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Patient Safety Learning

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  1. Patient Safety Learning
    General practices will struggle to cope with a second wave of COVID-19 unless urgent measures are put in place to support them, the BMA has warned.
    It said that practices in England were reporting that they did not have the capacity to carry out all of the work required of them while managing ongoing patient care, dealing with the backlog of care put on hold during the first wave of the pandemic, and reconfiguring services.
    Richard Vautrey, chair of the BMA’s General Practitioners Committee England, said, “GPs, like all doctors, are extremely concerned that without decisive action now services will be overwhelmed if we see another spike in the coming weeks and months.”
    In the report, the committee called for a package of measures to support the GP workforce, including making occupational health services available to all staff to ensure that they are properly risk assessed and to provide free supplies of personal protective equipment. It also called for the suspension of routine inspections by the Care Quality Commission and of the Quality and Outcomes Framework, as part of efforts to reduce bureaucracy.
    NHS England’s covid support fund for practices should be rolled over until March 2021 and expanded to ensure that all additional costs such as additional telephony and cleaning are included, it added.
    Vautrey said, “The measures we’ve outlined are aimed at supporting practices and their staff to deliver high quality care while managing the increased pressures of doing so during a pandemic, and it is vital that the government and NHS England listen and implement these urgently, to ensure that primary care can continue to operate safely through what looks to be an incredibly difficult winter.”

    Read full story
    Source: BMJ, 1 October 2020
  2. Patient Safety Learning
    The surgeon at the centre of a body parts scandal operated on patients who were dangerously sedated so that their procedures could be carried out simultaneously, according to a leaked investigation seen by The Independent.
    Renowned hip surgeon Derek McMinn and two anaesthetists at Edgbaston Hospital, Birmingham, were accused of putting “income before patient safety” in the internal investigation for BMI Healthcare, which runs the hospital.
    It comes after a separate review found that McMinn had hoarded more than 5,000 bone samples from his patients without a licence or proper permission to do so over a period of 25 years, breaching legal and ethical guidelines. Police are investigating a possible breach of the Human Tissue Act.
    According to the report on sedation by an expert from another hospital, the two anaesthetists, Imran Ahmed and Gauhar Sharih, sedated patients for so long that their blood pressure fell to dangerous levels in order to allow McMinn to carry out near-simultaneous surgery.
    It found this meant long delays in the operations starting, with one sedated patient being subjected to prolonged anaesthesia for longer than one hour and 40 minutes – recommended best practice is 30 minutes.
    Another patient was apparently "abandoned" for an hour and 26 minutes after their surgery was only partially completed while McMinn began operating on another patient.
    The report’s author, expert anaesthetist Dr Dhushyanthan Kumar of Coventry’s University Hospital, said this was unsafe practice by all three doctors and urged BMI Healthcare to carry out a review of patients to see if any had suffered lasting brain damage. Both anaesthetists work for the NHS – Ahmed at Dudley Group of Hospitals, Sharih at University Hospitals Birmingham – without restrictions on their ability to practise.
    Read full story
    Source: The Independent, 30 September 2020
  3. Patient Safety Learning
    Doctors and carers should look out for signs of confusion or strange behaviour in frail older people because it could be an early warning sign of COVID-19, research suggests.
    Even if they have no cough or fever, delirium is more common in vulnerable over-65s than other, fitter people of the same age. But it's not yet clear why this extreme confusion or delirium happens.
    In this King's College London study, data from more than 800 people over the age of 65 was analysed. They included 322 patients in hospital with COVID-19, and 535 people using the Covid Symptom Study app to record their symptoms or log health reports on behalf of friends and family. All had received a positive test result.
    The researchers found that older adults admitted to hospital who were classified as frail were more likely to have had delirium as one of their symptoms, compared with people of the same age who weren't frail.
    For one in five patients in hospital with Covid, delirium was their only symptom.
    The study calls for more awareness of it in hospitals and care homes.
    Read full story
    Source: BBC News, 30 September 2020
  4. Patient Safety Learning
    Almost nine in ten maternity services experienced a decline in emergency pregnancy appointments during the pandemic due to women avoiding healthcare providers amid coronavirus chaos, a study has found.
    The Royal College of Obstetricians and Gynaecologists, who carried out the research, said women refrained from attending appointments due to anxiety around going into a hospital and fears of overwhelming the NHS, as well as not being clear if the appointments were essential.
    Researchers found 70% of maternity services reported a reduction in antenatal appointments, while 60% of units stopped the option of giving birth at home or in a midwife-led unit. Over half of services said postnatal appointments after childbirth had been reduced.
    The findings come as maternity services warn staff must not be sent to work in other parts of the hospital in the wake of a second wave of coronavirus.
    Royal College of Obstetricians & Gynaecologists and the Royal College of Midwives, who together represent the overwhelming bulk of maternity staff, say there must not be a repeat of the acute and widespread maternity staff shortages which played out during the health emergency’s peak.
    Read full story
    Source: The Independent, 30 September 2020
     
  5. Patient Safety Learning
    The stress and anxiety caused to patients by "poor communication" from NHS bodies in England during the covid pandemic has been criticised by MPs.
    While recognising the huge burden placed on the NHS, their report said cancelled treatments and surgery had left some "in limbo" and others "too scared" to seek medical help. The report also questioned why weekly testing of NHS staff had not yet begun. And it called for their mental and physical wellbeing to be supported.
    Jeremy Hunt, who chairs the Health and Social Care Committee, which compiled the report, praised the "heroic contribution" made by front-line NHS staff during the pandemic, which had saved many lives. But he said the pandemic had "massively impacted normal NHS services" and this situation could have been improved with clearer communication to patients and better infection control measures in hospitals.
    The report, based on evidence from doctors, nurses, patient groups and NHS leaders, said the case for routine testing for all NHS staff in all parts of the country was "compelling" and it should be introduced as soon as possible before winter to help reduce the spread of the virus.
    The government and NHS England told the committee they wanted to bring in routine testing of staff but any plans depended on the capacity available.
    Read full story
    Source: BBC News, 1 October 2020
  6. Patient Safety Learning
    Most operations have been cancelled at a hospital in a COVID-19 hotspot in south Wales after an outbreak of the virus involving more than 80 people.
    Hospital chiefs said transmission had taken place within the Royal Glamorgan hospital at Llantrisant and some wards where patients and staff had been infected were closed.
    The hospital, which is within Rhondda Cynon Taf, one of the areas under local lockdown restrictions, said it was trying to speed up the testing of patients and staff.
    In a statement, it said: “Significant temporary service restrictions will be put in place at Royal Glamorgan hospital from 2pm Wednesday 30 September as increased action is taken to contain a COVID-19 outbreak within the hospital.
    Teams have been working at pace to implement robust measures to manage the outbreak. However, additional cases linked to transmission within the hospital have been confirmed in recent days with the number of cases currently standing at 82."
    Andrew RT Davies, shadow health minister for the Welsh Conservatives, called on the Welsh government to explore using field hospitals and other health facilities to alleviate pressure on the Royal Glamorgan.
    He added: “This is very concerning, particularly as many of the additional cases are linked to transmission within the hospital, and so questions over processes and protocols must be asked.”
    Read full story
    Source: The Guardian, 30 September 2020
  7. Patient Safety Learning
    A frailty index is rationing treatment for older and disabled people who catch coronavirus, says Patience Owen. Patience has has a debilitating connective tissue disorder and, like thousands of others with rare conditions, is already in a minority within a minority, marginalised by our NHS, battling increasing disability day by day.
    Back in March, without consultation and days before the first lockdown, the Clinical Frailty Scale (CFS), a worldwide tool used to swiftly identify frailty in older patients to improve acute care, was adapted by the National Institute for Health and Care Excellence (NICE). It asked NHS staff in England to score the frailty of Covid patients. Rather than aiming to improve care, it seems the CFS – a fitness-to-frailty sheet using scores from one to nine – was used to work out which patients should be denied acute care. Nice’s new guidelines advised NHS trusts to “sensitively discuss a possible ‘do not attempt cardiopulmonary resuscitation’ decision with all adults with capacity and an assessment suggestive of increased frailty”.
    "Checking the scale, I found I would score five, the 'mildly frail' category, and therefore should I get Covid I could be steered towards end-of-life care. Bluntly, if I catch the virus, the NHS may help me to die, not live," says Patience.
    By early April, there was a proliferation of illegal “do not resuscitate” (DNR) notices in care homes for people with learning disabilities, and for older people in care homes and in hospitals. Many acutely ill patients stayed at home with Covid symptoms in the belief that they risked being denied care in hospital. Following warnings by the healthcare regulator, the Care Quality Commission, and other medical bodies, that the blanket application of the notices must stop, and legal challenges by charities, exclusions were made to the NICE guidelines.
    These included “younger people, people with stable long-term disabilities, learning disabilities or autism”. Yet the guidelines remain in place, in spite of the fact that they appear to contravene the Human Rights Act (including the right to life, article 2, and the right to non-discrimination, article 14). 
    A spokeswoman for NICE says it is “very aware of the concerns of some patient groups about access to critical care, and we understand how difficult this feels. Our COVID-19 rapid guideline on critical care was developed to support critical care teams in their management of patients during a very difficult period of intense pressure."
    “'Difficult' is a hollow word for the feeling of being selected to die," says Patience. "It’s difficult not to conclude that those with long-term conditions and disabilities, like myself, have become viewed as a sacrificial herd."

    Read full story
    Source: The Guardian, 29 September 2020
  8. Patient Safety Learning
    Experts say robust legal protections are needed to inspire public confidence. The UK government has set out plans to amend drug regulations in case it decides that COVID-19 vaccines should be used before they are licensed, in a bid to roll them out more quickly.
    In a consultation on the proposals that ran from 28 August to 18 September the Department of Health and Social Care for England explained that if a suitable vaccine emerged with strong evidence of safety, quality, and efficacy the government would seek to license it through the usual route but could supply it in the meantime.
    The document added, “A COVID-19 vaccine would only be authorised in this way if the UK’s licensing authority was satisfied that there is sufficient evidence to demonstrate the safety, quality, and efficacy of the vaccine. ‘Unlicensed’ does not mean ‘untested.”
    The consultation, and the timeframe in which it was conducted, prompted some people to post their concerns on social media. 
    However, the Human Medicine Regulations 2012 already allow the licensing authority to temporarily authorise the supply of an unlicensed product in response to certain public health threats, including the suspected spread of pathogens. The proposed change would allow conditions to be attached “to ensure product safety, quality, and efficacy”
    The 2012 regulations also give healthcare professionals and manufacturers immunity from being sued in the civil courts for the use of some unlicensed products recommended by the licensing authority in response to a public health threat. The new regulations would extend the immunity to drug companies that have not manufactured the product but placed it on the market with the approval of the licensing authority, and they clarify the consequences for a breach of conditions imposed by the authority.
    Social media posts play into existing concerns that many people might not accept the vaccine, as surveys indicate. Lawyers have told the Department for Health and Social Care that to inspire public confidence it must provide redress for the few people who might experience adverse effects.
    Bozena Michalowska, a partner specialising in product liability at the law firm Leigh Day, said, “I do not believe that people will want to play Russian roulette with their health by taking a vaccine which they know nothing about, especially when they know that the risks they take are just taken by them and not a shared risk and they will not have sufficient protection should things go wrong.”
    Read full story
    Source: The BMJ, 28 September 2020
  9. Patient Safety Learning
    Covid survivor Tam McCue is one of the lucky ones. Earlier in the year he was in intensive care in the Royal Alexandra Hospital in Paisley where he had been on a ventilator for nearly two weeks.
    At one point Mr McCue, who could barely speak, didn't think he would live. 
    Fast forward five months and Mr McCue, of Barrhead, East Renfrewshire, is back from the brink.
    He became desperately ill but, thankfully, it only went as far as his lungs. With coronavirus some patients have have suffered multiple organ failure which also affected their heart, kidneys, brain and gut.
    Mr McCue describes his recovery as a "rollercoaster".
    He added: "It's a slow process. You think you can do things then the tiredness and fatigue sets in."
    He said: "It lies in the back of your mind. As years go on, how are you going to be? Is it going to get you again? It does play on you. It definitely does."
    As part of his recovery Mr McCue is attending the Ins:pire clinic online. It is normally a face-to-face rehabilitation clinic which involves multiple specialties, including pharmacists, physiotherapists and psychologists. Mr McCue is one of the first Covid survivors to take part in the five-week programme, which started earlier this month.
    Read full story
    Source: BBC Scotland News, 29 September 2020
  10. Patient Safety Learning
    Official data from mid-September shows that nearly 6,400 people had waited more than 100 days following a referral to cancer services.
    The leaked data reveals for the first time the length of the cancer waiting list in the wake of the first pandemic peak, during which much diagnostic and elective cancer care was paused.
    The list consists of those waiting for a test, the outcome of a test, or for treatment. NHS England and Improvement only publish waiting times for patients who have been treated – not the number still waiting – so this information has been secret.
    The data, obtained from official emails seen by HSJ, showed the total number of people on the cancer waiting list grew substantially, from 50,000 to around 58,000, between the start of August and the middle of September. 
    Of the 6,400 people recorded to be waiting more than 104 days on 13 September, 472 had a “decision to treat classification”, meaning they have cancer and are awaiting treatment. 
    NHS England has said reducing the cancer waiting list would be overseen by a national “taskforce”, which is being chaired by national director for cancer Peter Johnson.
    Experts have warned the delays already stored up in the system could cost tens of thousands of lives as patients go undiagnosed or have their diagnosis and treatment later than they otherwise would.
    HSJ asked NHS England if harm reviews had been carried out for those on the waiting list and whether it had discovered if those waiting longer than104 days had been harmed, but did not receive an answer.
    Read full story (paywalled)
    Source: HSJ, 29 September 2020
  11. Patient Safety Learning
    The NHS is facing a "triple whammy" of rising COVID-19 cases, a major backlog in treatment and reduced capacity due to infection-control measures, according to health bosses. 
    The NHS Confederation report on the English NHS said more investment was desperately needed. The NHS bosses also called on ministers to be "honest and realistic" about waiting lists for treatment.
    It comes despite the government promising an extra £3bn this winter. That money - announced over the summer - was intended to help hospitals cope with the extra-infection control measures required and to pay for patients to be treated privately for routine treatment, such as knee and hip replacements. 
    But hospitals are still performing only half the number of routine operations they normally would. Two million patients have already waited longer than 18 weeks for treatment, the highest number since records began, in 2007.
    And services in other areas, such as cancer care, are running at about three-quarters capacity. 
    Of the more than 250 bosses who responded to the confederation's survey:
    fewer than one in 10 said the current level of funding allowed them to deliver safe and effective care nearly nine in 10 said a lack of funding would be a significant barrier to achieving waiting-time targets for everything from mental-health care to cancer treatment and routine operations. Read full story
    Source: BBC News, 29 September 2020
  12. Patient Safety Learning
    When Sarah found herself suffering sudden bouts of breathlessness in May, she took herself to hospital. But after her COVID-19 swab test came back negative, doctors said she was probably anxious, and sent her home.
    Despite this, Sarah’s symptoms continued to worsen. A week later, she was rushed to hospital in an ambulance. Paramedics told her that based on her clinic observations, she should be in a coma.
    Then came more surprising news: She had tested positive for coronavirus
    Sarah’s story – given to a patient safety charity under a pseudonym – is one that resonates with Dr Claudia Paoloni, president of the Hospital Consultants and Specialists Association. She detailed another case in which a patient tested negative twice: once when she was first admitted to hospital and once later in her hospital stay. She finally tested positive on her third test – by which time she was on a ventilator in intensive care.
    Paolini believes COVID-19 swab tests produce a troublingly high rate of false negative results, and the problem lies in the reliance on a single test.
    “To use as a one-off test in any capacity to exclude someone from having COVID-19 is a folly.” 
    If you want to exclude someone from having the virus, Paoloni said, you must do multiple tests and collect multiple negative results. “If the test and tracing system is not working, which is the case here, transmission will continue unabated in the community.”
    The most recent data published by the Office for National Statistics says the test’s sensitivity - which it says can tell us how likely it is to return a false-negative result, may be somewhere between 85% and 98%. 
    Dr Deenan Pillay, Professor of Virology at University College London and member of Independent Sage, a group of scientists providing transparent advice during the crisis, said a significant number of self-administered tests could be coming back negative for people who do in fact have the virus.
    “The single biggest reason why a swab from someone who has COVID-19 comes up as negative is the quality of the swab that is taken,” Dr Pillay said. “Swabbing your nose and throat in a way that will pick up the virus means really scraping down the side of the wall of the nose or back of the throat to get cells from the lining of the throat. That’s not a pleasant thing to do.”
    This is of course true for at-home testing, which relies on the patient or a family member to collect the swab. But it could be true at testing centres, too.
    Tom, a 29-year-old from London whose name has been changed for this story, said there were no medical staff on site when he visited a Covid testing centre in London. The only people he interacted with were staff from a third-party contractor paid to carry out testing.
    “The man simply handed me a test, read out the instructions to self-administer the test, and asked me to do it myself,” he said.
    Pillay agrees that testing methods are likely to have an impact on false negative results. “I have seen the documentation given out at testing centres and it is very confusing,” he said. “Centres often expect you to administer the test yourself or get someone else in your car to administer it for you, all of which creates difficulties.” 
    Pillay believes the solution lies in having medically trained staff at testing centres. “The way the system is developed at the moment, outsourced to private companies like Deloitte and Lighthouse Labs, is just woeful,” he said.
    “The whole system is failing at the moment. And it’s happening just as the numbers of infections are starting to rise,” Dr Pillay said.
    Read full story
    Source: Huffpost, 27 September 2020
  13. Patient Safety Learning
    Tens of thousands of people infected with coronavirus were incorrectly given the all clear by England’s Lighthouse Laboratories, a High Court trial will be told next week.
    Court documents seen by The Independent show the labs are accused of unfairly selecting software that was shown in a test to produce significant numbers of errors and false negatives, samples that should have been positive or classed as needing to be re-taken.
    The two companies behind the Lighthouse Labs in England – Medicines Discovery Catapult Ltd and UK Biocentre Ltd – are accused of treating British company, Diagnostics.ai unfairly and giving preferential treatment to Belgian company UgenTec, despite the British firm’s software performing better in the test.
    The case, first revealed by The Independent in June, also includes a judicial review of the procurement decision against health secretary Matt Hancock – one of the first court hearings over the procurement processes followed by the government since the start of the pandemic.
    The Independent understands lawyers for Diagnostics.ai will accuse the laboratories of choosing a software solution that went on to produce tens of thousands of incorrect results which will have led to infected people going about their normal lives while at risk of spreading the virus.
    In June, UgenTec chief executive Steven Verhoeven told The Independent the suggestion its software had made errors was “incorrect”.
    The Department of Health refused to comment on the legal action but said in June that the UgenTec software had been used for several months and was subject to quality assurance processes, though it did not give any further details.
    Mr Justice Fraser will hear opening arguments in the case on Monday at the High Court.
    Read full story
    Source: The Independent, 25 September 2020
  14. Patient Safety Learning
    Dr Neelam Dhingra, Coordinator, Patient Safety and Risk Management, World Health Organization, reflects on World Patient Safety Day 2020.
    "Dear Colleagues
    Congratulations. This is a moment of pride for all of us!
    The WHO Patient Safety Flagship would like to express its deepest appreciation to members of the Global Patient Safety Network for an outstanding commemoration of the World Patient Safety Day 2020 around the world. The response to the call was phenomenal and we have already received great stories and truly inspiring reports from multiple countries, regions, partners and stakeholders showcasing a variety of activities. A number of global virtual events amplifying the messaging for the day. “Safe health workers, Safe patients” and “Speak up for Health worker safety!”. Moreover, hundreds, if not thousands, of iconic monuments, landmarks and health care facilities were lit up in colour orange from all over the world. We are working on a short summary and a full report illustrating all these amazing contributions. Most importantly, the day was a witness to expression of strong commitment and leadership of ministries of health for urgent and sustainable action, from countries across the world.
    At WHO headquarters on 17 September 2020, a landmark Charter “Health worker Safety: A priority for patient safety”, was launched at a World Patient Safety Day Press Conference (https://twitter.com/who/status/1306496780649938944?s=24) by WHO Director General, Dr. Tedros Adhanom Ghebreyesus in the presence of International Labour Organization Director General, Dr Guy Ryder and Rt. Hon Mr Jeremy Hunt, Chair, Health and Social Care Select Committee, House of Commons of the UK, who played a key role in establishing World Patient Safety Day, an active campaigner on patient safety globally and also the Co-Chair of WHO Steering Committee on World Patient Safety Day.
    WHO Member States and all relevant stakeholders are invited to support health worker safety by endorsing and signing up to the Charter.
    Charter: Health worker safety: a priority for patient safety
    https://bit.ly/2FNEzRu  
    Sign up: https://www.who.int/campaigns/world-patient-safety-day/sign-up-to-the-charter---health-worker-safety
    A Global Virtual Event “One world: Global solidarity for health worker safety and patient safety” was held showcasing rich participations from members of this very network, regions and countries. WHO Deputy Director General, Dr Zsuzsanna Jakab, and also the Co-Chair of WHO Steering Committee on World Patient Safety Day, in her closing remarks emphasised 'World Patient Safety Day 2020 should not be seen only as Day but a platform for change.  WHO will work with partners to advance the themes of the Day throughout the entire year'.
    A number of advocacy, policy, technical products were launched at the event including:
    1. World Patient Safety Day 2020-21 Goals. From this year onwards, WHO will launch theme-related goals with the aim of achieving tangible and measurable improvements at the point of health service delivery. Ministries of health and health care organizations are encouraged to incorporate these goals into ongoing service improvement programmes and drives. As a new set of goals will be proposed each year, implementation teams at health care facilities are advised to institutionalize patient safety improvements achieved, and to take on new goals as well as sustaining action on goals from the previous year. WHO is setting up an online platform where health care facilities and organizations can report progress and learn from each other. A certificate of appreciation will be provided to the registered facilities. The World Patient Safety Day goals 2020–2021 are aimed at improving health worker safety. Please sign up to the goals.
    Goals https://www.who.int/publications/i/item/who-uhl-ihs-2020.8
    Sign up: https://www.who.int/campaigns/world-patient-safety-day/sign-up-for-wpsd-2020-2021-goals
    2. Patient safety incident reporting and learning systems: technical report and guidance: https://www.who.int/publications/i/item/9789240010338
    3. WHO-ILO joint publication "Caring for those who care: National Programmes for Occupational Health for Health Workers" https://www.who.int/publications/i/item/caring-for-those-who-care
    4. Protection of health and safety of health workers: Checklist for healthcare facilities https://www.who.int/publications/i/item/protection-of-health-and-safety-of-health-workers
    5. An OpenWHO course on: Occupational health and safety for health workers in the context of COVID-19
    https://openwho.org/courses/COVID-19-occupational-health-and-safety?tracking_user=79KWbMERvlyJs93otUBThL&tracking_type=news&tracking_id=5G2Mpe2LUQH0UI1yw8p8pV
    World Patient Safety Day provides a torch bearing platform, which brings spotlight on global, national and local patient safety issues. This year the World Patient Safety Day brought a spotlight on health worker safety and its impact and interaction with patient safety.
    This year’s WPSD came as a result of close collaboration between WHO and all stakeholders.  We strongly believe that the amazing sense of ownership was the key factor for success. For that, we thank you all.
    Thanks and best regards,"
    Dr Neelam Dhingra
  15. Patient Safety Learning
    Some 10,000 more deaths than usual have occurred in peoples’ private homes since mid June, long after the peak in Covid deaths, prompting fears that people may still be avoiding health services and delaying sending their loved ones to care homes.
    It brings to more than 30,000 the total number of excess deaths happening in people’s homes across the UK since the start of the pandemic.
    Excess deaths are a count of those deaths which are over and above a “normal” year, based on the average number of deaths that occurred in the past five years.
    In the past three months the number of excess deaths across all settings, has, in the main been lower than that of previous years. However, deaths in private homes buck the trend with an average of 824 excess deaths per week in people’s homes in the 13 weeks to mid-September.
    Experts are citing resistance from the public to enter hospitals or home care settings and “deconditioning” caused by decreased physical activity among older people shielding at home, for example not walking around a supermarket or garden centre as they might normally.
    Read full story
    Source: The Guardian, 24 September 2020
  16. Patient Safety Learning
    Hospitals have been ordered to allow partners and visitors onto maternity wards so pregnant women are not forced to give birth on their own.
    NHS England and NHS Improvement have written to all of the directors of nursing and heads of midwifery to ask them to urgently change the rules around visiting.
    The letter, which is dated 19 September and seen by The Independent, says NHS guidance was released on 8 September so partners and visitors can attend maternity units now “the peak of the first wave has passed”.
    “We thank you and are grateful the majority of services have quickly implemented this guidance and relaxed visiting restrictions,” it reads. “To those that are still working through the guidance, this must happen now so that partners are able to attend maternity units for appointments and births.”
    The letter adds: “Pregnancy can be a stressful time for women and their families, and all the more so during a pandemic, so it is vital that everything possible is done to support them through this time.”
    Make Birth Better, a campaign group which polled 458 pregnant women for a new study they shared exclusively, said mothers-to-be have been forced to give birth without partners and have had less access to pain relief in the wake of the public health crisis.
    Half of those polled were forced to alter their own childbirth plans as a result of the COVID-19 outbreak – while almost half of those who were dependant on support from a specialist mental health midwife said help had stopped.
    Read full story
    Source: The Independent, 23 September 2020
  17. Patient Safety Learning
    The government and NHS England appear unable to identify units set up to treat ‘long covid’, contrary to a claim by Matt Hancock in Parliament that the NHS had ‘set up clinics and announced them in July’. 
    There are growing calls for wider services to support people who have had COVID-19 and continue to suffer serious follow-up illness for weeks or months. Hospitals run follow-up clinics for those who were previously admitted with the virus, but these are not generally open to those who were never admitted.
    Earlier this month the health secretary told the Commons health committee: “The NHS set up long covid clinics and announced them in July and I am concerned by reports from Royal College of General Practitioners that not all GPs know how to get into those services.”
    Asked by HSJ for details, DHSC and NHS England declined to comment on how many clinics had been set up to date, where they were located, how they were funded or how many more clinics were expected to be “rolled out”.
    However, two charities and support groups — Patient Safety Learning and the Long Covid Support Group — told HSJ they were not aware of dedicated long covid clinics for community patients. An enquiry from Patient Safety Learning to NHS England has not been answered.
    The number of people affected by long covid is unclear due to a lack of research but there are suggestions it could be half a million or more. Symptoms can include fatigue, sleeplessness, night-time hypoxia, “brain fog” and cardiac problems. It appears to affect more people who were not hospitalised with coronavirus than those who were were. There is some evidence that small clinics have been set up locally on a piecemeal basis, without national funding.
    HSJ has only been able to identify only one genuine “long covid clinics” open to those who have never been in hospital with covid. 
    Trisha Greenhalgh, an Oxford University professor of primary care health sciences who has interviewed around 100 long covid sufferers, told HSJ: “Nobody I have interviewed had been seen in a long covid clinic but there is an awful lot of people who would like to be referred and who sound like the need to be but they haven’t.”
    Read full story (paywalled)
    Source: HSJ, 23 September 2020
    Read the letter Patient Safety Learning sent to NHS England
    hub Community thread - Long Covid: Where are these clinics?
     
  18. Patient Safety Learning
    Having flu and COVID-19 together significantly increases your risk of death, say government scientists who are urging all those at risk of getting or transmitting flu to get the vaccine in the coming weeks and months.
    The evidence for the double whammy is currently limited and comes mostly from a study with small numbers – 58 people – carried out in the UK during the early phase of the pandemic.
    “As I understand it, it’s 43% of those with co-infection died compared with 26.9% of those who tested positive for Covid only,” said England’s deputy chief medical officer, Prof Jonathan Van-Tam. These were people who had been hospitalised and had been tested for both viruses, he said, and so were very ill – but the rate of death from Covid alone in the study between January and April was similar to the known rate of Covid hospital mortality generally of around 25% or 26%.
    "I think it is the relative difference in size of those rates that’s rather more important than the absolute rate,” he said. The study may have been small and they would be doing further studies this season, but the findings tallied with other work that has been done, he said.
    “If you get both, you are in some serious trouble, and the people who are most likely to get both of these infections may be the very people who can least afford to in terms of their own immune system, or their risk for serious outcomes. So please protect yourself against flu, this year,” says said Prof Yvonne Doyle, medical director of Public Health England
    The government has bought 30,000,000 doses of flu vaccine, which is more than ever before. They will arrive in batches, so the elderly – over 65 – and those with medical conditions will be called for immunisation first. Relatives of those who are on the shielding list will also be called up. The letters will begin to go out this week.
    Because of the threat of Covid and the risk that people with flu could be infected if admitted to hospital, all those aged 50-64 will be offered flu vaccination, but not straight away. They should wait to be called by their GP.
    Read full story
    Source: The Guardian, 22 September 2020
  19. Patient Safety Learning
    Emergency departments across England are reporting ‘dangerous’ overcrowding similar to levels seen pre-covid, and struggling to maintain social distancing, A&E leaders have warned.
    The Royal College of Emergency Medicine said it was concerned about covid spreading among the most vulnerable patients, as overall transmission rates continue to rise sharply across the UK.
    It was always anticipated that A&E activity would return to pre-covid levels this winter, following a significant drop-off in A&E activity during the spring and early summer, and that service transformation would be needed to help maintain social distancing. But the emergence of widespread overcrowding so far ahead of winter is of serious concern to system leaders.
    A&E staff were already being forced to make difficult trade-offs over which patients to isolate, the college’s vice president told HSJ. He also urged NHS leaders not to place unrealistic expectations on the impact a new model involving walk-in patients booking slots by phone could make on addressing overcrowding in emergency departments.
    RCEM vice president Adrian Boyle said the NHS was “largely back to the pre-covid levels of crowding” but it was “much more dangerous now because of covid”.
    He said: “We are hearing that most emergency departments can’t maintain social distancing safely and staff are having to make fairly difficult trade-offs about which people need to be isolated. No one can be safely social distanced in a corridor.”
    Read full story (paywalled)
    Source: HSJ, 21 September 2020
  20. Patient Safety Learning
    Hundreds of people believe the helpline failed their relatives. Now they are demanding their voices be heard. 
    Families whose relatives died from COVID-19 in the early period of the pandemic are calling for an inquiry into the NHS 111 service, arguing that many critically ill people were given inadequate advice and told to stay at home.
    The COVID-19 Bereaved Families for Justice group says approximately a fifth of its 1,800 members – more than 350 people – believe the 111 service failed to recognise how seriously ill their relatives were and direct them to appropriate care.
    “We believe that in some cases it is likely these issues directly contributed to loved ones dying, due to causing a delay in receiving treatment, or a total lack of treatment leading to them passing away at home,” said the group’s co-founder Jo Goodman, whose father, Stuart Goodman, died on 2 April aged 72.
    Many families have said they had trouble even getting through to the 111 phone line, the designated first step, alongside 111 online, for people concerned they may have COVID-19.
    The service recorded a huge rise in calls to almost 3m in March, and official NHS figures show that 38.7% were abandoned after callers waited longer than 30 seconds for a response. Some families who did get through have said the call handlers worked through fixed scripts and asked for yes or no answers, which led to their relatives being told they were not in need of medical care.
    “Despite having very severe symptoms including skin discolouration, fainting, total lack of energy, inability to eat and breathlessness, as well as other family members explaining the level of distress they were in, this was not considered sufficient to be admitted to hospital or have an ambulance sent out,” Goodman said.
    Some families also say their relatives’ health risk factors, such as having diabetes, were not taken into account, and that not all the 111 questions were appropriate for black, Asian and minority ethnic people, including a question to check for breathlessness that asked if their lips had turned blue.
    Read full story
    Source: The Guardian, 21 September 2020
  21. Patient Safety Learning
    Almost two-thirds of black Britons think the NHS does less to protect their health than that of white people, research has found.
    That negative view of the health service is shared by a majority of black people of almost all ages, and is held especially strongly by black women, according to findings of a study commissioned by a parliamentary committee.
    Overall, 64% of black people do not believe that their health is as protected by the NHS compared with white people’s. When asked if they thought it was, 34.3% disagreed and another 29.6% disagreed strongly, while just 19.9% agreed and a further 2.4% agreed strongly.
    The survey was commissioned by MPs and peers on the joint committee on human rights as part of its inquiry into black people, racism and human rights in the UK. The report will be published and debated with the authors at an evidence session today.
    Read full story
    Source: The Guardian, 7 September 2020
  22. Patient Safety Learning
    Around 250,000 clear face masks are set to be delivered to frontline NHS and social care workers to allow for better care to be provided to those who use lip-reading and facial expressions to communicate, whilst still ensuring staff and patients remain safe during coronavirus.
    The clear face masks will allow for improved communication with people with certain conditions like hearing loss, autism and dementia.
    Designed with an anti-fogging barrier to ensure the face and mouth are always visible, the see-through masks will help doctors, nurses and carers get important messages across to all patients clearly.
    An estimated 12 million people in the UK are thought to have hearing loss, while those who rely on facial expressions to support communication – such as people with learning disabilities, autism or dementia, or foreign language speakers and their interpreters – will also see benefit from the government deal.
    Minister for Care Helen Whately said: “Everyone using our remarkable health and care system deserves the best care possible and communication is a vital part of that."
    “This pandemic has posed numerous challenges to the sector, so we are always on the hunt for simple solutions to support those giving and receiving care."
    Read full story
    Source: National Health Executive, 7 September 2020
  23. Patient Safety Learning
    The lungs and hearts of patients damaged by the coronavirus improve over time, a study has shown.
    Researchers in Austria recruited coronavirus patients who had been admitted to hospital. The patients were scheduled to return for evaluation 6, 12 and 24 weeks after being discharged, in what is said to be the first prospective follow-up of people infected with COVID-19, which will be presented at today's European Respiratory Society International Congress.
    Clinical examinations, laboratory tests, analysis of the amounts of oxygen and carbon dioxide in arterial blood, and lung function tests were carried out during these visits. 
    At the time of their first visit, more than half of the patients had at least one persistent symptom, predominantly breathlessness and coughing, and CT scans still showed lung damage in 88% of patients. But by the time of their next visit, 12 weeks after discharge, the symptoms had improved, and lung damage was reduced to 56%.
    Dr Sabina Sahanic, a clinical PhD student at the University Clinic in Innsbruck and part of the team that carried out the study, said: "The bad news is that people show lung impairment from COVID-19 weeks after discharge; the good news is that the impairment tends to ameliorate over time, which suggests the lungs have a mechanism for repairing themselves."
    A separate presentation to the congress said that the sooner COVID-19 patients started a pulmonary rehabilitation programme after coming off ventilators, the better and faster their recovery.
    Yara Al Chikhanie, a PhD student at the Dieulefit Sante clinic for pulmonary rehabilitation and the Hp2 Lab at the Grenoble Alps University in France, used a walking test to evaluate the weekly progress of 19 patients who had spent an average of three weeks in intensive care and two weeks in a pulmonary ward before being transferred to a clinic for pulmonary rehabilitation.
    She said: "The most important finding was that patients who were admitted to pulmonary rehabilitation shortly after leaving intensive care progressed faster than those who spent a longer period in the pulmonary ward where they remained inactive. The sooner rehabilitation started and the longer it lasted, the faster and better was the improvement in patients' walking and breathing capacities and muscle gain."
    Read full story
    Source: The Independent, 7 September 2020
  24. Patient Safety Learning
    Modelling being used by NHS officials forecasts that hospital admissions could peak at five times the level seen in April without additional measures to control the virus, HSJ can reveal.
    In all scenarios presented, covid hospital admissions would remain high for an extended period of many months, even if new lockdown actions were taken. However, putting multiple measures in place could contain them to a peak of less than that seen in the spring, according to the work.
    They were included in a document marked “confidential” and included, apparently by accident, in public papers for Thursday’s meeting of Medway Foundation Trust board. Within hours of HSJ asking for more information, they were removed.
    They were badged with Kent and Medway Clinical Commissioning Group, the NHS body which oversees services for that area. The forecasts were marked as being “Kent and Medway level”, but were referred to as “regional scenarios”, indicating they may have been produced by regional teams of NHS England and Improvement. The trust’s board papers said its own planning for the coming months would make use of the three scenarios presented in the document.
    Read full story
    Source: HSJ, 7 September 2020
  25. Patient Safety Learning
    A new study shows a quarter of mothers say their choices were not respected during childbirth, with some left with life-changing injuries as a result, despite Britain’s highest judges establishing women should be the primary decision makers during labour five years ago.
    A poll of 1,145 women, carried out by leading pregnancy charity Birthrights and shared exclusively with The Independent, also found that a third said healthcare professionals did not even seek their own opinions on the childbirth process, while 14& said their choices were overruled.
    One woman told The Independent she had been forced to give up her career as a lawyer following what she described as a “violent delivery”, while her baby daughter also sustained serious injuries to her face which can still be seen now – 12 years after she gave birth.
    Birthrights, which campaigns for respectful pregnancy care for women, pointed to the fact half a decade has passed since Nadine Montgomery’s Supreme Court case proved mothers-to-be are the primary decision-makers in their own care yet this is still not the reality for the majority of women.
    Read full story
    Source: The Independent, 3 September 2020
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