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Patient Safety Learning

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  1. Patient Safety Learning
    The government’s national review of mental health hospitals must urgently address the “lack of sympathy and compassion” towards patients if safety is to improve, the health ombudsman has said.
    Rob Berhens said the investigation, prompted by The Independent’s reporting on deaths and abuse of vulnerable patients, must look at three key issues, including a lack of empathy for those with mental health challenges, a lack of resources and poor working conditions for staff.
    Health Secretary Steve Barclay announced last week that a new safety body, the Health Services Safety Investigations Body (HSIB), would look into the care of young people, examine staffing levels and scrutinise the quality of care within mental health units.
    Mr Berhens said: “I trust [HSIB] to be able to understand what are the key issues, they’re about the lack of sympathy and compassion for people who have mental health challenges, which to me is a human rights issue."
    Read full story
    Source: The Independent, 1 July 2023
  2. Patient Safety Learning
    As the NHS turns 75, it is under unprecedented pressure: record waiting lists, demand for care and delays in discharging patients who are well enough to go home are putting all parts of the health service under immense strain. 
    Sickness absence is at record levels, while nearly 170,000 NHS workers in England quit their jobs last year. Recent strikes by nurses, ambulance staff and junior doctors, coupled with the historic decision by consultants and radiographers to strike, too, show the depth of anger.
    Five experts spell out what’s needed to make the health service thrive again.
    Read full story
    Source: The Guardian, 3 July 2023
  3. Patient Safety Learning
    Many vulnerable patients are struggling to access covid treatments after commissioning responsibility switched to integrated care boards this week, charities have warned.
    Approximately two million vulnerable patients must now contact local services themselves to access treatments designed to combat covid infections, such as the antivirals Paxlovid and Sotrovimab. Integrated care boards are expected to coordinate and fund “equitable” access.
    Prior to 27 June, identification of patients and the delivery of treatment was coordinated nationally under pandemic arrangements.
    However, a group of 20 patient charities have written to Steve Barclay warning that most ICBs have not drawn up plans to deliver this new responsibility, leaving patients and primary care clinicians unclear on how to access the treatments.
    “Despite continually raising our concerns with those carrying out the planning, implementation, and communication of this [policy], we now find that we are in exactly the position we warned against,” they said. 
    Read full story (paywalled)
    Source: HSJ, 3 July 2023
  4. Patient Safety Learning
    A major teaching trust is dominated by a “medical patriarchy”, while “misogynistic behaviour” is a regular occurrence, two investigations have discovered. 
    Two reports into University Hospitals Birmingham Foundation Trust  have been published. They are the outcome of an investigation into the trust’s leadership carried out by NHS England, and an oversight review by former NHSE deputy medical director Mike Bewick.
    They follow major concerns being raised over recent months about safety, culture, and leadership at the trust.
    The NHSE review said the trust “could do more to balance the medical patriarchy that dominates” the organisation. It noted consultants are invited to observe a chief executive’s advisory group meeting, but nursing, midwifery and allied health professional leaders are not.”
    On culture, NHSE said the trust should take steps to ensure staff can work in psychologically safe environments where “poor behaviours are consistently addressed” and to “eradicate bullying and cronyism at all levels of the organisation”. Staff had described “inequity and cronyism” being a feature of recruitment processes at all levels.
    Read full story (paywalled)
  5. Patient Safety Learning
    There has been an unusual rise in the number of children and teenagers around the world diagnosed with type 1 diabetes since Covid, say researchers.
    A new study in JAMA Network Open journal has collated available data from different countries, including the UK, on more than 38,000 young people diagnosed during the pandemic.
    The authors describe the increase in cases of diabetes as "substantial".
    More work is needed to understand why the rise is happening, they say.
    Some of the rise could be attributed to catch-up - from backlogs and delays when health services were shut - but does not explain all of the newly diagnosed cases, say scientists.
    Before the pandemic, the incidence rate of childhood type 1 diabetes was already increasing - by about 3% a year.
  6. Patient Safety Learning
    Thousands more doctors and nurses will be trained in England every year as part of a government push to plug the huge workforce gaps that plague almost all NHS services.
    The number of places in medical schools will rise from 7,500 to 10,000 by 2028 and could reach 15,000 by 2031 as a result of the NHS’s first long-term workforce plan.
    There will also be a big expansion in training places for those who want to become nurses, with the number rising by a third to 40,000 by 2028 – matching the number of nurses the health service currently lacks.
    Amanda Pritchard, the chief executive of NHS England, hailed the long-awaited plan as “a once in a generation opportunity to put staffing on a sustainable footing for years to come”.
    Medical groups, health experts and organisations representing NHS staff welcomed the plan as ambitious but overdue. Richard Murray, chief executive of the King’s Fund thinktank, said it could be a “landmark moment” for the health service by providing it with the staff it needs to provide proper care.
    Read full story
    Source: The Guardian, 29 June 2023
  7. Patient Safety Learning
    The Government is consulting on a draft code of practice which will ensure health and care staff, including GPs, receive training on learning disabilities and autism ‘appropriate to their role’.
    Since July last year, all CQC-registered health and social care providers including GP practices in England have been required to provide training for their staff in learning disability and autism, including how to interact with autistic people and people who have a learning disability.
    The legal requirement was introduced by the Health and Care Act 2022, but the Government has now launched a consultation on the Oliver McGowan Code of Practice, which outlines how providers can meet the new requirement.
    The BMA’s GP Committee last month said that the Act does not specify a training package or course for staff and that the CQC ‘cannot tell practices specifically how to meet their legal requirements in relation to training’.
    The Government’s draft code says that CQC-registered providers must ensure that all staff, regardless of role or level of seniority, have ‘the right attitude and skills to support people with a learning disability and autistic people’ and will need to demonstrate to the CQC how their training meets or exceeds the standards set out in the code.
    Read full story
    Source: Pulse, 29 June 2023
  8. Patient Safety Learning
    An acute trust’s leadership has been downgraded to ‘inadequate’ after some staff ignored concerns raised directly by CQC inspectors, while others said bullying was ‘rife’.
    The Care Quality Commission (CQC) found multiple reports of staff raising concerns at York and Scarborough Foundation Trust, but that staff felt they were “ignored”, dismissed or “swept under the carpet”.
    The trust’s leadership has been rated as “inadequate”, down from “requires improvement”, although its overall rating remains “requires improvement”.
    The CQC said “poor leadership was having an impact across all of the services” and there were occasions “where leaders displayed defensiveness or appeared to tolerate poor behaviours from staff.”
    The trust said it had been under “sustained pressure” but had already begun to make improvements, including a new information system in maternity services and a review of nursing establishment numbers.
    Read full story (paywalled)
    Source: HSJ, 30 June 2023
  9. Patient Safety Learning
    Healthcare staff from the European Union can join or continue to work in the NHS for the next five years without undergoing additional exams or further assessments, the government has decided.
    The “standstill provisions”, which were put in place after the UK left the European Union in 2020, have been extended by government until 2028.
    The NHS has become increasingly reliant on recruiting staff from overseas, particularly nurses, but has seen a significant drop in the number of staff joining from the European Union post-Brexit.
    The review by the Department of Health and Social Care said: “Retaining the standstill provisions for a temporary period of five years will support the [DHSC’s] ambition to attract and recruit overseas healthcare professionals, without introducing complex and burdensome registration routes.
    “[European Economic Area]-qualified healthcare professionals will be able to continue to register with the relevant professional regulator, without the need to sit additional professional exams, mitigating delays to registration and employment in the NHS.”
    Read full story (paywalled)
    Source: HSJ, 29 June 2023
  10. Patient Safety Learning
    A pensioner is furious with Northern Ireland politicians who, she said, left her with no option but to spend her savings on knee surgery in Poland.
    Christine Wallace was told the wait for her knee replacement surgery could be five years - although the health department says most waits are shorter.
    She spent £8,500 on her hospital stay.
    While Ms Wallace said the relief of her new knee was fantastic, she felt she had no alternative but to pay as she could no longer live with the pain.
    The latest available health department figures, from 31 March, showed 25,075 patients were waiting for inpatient or day case admission under the trauma and orthopaedic surgery specialty.
    The department said its median waiting time for such operations was 74 weeks, with only 1 in 20 patients waiting more than five years.
    "Our preferred measure of average is the median... because waiting times tend to be skewed by longer waits and therefore more patients are waiting for less time than the mean," said a department statement.
    Read full story
    Source: BBC News, 28 June 2023
  11. Patient Safety Learning
    An investigation has been launched into BT following the major disruption to 999 call services on Sunday.
    Emergency services across the country reported 999 calls were failing to connect because of a technical fault.
    BT, which manages the 999 phone system, apologised for the problems which were resolved by Sunday evening.
    The communications regulator, Ofcom, will now investigate whether BT failed to comply with its regulatory obligations.
    In a statement, Ofcom said its rules required BT and other providers to take "all necessary measures to ensure uninterrupted access to emergency organisations as part of any call services offered".
    While the incident was ongoing Cheshire Fire and Rescue Service warned of a 30-second delay to connect to 999, while Suffolk Police said its system was not working to full capacity.
    Read full story
    Source: BBC News, 28 June 2023
  12. Patient Safety Learning
    Maltese lawmakers have unanimously approved legislation to ease the strictest abortion laws in the EU, voting to allow terminations – but only in cases where a woman’s life is at risk.
    Ahead of the vote on Wednesday, pro-choice campaigners withdrew their support, saying last-minute changes make the legislation “vague, unworkable and even dangerous”.
    The original bill allowing access to abortion if a pregnant woman’s life or health is in danger was hailed as a step in the right direction for Malta, a majority-Catholic country. It was introduced last November after an American tourist who miscarried had to be airlifted off the Mediterranean island nation to be treated.
    Under the amendments, however, a risk to health is not enough. A woman must be at risk of death to access an abortion, and then only after three specialists consent. The new legislation allows a doctor to terminate a pregnancy without specialist consultation only if the mother’s life is at immediate risk.
    Read full story
    Source: The Guardian, 28 June 2023
  13. Patient Safety Learning
    30,000 people believe they are victims of negligence each week in the UK, new research carried out by YouGov for Injury Awareness Week (26-30 June) has found.
    Participants were asked if they have suffered an injury or illness in the last year which was caused because of negligence, for example by another road user, an employer, a colleague, or a medic.
    “We need to shine a light on the impact these injuries can have on people who were doing nothing more than living their lives before they fell victim to the recklessness or carelessness of others,” said Mike Benner, chief executive of the Association of Personal Injury Lawyers (APIL) which commissioned the Injury Awareness Week study.
    “Often these injures are severe, some are life-changing, and some are life-ending,” he said.
    “The fact that the harm has been caused by negligence is significant, because negligence could and should be avoided,” said Mr Benner.
    “An accident is simply an incident which no-one could have reasonably foreseen. Negligence is doing something, or failing to do something, that could cause injury to others. Employers have a duty to make sure we return home from a day’s work unscathed, for example, and drivers need to take care to not harm fellow road users.
    “If someone were to take one thing away from this Injury Awareness Week, it’s the knowledge that any one of us could be among the 30,000 injured needlessly in a week. Avoidable injuries are an issue we should all be concerned about,” he said.
    Read full story
    Source: APIL, 22 June 2023
  14. Patient Safety Learning
    More than half of all serious incidents where patients came to harm involving West Midlands Ambulance Service were due to clinical errors.
    A trust audit found choking management, cardiac arrests and inappropriate patient discharges as themes.
    It also noted a decision to close all community ambulance stations was taken without first doing a full risk assessment of the impact on safety.
    After the number of serious incidents increased from 138 in 2021-22 to 327 in 2022-23, an audit by WMAS found 53% were due to mistakes with their treatment.
    A situation where a person comes to significant harm in care is identified as a serious clinical incident.
    Sources say the trust also delayed looking into 5,000 serious patient incidents.
    Read full story
    Source: BBC News, 29 June 2023
  15. Patient Safety Learning
    A digital NHS Health Check is to be rolled out across England from next spring, the government has announced, in an attempt to alleviate the pressure on GP surgeries.
    The initiative will deliver 1m checks in the first four years, according to the Department for Health and Social Care (DHSC).
    Tens of thousands of cases of hypertension are expected to be identified and hundreds of strokes and heart attacks prevented. Patients will be able to access the check via a mobile phone, tablet or computer, the DHSC said.
    Participants will complete an online questionnaire, enter height, weight, and the results of a cholesterol test which they can carry out at home. They will also be asked to have their blood pressure checked at a pharmacy.
    The results, which will be available online, will direct people to personalised advice. Referrals to GPs will only be made if further tests and treatment are needed.
    Professor Sir Nilesh Samani, medical director at the British Heart Foundation, said: “This initiative will help to reach more people and encourage them to get their blood pressure and cholesterol levels checked so that, where necessary, healthcare professionals can work with them to manage their condition.
    “This could play an important role in helping people live healthier for longer and saving lives in the coming years, while reducing pressure on the NHS.”
    Read full story
    Source: The Guardian, 28 June 2023
  16. Patient Safety Learning
    Staff sickness in the NHS in England has reached record levels.
    Figures for 2022 show an absence rate - the proportion of days lost - of 5.6%, meaning the NHS lost the equivalent of nearly 75,000 staff to illness.
    This is higher than during the peak pandemic years of 2020 and 2021 - and a 29% rise on the 2019 rate.
    Mental health problems were the most common cause, responsible for nearly a quarter of absences, the Nuffield Trust analysis of official NHS data shows.
    Big rises were also seen in cold, coughs, infections and respiratory problems, likely to be linked to the continued circulation of Covid as well as the return of flu last year.
    The think tank warned the NHS was stuck in a "seemingly unsustainable cycle" of increased work and burnout, which was contributing to staff leaving.
    The analysis, exclusively for BBC News, comes ahead of the publication of the government and NHS England's long-awaited workforce plan.
    Read full story
    Source: BBC News, 29 June 2023
  17. Patient Safety Learning
    A paramedic was hallucinating after a traumatic call-out when he crashed into a car, an inquest heard.
    Jason Allen, 49, and Andrew Ralph, 61, were killed after their car was hit by Kevin Lilwall's ambulance on the A49 in Pengethley, Herefordshire.
    An inquest heard Mr Lilwall was having flashbacks to the previous day when he had been in the area responding to the sudden death of a baby.
    The paramedic, who had worked for West Midlands Ambulance Service (WMAS) for 28 years, was driving the ambulance when it crossed the white line into the car. The ambulance dashcam showed it heading directly towards Mr Allen’s car for six seconds before the collision.
    The families of Mr Allen and Mr Ralph said they had been through hell in the past four years, adding they had never had an apology from Mr Lilwall and only one from WMAS after the inquest.
    The hearing in Hereford was told Mr Lilwall had spent more than 25 hours on duty in the previous 36 hours, with just a 10-hour break between shifts.
    Medical experts agreed that the hallucination could have been caused by post traumatic stress disorder.
    Jason Wiles from WMAS admitted it had been a "missed opportunity" regarding the apology and said it had changed its policy to ensure staff had a break of at least 11 hours between shifts following the crash.
    Read full story
    Source: BBC News, 28 June 2023
  18. Patient Safety Learning
    Ambulance staff in the West Midlands have had their ability to speak up as whistleblowers stifled for many years, an independent inquiry has found.
    The investigation, commissioned by NHS England, also identified failings in financial governance at West Midlands Ambulance Service (WMAS).
    Five senior and former members of staff spoke out to NHS England.
    WMAS accepts it has learning to do, but says the report expresses confidence in the service's ability to address the issues raised.
    The whistleblowers included a finance director, medical, operations and quality control staff.
    They raised issues through the Freedom to Speak Up scheme with the National NHS England Team.
    The inquiry, led by Carole Taylor Brown, had terms of reference which included "Governance, probity, the difficulty of speaking up about these issues and the alleged behaviour of some senior leaders".
    Read full story
    Source: BBC News, 28 June 2023
  19. Patient Safety Learning
    GP services "will collapse in Wales and the NHS will follow" soon after unless urgent support is provided, the British Medical Association (BMA) has warned.
    As patient levels rise, numbers of GP surgeries and doctors are falling amid inadequate resources and unsustainable workloads, BMA Cymru Wales has claimed.
    It has written to the Welsh government, urging more funding and staff help.
    The Welsh government said it was acting to cut pressure on GPs and increasing services by community pharmacists.
    Launching its Save Our Surgeries campaign, the BMA said the number of GP practices in Wales had decreased by 18% in the past decade from 470 to 386.
    Read full story
    Source: BBC News, 28 June 2023
  20. Patient Safety Learning
    An independent review has raised concerns about a mental health trust’s reporting systems and has highlighted a significant number of patient deaths shortly after leaving the trust’s care, including almost 300 who died on the same day they were discharged. 
    However, the review into how Norfolk and Suffolk Foundation Trust collects, processes and reports mortality data made no conclusions on the number of avoidable deaths – the issue which had originally prompted the probe. 
    Local NHS leaders argued the review’s purpose was focused on auditing the trust’s processes, and this had been delivered. But a local MP, Clive Lewis, accused it of “explicitly dodg[ing] the big questions”. 
    The report, which looked at data from between April 2019 and October 2022, has however raised concerns about the number of patients dying soon after being discharged.
    Read full story (paywalled)
    Source: HSJ, 28 June 2023
  21. Patient Safety Learning
    Nurses strikes are set to end but the disruption for NHS patients will continue as senior doctors are the latest to vote to walk out.
    The Royal College of Nursing failed to reach the threshold needed to hold further action, with just 43% of the required 50% of members returning a ballot to hold fresh walkouts.
    But more than 24,000 members of the British Medical Association (BMA) backed industrial action by 86% on a turnout of 71%, well above the legal threshold of 50%, with senior doctors set to strike on 20 and 21 July. It comes after the union last week announced a five-day strike by junior doctors will be held from 13 July.
    NHS leaders have said consecutive walkouts from junior doctors and now consultants presents a “huge risk” for the health service.
    Read full story
    Source: The Independent, 27 June 2023
  22. Patient Safety Learning
    Ex-health secretary Matt Hancock has criticised the UK's pandemic planning before Covid hit, saying it was "completely wrong".
    He told the Covid Inquiry that planning was focused on the provision of body bags and how to bury the dead, rather than stopping the virus taking hold.
    He said he was "profoundly sorry" for each death.
    After giving evidence he approached some of the bereaved families, but they turned their backs on him as he left.
    The former health secretary, who answered questions from the inquiry on Tuesday, said he understood his apology might be difficult for families to accept, even though it was "honest and heartfelt".
    Under questioning from Hugo Keith KC, lead counsel to the Covid Inquiry, Mr Hancock stressed that the "attitude, the doctrine of the UK was to plan for the consequences of a disaster".
    Read full story
    Source: BBC News, 27 June 2023
  23. Patient Safety Learning
    Northern Ireland’s chief pharmaceutical officer has said that the use of prescribed medicines and the associated costs remains too high, exceeding £800m a year.
    In a blog to reflect on the 75th anniversary of the NHS, Professor Cathy Harrison added that medicine costs in NI are the second largest single investment made in the health service, after staff.
    “The average number of prescription items a year is 21 per person, at a cost of £227. This cost is the highest in the UK and the volume of prescription items is still rising each year,” she said.
    “There is an uncomfortable truth that manifests in the prescribing data for medicines. In Northern Ireland, we continue to use more of almost every type of medicine than other parts of the UK.
    “That includes more antibiotics, more painkillers, more baby milks, more nutritional supplements, even more oxygen.”
    Read full story
    Source: Belfast Telegraph, 27 June 2023
  24. Patient Safety Learning
    U.S. News & World Report's Best Children's Hospital list for 2023-2024, released 21 June, said 11 children's hospitals are at the top of their game when it comes to 10 pediatric specialties. This year, 11 children's hospitals are included on this list due to a tie in the diabetes and endocrinology category.
    U.S. News gathered subjective data from more than 15,000 pediatric specialists and clinical data from close to 200 children's hospitals to develop its Best Children's Hospitals 2023-2024 listings. 
    For the first time, Cincinnati Children's Hospital Medical Center took the top spot on the list. The hospital has the only level 4 neonatal intensive care unit, which offers care to infants at all level 3 NICUs in the area. The hospital discovered a "super antibody" it believes will inform new vaccines and offered a specialized approach to reduce stays in the NICU for opioid-exposed newborns.
    Steve Davis, MD, president and CEO: "This distinction only confirms what we have always known — that we have outstanding, talented team members who are unmatched in their dedication to ensuring that all children have access to exceptional care."
    Read full story
    Source: Becker's Hospital Review, 23 June 2023
  25. Patient Safety Learning
    The gap between the areas with the best and worst records on the early detection of cancer has remained almost unchanged over the past five years, new NHS England data indicates.
    The proportion of cancers detected at stages one and two – when they are more curable – has improved by 2.7 percentage points to 58.1% nationally, but this masks significant regional variation.
    In the 12 months to February 2019, the percentage point difference between the top performing cancer alliance – Thames Valley (63.1%t) – and the worst performing – Lancashire and South Cumbria (51.6%) – was 11.5.
    Read full story (paywalled)
    Source: HSJ, 27 June 2023
     
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