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Patient Safety Learning

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  1. 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
  2. Patient Safety Learning
    National guidelines are needed to help maternity care professionals navigate discussions with pregnant women about past traumas, experts have said.
    Their study, published in the journal Plos One, also found that while talking about previously experienced traumas can be valuable, they can also trigger painful memories if not approached sensitively.
    The authors also raised concerns about the support available for professionals who may not feel equipped to explore challenging topics such as domestic or sexual abuse, childhood trauma and birth trauma without adequate guidelines or referral pathways.
    Joanne Cull, a midwife and PhD student at the University of Central Lancashire’s School of Community Health and Midwifery, who is corresponding author on the study, said: “As awareness of the long-term effects of trauma on health and wellbeing has grown, there has been a move toward asking pregnant women about previous trauma, usually at the first appointment.
    “No national guidance on this has been published in the UK so NHS Trusts have implemented this on a piecemeal approach.”
    Read full story
    Source: The Independent, 17 May 2023
  3. Patient Safety Learning
    NHS England’s approach to recovering cancer services has been described as ‘pathetic and dishonest’ by the deputy chief executive of a major trust.
    Andy Welch, deputy chief executive and medical director of Newcastle Hospitals Foundation Trust, has publicly criticised comments made in November by NHSE’s national cancer director Dame Cally Palmer, who said “we have our foot on the gas” towards reaching cancer waiting time targets.
    Mr Welch is an outspoken figure who has also slammed NHSE for “destroying” the morale of midwives through its “failed ‘continuity of care’ concept”, and described the potential “toppling” of the government as “brilliant” within the last three weeks alone.
    The Newcastle medic is the chair of the Northern Cancer Alliance. His criticism of Dame Cally comes as performance against the flagship cancer target remains largely unchanged since last year.  
    Read full story (paywalled)
    Source: HSJ, 18 May 2023
  4. Patient Safety Learning
    Factors like deprivation should be considered in prioritising waiting lists, NHS England’s inequalities director has said, but in a ‘very sophisticated, thoughtful way’ alongside clinical need and waiting times.
    NHSE said in summer 2020 the service would “restore services inclusively”, and some systems and trusts have developed tools they say could allow them to consider factors such as deprivation, race, employment, and lifestyle risk factors, such as smoking.
    But the issue has been controversial. Research for University Hospitals Coventry and Warwickshire Trust, which has developed a new prioritisation system, found many members of the public are opposed to taking these factors into account.
    NHSE standard contract guidance for 2023-24, seemingly cautioning against such moves, said: “[The Department of Health and Social Care] asked us to make clear that providers are ‘recommended to prioritise waiting lists according to clinical need and then in chronological order from the longest waiting patient.’” 
    Read full story (paywalled)
    Source: HSJ, 18 May 2023
  5. Patient Safety Learning
    Nineteen suspects have been identified by police as part of a new inquiry into hundreds of deaths at a hospital.
    An independent panel found 456 patients died after being given opiates inappropriately at Gosport War Memorial Hospital between 1987 and 2001.
    The new criminal investigation is being led by Kent Police after three previous ones by Hampshire Constabulary resulted in no prosecutions.
    Police said interviews with the suspects under caution were ongoing.
    Detectives are examining more than 750 patient records as part of Operation Magenta after families, who have also campaigned for judge-led "Hillsborough-style" inquests, repeatedly called for justice.
    Read full story
    Source: BBC, 17 May 2023
  6. Patient Safety Learning
    A therapy using magnets to treat severe depression is available on the NHS in the West for the first time.
    Wellsprings clinic in Taunton can now deliver the repetitive Transcranial Magnetic Stimulation treatment (rTMS) to NHS patients through a referral.
    During a session, a strong magnetic field is used to stimulate or inhibit different parts of the brain.
    The National Institute for Health and Care Excellence (NICE) said it had "no major safety concerns" for the therapy.
    Mark Rickman, 60, from Dartmoor deals with bipolar and depression and said rTMS has had a positive impact on him.
    Mr Rickman previously tried Electroconvulsive Therapy (ECT), where electric shocks cause a brief surge of electrical activity in the brain, but said it was "debilitating" compared to rTMS.
    NICE cleared rTMS for use in 2015, for people who had not responded well to antidepressants, and had "no major concerns" about the therapy.
    The main side effects were said to be headaches, and patients at risk of seizures are screened.
    Read full story
    Source: BBC News, 18 May 2023
  7. Patient Safety Learning
    It was created with the very best of intentions – to help hospitals learn lessons when a baby or mother is harmed or dies.
    But a Channel 4 News investigation has been hearing that the maternity programme of the Healthcare Safety Investigation Branch – or HSIB – was riddled with flaws.
    One former senior staff member spoke to Channel 4 about bullying within the organisation and failings which could have led to harm.
    In a previous report, Channel 4 heard from the mothers of Beatrice and Marnie, who were stillborn and other parents have come forward with their experience.
    Watch the story
    Source: Channel 4 News, 16 May 2023
  8. Patient Safety Learning
    Hospitals are deploying staff with less training than nurses – wearing the same uniforms – a conference has heard.
    Nurses said trusts trying to make “cost savings” were using cheaper nursing associates, and treating student nurses as free labour, to try to plug gaps that should be filled by more qualified staff.
    They are trained in similar basic skills to nurses, but have two years of training and a foundation degree qualification, compared to three years studying and a university degree for registered nurses.
    Nurses at the RCN annual congress in Brighton said the associate workers are frequently being given equally complex tasks, as pressures mounted.
    In some cases, they were even being given the same uniforms, meaning patients cannot distinguish between nurses and less-qualified staff, nurses said.
    Meanwhile, student nurses, who should be shadowing trained staff to learn new skills, were increasingly being asked to fill in for healthcare assistants, the conference heard.
    Read full story (paywalled)
    Source: The Telegraph, 16 May 2023
  9. Patient Safety Learning
    More than 26,000 adults with severe mental illness die prematurely each year from preventable physical illnesses, analysis by the Royal College of Psychiatrists suggests. 
    New data from the Office for Health Improvement & Disparities shows 120,273 adults in England with severe mental illness, including psychosis, post-traumatic stress disorder and schizophrenia, died before the age of 75 between 2018 and 2020. 
    Of these, the College estimates 80,182 deaths (two in three) were potentially preventable, which is an average of 26,727 people each year. 
    Preventable deaths include deaths from diseases like cancer and heart disease which could have been prevented with earlier detection and treatment or lifestyle changes. While adults with severe mental illness are more likely to engage in unhealthy behaviours like smoking and drinking alcohol excessively, they are also less likely to access screening and treatment for a range of reasons including stigma associated with having a mental illness.  
    While cancer is the leading cause of premature death among those with a severe mental illness, it also significantly increases the risk of dying before the age of 75 across a range of physical health conditions. Adults with severe mental illness are on average:
    6.6 times more likely to die prematurely from respiratory disease 6.5 times more likely to die prematurely from liver disease 4.1 times more likely to die prematurely from cardiovascular disease 2.3 times more likely to die prematurely from cancer. Read full story
    Source: Royal College of Psychiatrists, 17 May 2023
  10. Patient Safety Learning
    Experts are calling for "do not resuscitate" orders to be scrapped, saying they are being misused and putting people's lives at risk. One woman told BBC News that her elderly father might still be alive if the DNR in his medical file had been properly checked.
    When Robert Murray began choking on a piece of fruit at breakfast, staff at his care home called 999. He'd stopped breathing and the ambulance service operator immediately sent paramedics to attend.
    But seconds later, the care home told the dispatcher that the 80-year-old had a do not resuscitate form (DNR) in his medical records. The paramedics were stood down. Mr Murray died minutes later.
    However, it was all a terrible mistake. It hadn't been made clear to the ambulance service that Mr Murray was choking - the DNR was only meant to apply should he have a cardiac arrest.
    Mr Murray's death, at a nursing home in Eastbourne in June 2021, is an example of what experts call "mission creep" in the use of DNR - also known as DNACPR (Do Not Attempt Cardiac Pulmonary Resuscitation) - decisions.
    Researchers from Essex University say some care home residents are "being inappropriately denied transfer to hospital or access to certain medicines" due to the recommendations.
    Read full story
    Source: BBC News, 16 May 2023
  11. Patient Safety Learning
    Trainee medics in a troubled maternity department have flagged concerns with national regulators over the safety of patients, it has emerged.
    Last year the General Medical Council said it had concerns about the treatment of obstetric and gynaecology trainees at University Hospitals Birmingham and placed medics at Good Hope Hospital and Heartlands Hospital under intensive support known as “enhanced monitoring”.
    The GMC’s review flagged serious concerns about emergency gynaecology cover arrangements and said there was a real risk trainees would become hesitant and reluctant to call on consultant support. In September it placed additional restrictions on training, due to “ongoing significant concerns about the learning environment and patient safety”.
    Now it has emerged in board papers for Birmingham and Solihull integrated care board that Health Education England, now part of NHS England, and the GMC carried out a follow-up visit to UHB in late March to review progress. 
    Board documents state that “several patient safety concerns [were] reported by postgraduate doctors in training to the visiting team”, with a subsequent feedback letter from HEE urging immediate changes to dedicated consultant time and job plans.
    Read full story (paywalled)
    Source: HSJ, 17 May 2023
  12. Patient Safety Learning
    As excitement builds throughout health and information systems worldwide over the rich potential benefits of new tools generated by artificial intelligence (AI), the World Health Organization (WHO) has called for action to ensure that patients are properly protected.
    Cautionary measures normally applied to any new technology are not being exercised consistently with regard to large language model (LLM) tools, which use AI for crunching data, creating content, and answering questions, WHO warned.
    “Precipitous adoption of untested systems could lead to errors by healthcare workers, cause harm to patients, erode trust in AI, and thereby undermine or delay the potential long-term benefits and uses of such technologies around the world,” the agency said.
    As such, WHO proposed that these concerns are addressed and clear evidence of benefits are measured before their widespread use in routine health care and medicine.
    Read full story
    Source: United Nations News, 16 May 2023
  13. Patient Safety Learning
    The UK medical regulator has launched an investigation into a “stalker” doctor who accessed intimate details of the health history of a woman who had begun dating the doctor’s ex-boyfriend.
    The General Medical Council (GMC) is investigating whether the doctor – a consultant at Addenbrooke’s hospital in Cambridge – breached their professional, ethical and legal duties to protect the woman’s personal information.
    The victim has given the watchdog a statement detailing the consultant’s repeated violations of her medical records and documentation that shows what she did.
    The GMC declined to comment because it has not yet decided to open a formal disciplinary case against the consultant, who could face serious sanctions including a ban on working as a doctor. One of the GMC’s investigative officers is examining the victim’s claims and collecting evidence.
    The Guardian revealed how the doctor had looked at the victim’s hospital and GP records seven times last August and September, in the early stages of the woman’s relationship with a man the consultant had been involved with for several years.
    Read full story
    Source: The Guardian, 15 May 2023
  14. Patient Safety Learning
    More than half of £2.7bn awarded to NHS organisations for capital projects in 2017 and 2018 has yet to be delivered, research by HSJ has discovered. 
    The government announced almost £3bn  in capital funding to upgrade NHS estates and services in four waves during 2017 and 2018. This was before the pledge to build 40 “new hospitals” by 2030, which has since largely dominated decisions about NHS capital investment.
    HSJ looked at the progress of the 143 schemes, worth a total of £2.7bn, known to have been included in the “sustainability and transformation partnership” capital funding programmes. 
    Only £1.2bn has been given to the organisations involved, and over a fifth of live schemes – which range from emergency department upgrades to new primary care hubs – have not received any allocated funds to date. 
    Read full story (paywalled)
    Source: HSJ, 15 May 2023
  15. Patient Safety Learning
    UK ministers must set out how to recruit and retain thousands more mental health nurses to plug the profession’s biggest staff shortage, healthcare leaders are warning.
    Mental health nurses account for nearly a third of all nursing vacancies across England, resulting in overstretched services that are struggling to deliver timely care, according to research carried out by the NHS Confederation’s mental health network.
    Sean Duggan, the network’s chief executive, said: “Mental health leaders and their teams are pulling out all the stops in what are very constrained circumstances, but they cannot be expected to solve this staffing crisis alone.
    “The knock-on effect means that the mental health crisis the nation is facing will in turn become a crisis for the whole healthcare system and the country. This relentless pressure on mental health staff cannot be allowed to continue with the ultimate impact being on the patients who most need that care.”
    Read full story
    Source: The Guardian, 16 May 2023
  16. Patient Safety Learning
    Blind people are being put “at risk” when the NHS provides them with “inaccessible” information about their health, a charity has warned.
    People with sight loss have missed appointments, cancer screenings or been unable to use home test kits because of a lack of clear instructions in an accessible format, according to the sight loss charity RNIB.
    It warned that denying people access to their information can also “cause embarrassment and loss of dignity”.
    Linda Hansen, from Bradford, who is severely sight-impaired, said that she needed to get her daughter to read her the results of a medical exam which was sent to her in print format.
    Ms Hansen, 62, said: “I can get my bank statement or a gas bill in accessible formats, but yet I still receive health information that I can’t read. What could be more personal than your health status?”
    A new RNIB campaign – My Info My Way – has been launched calling for all blind and partially sighted people to be given accessible information.
    The charity said that a failure to provide information in an accessible format is putting blind and partially sighted people “at risk”.
    Read full story
    Source: The Independent, 16 May 2023
  17. Patient Safety Learning
    Trusts must start submitting full data on surgeries which include a high-risk medical device into a new national registry by December as part of a national push to increase accountability and safety around surgery.
    NHS England is launching the new mandatory medical device outcome registry this month. The new registry was created in response to Baroness Cumberlege’s “First Do No Harm” review and initial data submissions about surgeries that include a high-risk medical device will begin in June.
    Details of the launch arrangements have been set out in a draft letter which HSJ has seen and understands is set to be sent to medical directors and other system leaders imminently.
    Relevant procedures include those, for example, involving either a Class III device, like an implant, or a Class IIb therapeutic device, such as drug-eluting balloon catheter.
    Read full story (paywalled)
    Source: HSJ, 16 May 2023
  18. Patient Safety Learning
    A hospital trust, which has already implemented a series of safety measures to protect employees, has reported a 17% rise in incidents of abuse against staff by patients and the public in the last year. 
    Data from the Oxford University Hospital’s clinical incident system, shared with HSJ, shows there were 1,181 cases of violence and aggression against staff in 2022, up from 1,003 in 2021.
    Before late 2021, the monthly incident rate very rarely hit 100, while since January 2022 it has topped 100 in seven months, including 162 and 131 incidents respectively in January and February this year.
    The ongoing growth is despite the trust launching a campaign, called “No Excuses”, in January 2022,. Measures include bodyworn cameras, and safety devices with alarms and positioning technology for lone workers. 
    Read full story (paywalled)
    Source: HSJ, 16 May 2023
  19. Patient Safety Learning
    Nine online talking-therapy treatments for anxiety or depression have been given the green light to be used by the NHS in England.
    They offer faster access to help but less time with a therapist, which may not suit everyone, the health body recommending them said.
    There is huge demand for face-to-face services, with people waiting several weeks to see a therapist.
    The new digital therapies, delivered via a website or an app using cognitive-behavioural therapy (CBT), provide an alternative way of accessing support, which may be more convenient for some, the National Institute for Health and Care Excellence (NICE) says.
    They could also free up resources and help reduce the wait for care. However, psychiatrists said digital therapies were not a long-term solution.
    Mental-health charity Sane said they were no substitute for a one-to-one relationship and could leave people feeling even more isolated than before.
    Read full story
    Source: BBC News, 16 May 2023
  20. Patient Safety Learning
    An acute trust chair has said its emergency department is effectively operating as a primary care service. 
    Hattie Llewelyn-Davies, who has chaired The Princess Alexandra Hospital Trust since late 2021, told HSJ: “We’ve done an awful lot of changes in the way we run out A&E and same day emergency care service to try and get the flow through working better…
    “We have particular problems with the Princess Alexandra because we are right in the middle of Harlow. And we have a GP service and primary care service which is under massive pressure. We have very high levels of deprivation in Harlow.
    “When somebody is sick in Harlow and can’t get a doctor’s appointment on the spot, they walk into us. We have a very high level of people coming in, so a very high level of footfall but a very low level of admissions.
    “We are therefore running effectively a primary care service through our A&E.”
    Read full story (paywalled)
    Source: HSJ, 15 May 2023
  21. Patient Safety Learning
    Two mothers have renewed calls for a government allergy tsar following their daughters' deaths from severe allergic reactions.
    In a letter to Health Secretary Steve Barclay, Tanya Ednan-Laperouse and Emma Turay, from London, said the deaths were "entirely preventable".
    MPs are set to debate two allergy petitions on Monday, including one calling for the introduction of an allergy tsar.
    In the letter, Mrs Ednan-Laperouse, from Fulham in west London, and Ms Turay, from Wood Green in north London, tell Mr Barclay: "As mothers, we have come together for change so that our tragedies never happen again.
    "There are no clear lines of accountability in relation to overall NHS provision of allergy care, nor for the many other areas where policy change is required.
    "This lack of national leadership has been raised time and again by coroners at the inquests of those who died following severe allergic reactions."
    Ms Turay explained the issue was raised at the inquest into the death of her daughter, Shante.
    "The coroner highlighted the fact that 'there is no person with named accountability for allergy services and allergy provision at NHS England or the Department of Health as a whole'," she said.
    Read full story
    Source: BBC News, 15 May 2023
    Further reading:
    Prevention of future deaths report: Alexandra Briess (6 April 2023) Why allergies are the Cinderella service of the NHS – a blog by Tim McLachlan  
  22. Patient Safety Learning
    Hundreds of babies are dying unnecessarily because overstretched maternity services are delivering substandard care and struggling to overcome entrenched poverty and racial inequalities, a report has warned.
    The report by baby loss charities Sands and Tommy’s says the government’s aim to halve the number of stillbirths and neonatal deaths in England by 2025 is stalling, while there is no target in Scotland, Wales or Northern Ireland.
    Stillbirths are creeping up in England after falling in the past decade. Babies dying before and during delivery rose to just over four in every 1,000 births in 2021. Similarly, long-falling rates of neonatal deaths, where newborns die within the first four weeks of birth, are also rising. There were 1.4 deaths of newborn babies for every 1,000 births in 2021, compared with 1.3 in 2020.
    Robert Wilson, head of the charities’ joint policy unit, said the government and NHS need to make fundamental changes. “The UK is not making enough progress to reduce rates of pregnancy loss and baby death, and there are worrying signs that these rates are now heading in the wrong direction,” he said.
    Read full story
    Source: The Guardian, 14 May 2023
  23. Patient Safety Learning
    Home test kits for a virus which attacks the liver are now available to order online in England, as the NHS tries to reach those needing treatment.
    Hepatitis C tends to affect current or past drug users and people who have had contact with infected blood through a tattoo or medical procedure abroad.
    It can lead to liver disease and cancer, but symptoms often go unnoticed for many years.
    The NHS website says it can usually be cured by taking a course of tablets.
    More than 70,000 people are thought to be living with the virus in England. Some may not know they have it, so would be unlikely to go to their GP for a test.
    Read full story
    Source: BBC News, 13 May 2023
  24. Patient Safety Learning
    Nurses fear they could be taken to court or struck off over the level of care they are able to give to patients, a union has warned, as the NHS stands on the brink of six more months of strikes.
    The Royal College of Nursing, one of the two unions to turn down the recent government pay offer to NHS staff, revealed that over nine in 10 A&E nurses had raised concerns that patients may be receiving unsafe care and that patient dignity, privacy and confidentiality is compromised.
    Six in 10 fear they will be struck off the nursing register or have a court case brought against them as a result of patient harm due to their working conditions, the RCN said.
    Ms Cullen insisted that patient safety is “at the centre of everything that we do” but warned that it “cannot be guaranteed on any day of the week”, given it is missing 47,000 nurses “every single day and night”.
    Speaking before its annual congress in Brighton, which begins on Monday, some nurses described themselves as “broken” and feeling “suicidal”, with corridor treatment being deemed “degrading for patients” and as “destroying staff morale”.
    Read full story
    Source: The Independent, 15 May 2023
  25. Patient Safety Learning
    Almost a quarter of people with dementia symptoms waited more than six months before seeing a doctor, new research shows.
    A new survey for the Alzheimer’s Society to mark Dementia Action Week also found one in three people who notice they or a loved one has symptoms keep their fears to themselves or dismiss them as old age.
    Just 15% of the 1,137 people surveyed raised the issue straight away and 11% said they hadn’t raised concerns after first spotting symptoms.
    Kate Lee, chief executive of the Alzheimer’s Society, said: “We can’t continue to avoid the ‘d’ word – we need to face dementia head-on.
    “As soon as you realise something is not right, come to Alzheimer’s Society – you can use our symptoms checklist to help have that all-important first chat with your GP.”
    An early diagnosis is crucial to help manage symptoms, according to the charity, which has launched a new campaign called – It’s not called getting old, it’s called getting ill – to encourage people to seek support in getting a diagnosis.
    Read full story
    Source: The Independent, 15 May 2023
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