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Patient Safety Learning

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  1. Patient Safety Learning
    Patients contacting NHS 111 in England are having to wait so long for medical help that they are abandoning millions of calls, with 3.6m ditched in the past 12 months, official figures reveal.
    The national helpline service is supposed to make it quicker and easier for patients to get the right advice or treatment they need, either for their physical or mental health. It is billed as being open 24 hours a day, seven days a week.
    However, analysis by the House of Commons Library, commissioned by the Liberal Democrats, shows callers are waiting so long to speak to someone that nearly one in five give up. In 2022, 3,682,516 calls to NHS 111 were abandoned.
    MPs said the “dire” figures exposed how the NHS had reached “breaking point” after years of “neglect and underfunding” by the government.
    The data suggests that, on average, more than 10,000 callers hang up every day without receiving medical advice or treatment.
    As well as being distressing for those who are unwell, abandoned NHS 111 calls pose a risk to patient safety. The problem also increases pressure on other urgent care services as people seek care elsewhere.
    Read full story
    Source: The Guardian, 10 April 2023
  2. Patient Safety Learning
    Eighteen months after April Adcox learned she had skin cancer, she finally returned to Charleston's Medical University of South Carolina last May to seek treatment.
    Adcox had first met with physicians at the academic medical center in late 2020, after a biopsy diagnosed basal cell carcinoma. The operation to remove the cancer would require several physicians, she was told, including a neurosurgeon, because of how close it was to her brain.
    But Adcox was uninsured. She had lost her automotive plant job in the early days of the pandemic, and at the time of her diagnosis was equally panicked about the complex surgery and the prospect of a hefty bill. Instead of proceeding with treatment, she attempted to camouflage the expanding cancerous area for more than a year with hats and long bangs.
    If Adcox had developed breast or cervical cancer, she likely would have qualified for insurance coverage under a federal law that extends Medicaid eligibility to lower-income patients diagnosed with those two malignancies. For female patients with other types of cancer, as well as pretty much all male patients, the options are scant, especially in South Carolina and the 11 other states that haven't yet implemented Medicaid expansion, according to cancer physicians and health policy experts who study access to care.
    In the face of potentially daunting bills, uninsured adults sometimes delay care, which can result in worse survival outcomes, research shows. The odds of patients getting insurance to help cover the cost of treatment play out a bit like a game of roulette, depending upon where they live and what type of cancer they have.
    "It is very random — that's, I think, the heartbreaking part about it," said Dr. Evan Graboyes, a head and neck surgeon and one of Adcox's physicians. "Whether you live or die from cancer shouldn't really be related to what state you live in."
    Read full story
    Source: CBS News, 7 April 2023
     
  3. Patient Safety Learning
    Giving women a third scan at the end of their pregnancy could dramatically reduce the number of unexpected breech births and the risk of babies being born with severe health problems, research suggests.
    Pregnant women in the UK have routine scans at 12 and 20 weeks only, with no further scan offered in the third trimester unless they are considered at risk of a complicated pregnancy. The researchers hope their findings could lead to a change in guidance for clinicians that will improve maternity care.
    Prof Asma Khalil, who led the study at St George’s, University of London, said: “For the first time we’ve shown that just one extra scan could save mothers-to-be from trauma, an emergency C-section, and their babies from having severe health complications which could otherwise have been prevented.”
    She said the two routine scans were “far too early” to establish how the baby would be positioned during labour. “That’s why a third scan at 36-37 weeks could be a gamechanger to pregnancy and birth care.”
    Read full story
    Source: The Guardian, 7 April 2023
  4. Patient Safety Learning
    The leaders of acute trusts across England have told HSJ the second junior doctor’s strike ‘feels very different’ from the first stoppage, and services are much more vulnerable because of ‘thinner’ consultant coverage.
    They also reported that the instruction from NHS England not to proactively cancel elective procedures and apppointments has been largely ignored by trusts.
    The chief executive of a large trust in the east of England said they were “more concerned about clinical safety than at any time during covid surges”.
    A trust CEO in the North West told HSJ this week’s stoppage “feels much more risky than the previous strike. We have managed to cover rotas but we are very stretched and concerned about short notice cancellation from agencies and short term sickness after bank holiday.”
    Read full story (paywalled)
    Source: HSJ, 11 April 2023
  5. Patient Safety Learning
    Mehdian-Staffell, 37, is part of a new generation of female surgeons who are challenging the male-dominated culture in the profession.
    It is clear that she loves her job. “My aim is not just to be a surgeon – it is to be a damn good one. I didn’t go into it to be average,” she says. But she is also exhausted and demoralised. “The sexism comes from patients as well as other members of staff. People will assume you’re a nurse. I’ve previously worked in departments where the guys all went off to golf and men were prioritised for opportunities over women. Sometimes, as female surgeons, we feel as if we have to work twice as hard.”
    She says many of her more recent male colleagues have been supportive, but there is a systemic problem. Even the surgical instruments are made for male hands. Traditionally, surgeons are known as “Mr” rather than “Dr”, but women often get called by their first name.
    There have been darker moments. “I’ve been sexually harassed lots of times,” she says.
     In 2021 the Royal College commissioned the human rights lawyer Helena Kennedy to do a review of diversity and inclusion in surgery. “The evidence I had from women was that the culture was very male and the chat in and around the operating theatre for surgeons was often inappropriate. It’s really not a very conducive environment for women.” She made a raft of recommendations to improve the situation but says she is “disappointed” at how slowly they are being implemented.
    Read full story (paywalled)
    Source: The Times, 8 April 2023
    Related reading on the hub:
    Calling out the sexist and misogynist culture within healthcare: a blog by Dr Chelcie Jewitt, co-founder of the Surviving in Scrubs campaign  
  6. Patient Safety Learning
    A former adviser for the Care Quality Commission (CQC) has called on the regulator to explain what action it has taken against the officials responsible for wrongly dismissing him after he raised whistleblowing concerns.
    Shyam Kumar, a surgeon who was part of inspection teams in the North West, told HSJ that he had to live with question marks over his reputation for several years. He is furious that a senior CQC official sought to question his honesty and integrity in evidence submitted to the employment tribunal examing his dismisal.
    The tribunal heard Mr Kumar had raised a number of whistleblowing disclosures to the CQC, including concerns about the lack of appropriate expertise on inspection teams.
    After a wide-ranging review around its handling of whistleblowing concerns, CQC chief executive Ian Trenholm last week apologised to Mr Kumar for “unacceptably poor treatment” by his organisation, and thanked him for contributing to the review.
    However, Mr Kumar told HSJ: “I’m glad the CQC has looked at this and finally acknowledged what they did to me was wrong. But I want to know what has happened to the individuals that were responsible.”
    Read full story (paywalled)
    Source: HSJ, 6 April 2023
  7. Patient Safety Learning
    A single children’s mental health hospital with just 59 beds reported more than 1,600 “sexual safety incidents” in four years, shocking NHS figures reveal.
    Huntercombe Hospital in Maidenhead was responsible for more than half of the sex investigations reported in the 209 children’s mental health units across the country.
    Despite warnings at a rate of more than one a day to the health service since 2019, no action was taken to stop vulnerable NHS patients being sent to the scandal-hit unit as a result of the 1,643 sexual incident reports.
    The private unit is now finally due to be closed after an investigation by The Independent revealed allegations of verbal and physical abuse, prompting the NHS to withdraw patients. The hospital since said it plans to reopen as an adult unit.
    Figures obtained from the NHS show Huntercombe’s Maidenhead unit, Taplow Manor, was behind 57% of the 2,875 reported sexual incidents and assaults reported at England’s child and adolescent mental health services (CAMHS) over the past four years. Reported incidents can range from sexually inappropriate language to serious sexual assault and rape.
    Read full story
    Source: The Independent, 11 April 2023
  8. Patient Safety Learning
    A woman who may only have months to live has told the BBC she is "angry and frustrated" at being in hospital five months after being cleared to go home.
    Charlotte Mills-Murray, 34, said attempts to organise care at her family home had been repeatedly delayed.
    Charlotte lives with intestinal failure caused by a severe form of Ehlers-Danlos syndrome, which weakens her body's connective tissue.
    She was admitted to St James's Hospital in Leeds in June 2022 following an infection, and a new Hickman line - a tube that allows feeding and the administering of pain relief - was inserted.
    By November, Charlotte was told she was well enough to be cared for at home, but she remains in hospital following delays in the hiring and training of staff able to support her.
    With limited access to a hoist which would enable her to use her wheelchair, Charlotte said she had spent 10 months "stuck in bed".
    Because of the complexity of her condition, Charlotte only has months to live. She believes her situation merits greater urgency because of the increased risk of infection in hospital.
    Charlotte qualifies for 24-hour home care support through the NHS Continuing Healthcare scheme, but she said decisions over how this would be put in place had been slow and unclear.
    The BBC has found a 16% rise over the past year in the number of patients in England who are in hospital despite being well enough to leave.
    The Department of Health and Social Care said it was "fully committed to speeding up the safe discharge of patients who no longer need to be in hospital" and was making £1.6bn available in England over the next two years to support this, on top of £700m of extra funding in 2022 to ease NHS pressures over the winter.
    Read full story
    Source: BBC News, 9 April 2023
  9. Patient Safety Learning
    The four-day strike by junior doctors in England will have a “catastrophic impact” on NHS waiting lists, with up to 350,000 appointments and operations likely to be cancelled, the chief executive of the NHS Confederation has said.
    Matthew Taylor said the industrial action this week posed risks to patient safety and called on the public to avoid “risky behaviour”.
    “These strikes are going to have a catastrophic impact on the capacity of the NHS to recover services,” he told Sky News. “The health service has to meet high levels of demand at the same time as making inroads into that huge backlog that built up before Covid, but then built up much more during Covid."
    He said he hoped everyone who needed urgent care would get it, but added: “There’s no point hiding the fact that there will be risks to patients – risks to patient safety, risks to patient dignity – as we’re not able to provide the kind of care that we want to.”
    He called on the public to use NHS services responsibly.
    Read full story
    Source; The Guardian, 10 April 2023
  10. Patient Safety Learning
    The NHS should abolish many of its national targets while shifting its focus towards preventive healthcare, according to a review by a former Labour health secretary.
    The study by Patricia Hewitt, commissioned by the government said that, while targets can help concentrate the minds of those responsible for a service, having too many makes them less effective.
    It comes at a time when record numbers of people are on NHS waiting lists and as the health service in England continues to miss targets on A&E waits, the speed of ambulance responses, and cancer treatment times.
    The review sets out new targets and failing to provide adequate funding for new initiatives makes it far harder to plan new services and recruit staff.
    It  adds that an excessive focus on hitting targets by managers can lead to “gaming” of the targets and a “disastrous neglect of patients themselves”.
    Read full story
    Source: The Guardian, 3 April 2023
  11. Patient Safety Learning
    According to the South West Ambulance Service Foundation Trust, 104 patient deaths reviewed under National Quality Board guidelines in quarter three of 2022-23 related to delays “which are thought to be a result of pressures within the wider health system”.
    The trust has stressed the deaths were not necessarily directly caused by delays, but that delays were a “common factor” in the 104 cases.
    Since July 2019, all ambulance trusts have been required to implement Learning from Deaths reviews following a report by the Care Quality Commission three years earlier, which found that opportunities were being missed to learn from patient deaths.
    A total of 876 incidents were identified as being within the scope of a review at the end of last year by SWASFT, of which 210 were reviewed.
    Deaths included in the review occurred while the patient is under the care of the ambulance service, from the initial 999 call being made to their care being transferred to another part of the system or to the point where a decision is made not to convey them to hospital.
    Read full story (paywalled)
    Source: HSJ, 4 April 2023
  12. Patient Safety Learning
    The government is actively considering whether to give full legal powers to an independent inquiry investigating the deaths of mental health patients.
    Roughly 2,000 deaths at the Essex Partnership University NHS Foundation Trust (EPUT) are being examined.
    The BBC understands Conservative Health Secretary Stephen Barclay is minded to make the inquiry statutory, which would compel witnesses to come forward.
    Only 11 current and former trust staff have agreed to give live evidence.
    Melanie Leahy, whose son Matthew died aged 20 while an inpatient at the Linden Centre in Chelmsford, said families were "definitely" a step closer to what they had campaigned for.
    "We just need it converted [to a statutory inquiry] - it's just delay after delay after delay and we need those powers," she told BBC Essex.
    Read full story
    Source: BBC News, 3 April 2023
  13. Patient Safety Learning
    Funding promised to develop the social care workforce in England has been halved, the government has confirmed.
    In 2021 the government pledged "at least" £500 million for reforms, to be spent on training places and technology over three years.
    But that figure is now £250 million, according to the Department of Health.
    A coalition of charities said this cut is "just the latest in a long series of disappointments" over social care.
    The government said its reforms would give care "the status it deserves" but some organisations in the sector say they fall short of what is needed.
    Caroline Abrahams, co-chair of the Care and Support Alliance - which represents more than 70 charities - and charity director of Age UK, said the measures "aren't remotely enough to transform social care".
    Millions of older and disabled people and their carers "needed something far bigger, bolder and more genuinely strategic to give them hope for the future", she said.
    Read full story
    Source: BBC News, 4 April 2023
  14. Patient Safety Learning
    The independent sector should be commissioned to provide more NHS outpatient appointments, rather than just be focused on cutting cataract waiting lists, the president of the Royal College of Ophthalmologists has said.
    A “workforce census” survey carried out by the college and shared with HSJ found almost 60% of respondents believed independent providers were having a “negative impact” on care and ophthalmology services in their area.
    Speaking about its findings to HSJ, RCOphth president Bernie Chang said Covid had exacerbated problems caused by use of independent sector providers. These problems included cases being passed back to the NHS when IS care failed, and the NHS being left with a greater concentration of more serious, and costly, cases as the IS focussed on routine cataract operations.
    Read full story (paywalled)
    Source: HSJ, 3 April 2023
     
  15. Patient Safety Learning
    NHS England has told trust, system and regional leaders to avoid “block rescheduling” of elective cases during the four-day junior doctors’ strike next month.
    In a letter sent by national medical director Sir Steve Powis and NHSE’s chief operating officer Sir David Sloman, NHS leaders are asked instead to use “rolling day-to-day cancellations” and reschedule cases “based on clinical risk”.
    The letter also urges leaders to maintain “as much day case and outpatient capacity as possible” and to use digital or virtual consultations to support outpatient delivery. However, it acknowledges that because of the “unprecedented scale and timing of these strikes we accept that rescheduling activity is going to be essential to minimise risks to patients”.
    Read full story (paywalled)
    Source: HSJ, 31 March 2023
  16. Patient Safety Learning
    NHS England has launched a “very aggressive campaign” to ensure all acute trusts give patients the ability to make appointments and receive messages online. 
    Details of the new “national requirement” which must be met by the end of 2023-24 were sent by NHS England to acute trust chief information officers on Friday.
    NHSE wants all trust portals to integrate with the NHS App to enable patients to manage outpatient appointments and respond to messages through a single channel. 
    Under NHSE’s requirements, the portals must:
    Enable patients to view their outpatient appointments; Enable the trust to send a waiting list validation questionnaire to patients; Provide patients with a single point of access to contact the provider, for example to cancel appointments; and Enable patients to access their correspondence from the trust. Read full story (paywalled)
    Source: HSJ, 31 March 2023
  17. Patient Safety Learning
    Doctors are warning that embarrassment about naming parts of the female anatomy is putting women's health in jeopardy.
    Dr Aziza Sesay said the hyper-sexualisation of women's bodies and anatomy "perpetuates the taboo, stigma and embarrassment".
    She said it could lead to women not getting the medical help they need.
    She said a lot of women's health conditions are often considered benign - meaning they're not life-threatening - but that she disliked the term as it minimised "how much it will affect someone's life".
    Dr Sesay is one of a number of women's health specialists who are due to appear at Cardiff's Everywoman Festival on 24 June, where topics will range from periods to menopause.
    The festival is the brainchild of colorectal surgeon, Julie Cornish, who works for Cardiff and Vale health board.
    She said "embarrassing" symptoms are all too often never discussed.
    "It's not uncommon to see patients who waited 10, 15 years with symptoms," she said. "It's got to the point where they've had to stop working, or their relationship has broken down.
    "People retire early, they stop working or stop socialising. And that delay often means it's more severe. They might need surgery rather than simple physiotherapy, dietary tricks or modifications that could've worked so easily early on."
    Read full story
    Source: BBC News, 3 April 2023
  18. Patient Safety Learning
    The director of a leading pharmacy chain invited to advise the prime minister on healthcare reform has claimed the NHS makes people too “lazy” to take responsibility for their health.
    Day Lewis director Sam Patel also said the fact the NHS was “free” meant there was little “jeopardy” discouraging people from becoming ill, and encouraged people to accept a lower level of care.
    Mr Patel’s fellow Day Lewis director Jay Patel was one of the private healthcare leaders invited to Rishi Sunak’s Downing Street health summit this January. The company has more than 250 branches concentrated in London and the south of England.
    Speaking at an event organised by strategy advisory firm Global Counsel last week, Mr Patel said: “Having an NHS fundamentally makes too many people lazy about taking care of their own health.
    “Anything that’s free we just accept a lower level of care…. [We should be] making sure we’re taking good care of ourselves with vitamins, minerals, supplements, staying fit."
    ”... the jeopardy of feeling ill is not that bad because you get taken care of. In other countries, even in emerging markets like India where my parents originally come from, people spend vast amounts to make sure they don’t get ill because there is jeopardy in doing so. We need to change the population’s mindset to take care of themselves.”
    Read full story (paywalled)
    Source: HSJ, 3 April 2023
  19. Patient Safety Learning
    Adults in Northern Ireland seeking assessment for attention deficit hyperactivity disorder (ADHD) are being forced to go private because of a dire lack of referral services in some areas, a charity has said.
    Some health trusts have not been able to accept new referrals for adult assessment and diagnosis.
    ADHD charities said a lack of services or even waiting lists has forced many people to pay for a private diagnosis.
    The charity's chief executive Sarah Salters added that some people who do get a private diagnosis cannot then get medication from their GP through the NHS.
    The Department of Health said officials "are considering longer-term arrangements" for ADHD services, with future decisions "likely to be subject to ministerial approval and availability of funding".
    Read full story
    Source: BBC News, 2 April 2023
  20. Patient Safety Learning
    Thousands of children experiencing “unacceptable” long waits for NHS treatment face a “lifelong” impact on their health, a senior doctor has warned, as shocking figures reveal that nearly 15,000 paediatric operations were cancelled over the last year.
    Dr Camilla Kingdon, president of the Royal College of Paediatrics and Child Health, said the mounting treatment backlog in England risked “serious” and “devastating” physical and mental consequences for children and their families.
    She sounded the alarm as data obtained under freedom of information laws by the Liberal Democrats showed that a record high 14,628 children’s operations were postponed in 2022, up from 11,870 the year before and the highest in five years of data examined. Some children have now waited several years for surgery, according to the data.
    Delaying a child’s operation risks having a “lifelong impact” on their development, Kingdon said, and also “seriously impact” their mental health, with knock-on effects on their ability to socialise, go to school and reach their full potential.
    Read full story
    Source: The Guardian, 3 April 2023
  21. Patient Safety Learning
    NHS trusts have been given until 2027-28 to employ enough midwives to meet safe staffing requirements, NHS England’s new maternity delivery plan has said.
    The three-year delivery plan for maternity and neonatal services sets out to “make maternity and neonatal care safer, more personalised and more equitable for women, babies and families”.
    It says: “Trusts will meet establishment [requirements] set by midwifery staffing tools and achieve fill rates by 2027-28, with new tools to guide safe staffing for other professions from 2023-24.”
    The plan follows a series of high-profile maternity scandals in the NHS at Shrewsbury and Telford, East Kent, Morecambe Bay and an ongoing independent review by Donna Ockenden into Nottingham University Hospitals Trust. The Care Quality Commission has highlighted a string of other concerns across the NHS.
    Read full story
    Source: HSJ, 31 March 2023
  22. Patient Safety Learning
    The care watchdog is investigating possible safeguarding failures at an NHS trust after a documentary uncovered figures showing there were 24 alleged rapes and 18 alleged sexual offences in just three years at one of its mental health hospitals.
    The Care Quality Commission (CQC) told Disability News Service (DNS) that it had suspended the trust’s ratings for wards for people with learning difficulties and autistic people while it carried out checks.
    The figures were secured by the team behind Locked Away: Our Autism Scandal, a film for Channel 4’s Dispatches, which revealed the poor and inappropriate treatment and abuse experienced by autistic people in mental health units.
    None of the alleged rapes at Littlebrook Hospital in Dartford, Kent, led to a prosecution, with allegations of 12 rapes and 15 further sexual offences dropped because of “evidential difficulties” and investigations into 12 other alleged rapes and two sexual offences failing to identify a suspect.
    A CQC spokesperson said: “Sexual offences are a matter for the police in the first instance.
    “However, we take reports of sexual offences seriously and review them all, and raise these issues directly with the trust.
    “We do this alongside involvement from police and local authority safeguarding teams’ own investigations and monitor any actions and outcomes taken by the trust to ensure people are kept safe."
    Read full story
    Source: 30 March 2023
  23. Patient Safety Learning
    Covid testing is being scaled back even further in England from April.
    It is part of the "living with Covid" approach that relies on vaccines to keep people safe.
    Most staff and patients in hospitals and care homes will no longer be given swab tests, even if they have symptoms.
    Some will though, such as staff working with severely immunocompromised patients or if there is an outbreak on a ward or in a hospice or prison, for example.
    The long-running Office for National Statistics Covid infection survey that estimated how many people in the community had the virus each week - based on nose and throat swabs from volunteers - has already come to an end.
    The final one suggested 1.7 million people - about one out of every 35 (2.7%) - had Covid in the week ending 13 March, a14% rise on the previous week.
    But the UK Health Security Agency says thanks to the continuing success of the vaccination programme, testing in England can now become more like the approach used for other common respiratory infections such as flu.
    Read full story
    Source: BBC News, 30 March 2023
  24. Patient Safety Learning
    Cancer drug information leaflets for patients in Europe frequently omit important facts, while some are “potentially misleading” when it comes to treatment benefits and related uncertainties, researchers have found.
    Cancer is the biggest killer in Europe after heart conditions, with more than 3.7m new cases and 1.9m deaths every year, according to the World Health Organization.
    Medicines are a vital weapon against the disease. But critical facts about them are often missing from official sources of information provided to patients, clinicians and the public, according to a study led by researchers from King’s College London, Harvard Medical School and the University of Sydney, among others.
    “Regulated information sources for anticancer drugs in Europe fail to address the information needs of patients,” the study’s authors wrote in The BMJ journal. “If patients lack access to such information, clinical decisions may not align with their preferences and needs.”
    Read full story
    Source: The Guardian, 29 March 2023
  25. Patient Safety Learning
    Bupa is set to cut 85 dental practices amid a national shortage of dentists, in a move that will affect 1,200 staff across the UK.
    The group said patients at some practices were unable to access the NHS dental service they need.
    Bupa, which provides NHS and private care, said the 85 practices would be closed, sold or merged later this year.
    The healthcare group's boss said the industry faced "systematic challenges" and the decision was a "last resort".
    In August the BBC revealed 9 in 10 NHS dental practices across the UK were not accepting new adult patients for treatment under the health service.
    Bupa has not been able to recruit enough dentists to deliver NHS care in many practices for months and in some cases years, it said.
    Read full story
    Source: BBC News, 30 March 2023
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