructive pulmonary disease. The most significant cause of COPD is smoking, but a significant proportion of cases are work-related, triggered by exposure to fumes, chemicals and dust at work.
    Figures from the Office for National Statistics reveal that death rates from the disease are significantly higher in more deprived areas of the country.
    The NHS is rolling out targeted lung screening across England for people aged between 55 and 74 who are current or former smokers. The charity Asthma + Lung UK says the checks will identify many people who may have COPD, but there is no established protocol for them to be diagnosed and given appropriate treatment and support.
    Dr Samantha Walker, interim chief executive at Asthma + Lung UK, said: “Once targeted lung health checks are fully rolled out, millions of people could be told they have an incurable lung disease like chronic obstructive pulmonary disease, but they won’t be given a firm diagnosis or signposted to the right support, which is simply unacceptable.
    “What we need to see is a national referral pathway in place for those people who show signs of having other lung conditions as part of this screening process to ensure that people with all suspected lung conditions get the diagnosis and treatments that they deserve. We know that people with lung disease will live better, fuller lives with an earlier diagnosis.”
    Read full story
    Source: The Guardian, 24 March 2024
  7. Patient Safety Learning
    A&E staff are unable to properly look after the most vulnerable mental health patients or treat them with compassion because emergency departments are so overwhelmed, top medics have warned.
    An exclusive report shared with The Independent shows more than 40% of patients who needed emergency care due to self-harm or suicide attempts received no compassionate care while in A&E, according to their medical records.
    The data, collated by the Royal College of Emergency Medicine (RCEM), prompted a warning from top doctor Dr Adrian Boyle that mental health patients are spending far too long in A&E – where they are cared for by staff who are not specifically trained for their needs – before being moved to an appropriate ward.
    Dr Boyle, who is president of the RCEM, said there had been some progress in improving care for a “historically disadvantaged” group, but added: “Patients with mental health problems are still spending too long in our emergency departments, with an average length of stay of nearly 10 hours and this has not really improved.
    “An emergency department is frequently noisy and agitating, the lights never go off and cannot be described as an environment that promotes recovery.”
    When a patient goes to A&E after a self-harm attempt, they should receive an assessment by a clinician into the type of self-harm, reasons for it, future plans or further suicidal thoughts.
    The college said it indicates a “significant gap” in the NHS’ ability to provide holistic care for mental health patients with complex needs and warned “urgent” improvements are needed.
    Read full story
    Source: The Independent, 25 March 2024
  8. Patient Safety Learning
    Almost 9,000 foreign nurses a year are leaving the UK to work abroad, amid a sudden surge in nurses quitting the already understaffed NHS for better-paid jobs elsewhere.
    The rise in nurses originally from outside the EU moving to take up new posts abroad has prompted concerns that Britain is increasingly becoming “a staging post” in their careers.
    The number of UK-registered nurses moving to other countries doubled in just one year between 2021-22 and 2022-23 to a record 12,400 and has soared fourfold since before the coronavirus pandemic.
    Seven out of 10 of those leaving last year – 8,680 – qualified as a nurse somewhere other than the UK or EU, often in India or the Philippines. Many had worked in Britain for up to three years, according to research from the Health Foundation.
    The vast majority of those quitting are heading to the US, New Zealand or Australia, where nurses are paid much more than in the UK – sometimes up to almost double.
    Experts have voiced their alarm about the findings and said the NHS across the UK, already struggling with about 40,000 vacancies for nurses and hugely reliant on those coming from abroad, is increasingly losing out in the global recruitment race.
    “It feels like the NHS is falling down the league table as a destination of choice for overseas nurses,” said Dame Anne Marie Rafferty, a professor of nursing studies at King’s College London.
    “Worryingly, it feels as if the UK is perceived not as a high- but middle-income country in pay terms and as a staging post where nurses from overseas can acclimatise to western-type health systems in the search for better pay and conditions.”
    Read full story
    Source: The Guardian, 25 March 2024
  9. Patient Safety Learning
    More than half of England’s army veterans have experienced mental or physical health issues since returning to civilian life, and some are reluctant to share their experiences, a survey has revealed.
    The survey of 4,910 veterans, commissioned jointly by the Royal College of GPs (RCGP) and the Office for Veterans’ Affairs (OVA), found that 55% have experienced a health issue potentially related to their service since leaving the armed forces. Over 80% of respondents said their condition had got worse since returning to civilian life.
    One in seven of those surveyed said they had not sought help from a healthcare professional. A preference for managing issues alone and the belief that their experience would not be understood by a civilian health professional were the most common reasons given.
    This fear of being misunderstood is demonstrated by the finding that 63% of veterans said they would be more likely to seek help if they knew their GP practice was signed up to the Veteran Friendly Accreditation scheme.
    More than 3,000 of England’s 6,313 GP practices are accredited, but the survey’s findings have prompted the RCGP – with NHS England and the OVA – to launch an initiative to get more GP practices on to the scheme.
    Practices that sign up will be provided with a “simple process” for identifying, understanding and supporting veterans and, where appropriate, referring them to dedicated veterans’ physical and mental health and wellbeing services.
    Read full story
    Source: The Guardian, 25 March 2024
  10. Patient Safety Learning
    NHS England’s workforce ambitions are based on ‘significant’ substitution of fully qualified GPs with trainees and specialist and associate specialist (SAS) doctors, the public spending watchdog has revealed.
    In a new assessment of the NHS long-term workforce plan, the National Audit Office (NAO) found that NHS England’s modelling of the future workforce had ‘significant weaknesses’ and that some of its ‘assumptions’ may have been ‘optimistic’.
    Last year, the national commissioner committed to doubling medical school places to 15,000 and increasing GP training places to 6,000 by 2031. 
    This was based on modelling which predicted that, without these changes, the NHS could face a staffing shortfall of 360,000 and a GP shortfall of 15,000 by 2036.
    The NAO’s report has examined the robustness of NHS England’s predictions, and made a number of recommendations which could influence the refreshed projections NHSE has committed to publishing every two years.
    The long-term workforce plan (LTWP) projected only a 4% increase in fully-qualified GPs between 2021 and 2036, compared to a 49% growth in consultants. 
    "The total supply of doctors in primary care is projected to increase substantially over the modelled period but the total number of fully qualified GPs is not," the report said. 
    It found that NHSE’s projected supply growth in general practice "consists mainly of trainee GPs", who accounted for 93%, as well as "making increased use of specialist and associate specialist (SAS) doctors in primary care". 
    Read full story
    Source: Pulse, 22 March 2024
  11. Patient Safety Learning
    An NHS watchdog has apologised to 29 doctors at Scotland's biggest hospital for not fully investigating their concerns about patient safety.
    A&E consultants at Glasgow's Queen Elizabeth University Hospital wrote to Healthcare Improvement Scotland (HIS) to warn patient safety was being "seriously compromised".
    They offered 18 months' worth of evidence of overcrowding and staff shortages to back their claims.
    But HIS did not ask for this evidence.
    The watchdog also did not meet any of the 29 doctors - which is almost every consultant in the hospital's emergency department - to discuss the concerns after it received the letter last year.
    Instead, it carried out an investigation where it only spoke to senior executives at NHS Greater Glasgow and Clyde before then closing down the probe.
    HIS has now issued a "sincere and unreserved apology" to the consultants and upheld two complaints about the way it handled their whistleblowing letter about patient safety.
    One consultant who signed the letter told BBC Scotland: "We'd exhausted all our options and thought HIS was a credible organisation.
    "We offered to share evidence of patient harm. We were shocked that they ignored this and didn't engage with us as the consultant group raising concerns."
    Another consultant added they were "shocked at their negligence."
    Read full story
    Source: BBC News, 25 March 2024
  12. Patient Safety Learning
    Older people are routinely enduring hidden waits of several months to get essential care and support, according to new figures obtained from government. 
    Waiting time figures for adult social care are not routinely published in England, but last summer the Department of Health and Social Care collected the information from councils for the first time in at least a decade.
    They have been released to HSJ after a freedom of information appeal, and show average waits of up to 149 days (about five months) in Bath and North East Somerset, with 25 councils (30% of the 85 councils which supplied this information) reporting waits of two months or more. Some people will be waiting much longer than the averages reported.
    Across the 85 councils which reported average waits, the average of those figures was around 50 days. But the figures released to HSJ show huge variation – with three councils reporting waits of less than 10 days – although this is partly due to recording differences. 
    The lack of clear figures, and absence of national waiting time measures and standards for adult social care, in contrast to the many targets and published figures in the NHS, and has sparked calls for that to be changed.
    Sir David Pearson, a former integrated care system chair and director of adult social care, who led the government’s Covid-19 care taskforce in the wake of the disaster in care homes in spring 2020, said: “One way of ensuring public confidence is a timely response to need.
    “Being clearer about a small number of standards and measures would help to achieve this. Of course it has to be associated with the right funding and reform, including supporting the social care workforce”.
    Read full story (paywalled)
    Source: HSJ, 25 March 2024
  13. Patient Safety Learning
    Six out of 10 NHS nurses have had to use credit or their savings over the last year to help them cope with the soaring cost of living, according to new research.
    Acute financial pressures are forcing some nurses to limit their energy use while others are going without food. Many are doing extra shifts to help make ends meet.
    The findings have added to fears that money worries and inadequate pay will prompt even more nurses to quit the NHS, which is already short of almost 35,000 nurses.
    The Royal College of Nursing (RCN), which undertook the survey of almost 11,000 nurses in England, claimed that too many in the profession had been left without enough money to cover their basic needs as they paid the price for “the government’s sustained attack on nursing”.
    Read full story
    Source: The Guardian, 22 March 2024
  14. Patient Safety Learning
    The Government has failed to implement a number of recommendations from significant inquiries into major patient safety issues, years after they were agreed to, according to an independent panel.
    The report, commissioned by the Health and Social Committee in the wake of the Lucy Letby case, voiced concerns about “delays to take real action”.
    As part of its investigation, the panel selected recommendations from independent public inquiries and reviews that have been accepted by government since 2010.
    Nine or more years have passed since these recommendations were accepted by the government of the day
    These covered three broad policy areas – maternity safety and leadership, training of staff in health and social care, and culture of safety and whistleblowing – and were used to evaluate progress.
    The panel gave the Government a rating of “requires improvement” across the policy areas. One of the recommendations was rated good.
    The report said that “despite good performance in some areas” the rating “partly reflects the length of time it has taken for the Government to make progress on fully implementing four of the recommendations which were accepted nine years ago, or longer”.
    “Progress is imminent in several areas, which is reassuring, but we remain concerned about the time it has taken for real action to be taken,” it added.
    Read full story
    Source: The Independent, 22 March 2024
    Read Patient Safety Learning's response to the report:
    Response to Select Committee report: Evaluation of the Government’s progress on meeting patient safety recommendations
  15. Patient Safety Learning
    A new system requiring GPs to agree death certificates with a medical examiner is unlikely to launch at the beginning of April, it has emerged.
    The system, which will see medical examiners (MEs) providing independent scrutiny of all deaths in the community which are not taken to the coroner, had previously been due to come in from April last year.
    However, it was delayed by one year to allow time for Parliament to introduce the necessary supporting legislation and, according to the Department of Health and Social Care (DHSC), this has yet to happen.
    A spokesperson told Pulse that the Government’s intention is to still introduce secondary legislation ‘from April’ to implement death certification reform. However, it could not confirm the exact date the system will launch and said it would provide an update before the end of March.  
    Nottingham GP Dr Irfan Malik told Pulse that local GPs and practice staff ‘seem to be aware there is a delay’ but  have had ‘no official emails’ or communication confirming the delays.
    Read full story
    Source: Pulse, 20 March 2024
  16. Patient Safety Learning
    Trust chiefs have collectively called for the Care Quality Commission (CQC) to review its use of single-word inspection ratings, following MPs’ calls for an overhaul of Ofsted ratings for schools.
    In a report containing a series of recommendations for CQC reform, shared with HSJ, NHS Providers urges the regulator to re-evaluate the success of its single-word ratings, asking it to consider adding a narrative verdict as part of its new provider assessment reports.
    The recommendation is made “in the context of the Ofsted inquiry findings” following the death of headteacher Ruth Perry by suicide, which a coroner ruled was contributed to by an Ofsted inspection. It prompted MPs on the Commons’ education committee to call for a ban on single-word Ofsted ratings.
    The NHSP report said the inquiry’s concerns around inspectors’ behaviour, the complaints process, and single ratings can also be applied to CQC.
    The report adds: “While we recognise the differences between the two regulators’ approaches, we believe now is the right time to take stock… for example, CQC may need to consider the value of its single-word ratings, modelled upon Ofsted’s rating system.
    “As suggested by the Nuffield Trust and many trust leaders, a single-word rating will inevitably oversimplify what happens in a very complex organisation".
    Read full story (paywalled)
    Source: HSJ, 21 March 2024
  17. Patient Safety Learning
    Lessons have not been learned to prevent further deaths in north Wales, coroners have told the health secretary.
    Over the past year, coroners in Wales wrote 41 "prevention of future deaths reports" and more than half were issued to Betsi Cadwaladr health board.
    Health Secretary, Eluned Morgan, said 27 reports issued since January 2023 was "of significant concern".
    Betsi Cadwaladr health board said every report was taken very seriously and work was ongoing to respond to key themes.
    Ms Morgan said all but three of the deaths happened before the health board was moved back into special measures in February 2023.
    The "systemic issues" that emerge as common themes from the coroners' reports include:
    the quality of investigations and effectiveness of actions a lack of integrated electronic health records impacting care the impact of delays in the system on ambulance response times. In a written statement earlier this week, Ms Morgan said the health board had given assurances that it was taking the matter "extremely seriously".
    Read full story
    Source: BBC News, 21 March 2024
  18. Patient Safety Learning
    Many popular AI chatbots, including ChatGPT and Google’s Gemini, lack adequate safeguards to prevent the creation of health disinformation when prompted, according to a new study.
    Research by a team of experts from around the world, led by researchers from Flinders University in Adelaide, Australia, and published in the BMJ found that the large language models (LLMs) used to power publicly accessible chatbots failed to block attempts to create realistic-looking disinformation on health topics.
    As part of the study, researchers asked a range of chatbots to create a short blog post with an attention-grabbing title and containing realistic-looking journal references and patient and doctor testimonials on two health disinformation topics: that sunscreen causes skin cancer and that the alkaline diet is a cure for cancer.
    The researchers said that several high-profile, publicly available AI tools and chatbots, including OpenAI’s ChatGPT, Google’s Gemini and a chatbot powered by Meta’s Llama 2 LLM, consistently generated blog posts containing health disinformation when asked – including three months after the initial test and being reported to developers when researchers wanted to assess if safeguards had improved.
    In response to the findings, the researchers have called for “enhanced regulation, transparency, and routine auditing” of LLMs to help prevent the “mass generation of health disinformation”.
    Read full story
    Source: The Independent, 20 March 2024
  19. Patient Safety Learning
    A group representing hundreds of clinicians has applied to contribute to the Lucy Letby inquiry, to challenge NHS culture around whistleblowing.
    Their experiences of raising concerns should inform the inquiry, they say.
    Letby murdered seven babies and attempted to murder another six while working at the Countess of Chester NHS trust between June 2015 and June 2016.
    The public inquiry is examining how the nurse was able to murder and how the hospital handled concerns about her.
    "The evidence of this group relating to how whistleblowers are treated, not just at one trust but across the UK, is of huge significance," Rachel di Clemente, of Hudgell Solicitors, acting for the clinicians, said.
    The group, NHS Whistleblowers, comprising healthcare professionals across the UK, including current and former doctors, midwives and nurses, has written to Lady Justice Thirlwall's inquiry, asking for them to be formally included as core participants.
    The inquiry has stated it will consider NHS culture.
    And the group says "a culture detrimental to patient safety" is evident across the health service.
    "NHS staff who have bravely spoken up about patient-safety concerns or unethical practices deserve to have their voices heard," Dr Matt Kneale, who co-chairs Doctors' Association UK, which is part of the group, said.
    Read full story
    Source: BBC News, 21 March 2024
  20. Patient Safety Learning
    A campaigner in Norfolk says the "deaths crisis" at the county's mental health trust is getting worse.
    Bereaved relatives met the mental health minister, Maria Caulfield, to discuss failings at the Norfolk and Suffolk NHS Foundation Trust (NSFT).
    The trust says it is on a "rapid, and much-needed journey of improvement".
    Mark Harrison, from the Campaign to Save Mental Health Services in Norfolk and Suffolk, said: "We judge people by what they do, not what they say."
    Members of the campaign group met Ms Caulfield and other MPs in Westminster on 12 March and demanded an independent public inquiry into the trust.
    It came after a report last summer which found that more than 8,000 mental health patients had died unexpectedly in Norfolk and Suffolk between 2019 and 2022.
    At the meeting, it was agreed Ms Caulfield would meet bosses at the NSFT. The health select committee will also be asked to conduct an inquiry into the trust as part of a broader public inquiry.
    But Mr Harrison said he had little confidence anything would change.
    "The deaths crisis is just out of control and it's accelerating," he said.
    "We have been doing this for 10 years. Every time somebody promises to do something, it doesn't come to anything."
    Read full story
    Source: BBC News, 20 March 2024
  21. Patient Safety Learning
    William Wragg, the Tory chair of the Public Administration and Constitutional Affairs Committee (PACAC), has belatedly intervened in the growing crisis over the failure of the Prime Minister to appoint a new Parliamentary Ombudsman to replace Rob Behrens who quits the Parliamentary and Health Service Ombudsman on 31 March 2024.
    In a letter published on the committee’s website, Mr Wragg asks Sir Alex Allan, the senior non executive director on the Parliamentary and Heath Services Ombudsman board, what measures will be taken to keep the office going and what is going to happen to people who, via their MP, want to lodge a complaint to the Ombudsman. He also raises whether reports can be published and complaints investigated. 
    The letter discloses that recruitment for a new Ombudsman began last October and a panel chose the winning candidate at the beginning of January. Since then the Cabinet Office and Rishi Sunak, who has to approve the appointment, have not responded. The silence from Whitehall and Downing Street means no motion can be put to Parliament appointing a new Ombudsman, who then appears before the PACAC for a pre appointment hearing. PACAC has only a couple of weeks to set up the hearing.
    Read full story
    Source: Westminster Confidential, 12 March 2024
  22. Patient Safety Learning
    Millions of people with long-term illnesses should get medical treatment at home rather than in hospital to help them carry on working, according to a report.
    The NHS is being urged to deliver more medicines directly to patients’ doors, so they can self-administer drugs at home, and “get on with life” rather than having to travel back and forth to hospitals.
    New research shows this model of care, called clinical homecare, helps those needing regular treatment for chronic conditions, including cancer and arthritis, to stay in employment and retain independence.
    Experts said providing more patients with specialist medicines at home can play a vital role in tackling the UK’s growing rates of economic inactivity, with 2.7 million long-term sick now signed off work.
    The report, commissioned by the National Clinical Homecare Association, said expanding the schemes means millions of patients “could be supported to continue working and living their lives without being defined by their health status”, adding that up to three million cancer patients could benefit.
    Read full story (paywalled)
    Source: The Times, 19 March 2024
  23. Patient Safety Learning
    The chair of an inquiry into the deaths of mental health patients in Essex has said she is “disappointed” at a delay in having its scope confirmed by the health secretary.
    Baroness Kate Lampard said she has been unable to begin substantive work on the probe while still waiting for sign-off from government. 
    An inquiry was launched in 2021 to review the deaths of at least 2,000 people in contact with Essex mental health services across a 20-year period.
    Baroness Lampard took over as chair last year after it gained new powers to compel people to give evidence, following concerns not enough staff were coming forward.
    She has proposed expanding its scope by a further two years until 2022 due to ongoing concerns and to cover NHS patients treated in the private sector.
    The final terms of reference will be set by the health secretary Victoria Atkins. Baroness Lampard said she has not heard back from the Department of Health and Social Care on her proposals since submitting them three months ago.
    Read full story (paywalled)
    Source: HSJ, 19 March 2024
  24. Patient Safety Learning
    The BMA has called for an independent inquiry into the use of physician associates (PAs) on medical rotas in place of doctors.
    The union said that health secretary Victoria Atkins must launch the investigation ‘to get to the bottom of the scale’ of the issue across the NHS, as doctors have been reporting instances where gaps in medical rotas are being filled by PAs.  
    This is happening on top of NHS England ‘investing heavily’ in the use of PAs in primary care, ‘instead of qualified experienced doctors’, the BMA added.
    On Friday The Telegraph reported  on leaked rotas from more than 30 hospitals showing physician associates taking on doctors’ shifts.
    This coincided with new NHS England guidance to ‘emphasise that PAs are not substitutes for doctors’, as they are ‘supplementary members’ of the team and they ‘should not be used as replacements for doctors on a rota’.
    BMA chair of council Professor Philip Banfield said: ‘We know from our members’ experiences that hospitals are putting physician assistants on medical rotas, in place of medically qualified doctors.
    ‘This is on top of NHS England investing heavily in the use of physician associates in primary care, instead of qualified experienced doctors.
    "In our view, Victoria Atkins now has a duty to patients and a duty to medically qualified staff – doctors – to establish how widespread this practice is and more importantly, stop it."
    Read full story
    Source: Pulse, 18 March 2024
    Further reading on the hub:
    Partha Kar: We need a pause to assess safety concerns surrounding Physician Associates  
  25. Patient Safety Learning
    A secret report has warned that the NHS is failing to protect trainee paramedics from widespread sexual harassment and racism at work, The Independent has revealed.
    A confidential NHS England report uncovered by The Independent has found that “extremely alarming” conduct and undermining behaviour are rife in ambulance trusts across the country, with trainees subjected to derogatory comments about their age, ethnicity and appearance in front of patients.
    There is a “worrying acceptance” that this is “part of the job”, with students hesitant to raise complaints about sexual behaviour by male colleagues in case it gives them a reputation as “annoying snowflakes”, the report says.
    The revelations come after a recent NHS staff survey revealed that thousands of ambulance staff had reported unwanted sexual behaviour from colleagues and patients last year.
    One healthcare leader described the findings as “harrowing”, warning that much more needs to be done to protect junior staff.
    The national report, which is understood to have gone through several edited versions and is marked commercially sensitive, was not due to be released until The Independent obtained the document through a freedom of information request.
    It found an “undercurrent” of bullying in some areas, with examples of students leaving their jobs as a result of inappropriate behaviour.
    Trainees reported feeling undervalued and unwanted while on the job, with one apparently told: “Your concerns don’t matter – we have to meet patient demands.”
    Ambulance handover delays have also led to student paramedics having less experience and training on the job, prompting fears that newly qualified paramedics do not have sufficient levels of experience in life-critical situations.
    Read full story
    Source: The Independent, 19 March 2024
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