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Patient Safety Learning

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  1. Patient Safety Learning
    The UK risks becoming highly reliant on overseas care workers after nearly 58,000 visas were issued for the sector last year, a report says.
    Analysis by the Migration Observatory at the University of Oxford found that the demand for foreign staff had left the NHS and care homes open to “vulnerabilities” including “exposure to international competition for health workers and risks of exploitation”.
    The study, commissioned by the employment group ReWAGE, also examined where care workers were coming from. In 2022, 99% of care workers sponsored for work visas in the UK were from non-EU countries. The top countries were India (33%), Zimbabwe (16%), Nigeria (15%) and the Philippines (11%).
    Dr Madeleine Sumption, the director of the Migration Observatory, said: “Health and care employers have benefited a lot from international recruitment.
    “But relying this much on overseas recruits also brings risks. For example, care workers on temporary visas are vulnerable to exploitation and the rapid growth in overseas recruitments makes monitoring pay and conditions a real challenge.”
    Read full story
    Source: The Guardian, 27 June 2023
  2. 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
     
  3. Patient Safety Learning
    Relatives of a teenage rape survivor who died after failures by mental health services are joining other families to demand a new body to enforce coroners’ recommendations to prevent future deaths.
    Campaigners claim the failure to act on hundreds of coroners’ recommendations every year, and to learn from the findings of often expensive inquiries into disasters, means the same mistakes are being repeated.
    Gaia Pope, 19, was diagnosed with post-traumatic stress disorder after revealing that she had been drugged and raped when she was 16. She was found dead in undergrowth on a cliff 11 days after disappearing in Swanage, Dorset, in 2017.
    After one of the longest inquests in legal history, the coroner, Rachael Griffin, made multiple reports last year to authorities including the NHS and police to prevent future deaths, but Pope’s family says most have not been acted upon.
    The Inquest campaign, which works with families bereaved by state-related deaths, is calling for a “national oversight mechanism” to collate recommendations and responses in a new national database, analyse responses from public bodies, follow up on progress and share common findings.
    Read full story (paywalled)
    Source: The Times, 27 June 2023
  4. Patient Safety Learning
    The head of NHS England was critical of the government’s slogan urging people to “protect the NHS” at the start of the Covid pandemic, amid concerns it would stop people coming forward for much-needed treatment.
    Simon Stevens, who led the NHS until July 2021, was one of the slogan’s “greatest critics” and was not involved in the government discussion that led to the phrase being deployed.
    “It was a tremendously powerful slogan,” writes journalist Isabel Hardman in Fighting for Life: The Twelve Battles That Made Our NHS, and the Struggle for Its Future.
    “It was popular in government – but not universally so. In fact, one of its greatest critics was Simon Stevens. Stevens wasn’t on the calls where [government advisers] came up with ‘Protect the NHS’, and initially he complained in private that it gave the impression that the public was there for the health service – not the health service being there for the public.
    “Either way, the focus quickly became about the importance of ‘protecting the NHS’. But there was never a clear definition of what it was being protected from.”
    Later in 2020, Lord Stevens referred to his concerns about the slogan, writing: “Rather than say ‘Protect the NHS’, health service staff prefer to say: ‘Help us help you’.”
    Senior NHS figures also attempted to battle against the slogan from the spring of 2020, urging patients to come forward as normal.
    Read full story
    Source: The Guardian, 25 June 2023
  5. Patient Safety Learning
    A new type of artificial-intelligence technology that cuts the time cancer patients must wait before starting radiotherapy is to be offered at cost price to all NHS trusts in England.
    It helps doctors calculate where to direct the therapeutic radiation beams, to kill cancerous cells while sparing as many healthy ones as possible.
    Researchers at Addenbrooke's Hospital trained the AI program with Microsoft.
    For each patient, doctors typically spend between 25 minutes and two hours working through about 100 scan cross-sections, carefully "contouring" or outlining bones and organs. But the AI program works two and a half times quicker, the researchers say.
    When treating the prostate gland, for example, medics want to avoid damage to the nearby bladder or rectum, which could leave patients with lifelong continence issues.
    Read full story
    Source: BBC News, 27 June 2023
  6. Patient Safety Learning
    Black patients at trusts most affected by 2016’s junior doctors’ strike suffered significantly more than their white or Asian counterparts, a new analysis has suggested.
    Research by the Institute for Fiscal Studies analysed 30-day readmission rates after the 48-hour junior doctors’ strike in April 2016.
    The co-authors of the research, George Stoye and Max Warner, said: “We find that patients treated in hospitals that were more exposed to the strike did not, on average, experience worse outcomes.”
    However, they added that black patients were “more negatively affected by exposure to the strikes than white patients in the same hospitals”. The April 2016 strike affected both elective and emergency care and was the last before the dispute ended. 
    The current junior doctors’ strike has been ongoing since March. It also affects emergency and elective care but stoppages have been longer, with a five-day strike planned in July.
    Read full story (paywalled)
    Source: HSJ, 27 June 2023
  7. Patient Safety Learning
    What would the NHS see if it looked in a mirror, asks Siva Anandaciva, author of the King’s Fund’s study comparing the health service with those of 18 other rich countries, in the introduction to his timely and sobering 118-page report.
    The answer, he says, is “a service that has seen better days”.
    Britons die sooner from cancer and heart disease than people in many other rich countries, partly because of the NHS’s lack of beds, staff and scanners, a study has found.
    The UK “underperforms significantly” on tackling its biggest killer diseases, in part because the NHS has been weakened by years of underinvestment, according to the report from the King’s Fund health thinktank. It “performs poorly” as judged by the number of avoidable deaths resulting from disease and injury and also by fatalities that could have been prevented had patients received better or quicker treatment.
    The comparative study of 19 well-off nations concluded that Britain achieves only “below average” health outcomes because it spends a “below average” amount for every person on healthcare.
    Read full story
    Source: The Guardian, 26 June 2023
  8. Patient Safety Learning
    A permanent change in approach is needed for deciding which hospitals are built and  when, and should be led by the NHS not politicians, the government’s ‘new hospitals programme’ boss has told HSJ.
    Natalie Forrest, who is leading the government’s drive to build “40 new hospitals” by 2030, said the service must move beyond political targets, and towards the NHS having more autonomy to work through a list of rebuilds needed. 
    Ms Forrest, who has led the programme since 2021, said: “There shouldn’t be a special group that are getting rebuilt, and everyone else has to watch from the sidelines.” 
    The former Chase Farm Hospital chief said she believed this was now the direction of travel, and that a commitment from ministers for a “rolling programme” beyond 2030 represented the “biggest success [for the NHP] so far”. 
    Read full story (paywalled)
    Source: HSJ, 26 June 2023
  9. Patient Safety Learning
    Everyone who has ever smoked in England is to be offered lung screening in middle age under plans to detect and treat cancer earlier.
    Lung cancer kills about 35,000 people every year, and is the most common cause of cancer death in the UK, accounting for one in five. It also has one of the worst cancer survival rates, which is largely attributed to diagnoses at a late stage when treatment is less likely to be effective.
    Millions of people will be invited for lung checks in an effort to improve survival rates. About a million screenings of people aged 55 to 74 will be carried out every year under the programme.
    It follows a successful pilot of the scheme in deprived areas of the country where people are four times more likely to smoke. It resulted in more than 2,000 people being detected as having cancer, 76% of them at an earlier stage compared with 29% outside the programme in 2019.
    “Identifying lung cancer early saves lives, and the expansion of the NHS’s targeted lung health check programme is another landmark step forward in our drive to find and treat more people living with this devastating disease at the earliest stage,” said the chief executive of NHS England, Amanda Pritchard.
    Read full story
    Source: The Guardian, 26 June 2023
  10. Patient Safety Learning
    The NHS is set to undergo the "largest expansion in training and workforce" in its history, Rishi Sunak has said.
    Speaking to the BBC, the prime minister said the plans would reduce "reliance on foreign-trained healthcare professionals".
    It comes at a time of record-high waiting lists in the NHS and junior doctors set to stage a five-day strike next month.
    The full plans are expected to be published next week.
    Pressed about the length of time it would take to see the results of the changes, Mr Sunak accepted it could take "five, ten, fifteen years for these things to come through", but that did not mean it was not the right thing to do.
    Read full story
    Source: BBC News, 25 June 2023
  11. Patient Safety Learning
    A new six-year study, which aims to prevent the ‘silencing’ of patient voices and improve patient trust in the healthcare system, is due to begin thanks to a major funding award
    Researchers at the University of Nottingham, University of Bristol and University of Birmingham have received a £2.6M Wellcome Discovery Grant for the 'Epistemic Injustice in Healthcare (EPIC)’ project. The study will use philosophical expertise to explore forms of 'silencing'.
    Patients regularly report that their testimonies and perspectives are ignored, dismissed or explained away by the healthcare profession. These experiences are injustices because they are unfair and harmful - and philosophers call them ‘epistemic injustices’ because they jeopardise patient care and undermine trust in healthcare staff and systems.
    By studying these epistemic injustices, EPIC will find ways to correct them and improve the relationship between patients and healthcare practitioners.
    "Patients have long reported feeling ignored, dismissed, or silenced in ways that jeopardise their care and intensify their suffering. The challenge is to understand how this silencing happens and what can be done about it, in ways that can help patients and healthcare practitioners alike. The NHS is right to seek 'patient perspectives' and listen to 'patient voices'. Project EPIC will help them to do that better by fully diagnosing the causes of that silencing." Dr Ian James Kidd, EPIC Co-Investigator & Assistant Professor in the Department of Philosophy.
    Read more
    Source: University of Nottingham
  12. Patient Safety Learning
    A vaccine that promises to protect infants and the over-75s from a lung infection which adds to pressure on the NHS each winter has been backed by government advisers.
    Respiratory syncytial virus (RSV) is a leading cause of pneumonia in the very young and elderly. It typically causes between 22,000 and 30,000 hospital admissions of small children a year.
    RSV’s impact on the elderly is less well understood but important, and experts believe that an effective vaccine could significantly lessen winter pressures on the health service.
    After 60 years of research, vaccines for older adults from Britain’s GSK and its US rivals Pfizer and Moderna are in the final stages of development.
    The Joint Committee on Vaccination and Immunisation (JCVI) believes that they could be licensed this year or early next year and trial data suggest that they work well.
    Read full story (paywalled)
    Source: The Times, 23 June 2023
  13. Patient Safety Learning
    Artificial intelligence (AI) is set to be rolled out more widely across the NHS in a bid to diagnose diseases and treat patients faster.
    The Government has announced a £21 million funding pot that NHS trusts can apply for to implement AI tools for the likes of medical imaging and decision support.
    This includes tools that analyse chest X-rays in suspected cases of lung cancer.
    AI technology that can diagnose strokes will also be available to all stroke networks by the end of 2023 – up from 86% – and could help patients get treated faster and lead to better health outcomes.
    The Department of Health and Social Care (DHSC) said the technology could help cut NHS waiting lists ahead of winter.
    Read full story
    Source: The Independent, 23 June 2023
     
  14. Patient Safety Learning
    The number of adults living with diabetes worldwide will more than double by 2050, according to research that blames rapidly rising obesity levels and widening health inequalities.
    New estimates predict the number will rise from 529 million in 2021 to more than 1.3 billion in 2050. No country is expected to see a decline in its diabetes rate over the next 30 years. The findings were published in The Lancet and The Lancet Diabetes & Endocrinology journals.
    Experts described the data as alarming, saying diabetes was outpacing most diseases globally, presenting a significant threat to people and health systems.
    “Diabetes remains one of the biggest public health threats of our time and is set to grow aggressively over the coming three decades in every country, age group and sex, posing a serious challenge to healthcare systems worldwide,” said Dr Shivani Agarwal, of the Montefiore Health System and the Albert Einstein College of Medicine in New York.
    The research authors wrote: “Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors.”
    Structural racism experienced by minority ethnic groups and “geographic inequity” were accelerating rates of diabetes, disease, illness and death around the world, the authors said.
    Read full story
    Source: The Guardian, 22 June 2023
  15. Patient Safety Learning
    Litigation costs for specialties including intensive care, oncology and emergency medicine have rocketed by up to five times as much as they were before the pandemic, internal data obtained by HSJ reveals.
    HSJ's data reveal costs for claims relating to intensive care, oncology, neurology, ambulances, ophthalmology and emergency care have increased – both for damages and legal costs – by significantly more than average.
    The steepest cost rise was in intensive care, which saw the bill increase fivefold from £4.3m in 2019-20 to £23.7m in 2021-22.
    Other specialisms which reported higher than average percentage increases were oncology, a 159% increase from £15m to £38.9m, and neurology, a 95% uplift from £18.4m to £36m.
    Key findings from these reports included missed or delayed diagnosis, missing signs of deterioration, failure to recognise the significance of patients re-attending accident and emergency multiple times with the same problem, and communication issues.
    Adrian Boyle, president of the Royal College of Emergency Medicine, said: “I’m extremely worried about the amount of money we’re spending on litigation… There’s a good reason we must not normalise an abnormal situation and we need to invest in an emergency care system which avoids these huge costs.”
    Read full story (paywalled)
    Source: HSJ, 23 June 2023
  16. Patient Safety Learning
    England is engulfed in a cardiovascular disease emergency, health bosses have said, as stark figures reveal there have been almost 100,000 excess deaths since the start of the Covid pandemic.
    Analysis of official government data suggests that more than 500 people a week are dying needlessly from heart disease, heart attacks or strokes. There have been 96,540 extra cardiovascular-related deaths since March 2020, according to the report by the British Heart Foundation (BHF).
    The BHF said other factors were likely to be driving the continued increase in excess deaths involving cardiovascular disease, including severe and ongoing disruption to NHS heart services.
    “Covid-19 no longer fully explains the significant numbers of excess deaths involving cardiovascular disease,” said Dr Sonya Babu-Narayan, a consultant cardiologist and associate medical director at the BHF. “Other major factors are likely contributing, including the extreme and unrelenting pressure on the NHS over the last few years.
    “Long waits for heart care are dangerous – they put someone at increased risk of avoidable hospital admission, disability due to heart failure and premature death. Yet people are struggling to get potentially lifesaving heart treatment when they need it due to a lack of NHS staff and space, despite cardiovascular disease affecting record numbers of people.”
    Read full story
    Source: The Guardian, 22 June 2023
  17. Patient Safety Learning
    More than half of UK doctors have seen or experienced abuse by patients or their relatives in the last year, including incidents in which they have been spat at and threatened.
    Doctors have variously had their hair ripped out, been backed up against a wall and been racially abused, a survey and dossier of testimonies collated by a medical organisation has revealed.
    Long delays for care and staff shortages are cited as the main triggers for what NHS leaders say is an increased readiness by the public to be aggressive towards frontline staff.
    The research by the Medical Protection Society (MPS) found that 56% of the doctors questioned had experienced or witnessed a situation involving verbal or physical abuse over the last year.
    Almost half said incidents had occurred because of a lack of staff, while 45% blamed it on patients’ frustration at having to wait a long time to be treated.
    One doctor told the MPS how a “patient’s partner threatened to kill me as he felt his wife had waited too long to be seen”, while another said: “I had a handful of my hair ripped out despite the patient being in handcuffs and with the police.”
    Read full story
    Source: The Guardian, 22 June 2023
  18. Patient Safety Learning
    There is evidence of black, Asian and minority ethnic women being treated differently at the University Hospital of Wales, Healthcare Inspectorate Wales (HIW) has said.
    HIW completed an inspection of UHW's maternity services in November 2022 and served an urgent improvement notice.
    A follow up inspection in March found continuing issues with patient safety.
    The inspectorate said in November that it identified issues which meant that patients were not consistently receiving an "acceptable standard of timely, safe, and effective care".
    Although "some improvements had been made in many areas... there remained significant challenges, and overall, the improvements were not progressing at the pace required", it said.
    The report added: "We found low morale amongst staff that we spoke to, and similar comments were received following a staff survey.
    Read full story
    Source: BBC News, 22 June 2023
  19. Patient Safety Learning
    One in 10 health workers in England had suicidal thoughts during the Covid-19 pandemic, according to research that highlights the scale of its mental impact.
    The risk of infection or death, moral distress, staff shortages, burnout and the emotional toll of battling the biggest public health crisis in a century significantly affected the mental wellbeing of health workers worldwide.
    A study involving almost 20,000 responses to two surveys reveals the full extent of the mental health impact on workers at the height of the pandemic.
    Research led by the University of Bristol analysed results from two surveys undertaken at 18 NHS trusts across England. The first was carried out between April 2020 and January 2021 and completed by 12,514 workers. The second – covering October 2020 to August 2021 – was completed by 7,160.
    The first survey found that 10.8% of workers reported having suicidal thoughts in the preceding two months, while 2.1% attempted to take their own life in the same period. Some 11.3% of workers who did not report suicidal thoughts in the first survey reported them six months later, with 3.9% – about one in 25 – saying they had attempted to take their own life for the first time.
    Responses showed that a lack of confidence in raising safety concerns, feeling unsupported by managers, and having to provide a lower standard of care were among the factors contributing to staff distress.
    Read full story
    Source: The Guardian, 21 June 2023
  20. Patient Safety Learning
    Women who underwent mesh surgery were not given accurate information before the life-altering procedure, a case review has found.
    The study also said poor communication between patients and doctors led, in some cases, to mistrust.
    Medical notes were often misleading or did not detail the surgery that had occurred or its outcomes.
    The review spent two years looking at the cases of 18 women who received transvaginal mesh implants.
    It has now called for a comprehensive register to be set up to keep track of women who have had operations to remove mesh in Scotland, abroad and privately.
    The Transvaginal Mesh Case Record Review by Glasgow Caledonian University makes a series of other recommendations, including:
    Better aftercare following surgery Clear language so patients understand exactly what surgery is going to achieve. Read full story
    Source: BBC News, 21 June 2023
  21. Patient Safety Learning
    The government has proposed new legislation to make patient visiting a legal right and also give the Care Quality Commission (CQC) fresh powers to enforce it.
    The Department of Health and Social Care has launched a consultation to seek views from patients, care home residents, families, professionals and providers on the introduction of new legislation which will require health and care settings, including hospitals, to accommodate visitors in most circumstances. 
    It said the new visiting laws will also provide the CQC with a “clearer basis for identifying where hospitals and care homes are not meeting the required standard”, and enable it to enforce the standards by issuing requirement or warning notices, imposing conditions, suspending a registration or cancelling a registration.
    It said although the CQC currently has powers “to clamp down on unethical visiting restrictions”, the expected standard of visiting rules is not “specifically outlined in regulations”.
    Read full story (paywalled)
    Source: HSJ, 21 June 2023
  22. Patient Safety Learning
    A warning has been made over the possible side effects of a common NHS antibiotic by a coroner after a newly retired senior doctor died by suicide.
    "Respected and experienced" consultant cardiologist Robert Stevenson had no history of depression or mental health problems before he started a course of ciprofloxacin.
    But just over a week later, the 63-year-old went for a walk and messaged his wife to tell her he had left a note under his pillow.
    He was later found dead in a nearby wood.
    The note he had left was said to be "uncharacteristically confused and illogical" with "baseless concerns" that he might have AIDS after taking an online HIV tester kit, an inquest heard.
    The hearing was told Dr Stevenson hadn't been told about a "potential rare link" to suicidal behaviour in patients who took the drug, as this wasn't in line with medical guidance.
    Now, coroner Martin Fleming issued a warning to highlight the risk of taking the antibiotic, which is prescribed by the health service for serious conditions.
    Read full story
    Source: The Mirror, 20 June 2023
  23. Patient Safety Learning
    The human papillomavirus (HPV) vaccination given in schools – which is helping to virtually eliminate cervical cancer – will move to a single dose from September, it has been announced.
    The UK Health Security Agency (UKHSA) said the change in England follows advice from the Joint Committee on Vaccination and Immunisation (JCVI) and World Health Organisation scientists that a single dose “delivers robust protection” against HPV when compared with the two doses given at present.
    The HPV vaccine programme is offered to all children in school Year 8, when they are aged 12 to 13.
    Dr Vanessa Saliba, immunisation consultant epidemiologist at the UKHSA, said: “The HPV vaccination programme is one of the most successful in the world and has dramatically lowered the rates of cervical cancer and harmful infections in both women and men – preventing many cancers and saving lives.
    “The latest evidence shows that one dose provides protection as robust as two doses. This is excellent news for young people."
    Read full story
    Source: The Independent, 20 June 2023
  24. Patient Safety Learning
    More than 5,000 mental health patients have been sent at least 62 miles from home for treatment in the two years since ministers pledged to banish the “dangerous” practice.
    The disclosure prompted calls for the “scandal” of out of area placements in mental health care to end, with claims that it represents “another broken government promise on the NHS”.
    Chronic shortages of mental health beds have for years forced the health service in England to send hundreds of patients a month to be admitted for care, sometimes a long way from their own area.
    Mental health campaigners, psychiatrists and patients’ families have argued that being far from home can make already vulnerable patients feel isolated, deprive them of regular visits from relatives, increase the risk of self-harm and reduce their chances of making a recovery.
    Read full story
    Source: The Guardian, 21 June 2023
  25. Patient Safety Learning
    Investigators have begun a further review of how a major trust handles disciplinary and professional standards cases, including allegations leaders had targeted some doctors with referrals to the medical regulator, HSJ has learned.
    The claims were part of a raft of concerns raised about University Hospitals Birmingham Foundation Trust over recent months, including BBC Newsnight reporting that a large number of General Medical Council referrals had led to no action; and claims of whistleblowing doctors “being bullied… by the threat of referrals to the GMC”.
    One external review of UHB, whose report was published in March, already examined the issue, and said it had identified 17 cases which contradicted Newsnight’s claim, with two referrals resulting in criminal conviction and removal from the medical register.
    It said there was “nothing exceptional” about the referral numbers or types at UHB, or their outcomes, but also noted that medical staff told the review about “dysfunctional processes for maintaining higher professional standards”, and “expressed a perception that there was a rather rapid process to escalate to a GMC referral”.
    Read full story (paywalled)
    Source: HSJ, 21 June 2023
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