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Patient Safety Learning

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  1. Patient Safety Learning
    A doctor with a key role in reforming a controversial gender identity clinic for children has been recorded questioning the need for change.
    Prof Gary Butler, clinical lead for the children's gender clinic in England and Wales, also appeared to accuse the author of a report, which will underpin the new service, of "nepotism".
    He was recorded making the comments in a keynote speech at a major conference.
    The Gender Identity Development Service (Gids), based at London's Tavistock and Portman NHS Foundation Trust, was rated as "inadequate" by inspectors, who visited in late 2020. It was earmarked for closure in July 2022.
    An independent review, led by Dr Hilary Cass, also called for a "fundamentally different" model of care for children with gender dysphoria.
    Prof Butler has been awarded a key role in shaping the new service, as one of several people tasked with implementing a new training programme, underpinned by Dr Cass's recommendations.
    However, BBC Newsnight has learned Prof Butler has publicly questioned the need for change and described Dr Cass's recommendations as "slightly unusual".
    In the 14-minute speech at the conference, he talked about current services across the UK, the legal challenges to the situation in England, and how he felt Gids has been the subject of "lies" in the media.
    Read full story
    Source: BBC News, 24 May 2023
  2. Patient Safety Learning
    Work pressures are driving thousands of nurses and midwives a year away from the profession, the Nursing and Midwifery Council  (NMC) says.
    The NMC said retention was becoming a major concern despite an overall growth in the register.
    Its annual report found 27,000 professionals had left the register in the UK in the year to the end of March.
    While retirement appeared to be the most common reason for leaving, health and exhaustion were cited as the next.
    NMC Chief Executive Andrea Sutcliffe said: "There are clear warnings workforce pressures are driving people away.
    "Many are leaving earlier than planned, because of burnout and exhaustion, lack of support from colleagues, concerns about quality of care and workload and staffing levels."
    Read full story
    Source: BBC News, 24 May 2023
  3. Patient Safety Learning
    There has long been an acknowledgment by ministers and NHS leaders that violence against staff by patients was an issue that needed addressing, with a strategy to tackle it announced nearly five years ago.
    The health service’s 2019 long-term plan included a pilot for the use of body-worn cameras by paramedics in a bid to “de-escalate” situations. The following year the Crown Prosecution Service announced an agreement with the police and NHS England to “secure swift prosecutions” of those who assault staff, and the maximum penalty for assaulting emergency workers, including doctors and nurses, was also doubled to two years.
    Despite these measures, there have been internal disagreements within NHS England about the best approach to the problem, which affected almost 15% of staff last year, according to the latest national survey of the health service workforce.
    The Guardian understands that senior managers in NHS England told staff in its violence prevention and reduction (VPR) team last April that prosecutions of those who assaulted healthcare workers and dismissals of abusive staff should be a last resort. Instead, the focus should be on improving the culture of the NHS and staff wellbeing.
    It is also understood that managers cautioned against using the term “zero tolerance” because they said it did not take into account that some people who abuse NHS staff might lack capacity, an apparent reference to mentally ill patients.
    Read full story
    Source: The Guardian, 23 May 2023
  4. Patient Safety Learning
    A new treatment could help people to stop taking addictive opioid painkillers for chronic pain, research suggests.
    Data suggests there are one million people at risk from longer-term continuous opioid prescriptions, and more than 50,000 have been taking these for six months or more.
    While recent NHS initiatives have managed to reduce opioid prescribing by 8%, saving an estimated 350 lives, the new research has found evidence that could help many more people stop their opioid painkiller use.
    A team of researchers and doctors has developed and successfully trialled a programme designed to guide people in coming off prescription painkillers, tapering their opioid intake and learning how to manage their pain using alternative techniques with a course which combines one-to-one and group support.
    According to the findings, after one year, one in five people were able to stop taking opioids without their pain increasing.
    The scientists suggest the new treatment is an alternative to opioid use and has potential to give patients a better quality of life.
    Read full story
    Source: The Independent, 23 May 2023
  5. Patient Safety Learning
    A GP accused of trying to pull down a patient's gym shorts and of touching her genitalia has been struck off the medical register.
    The Medical Practitioners Tribunal Service found Dr Kamran Ali's behaviour towards four women at a surgery in Essex amounted to misconduct.
    The tribunal heard he had not practised since the allegations in 2016.
    The 44-year-old, of Glendale Gardens, Leigh-on-Sea, was cleared of criminal charges following a trial in 2018.
    Panel chairman William Hoskins said at the tribunal on Thursday that erasing him from the register was necessary to "protect public confidence in the medical profession".
    A female patient - referred to as Patient C - reported his behaviour to police in the November.
    She had complained of spots on her face, white coating on her tongue and wanted a repeat prescription for anxiety medication.
    The panel heard Dr Ali began to pull down her gym shorts and examined her genitalia without wearing gloves and without obtaining consent.
    Read full story
    Source: BBC News, 23 May 2023
  6. Patient Safety Learning
    A 58-year-old woman died alone curled up in a blanket on the floor of her bedroom as she waited more than five hours for an ambulance.
    Relatives of Rachel Rose Gibson believe she had a heart attack at her home in Wrexham, north Wales, only a short drive away from a hospital, but died before an ambulance reached her.
    The Welsh ambulance service said that on the day Gibson died, its crews spent more than 700 hours waiting outside hospitals for patients to be admitted, which meant they could not respond quickly to people needing help.
    Family members said Gibson, a grandmother of seven, called an ambulance at 4pm on 5 April as she was coughing up blood and in chronic pain. By the time an ambulance arrived at 9.30pm, she had died.
    Her daughter, Nikita, 29, said: “She was lying on the floor curled up in a blanket. It haunts me to know she died alone in so much pain.
    “I feel like I can’t fully grieve because I’m so angry. She only lives five minutes away from the hospital, but must have been in too much pain to get into a taxi.”
    Read full story
    Source: The Guardian, 22 May 2023
  7. Patient Safety Learning
    Only 10-15% of GP practices are using all three of the ‘modern’ patient access tools — including overhauling their approach to triage — which are at the centre of NHS England’s primary care recovery plan, its GP lead has told HSJ. 
    Amanda Doyle, national director for primary care and community services, told HSJ this was its current estimate of the share of practices which already have in place all three of: digital phone systems; online messaging; and modern triage, response and care navigation.
    These are cornerstones of the primary care recovery plan,published by the government and NHS England this month, which says they are prerequisites for offering “modern general practice access”.
    Read full story (paywalled)
    Source: HSJ, 23 May 2023
  8. Patient Safety Learning
    A woman who had a hysterectomy has said she was discharged without sufficient information on its impact on her physical and mental health.
    Mechelle Davis, from County Down, said it was crucial women left hospital with appropriate medication and advice.
    Her operation involved removal of her womb, ovaries, fallopian tubes, and cervix.
    Ms Davis was 48 when she had her operation and said she had no option but to look online for advice, something she described as "unsatisfactory".
    "I had the operation in October 2022 and didn't go on HRT until the following February," she told BBC News NI.
    "Every woman who is going through the menopause - including surgically induced - needs support.
    In its online tool for clinicians, British Menopause Society advise that HRT plays a significant role in managing surgical menopause, especially in women under 45 - provided there are no contradictions such as personal history of hormone dependant cancer.
    It also adds that "all women undergoing surgical menopause should have counselling and be provided with information about the hormonal consequences of surgery and the role of HRT, both before surgery and before leaving hospital with clear communication to the primary care team."
    BBC News NI has spoken to other women who, after having a hysterectomy, were discharged without advice or a HRT prescription.
    Read full story
    Source: BBC News, 23 May 2023
    Further reading on the hub:
    World Menopause Day 2022: Raising awareness of surgical menopause
     
  9. Patient Safety Learning
    Social Beats, a networking platform for those living with Long Covid, has been launched by free social community service Biocomm, allowing people to exchange health information from trusted sources, share experiences and interact with other people with Long Covid.
    The goal of the platform is to help connect those living with Long Covid so that they can receive and provide emotional and social support to others in the same position.
    The platform is the brainchild of BiocommAI and is sponsored by InnoMedica and Normax Biomed.
    Peter Jensen, CEO and chairman of Normax, said: “Community is key for anyone dealing with an illness or long-term condition. Biocomm.net is a safe space for people affected by Long Covid – a platform designed to help people living with the condition to connect with others and to build a better life.
    “We have recognised that Long Covid has impacted people in many ways and now is the time to help them by enabling them to connect, learn and share knowledge.”
    Read full story
    Source: Digital Health, 22 May 2023
  10. Patient Safety Learning
    More than 35,000 incidents of sexual misconduct or sexual violence - ranging from derogatory remarks to rape - were recorded on NHS premises in England between 2017 and 2022.
    Rape, sexual assault or being touched without consent accounted for more than one in five cases.
    Most incidents - 58% - involved patients abusing staff.
    The data was collected by the BMJ and the Guardian, and shared with BBC File on 4.
    Freedom of Information requests were received from 212 NHS trusts and 37 police forces in England.
    The data that came back from trusts showed at least 20% of incidents involved rape, sexual assault or inappropriate physical contact - including kissing. Other cases included sexual harassment, stalking and abusive or degrading remarks. One in five cases involved patients abusing other patients - although not all trusts provided a detailed breakdown.
    Meanwhile, police recorded nearly 12,000 alleged sexual crimes on NHS premises in the same time period - including 180 cases of rape of children under 16, with four children under 16 being gang-raped.
    Read full story
    Source: BBC News, 23 May 2023
  11. Patient Safety Learning
    An integrated care board (ICB) has sent multiple warnings to a local trust highlighting ‘serious issues’ with the safety and quality of care provided.
    East Kent Hospitals University Foundation Trust had had severe and widely reported issues in its maternity services but the five emails and letters from Kent and Medway ICB, sent across a six-week period in February and March, flagged concerns extending into other parts of the organisation. These included:
    Serious incidents had “recurrent themes” and there was a “lack of evidence the trust is learning” from them. A spot audit had revealed more than one in five patients at the Queen Elizabeth The Queen Mother Hospital in Thanet had overdue modified early warning scores, which can show if a patient is deteriorating.
    Further concerns about adult safeguarding “have been raised in relation to 18 allegations of abuse against people in positions of trust” despite the provider implementing a review on the issue 18 months earlier.
    Read full story (paywalled)
    Source: HSJ, 22 May 2023
  12. Patient Safety Learning
    Regulators are probing a series of whistleblowing claims about the leadership culture of a trust which is rated ‘outstanding’ for its management, HSJ has learned.
    It is understood multiple current and former staff members at Bolton Foundation Trust, including people in senior positions, have been in contact with NHS England and the Care Quality Commission in recent months.
    The claims include a dramatic worsening in leadership culture at the trust, particularly around the FTSU process and people who speak up being bullied, side-lined and silenced. And investigations and meetings are stage-managed and tightly controlled by executives, with constant “sugar-coating” and positive spin on board reports, and intolerance of people who disagree.
    Read full story (paywalled)
    Source: HSJ, 22 May 2023
  13. Patient Safety Learning
    A Labour government would reverse the rise in the number of deaths from suicide as part of a health plan to replace pain and anxiety with a “hope of a renewed NHS”, Keir Starmer will pledge.
    In a speech today, the Labour leader will say his plan for reforming the NHS will focus on the biggest causes of death in the UK including suicide.
    He will point to coroners’ statistics showing that deaths from suicides have been rising since 2008, and reached a record high last year in England and Wales. If the party takes power Labour will reverse this rise within five years, Starmer will say.
    A segment of his speech previewed by the party says: “Suicide is the biggest killer of young lives in this country. The biggest killer. That statistic should haunt us. And the rate is going up. Our mission must be and will be to get it down.”
    Labour has not provided details on how it proposes to meet this pledge other than an aspiration to shift from “sickness to prevention”.
    Starmer will also propose introducing new NHS targets on cutting deaths in England from heart disease and strokes by a quarter over 10 years.
    Read full story
    Source: The Guardian, 21 May 2023
  14. Patient Safety Learning
    Maternity services in Gloucestershire will remain shut for months because of staff shortages, it has been confirmed.
    The Aveta Birth Unit in Cheltenham and Stroud's post-natal facilities are not expected to re-open until at least October, bosses say.
    The announcement by Gloucestershire Hospitals NHS Foundation Trust means women will have been unable to use the services for more than a year.
    Maternity campaigners say new mothers are not getting support they need.
    The trust said it had a long-term commitment to both units, but they cannot reopen safely at the moment.
    The Aveta unit has been shut since last June and Stroud's six postnatal beds have been closed since September.
    It means new mothers are forced to go home 12 hours after giving birth, or if they have medical needs being sent to Gloucestershire Royal Hospital.
    Read full story
    Source: BBC News, 19 May 2023
  15. Patient Safety Learning
    NHS England is ‘sorry’ for backing a mental healthcare model which it now admits has caused hurt to patients, according to a leaked draft policy document.
    The serenity integrated mentoring model was launched in 2013 in the Isle of Wight and Hampshire. It quickly became viewed by mental health trusts as an “innovative approach” to helping support frequent users of the emergency services.
    A core element of the scheme involves placing a local community police officer within the healthcare team charged with supporting those patients. 
    In 2021, the pressure group StopSIM raised concerns about the model, which included a belief that police involvement was potentially coercive, criminalised mental health crises, and could result in withholding healthcare from people, which would breach human rights legislation. The group also argued the SIM programme had not been robustly and clinically evaluated.
    As a result, NHSE committed to co-producing policy guidance on SIM with StopSIM. 
    The draft document states: “NHS England did not apply sufficient scrutiny to the decision [to endorse SIM] and involve the voice of lived experience sufficiently. This compromised the safety and quality of care for service users and has caused hurt to patients. For this, NHS England is sorry.”
    Read full story (paywalled)
    Source: HSJ, 19 May 2023
    Further reading on the hub:
    The High Intensity Network (HIN) approach and SIM model for mental health care and 'high intensity users' – what are your views?
     
  16. Patient Safety Learning
    A baby has died and seven others were left requiring intensive care after a “usually mild” virus appeared to trigger a serious heart condition, health officials have said.
    The World Health Organization (WHO) said it had been notified of an “unusual” increase in myocarditis –inflammation of the heart – among newborns in south Wales infected with an enterovirus over the past year.
    While enteroviruses are common and often asymptomatic, they are known to cause “occasional outbreaks in which an unusually high proportion of patients develop clinical disease, sometimes with serious and fatal consequences – in this instance myocarditis”, the UN health agency said.
    While prior to the recent cluster of cases, south Wales had experienced only two similar cases in six years, the 10 months to April saw 10 cases of myocarditis in babies under the age of 28 days who tested positive for enterovirus, according to WHO.
    Read full story
    Source: The Independent, 19 May 2023
  17. Patient Safety Learning
    An inquiry into maternity care failings at an NHS trust that left dozens of babies dead or brain-damaged is “wholly insufficient” because only a fraction of Black and Asian women have come forward, its chair has warned.
    Donna Ockenden, who is leading a review into Nottingham University Hospitals NHS Trust, suggested the health service must do more to increase the number of responses from ethnic minorities if the trust is to learn from the scandal.
    Less than 20 families from Black and Asian communities are currently involved in the inquiry, compared to more than 250 white families, The Independent understands.
    It is understood letters have only been sent out in English, while Ms Ockenden pointed to examples of women being unable to access translation services and expectant Muslim mothers being turned away if they objected to male sonographers.
    She said the communities’ “mistrust” towards the trust had “deepened”, leaving the review team “climbing a mountain” to engage with them.
    Read full story
    Source: The Independent, 18 May 2023
  18. Patient Safety Learning
    Male GPs are less likely to refer eligible patients for IVF, research by a fertility charity suggests, raising concerns about access to NHS-funded treatment.
    The Progress Educational Trust’s (PET) report highlights “utter confusion” and a lack of knowledge among GPs about eligibility criteria for NHS-funded treatment, which it says is exacerbating the so-called IVF postcode lottery. GPs typically make the initial referral to fertility clinics, meaning that they play a crucial role in access.
    “For NHS treatment, GPs are the main initial gatekeeper. If you’re not getting pregnant, that’s who you go to for advice and support,” said Sarah Norcross, the director of PET. “It struck me that, when people have a known cause of infertility, male GPs still weren’t passing them on.”
    The report is based on a survey of 200 GPs and commissioners across England, carried out by an independent research company, which investigated knowledge of national fertility guidelines and criteria they use for referral decisions.
    Read full story
    Source: The Guardian, 19 May 2023
  19. Patient Safety Learning
    A mental health trust’s acute and intensive care wards have been downgraded to “inadequate”, following a series of incidents including sexual assaults, fire setting, and patients taking their own lives while on leave.
    The Care Quality Commission (CQC) inspection was prompted by reports of several serious incidents involving patients in these services. These included three occasions where patients had taken their own lives while on leave from wards, and four incidents where fires had been set at the Redwoods Centre in Shrewsbury.
    Inspectors also identified a steep rise in mixed accommodation breaches, with just one ward out of the four inspected at St George’s Hospital in Stafford and none of the three inspected at Redwoods providing single sex units. 
    The CQC report added “there were concerns about the implications of mixed sex ward environments contributing to sexual safety incidents”, with 158 such incidents recorded in a six-month period leading up to the inspection. These included assaults, verbal threats of sexual assault, and sexual orientation related abuse, with 126 recorded at Redwoods and 32 at St George’s.
    Read full story (paywalled)
    Source: HSJ, 19 May 2023
  20. Patient Safety Learning
    The government in England should increase its use of the private sector to tackle the NHS backlog, Labour says.
    It said as many as 300,000 patients have missed out on treatment since it called for greater use of private clinics in January 2022.
    And the party said it was unjust that the lack of action meant only those who could afford to pay for treatment themselves were being seen on time.
    The government said it was delivering by cutting long waits. However, data published by NHS England last week showed key targets to tackle the backlogs in cancer care and routine treatment had been missed.
    Overall, there are now a record 7.3 million people on a hospital waiting list, which is nearly three million higher than it was before the pandemic started.
    Read full story
    Source: BBC News, 19 May 2023
  21. Patient Safety Learning
    Patients spent up to 25 hours on trolleys in corridors waiting for treatment and in some cases were left lying on "urine-soaked sheets" and in another on a "blood-stained pillow for several hours" at the Royal Infirmary of Edinburgh.
    Healthcare Improvement Scotland (HIS) inspectors also raised concerns over fire safety in the overcrowded A&E after two visits to the hospital - the first of which was carried out between February 20 to 22 and a further unannounced follow-up in March.
    The watchdog found "multiple systemic failures" in a report published on Thursday but NHS Lothian said a major improvement drive was already underway.
    The health board added that the hospital was had just endured its busiest winter on record ahead of the inspections.
    At the time of the inspection, the emergency department was on some days operating at over three times its capacity.
    The report described this as unsafe and a "fire safety risk" with the evacuation plan in place at the time not reflecting the "significant" impact of overcrowding. 
    Read full story
    Source: The Herald, 18 May 2023
  22. Patient Safety Learning
    Obese patients cost the NHS double the amount that people who are a healthy weight do, a landmark new study has revealed.
    One million patients who were a healthy weight cost the NHS £638 on average in 2019, the research found. Meanwhile, £1,375 was spent per year on morbidly obese patients with a body mass index (BMI) of more than 40.
    Experts warned the future viability of the NHS relies on combatting increasing obesity as it was leading to record levels of long-term sickness.
    The research, presented at the European Congress of Obesity in Dublin, is the first to show how NHS spending varies depending on a patient’s weight.
    The findings showed a staggering rise in spending on heavier patients because they develop obesity-related conditions like type 2 diabetes and heart disease.
    Read full story
    Source: The Independent, 18 May 2023
  23. Patient Safety Learning
    Investors are pouring billions into companies claiming they can analyse DNA to find the disease early. But some scientists question if they really work.
    A pioneering group of people in the US and UK who have elected to take part in a new form of cancer screening known as multi-cancer early detection tests (MCED). The tests use gene sequencing or other novel technologies to detect fragments of DNA expelled by cancerous cells which circulate in people’s blood, allowing the identification of multiple types of cancer from a single blood draw. They have been hailed as “revolutionary” and “cutting edge” by British and US health chiefs.
    Health bodies in both nations have set up MCED clinical trials in the hope that the tests can be rolled out to the population at large. The UK’s NHS is participating in a clinical trial of the Galleri test involving 140,000 patients. 
    But not everyone is convinced the tests live up to the hype. Several health experts and scientists told the Financial Times that the tests could harm rather than help some patients due to risks associated with misdiagnosis, over-diagnosis and over-treatment.
    Read full story (paywalled)
    Source: The Financial Times, 17 May 2023
  24. Patient Safety Learning
    Healthcare providers caring for pregnant patients in the months after the US Supreme Court’s decision to strike down Roe v Wade have been unable to provide standard medical care in states where abortion is effectively outlawed, leading to delays and worsening and dangerous health outcomes for patients, according to an expansive new report.
    In the wake of the Supreme Court’s ruling last year, individual reports from patients and providers have shed some light on the wide range of harm facing pregnant women in states where access to abortion care is restricted or outright banned.
    But a first-of-its-kind report from the University of California San Francisco captures examples from across the country, documenting 50 cases in more than a dozen states that enacted abortion bans within the last 10 months, painting a “stark picture of how the fall of Roe is impacting healthcare in states that restrict abortion,” according to the report’s author Dr Daniel Grossman.
    “Banning abortion and tying providers’ hands impacts every aspect of care and will do so for years to come,” he said in a statement accompanying the report. “Pregnant people deserve better than regressive policies that put their health and lives at risk.”
    Read full story
    Source: The Independent, 16 May 2023
  25. Patient Safety Learning
    Staff were suspended by their trust after they were found to have been sleeping in a patient’s bed, a Care Quality Commission (CQC) report has revealed.
    The regulator inspected acute wards for adults and psychiatric intensive care units at Black Country Healthcare Foundation Trust in February, after safeguarding concerns were raised.
    As HSJ revealed earlier this year, inspectors investigated a series of incidents, while a referral was also made to the police. As well as reports of staff using a mental health inpatient’s bed, there were complaints involving alleged inappropriate sexual behaviour and a governance breach. The concerns were said to relate to Hallam Street hospital in West Bromwich and Penn Hospital in Wolverhampton. 
    The CQC inspection report said it inspected the service following allegations that “abuse had occurred” and a “multi-agency safeguarding meeting was convened to discuss the investigations of these”.
    Read full story (paywalled)
    Source: HSJ, 18 May 2023
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