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Patient Safety Learning

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  1. Patient Safety Learning
    Peers are launching an inquiry into private health companies paid millions of pounds to courier NHS medicines in England, after the Guardian exposed how sick children and adults were being harmed by botched, delayed or missed deliveries.
    The House of Lords public services committee will examine “the extent of the problems in homecare medicine services”, and the impact on patients, clinicians and the wider health service. More than 500,000 patients and their families rely on private companies contracted by the NHS to deliver essential medical supplies and care to their homes.
    A Guardian investigation revealed how Sciensus, Britain’s biggest provider of homecare medicines services, has struggled to provide a safe or reliable service. Seriously ill children as young as four have been let down, with some becoming sicker because of failings by the company.
    Patients and medics have complained to Sciensus and to regulators, but little has changed.
    Read full story
    Source: The Guardian, 13 June 2023
  2. Patient Safety Learning
    An external review of waiting list management at a large acute trust has found several serious problems – including ‘pop-up’ patients and thousands of cancelled appointments each week – but concluded they were no worse than would be found at ‘most NHS trusts’.
    The review appears to have been triggered after University Hospitals of the North Midlands declared unexpected increases in the number of 78-week and 104-week waiters earlier this year, while the government and NHS England have been intensively performance managing these measures.
    The independent report by independent consultant Wendy Baines states: “The review found no evidence of deliberate irregularities in the management of waiting times.
    “Although as the case for most NHS trusts, the capacity to misrepresent the ‘true’ volume of waiters at a certain point in time is significant.
    “Managing this risk by minimising the capacity for errors through training, the right pathway administration systems and tools, and the ability to monitor data quality through a defined set of process assurance measures is key. Whilst UHNM possesses these components, they are not necessarily working in cohesion to provide the assurance and oversight needed to manage patient waiting times.”
    Read full story (paywalled)
    Source: HSJ, 13 June 2023
  3. Patient Safety Learning
    Most women with early breast cancer now beat the disease thanks to huge improvements in treatments in recent years, a BMJ analysis has found.
    Their risk of dying within five years of diagnosis is estimated to be around 5% - down from 14% in the 1990s.
    The BMJ analysis tracked more than half a million women with early, invasive breast cancer - mostly stage one and two - diagnosed in the 1990s, 2000s and between 2010 and 2015.
    It found the prognosis for nearly all women "has improved substantially since the 1990s", with most becoming long-term cancer survivors.
    And based on those trends, the researchers behind the Oxford University-led study say women diagnosed today also have a much lower risk.
    "That's good news - and reassuring for clinicians and patients," oncologist and lead researcher Prof Carolyn Taylor says.
    Cancer Research UK says this offers "reassurance" to many women but warns more highly-trained staff are needed to meet rising demand.
    Read full story
    Source: BMJ, 14 June 2023
  4. Patient Safety Learning
    A campaigning whistleblowing surgeon who wrote two books about his experiences has decided to leave the medical profession out of fear that he is being “hunted” by the NHS.
    Peter Duffy, a consultant urologist, is quitting work several years earlier than planned and intends to remove his name from the medical register. After a two year investigation the General Medical Council has decided to take no action against him. But he told The BMJ that he is worried that, after several investigations into his conduct, he remains vulnerable as long as he stays on the register.
    Duffy, 61, who blew the whistle on patient safety issues at University Hospitals of Morecambe Bay NHS Foundation Trust’s urology department, left the NHS nearly seven years ago. He claimed he was forced to resign from the trust for his own protection and won a claim for unfair constructive dismissal in 2018, when the trust was ordered to pay him £102 000 in compensation.
    Read full story (paywalled)
    Source: BMJ, 12 June 2023
  5. Patient Safety Learning
    The Covid inquiry is being urged to investigate if health officials dismissed evidence of collateral deaths during lockdown after a whistleblower claimed that pathologists’ concerns were shut down.
    As the inquiry prepares to hold its first full public hearing this week, Prof Sebastian Lucas, who worked as a consultant pathologist at St Thomas’ Hospital in London, claimed that PHE was not interested in what he described as “collateral deaths”.
    Prof Lucas wrote to Prof Kevin Fenton, the director of PHE London, on behalf of the London Inner South Jurisdiction Pathology Advisory Group. 
    He approached the agency in January 2021 as the UK entered its third lockdown, warning that collateral deaths as a result of the pandemic had not been recorded properly.
    The group, which was headed up by a coroner, had identified several deaths that would not have happened had the NHS been functioning as normal. This included people who did not want to bother the doctor or who took their own lives because of lockdowns.
    Read full story (paywalled)
    Source: The Telegraph, 10 June 2023
  6. Patient Safety Learning
    Despite the drawbacks of turning to artificial intelligence in medicine, some US physicians find that ChatGPT improves their ability to communicate with patients.
    Last year, Microsoft and OpenAI released the first free version of ChatGPT. Within 72 hours, doctors were using the artificial intelligence-powered chatbot.
    Experts expected that ChatGPT and other A.I.-driven large language models could take over mundane tasks that eat up hours of doctors’ time and contribute to burnout, like writing appeals to health insurers or summarising patient notes. However, they found that doctors were asking ChatGPT to help them communicate with patients in a more compassionate way.
    Dr Michael Pignone, the chairman of the department of internal medicine at the University of Texas at Austin, has no qualms about the help he and other doctors on his staff got from ChatGPT to communicate regularly with patients.
    However, skeptics like Dr Dev Dash, who is part of the data science team at Stanford Health Care, are so far underwhelmed about the prospect of large language models like ChatGPT helping doctors. In tests performed by Dr Dash and his colleagues, they received replies that occasionally were wrong but, he said, more often were not useful or were inconsistent. If a doctor is using a chatbot to help communicate with a patient, errors could make a difficult situation worse.
    Read full story (paywalled)
    Source: New York Times, 12 June 2023
  7. Patient Safety Learning
    These are challenging times for hospitals. Covid-19 put unprecedented stress on health systems, as have inflation and global financial uncertainty. In the USA and around the world, leading hospitals are dealing with rising costs, aging populations and a medical workforce exhausted from battling a global pandemic.
    Among the hallmarks of great hospitals, however, are not just first-class care, first-class research and first-class innovation. The very best institutions also share another quality: consistency. The world's best hospitals consistently attract the best people and provide the best outcomes for patients as well as the most important new therapies and research. Of all the hospitals in the world, relatively few can do all those things year in and year out. 
    To recognise them, Newsweek and global data firm Statista have put together their fifth annual listing of the World's Best Hospitals 2023. This year, they have ranked over 2,300 hospitals in 28 countries, including one that is new to the list, Taiwan. For the first time, they have ranked all top 250 global hospitals. They have listed the best hospitals by country; each country list also includes a listing of top specialty hospitals.
    Read full story
    Source: News Week
  8. Patient Safety Learning
    More than three quarters of all multimillion-pound NHS medical negligence payouts are the consequences of failures in maternity care, new figures show.
    In total, 364 patients or families received the highest-value compensation payments of at least £3.5 million after suing the NHS last year. Of those, 279 (77%) were maternity-related damages, according to figures from NHS Resolution. The large payouts have been offered to parents whose babies were stillborn or suffered avoidable life-changing disabilities or brain injuries.
    Maternity makes up the bulk of NHS compensation payments. There were more than 10,000 clinical negligence claims brought against the NHS in 2021-22, with a total value of more than £6 billion. Maternity accounted for 62% of payments, or £3.74 billion.
    When taking into account all cost of harm, including future periodic payments and legal costs, the cost of compensating mothers and their families rises to £8.2 billion a year. Analysis by The Times Health Commission found that this is more than twice the £3 billion spent by the NHS annually on maternity and neonatal services. Maternity claims have increased during the past decade amid a string of high-profile scandals and a shortage of midwives.
    Read full story (paywalled)
    Source: The Times, 12 June 2023
  9. Patient Safety Learning
    More than three years after Boris Johnson announced a nationwide lockdown, the Covid investigation will cover every aspect of the UK’s pandemic response.
    More than three years after the first lockdown began, two years after the last one ended, the public hearings are at last starting. Over the months that come the inquiry will have many questions to answer. Should we have locked down earlier? Should we have not locked down at all? Did we eat out to help restaurants out, or eat out to help the virus out? Could more have been done to protect care homes from infection? Should more have been done to protect residents from loneliness?
    Baroness Hallett, the judge presiding, said her chief role is “to determine whether [the] level of loss,” in the broadest sense of the word, “was inevitable or whether things could have been done better”.
    Read full story (paywalled)
    Source: The Times, 13 June 2023
  10. Patient Safety Learning
    Almost all routine NHS care in England will be disrupted for three days this week when junior doctors strike in their latest attempt to force ministers to increase their pay.
    Prof Stephen Powis, NHS England’s national medical director, said the stoppage would have an enormous impact and lead to huge numbers of patients missing out on planned care.
    Many thousands of junior doctors are due to stage a 72-hour walkout starting at 7am on Wednesday and continuing until 7am on Saturday.
    “The NHS has been preparing extensively for this next set of strikes,” said Powis. “But we know that – with the sheer number of appointments that need to be rescheduled – it will have an enormous impact on routine care for patients and on the waiting list, as procedures can take time to rearrange with multiple teams involved.”
    Read full story
    Source: The Guardian, 13 June 2023
  11. Patient Safety Learning
    Twenty-four doctors have been disciplined by the UK medical regulator in the last five years after accessing and using information from patients’ treatment records without good reason.
    The General Medical Council (GMC) said it had struck off two of the 24 doctors it had sanctioned after finding that they had undertaken “inappropriate use” of medical records.
    Another 10 were suspended, 10 were warned about their future conduct, one had a condition imposed on their licence to practise medicine and the other had to undertake not to repeat their behaviour.
    The 24 cases were among 194 incidents of doctors allegedly accessing medical records without a clinical justification that prompted a complaint to the regulator between 2017 and 2022.
    Privacy campaigners said it was shocking that almost 200 people had made complaints to the GMC accusing doctors of violating patients’ confidentiality in that way.
    Read full story
    Source: The Guardian, 13 June 2023
  12. Patient Safety Learning
    The NHS Confederation chief says he will this week demand clarity about Rishi Sunak’s flagship waiting list reduction target, warning it may not be ‘the most sensible target [or] within the service’s control’.
    Matthew Taylor also reflected in an exclusive interview with HSJ about a “pretty bruising” recent planning round for 2023-24.
    Speaking ahead of the conference, which starts this week, he said he would ask Steve Barclay for “clarity” about “what exactly the government means when it talks about reducing waiting lists”.
    The prime minister’s waiting list pledge is one of his frequently-referenced five priorities, which when he set them out in January stated: “NHS waiting lists will fall and people will get the care they need more quickly.”
    But Mr Taylor said yesterday: “It’s a bit unclear to me… Does it mean the overall waiting list? Does it mean long waiters? And what about the other waiting lists that we don’t talk about [like psychiatric care for children]?”
    Read full story (paywalled)
    Source: HSJ, 13 June 2023
  13. Patient Safety Learning
    A study in 11 countries over four continents has shown the “catastrophic impact” of antibiotic resistance on babies with sepsis, with nearly one in five dying.
    The two year observational study enrolled 3204 babies with clinical sepsis in 19 hospitals in Africa, Asia, Europe, and Latin America. It found that 17.7% were blood culture pathogen positive, and mortality rates among infants up to 60 days old with culture positive sepsis was 17.7%.
    The research, published in PlOS Medicine, also highlighted wide variation in treatment and frequent switching of antibiotics because of resistance, with 206 antibiotic combinations used by the hospitals studied in Bangladesh, Brazil, China, Greece, India, Italy, Kenya, South Africa, Thailand, Vietnam, and Uganda.
    Read full story
    Source: BMJ, 9 June 2023
  14. Patient Safety Learning
    The number of NHS staff who feel able to raise concerns about clinical safety has fallen for the second year in a row, an analysis of NHS staff survey data has shown.
    A report by the NHS’s National Guardian’s Office, which represents local “freedom to speak up guardians” who help NHS workers to raise concerns, said that staff were increasingly disillusioned and that they believed that speaking up was “futile,” which had “worrying implications for patient safety.”
    Dr Jayne Chidgey-Clark, National Guardian for the NHS said: “It is not acceptable that two in five workers responding to the NHS staff survey do not feel able to speak up about anything which gets in the way of them doing their job.
    “These survey responses show us that there is a growing feeling that speaking up in the NHS is futile – that nothing changes as a result. When workers speak up about concerns, including the impact of under staffing and a crumbling infrastructure, their leaders themselves may struggle to be heard when trying to address these concerns.
    “I would add my voice to that of others that this urgently needs to be addressed".
    Read full story
    Source: BMJ. 9 June 2023
  15. Patient Safety Learning
    Puberty blockers will only be prescribed to children attending gender identity services as part of clinical research, NHS England has announced.
    The move comes after an interim report into children's gender services said there were "gaps in evidence" around the drugs.
    Blockers are used to "pause puberty" and work by supressing hormone release.
    Dr Hilary Cass's report called for a transformation in the model of care for children with gender-related distress.
    Currently, if a child seeks medical help, the drugs are one of the options a doctor could offer to help delay the onset of physical changes that do not match a child's gender identity.
    This change will come into effect when new clinics replacing the Gender Identity and Development Service (Gids) begin to open later this year. No patients being treated by the current Gids service will be affected.
    Read full story
    Source: BBC News, 10 June 2023
  16. Patient Safety Learning
    The World Health Organization’s new pandemic preparedness treaty is being watered down and stripped of the key stipulations needed to prevent another global health disaster, say leading international health experts and civil society groups.
    WHO’s 194 member states agreed in December 2021 to draw up a new convention to ensure that the world would be prepared for future global health threats and to prevent the “catastrophic failure” seen during the covid pandemic.
    The “zero draft” of the accord, published in February, had excited observers because its scope went beyond the closest existing legally binding framework, the International Health Regulations. That draft stipulated strong obligations for information sharing and the importance of having a strong health workforce and universal healthcare, among other requirements.
    The latest 42 page document, leaked during the World Health Assembly, has revealed that many passages that experts regard as key to improving global health have been weakened or made optional, meaning that they could be removed in the final draft.
    Read full story
    Source: BMJ, 31 May 2023
  17. Patient Safety Learning
    Trusts and systems must draw up plans to improve the diversity of their executive and senior leadership teams over the next 12 months, and evidence progress against them by summer 2025, NHS England has announced.
    A new equality, diversity and inclusion (EDI) improvement plan also says every board and executive team member will have EDI objectives they will be assessed against during annual appraisals by spring 2024.
    The targets form part of six “high impact actions,” each with set targets that aim to address the “widely known intersectional impacts of discrimination and bias” within the NHS.
    Read full story (paywalled)
    Source: HSJ, 8 June 2023
  18. Patient Safety Learning
    Bereaved families of coronavirus victims feel the Welsh government has not adequately taken part in the Covid public inquiry, their solicitor says.
    Craig Court, who represents bereaved families, said the Welsh government had not participated "as well as they should have".
    He claimed the Welsh government failed to deliver crucial paperwork with just days to go before Tuesday's inquiry. The UK-wide inquiry could go on as long as three years, and will predominantly look at the UK government's approach to the pandemic.
    A Wales-specific inquiry was blocked by Labour members of the Senedd, with First Minster Mark Drakeford saying it should wait until after the UK-wide investigation had been completed.
    Mr Court told BBC Wales "there is a great concern over the duty of candour" displayed by the Welsh government.
    Read full story
    Source: BBC News, 9 June 2023
  19. Patient Safety Learning
    Ministers have been accused of failing to grasp the “tidal wave” of mental ill health blighting children’s lives, after research found that only a quarter of English primaries will be able to offer vital school-based support by the end of next year.
    With almost one in five pupils aged 7 to 16 now thought to have a mental health disorder, specialist support teams were set up to work with children in schools, addressing early symptoms and reducing pressure on overstretched NHS services.
    According to new figures shared exclusively with the Guardian, however, pupils in almost three-quarters (73.4%) of primary schools in England will have had no access to the new mental health support teams (MHSTs) by the end of 2024.
    The research follows reports that a quarter of a million children in the UK with mental health problems have been denied help by the NHS, with some trusts failing to offer treatment to 60% of those referred by GPs.
    Read full story
    Source: The Guardian, 9 June 2023
  20. Patient Safety Learning
    NHS England has described the Metropolitan Police commissioner’s warning that his force will stop responding to emergency mental health calls as ‘very disappointing’, HSJ has learned.
    Last month, Sir Mark Rowley told NHS and social care chiefs he had instructed his force to withdraw from health-related calls in the capital no later than 31 August – a warning which attracted high-profile media coverage.
    Sir Mark stressed the “urgency” of needing to implement a model that originated in Humberside called “right care right person”, where after a year of tense negotiations, police and health services reached an agreement under which many mental health calls are dealt with by health professionals rather than officers.
    NHSE’s letter says it agrees with the issues Sir Mark raises, adding it is inappropriate for police to spend significant amounts of time on mental health callouts.
    But it adds that the NHS was “very disappointed” to receive the commissioner’s letter, stressing that the problem is better solved in partnership than unilaterally declaring the force will not respond to calls.
    Read full story (paywalled)
    Source: HSJ, 8 June 2023
  21. Patient Safety Learning
    A chief executive whose hospital has been accused of failing children has admitted it has not always "got it right" and apologised at a meeting.
    The care regulator has warned Kettering General Hospital (KGH) over its children's and young people's services and rated them inadequate.
    Dozens of parents with children who died or became seriously ill have contacted the BBC with concerns.
    Deborah Needham told a board meeting she was "here to listen" to worries.
    In April it was revealed inspectors from the Care Quality Commission (CQC) raised concerns over sepsis treatment, staff numbers, dirt levels and not having an "open culture" where concerns could be raised without fear, following an inspection in December.
    The CQC had inspected the Northamptonshire hospital's paediatric assessment unit, Skylark ward, and the neonatal unit after hearing concerns of safety.
    Read full story
    Source: BBC News, 9 June 2023
  22. Patient Safety Learning
    Health leaders have blamed staff shortages for waiting lists reaching another record high, with 7.4 million people in England waiting to start treatment as of the end of April.
    One NHS leader said the figures showed that unsustainable “pressure continues to pile on an overstretched NHS”, and urged the government to speed up publication of its long-awaited workforce plan, which has been repeatedly postponed.
    Waiting list figures in England have crept up again after showing signs of improvement in recent months, despite Rishi Sunak citing bringing numbers down as one of the government’s top five priorities for 2023.
    Downing Street on Thursday insisted the NHS was “continuing to make progress to ensure patients are seen more quickly”, pointing to record numbers of doctors and nurses in the NHS.
    Read full story
    Source: The Guardian, 8 June 2023
  23. Patient Safety Learning
    Patients may be found guilty of discrimination if they refuse the care of a transgender medic, according to new NHS guidance.
    Health bosses have been warned that patients have no right to be told a healthcare worker’s assigned sex at birth.
    However, transgender health workers can choose not to treat patients if they feel uncomfortable doing so, the report by NHS Confederation says.
    The report, published earlier this month in partnership with the LGBT Foundation, says patients can only request care from a same-sex staff member in limited circumstances, such as if they are having an intimate examination.
    It states that when a patient requests an employee administering care to be a woman or a man, “the comfort of the staff member should be prioritised”.
    Read full story
    Source: Telegraph, 9 June 2023
  24. Patient Safety Learning
    Metformin—a cheap, safe, and widely available diabetes drug—could reduce the incidence of long covid if given during the acute phase of Covid-19, a new study indicates.
    A two week course of metformin given within three days of testing positive for SARS-CoV-2 led to 40% fewer Long Covid diagnoses over the following 10 months compared with people who had taken placebo, according to a randomised controlled trial.
    The authors of the study, published in Lancet Infectious Diseases, caution that the trial did not look at whether metformin would be effective as a treatment for those who already have Long Covid.
    Jeremy Faust from Harvard Medical School, who was not involved in the research, said the findings, if confirmed, are “profound and potentially landmark.” Writing in a linked comment, he said, “This is the first high quality evidence from a randomised controlled trial to show that the incidence of long covid can be reduced by a medical intervention, metformin—an inexpensive treatment with which clinicians have ample experience".
    Read full story
    Source: BMJ, 8 June 2023
  25. Patient Safety Learning
    Community diagnostic centres (CDCs) — the government’s flagship policy for recovering cancer testing after Covid — will have up to 6,500 fewer staff than they need by 2025, according to NHS England projections seen by HSJ. 
    The workforce “gap analysis” modelling highlights large and sustained staffing shortfalls across most professional groups required to run the CDCs until at least 2025. It was released after a Freedom of Information Act request to the Department of Health and Social Care, which said it was given the analysis by NHSE. 
    The total gap between demand and supply for the programme by 2025 is estimated at 6,663, out of a total demand of 61,152 (about 1 in 10 staff).
    Read full story (paywalled)
    Source: HSJ, 8 June 2023
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