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Patient Safety Learning

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  1. Patient Safety Learning
    A former national director has expressed her shock at visiting an accident and emergency department struggling with record numbers of mental health patients accompanied by police officers, and warned the issue needs an “absolute solution” from the area’s mental health trusts.
    Kathy McLean, a non-executive director at Barking, Havering, and Redbridge University Hospitals Trust, and previously NHS Improvement’s medical director, told a board meeting last week there were “police officers everywhere you looked” at the accident and emergency at King George Hospital in Ilford, which had just experienced its third consecutive record month for mental health referrals.
    While she recognised nearby mental health trusts North East London Foundation Trust and East London FT were “working hard”, she added: “This is not our problem, it is their problem that we’ve now got, and it’s not right for [patients], nor is it right for other people attending the emergency departments.
    “I’ve been to more emergency departments than most people in the country and I was shocked, everywhere you looked there was a police officer… This now needs an absolute solution. If this was ambulances sitting outside our ED, people would be saying, you’ve got to sort it.”
    Read full story (paywalled)
    Source: HSJ, 14 July 2023
  2. Patient Safety Learning
    The US Food and Drug Administration (FDA) has approved the first over-the-counter contraceptive pill, allowing millions of women and girls in the country to buy contraception without a prescription at a time when some states have sought to restrict access to birth control and abortion.
    FDA officials said on Thursday it cleared Perrigo’s Opill – an every day, prescription-only hormonal contraception first approved in 1973 – to be sold over-the-counter. The pill will be available in stores and online in the first quarter of next year, and there will be no age restrictions on sales. The regulatory approval paves the way for people to purchase the pill without a prescription for the first time since oral contraceptives became widely available in the 1960s.
    “Today’s approval marks the first time a nonprescription daily oral contraceptive will be an available option for millions of people in the United States,” Patrizia Cavazzoni, the director of the FDA’s center for drug evaluation and research, said in a statement.
    “When used as directed, daily oral contraception is safe and is expected to be more effective than currently available nonprescription contraceptive methods in preventing unintended pregnancy.”
    Read full story
    Source: The Guardian, 13 July 2023
  3. Patient Safety Learning
    The Care Quality Commission (CQC) inspection process may be ‘disproportionate’, a Government survey found, although the incredibly low response rate hampered conclusions.
    All 51,000 providers registered with the CQC were given access to a survey as part of a post implementation review but only 86 responded and only 36 of those were NHS providers.
    Most NHS responses to the survey came from organisations employing between 10 and 49 people, the review found.
    The lack of engagement with the survey meant no conclusion could be reached about whether an alternative system would impose less regulation of the health and social care sector.
    Criticisms among those who did respond included that the registration process is too inflexible, and the regulations too onerous and burdensome.
    Some also felt the CQC regulations do not cover all health and social care activities where there is a possible risk to patient safety or service users.
    Read full story
    Source: Pulse, 13 July 2023
  4. Patient Safety Learning
    More families have been told by a health board that their relatives' deaths may have been linked to treatment by vascular services.
    Betsi Cadwaladr University Health Board (BCUHB) has written to families who were part of a review after concerns were raised last year.
    Four cases had already been reported to a coroner and the health board says it has been "very open" with relatives of other patients.
    The service has recently been described by inspectors as making "satisfactory progress", but the health board admit it is still on a "long journey".
    A report by the Royal College of Surgeons England (RCSE) in January 2022 found risks to patient safety due, in part, to poor record keeping.
    It recommended to the health board that it investigate fully what happened to the 47 patients its report focused on.
    Read full story
    Source: BBC News, 13 July 2023
  5. Patient Safety Learning
    The government will set up an independent panel to oversee disputes arising from decisions made under a new provider selection regime, it said today.
    The new panel should “help ensure that… procurement processes are transparent, fair and propionate, enabling all providers to compete for contracts” and “are not unfairly excluded from offering services to patients and service users”, the Department of Health and Social Care said in a response to its consultation on the new rules governing the commissioning of healthcare services.
    The intent is to move the NHS away from always putting new contracts out to competitive tender and “towards collaboration across the health and care system”, the document says. 
    Read full story (paywalled)
    Source: HSJ, 14 July 2023
  6. Patient Safety Learning
    NHS waiting lists in England have climbed to a record level, according to new figures that show 7.47 million patients were waiting to start routine hospital treatment at the end of May, up from 7.42 million at the end of April.
    The growing list includes 416,000 children waiting to start treatment – up 9.7% in just one month, and including 21,282 who have been waiting more than a year.
    Royal College of Paediatrics and Child Health president Camilla Kingdon said it is “unacceptable” and “unfathomable” to have so many children waiting so long.
    However, hospital leaders warned on Thursday they are not confident they will hit key NHS targets to reduce the waiting list in 2024 and 2025.
    The figures come during a five-day junior doctors’ strike during which tens of thousands of operations and appointments are expected to be cancelled and ahead of NHS consultants’ strikes where the major of planned care is expected to be paused.
    Read full story
    Source: The Independent, 13 July 2023
  7. Patient Safety Learning
    NHS trusts have committed to financial plans without properly considering their consequences, with finance directors turning a blind eye to unrealistic forecasts under pressure from NHS England, some of the country’s top NHS chief executives have warned.
    Many of the senior trust leaders speaking at HSJ’s Top CEOs roundtable admitted they had gone further than they wanted to in agreeing to higher levels of planned savings.
    At the roundtable event, University College London Hospitals Foundation Trust CEO David Probert said there were “definite challenges to the professionalism of some of our fantastic finance leaders”, who were “being asked to put in place plans that [they] may not fully agree are deliverable or are highly risky.”
    Read full story (paywalled)
    Source: HSJ, 7 July 2023
  8. Patient Safety Learning
    End-of-life care across the NHS in England is “variable and inequitable” and “often falls below expectations”, according to the Healthcare Safety Investigation Branch (HSIB).
    HSIB found care for patients who are dying is “inconsistent” across England, despite a national strategy for proceedings being in place since 2008.
    The report highlighted “concerns about the limitations of the delivery of palliative and end-of-life care” which are more noticeable in deprived areas.
    Services were found to not always be able to deliver individualised care, and varied due to the likes of staff shortages and the availability of charitable donations.
    Nick Woodier, a national investigator at the HSIB, said: “Conversations about death and end-of-life care are challenging and emotive but it is crucial that health and care professionals can discuss needs and expectations with their patients and families.
    “They should be supported by a system that provides continuity of care, reassurance and dignity at what is sometimes a very distressing time.”
    Read full story
    Source: The Guardian, 13 July 2023
  9. Patient Safety Learning
    Black women in the Americas bear a heavier burden of maternal mortality than their peers, but according to a report released Wednesday by the United Nations, the gap between who lives and who dies is especially wide in the world’s richest nation — the United States.
    Of the region’s 35 countries, only four publish comparable maternal mortality data by race, according to the report, which analyzed the maternal health of women and girls of African descent in the Americas: Brazil, Colombia, Suriname and the United States. And while the United States had the lowest overall maternal mortality rate among those four nations, the report said Black women and girls were three times more likely than their U.S. peers to die while giving birth or in the six weeks afterward.
    “The risk factor is racism,” said Joia Crear-Perry, an OB/GYN and founder of the National Birth Equity Collaborative, a nonprofit group dedicated to eliminating racial inequities in birth outcomes and one of the report’s co-sponsors. “This report drives this home over and over. When your pain is ignored, when your blood pressure is ignored, you die, and that happens across the Americas.”
    Read full story (paywalled)
    Source: The Washington Post, 12 July 2023
  10. Patient Safety Learning
    Acute trust leaders have expressed ‘extreme concern’ over their ability to maintain safe services in the upcoming junior doctor and consultant strikes.
    Leaders at Worcestershire Acute Hospitals Trust are “extremely concerned about the impact on patients… as well as on the health and wellbeing of staff”, according to its latest CEO report to the board,
    Junior doctors are striking between 7am on Thursday 13 July and 7am on Tuesday 18 July. The report warned this would result in “complete withdrawal of labour, with no exemptions to cover emergency and critical services”.
    The report said: “Junior doctors may only be recalled to work in the event of a mass casualty incident… Although other staff can cover for junior doctors they are becoming exhausted and increasingly reluctant to do so. 
    “We are therefore extremely concerned about our ability to maintain safe services.”
    Read full story (paywalled)
    Source: HSJ, 12 July 2023
  11. Patient Safety Learning
    NHS England has reduced its elective activity target for the service because of the impact of junior doctors’ strike, and acknowledged the service may not hit the prime minister’s pledge to reduce waiting lists before the next general election if the industrial action continues.
    NHSE has agreed a deal with ministers which will see the “value based” elective activity target set for the service reduced for 2023-24 from 107 per cent of pre-pandemic levels to 105 per cent (See explainer box on value-based targets below).
    Trust finance bosses were briefed by NHSE chief finance officer Julian Kelly this morning (Wednesday 12 July) on the eve of junior doctors’ longest strike action to date.
    Read full story (paywalled)
    Source: HSJ, 12 July 2023
  12. Patient Safety Learning
    An ambulance service has apologised to families following a review into claims it covered up errors by paramedics and withheld evidence from coroners.
    The families of a teenager and a 62-year-old man were not told paramedics' responses were being investigated by North East Ambulance Service (NEAS).
    The deaths, in 2018 and 2019, were raised by a whistleblower last year.
    Among the findings of the independent review carried out by Dame Marianne Griffiths, were inaccuracies in information provided to the coroner, employees who were "fearful of speaking up" and "poor behaviour by senior staff".
    The study, commissioned by the former health secretary Sajid Javid in August, examined four of the five cases that were highlighted by the whistleblower, initially in The Sunday Times.
    It found two bereaved families were left in the dark about investigations into the response of paramedics called to help their loved ones.
    Read full story
    Source: BBC News, 12 July 2023
  13. Patient Safety Learning
    A former breast cancer surgeon has said the NHS needs a MeToo movement because of sexual harassment in hospitals.
    Dr Liz O'Riordan said she experienced sexual harassment from colleagues on a weekly to monthly basis in some of her jobs as a junior doctor.
    In her first week as a junior doctor, she recalled a colleague asking if she "got an erection" after removing an 11-year-old boy's appendix.
    "We need to be able to say this is not good enough," said Dr O'Riordan. "When you are a trainee in a practical field, you are relying on your boss to let you operate to show you how to cut; it is a craft that you learn."
    "Basically you are naked in scrubs stood from shoulder, to hip, to knee, next to someone all squeezed in; a lot of body contact; you are relying on them to let you cut, and if you call them out they may say 'I don't like you, you are not coming to theatre today'.
    "It's very, very, very hard to stand up for yourself and say 'that is not on' and the minute you let them get away with it, it is accepted and they can carry on getting away with it."
    Read full story
    Source: BBC News, 12 July 2023
    Related reading on the hub:
    Under the knife: Life Lessons from the operating theatre by Liz O’Riordan Calling out the sexist and misogynist culture within healthcare: a blog by Dr Chelcie Jewitt, co-founder of the Surviving in Scrubs campaign  
  14. Patient Safety Learning
    GP trainers are more at risk of burnout than the average for all specialties, according to the GMC’s annual training survey results. 
    The survey of over 70,000 doctors who are trainees or trainers found that 15% of GP trainers are at high risk of burnout, which is higher than the average of 12% and ranked second only to emergency medicine at 24%.
    The results also showed that 24% of GP trainers said that every working hour is tiring for them, compared to 11% of public health trainers. 
    Last month, GP leaders raised concerns about how trainers and experienced GPs will handle the long-term workforce plan’s expansion of training places, especially given the existing pressures and lack of retention measures.
    Read full story
    Source: Pulse, 11 July 2023
  15. Patient Safety Learning
    Almost 900,000 older people are admitted to hospital every year as an emergency because the NHS is failing to keep them healthy at home, Age UK has warned.
    A major lack of services outside hospitals means elderly people are also suffering avoidable harm, such as falls and urinary tract infections, the charity said.
    In a new report it urges NHS bosses to push through huge changes to how the “hospital-oriented” service operates and establish “home first” as the principle of where care is provided.
    Doing so would reduce the strain on overcrowded hospitals and leave the NHS better set up to respond to the increase in the number of over-65s and especially over-85s, Age UK said.
    Its report, on the state of health and care of older people in England, concluded that “our health and care system is struggling, and too often failing, to meet the needs of our growing older population.”
    Read full story
    Source: The Guardian, 11 July 2023
  16. Patient Safety Learning
    New guidance for doctors discouraging them from recommending exercise and cognitive behavioural therapy for chronic fatigue patients is not evidence based, according to researchers.
    A study questions the National Institute for Health and Care Excellence (NICE) review process for this guideline for clinicians dealing with chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME) patients and its use of scientific standards in considering the evidence.
    One of the study’s lead authors, Prof Trudie Chalder from the psychiatry department at King’s College London said: “The decision to change the guideline has had a direct effect on doctors’ and therapists’ ability to treat patients. Services are no longer able to provide a full range of evidence-based therapeutic interventions.
    “This could have a devastating impact on people’s lives in that they will no longer be able to access the treatment that could help them the most.”
    ME, also called CFS, is a long-term condition believed to affect about 25,000 people in the UK, which has a wide range of symptoms including extreme tiredness, muscle pain, mental fogginess and insomnia.
    Read full story
    Source: The Guardian, 11 July 2023
  17. Patient Safety Learning
    A further 11 inquests are to be opened this week as part of an investigation into dozens of deaths linked to jailed breast surgeon Ian Paterson.
    Paterson is currently serving a 20-year sentence after he carried out unnecessary or unapproved procedures on more than 1,000 breast cancer patients.
    Judge Richard Foster said 417 cases of former patients had been reviewed.
    The inquests will open and be adjourned on Friday. More than 30 deaths are already the subject of an inquest.
    Paterson worked at Spire Parkway Hospital and Spire Little Aston Hospital in the West Midlands between 1997 and 2011, as well as NHS hospitals run by the Heart of England NHS Foundation Trust.
    Paterson was jailed in 2017 after being convicted of 17 counts of wounding with intent.
    An independent inquiry found he had been free to perform harmful surgery in NHS and private hospitals due to "a culture of avoidance and denial" in a healthcare system where there was "wilful blindness" to his behaviour.
    Read full story
    Source: BBC News, 10 July 2023
  18. Patient Safety Learning
    Olly Vickers died of a brain injury in February last year just weeks after two midwives at Royal Bolton Hospital let his mother Emma Clark feed him while she was having gas and air – in breach of guidelines.
    Despite being well when he was born, Olly was found “pale and floppy” hours later due to his airways being obstructed. He developed a brain injury and died five months later.
    Coroner Peter Sigee ruled his death was a result of “neglect” and due to a “gross failure to provide basic medical care”.
    An inquest into his death heard a student midwife placed a pillow under his mother’s arm while she was feeding him, “contrary to accepted practice”.
    Another midwife then gave Ms Clark gas and air while she was feeding Olly as she was stitched up for a tear obtained during labour – which again went against guidance.
    No risk assessment was carried out and the coroner said Olly’s breastfeeding should have been stopped before the midwives began to suture Ms Clark.
    Read full story
    Source: The Independent, 8 July 2023
  19. Patient Safety Learning
    A review into failings in maternity care in hospitals in Nottingham is set to become the largest in the UK, the BBC understands.
    Donna Ockenden, chair of the inquiry, is expected to announce that 1,700 families' cases will be examined.
    She was in charge of the probe into services in Shropshire, which found at least 201 babies and mothers might have survived had they received better care.
    The review comes after dozens of baby deaths and injuries in Nottingham and focuses on the maternity units at the Queen's Medical Centre and City Hospital.
    So far, 1,266 families have contacted the review team themselves directly and to date, 674 of these have given consent to join it.
    But Ms Ockenden has called for a "radical review" to ensure "women from all communities" were being contacted by the trust and "felt confident" to come forward.
    Read full story
    Source: BBC News, 10 July 2023
  20. Patient Safety Learning
    Cheshire and Merseyside won Gold in the ‘Supporting Elective Recovery Through Digital’ category, at the HSJ Digital Awards, alongside technology partner C2-Ai, after transforming how waiting lists are managed with the help of an AI-backed waiting list model.
    The tool helps surgical teams identify previously hidden high-risk patients, and to make informed decisions on how, when and where to treat patients to achieve the best outcomes.
    NHS England, who commissioned the project, reported that within six weeks patient waiting lists dropped by nearly 30%, as well as a 66% decrease in intensive care needs for high-risk patients, saved about 2,500 hospital bed-days across 20,000 patients, and cut emergency admissions to the waiting list by 8%.
    Read full story
    Source: NHS Cheshire and Merseyside, 3 July 2023
  21. Patient Safety Learning
    Racism is “a stain on the NHS” and tackling it is key to recruiting and retaining staff, the outgoing president of the Royal College of Psychiatrists (RCP) will warn.
    The health service has a moral, ethical and legal duty to do more to stamp out racism, Dr Adrian James is expected to say at the college’s international congress in Liverpool.
    He will cite pay gaps, disparities in disciplinary processes and a “glass ceiling” for doctors from minority ethnic backgrounds who want to progress into management positions as problems in the NHS that are linked to racism.
    Last month, the NHS Race and Health Observatory, which was formed in 2021 to examine disparities in health and social care based on race, said better anti-racism policies could strengthen the NHS workforce.
    The RCP agreed that “better care, training and anti-racist policies” would increase staff numbers in the NHS, and that this would “improve patient experience and save millions of pounds spent annually on addressing racism claims brought by staff, clinicians and patients”.
    Read full story
    Source: The Guardian, 10 July 2023
  22. Patient Safety Learning
    A growing number of disadvantaged and vulnerable women living in one of the poorest parts of England are dying prematurely because public services are not meeting their needs, according to a report.
    Research published on Monday calculates that in 2021, a woman in the north-east of England was 1.7 times more likely to die early as a result of suicide, addiction or domestic murder than women living in England and Wales as a whole.
    Laura McIntyre, the head of women and children’s services at Changing Lives, described the report as shocking. “But I’m more saddened,” she said. “To not reach your 40th birthday is just not right.”
    The report says the reasons for early and avoidable deaths are complicated, involving a patchwork of unaddressed issues including domestic abuse, debt, poverty, mental and physical ill-health, alcohol and substance misuse, and housing problems.
    But the conclusions are striking. “Put plainly, women living in the north-east are more likely to live shorter lives, to spend a larger proportion of time living in poor health and to die prematurely from preventable diseases,” the report states.
    Read full story
    Source: The Guardian, 10 July 2023
  23. Patient Safety Learning
    The government is resisting what it believes are inflationary pay demands from junior doctors for the sake of NHS staff, health and social care secretary Steve Barclay has told HSJ.
    In a wide-ranging interview, Mr Barclay also:
    Rejected the idea that it would be impossible to hit the prime minister’s waiting times pledge without settling the junior doctors strike; Defined what he believed was the difference between good and bad management; Refused to apologise to the 123 trusts whose bids for “new hospital programme” funding were rejected. Read full story (paywalled)
    Source: HSJ, 10 July 2023
  24. Patient Safety Learning
    Europe's drugs regulator has told BBC News it is conducting a review of some weight-loss jabs after being alerted to a possible link to thoughts of suicide and self-harm among users.
    Member state Iceland notified the European Medicines Agency after seeing three cases.
    The safety assessment will look at Wegovy, Saxenda and similar drugs, such as Ozempic, that help curb appetite.
    Product leaflets already list suicidal thoughts as a possible side effect.
    An EMA official said: "The review is being carried out in the context of a signal procedure raised by the Icelandic Medicines Agency, following three case reports.
    "A signal is information on a new or known adverse event that is potentially caused by a medicine and that warrants further investigation.
    "The case reports included two cases of suicidal thoughts - one following the use of Saxenda and one after Ozempic.
    "One additional case reported thoughts of self-injury with Saxenda.
    "The EMA will communicate further when more information becomes available."
    Read full story
    Source: BBC News, 10 July 2023
  25. Patient Safety Learning
    A cancer patient has died and three others have been hospitalised after they were administered unlicensed versions of chemotherapy by Sciensus, a private company paid millions by the NHS to provide essential medication.
    Three health regulators have launched inquiries into the incident, according to people familiar with the matter. It was caused by an issue at the firm’s medicines manufacturing unit.
    In a statement, Sciensus confirmed an “isolated incident” had “affected four patients” and that it was “deeply saddened” that one of them had died.
    Sciensus offered its “sincere condolences” to the family and friends of the patient who died, and is conducting a thorough investigation, it added.
    The four patients received unlicensed versions of cabazitaxel, a licensed chemotherapy used to treat prostate cancer. The versions administered to the patients differed from the licensed product and therefore were considered unlicensed medicines. 
    Sciensus is required to comply with official standards to ensure the quality of the products it produces and the protection of public health. Breaches of these standards can result in the MHRA suspending or removing a company’s licence.
    “Patient safety is our highest priority,” said Dr Alison Cave, the MHRA’s chief safety officer. “We are urgently investigating this issue and we will take any necessary regulatory measures to ensure patients are protected."
    Read full story
    Source: The Guardian, 7 July 2023
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