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Patient Safety Learning

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  1. Patient Safety Learning
    India faces a “pandemic” of superbugs, the country’s top public health experts have warned, as resistance to common antibiotics has jumped by 10% in just one year
    In the fifth edition of its annual report on antimicrobial resistance (AMR), the Indian Council of Medical Research warned that urgent action is needed to prevent a major health crisis caused by the rampant misuse of antibiotics.
    “The resistance level is increasing to five to ten per cent every year for broad spectrum antimicrobials, which are highly misused,” said Dr Kamini Walia, who led the ICMR’s report.
    “Antibiotic resistance has the potential of taking the form of a pandemic in the near future if corrective measures are not taken immediately.”
    The report warned that only 43% of pneumonia infections in India could be treated with first line antibiotics in 2021 – down from 65% in 2016.
    “We could absolutely see a pandemic driven by AMR infections in India,” said Ramanan Laxminarayan, director of the One Health Trust, a global public health think tank. “It is certainly within the realms of possibility, it could be next year or over the next two decades.
    “Bacterial infections were the biggest killers in the early 20th Century and we risk going back to that time where there are no effective antibiotics and infections can spread rapidly,” he added.
    Read full story (paywalled)
    Source: The Telegraph, 16 September 2022
  2. Patient Safety Learning
    The chair of an inquiry into hundreds of deaths at a mental health trust has revealed she may not be able to deliver it in its current form following a ‘hugely disappointing’ lack of staff coming forward to give evidence.
    Former national clinical director for mental health, Geraldine Strathdee, chair of the non-statutory inquiry into deaths at Essex Partnership University Trust, has penned an open letter warning just 11 of 14,000 staff contacted said they will attend evidence sessions. 
    It was meant to report in spring 2023. However, after raising concerns with ministers, Dr Strathdee said she believes the inquiry will not be able to meet its terms of reference with a non-statutory status.
    The inquiry was announced in 2021 and last year chiefs revealed they were probing 1,500 deaths of people in contact with Essex mental health services between 1 January 2000 and 31 December 2020.
    However, without statutory powers, staff are not compelled to give evidence under oath. Many bereaved families, of which just one in four has engaged with the current probe, are campaigning for a statutory inquiry into deaths.
    Read full story (paywalled)
    Source: HSJ, 13 January 2023
  3. Patient Safety Learning
    Death rates from cancer in the US have fallen by 32% over the three decades from 1991 to 2019, according to the American Cancer Society.
    The decline is thanks to prevention, screening, early diagnosis and treatment of common cancers, including lung and breast cancer.
    The drop has meant 3.5m fewer deaths. However, cancers are still the second leading cause of death in the US, after heart disease.
    In 1991, the cancer death rate was 215 per 100,000 people and in 2019 it dropped to 146 per 100,000 people.
    Lung cancer, of which there are 230,000more cases each year, kills the most patients, 350 per day.
    But people are being diagnosed sooner, and technological advancements have increased the survival rate by three years.
    The report also examined racial and economic disparities in cancer outcomes.
    The Covid-19 pandemic added to already existing difficulties for marginalised groups to get cancer screenings and treatment.
    For nearly every type of cancer, white people have a higher survival rate than black people. Black women with breast cancer face a 41% higher death rate than white women.
    Read full story
    Source: BBC News, 12 January 2023
  4. Patient Safety Learning
    Health secretary Steve Barclay has privately conceded that he will have to offer a higher pay rise to NHS staff.
    Mr Barclay has admitted that more than one million NHS staff members deserve more money despite previously insisting that existing pay increases were all the government could afford.
    But, he also made clear that any new pay rises would come from the current health budget meaning potential cuts to key services, according to The Guardian.
    His U-turn comes in advance of nurses in England staging two more strikes next week, which is likely to force hospitals to again work at a reduced capacity following previous industrial action.
    Read full story
    Source: The Independent, 13 January 2023
  5. Patient Safety Learning
    ADHD awareness hassoared among women in the UK in the past year, but waiting times and the dearth of clinical awareness are leaving people awaiting diagnosis in a perilous position, leading experts have warned.
    Dr Max Davie, a consultant paediatrician and co-founder of ADHD UK, said that people talking openly about their diagnoses – including a number of high-profile celebreties – had led to more people seeking referrals for the condition.
    However, while awareness is increasing many trusts and private providers have shut waiting lists because of demand.
    “I think it’s probably as big a year as we’ve ever had. We are seeing a lot more people from all walks of life seeking a diagnosis later in life, particularly women,” Dr Davie said. “At the same time waiting lists have gone through the roof. NHS services have been swamped for a while and private providers are also closing their lists – there are wildly inadequate services for ADHD diagnosis, particularly for adults.”
    Dr Tony Lloyd, the chief executive of the ADHD foundation, said its own figures suggested a 400% increase in the number of adults seeking a diagnosis since 2020, adding that prescription volumes did not take account of those who do not use medication.
    “ADHD remains significantly under-diagnosed and under-treated in the UK – at great cost to public services and to the individual and the workforce,” he said. "Stigma around the condition, which the charity says affects one in 20 people in the UK, resulted in negative outcomes for individuals and high costs to the economy. Dismissing ADHD as a cultural construct and undeserving drain on finite NHS resources only adds to the enduring stigma and stereotyping of those with ADHD,” 
    Read full story
    Source: The Guardian, 13 January 2023
  6. Patient Safety Learning
    Eight trusts have been awarded roles trialling a new accreditation scheme for surgical hubs as part of an NHS England pilot that will run until March.
    The creation of up to 140 surgical hubs, sites which are ring-fenced for surgical work only, is a key plank of the NHS England and government elective recovery plan for addressing the backlog.
    The full benefits are still being finalised but accredited trusts will likely get better access to additional recovery funding and central support from the Getting It Right First Time team.
    The hubs will focus mainly on providing high volume, low complexity surgery, as previously recommended by the Royal College of Surgeons of England, with particular emphasis on ophthalmology, general surgery, trauma and orthopaedics (including spinal surgery), gynaecology, ear nose and throat, and urology.
    Read full story (paywalled)
    Source: HSJ, 12 January 2023
  7. Patient Safety Learning
    The intense pressure on the NHS in recent weeks has left hospitals unable to cope, patients at risk and staff in despair, writes an A&E doctor in this Guardian article.
    "I’ve worked in the NHS for over 10 years and I’ve never known it as bad as it is now. A&Es are swamped and primary care is swamped too. It’s a very sorry of state for all concerned. The last few weeks have been beyond dreadful and it was all predicted by those on the ground months ago".
    We’re now in a position in our A&E where we are looking after a ward and a half of admitted patients, who take up the bedded spaces, while simultaneously running an emergency department out of the corridor and waiting room. Having to manage the very sick in inappropriate areas is now becoming the norm.
    An emergency department (ED) is not a safe place. It’s filled with some of the sickest people in a hospital, in a chaotic environment. There are lots of comings and goings, with patients being moved frequently and staff looking after multiple patients. It’s a recipe for things getting missed.
    If you add in the fact that ED personnel work a shift rota, so new staff come on duty every few hours and they don’t necessarily know the patients, there is more scope for potentially vital information being lost.
    "As ED doctors, we have always tried to give the dying a place of privacy, where loved ones can be with them in some relative peace. I would hope that same degree of compassion was present in all A&Es, but it’s becoming more challenging to provide."
    Read full story
    Source: The Guardian, 12 January 2023

  8. Patient Safety Learning
    About 15 million more people in England could be prescribed daily cholesterol-lowering statin pills to cut their risk of heart attacks and stroke, new advice for the NHS says.
    Given the very cheap price of the tablets and the possible health gains, they should be considered more often, the draft guidance says.
    There can be side effects though and there is debate about how widely this long-term treatment should be given and what associated risks are acceptable.
    The National Institute for Health and Care Excellence (NICE), which advises the NHS, says people should be thoroughly assessed before statins are prescribed, warning the pills are not a quick fix or substitute for a healthy diet and exercise.
    The previous advice was for anyone with a one in 10 chance of having a cardiovascular event, such as a heart attack or stroke, within the next 10 years - based on factors such as age, blood pressure and cholesterol levels - to be offered a statin.
    But NICE now says including adults with a one in 20 chance could save 2% of them from having a heart attack or stroke during that period.
    Spokesman Paul Chrisp said patients should discuss the benefits and risks with their doctor, adding: "The evidence is clear, in our view, that for people with a risk of 10% or less over 10 years, statins are an appropriate choice."
    Read full story
    Source: BBC News, 12 January 2023
  9. Patient Safety Learning
    John Watkinson was one of the country's top ear, nose and throat surgeons.
    But Mr Watkinson's life and career were turned upside down when he was accused of shortening the lives of three patients, suspended and investigated.
    General Medical Council investigators would eventually close his case, taking no further action, and Mr Watkinson would receive an apology for what he had experienced from his employer University Hospitals Birmingham (UHB) NHS Trust.
    But that was six years after he was first suspended - six years that would see him pushed to the brink.
    "As doctors, we're trained in communication skills, we have appraisals, mandatory training," he says. "But the one thing we're not trained to cope with is when somebody declares war on you."
    The hospital trust stands by its decision to suspend Mr Watkinson and says its referral to the General Medical Council was "appropriately made following a clinical colleague raising significant concerns" about patient care.
    UHB has been in the spotlight in recent weeks, with reviews launched into its culture, leadership, and allegations of poor patient care aired in a Newsnight investigation late last year. It says a review into patient care is now well under way.
    Mr Watkinson says he was at the sharp end of this culture when he was suspended and suddenly went "from hero to zero".
    He accepts mistakes were made, but not just by him and not ones that would have affected the patients' outcomes.
    Read full story
    Source: BBC News, 13 January 2023
  10. Patient Safety Learning
    Other countries are looking on appalled as the UK’s failure to reform social care has left its health service struggling to survive.
    There are blockages on the way in to the hospital, blockages inside them, and perhaps most frustrating for healthcare staff and patients, blockages getting those who have been treated and have recovered out of the front door and home, or into the community.
    It is this last problem that is proving hardest to crack. Despite promises from successive UK prime ministers to mend the broken social care system, it remains completely dysfunctional.
    This country is by no means unique in its health and social care struggles. Even in nations often held up as having model healthcare systems – such as France and Germany – the combined pressures caused by ageing populations, financial constraints, recruitment problems, Covid-19 and flu have taken their toll.
    On the issue of social care, French doctors and experts admit to shortcomings, though not on the scale of those in the UK. “It’s not that we don’t have problems, but things are organised differently,” said Blanche Le Bihan, a professor at the French School of Public Health and researcher at the Arènes scientific research centre in Rennes specialising in social care.
    “The system is far too fragmented, that’s the main issue with social care in France – communication, coordination are always complicated,” Le Bihan says. “But while it’s far from perfect, it’s not a major factor in hospitals’ current problems.”
    Read full story
    Source: The Guardian, 8 January 2023
  11. Patient Safety Learning
    Pupils should learn what health problems they must not bother the NHS with, doctors and pharmacists have said.
    In a new strategy paper they call for a “wholesale cultural shift” towards more self-care, insisting this could both empower patients and reduce demand.
    Conditions like lower back pain, the common cold and acute sinusitis can generally be treated without the need for GPs or hospital visits, experts said.
    They called for the national curriculum to include requirements for both primary and secondary pupils to be taught to treat and manage common health problems at home. Medical students or pharmacists could go into school to offer lessons on “self-care techniques and signposting to appropriate use of NHS services”, they said.
    The paper is from the Self-Care Strategy Group, a coalition of pharmacy bodies and GP and patient groups.
    Read full story (paywalled)
    Source: The Times, 9 January 2023
  12. Patient Safety Learning
    More and more older people are being “warehoused” in inappropriate care beds, condemned unnecessarily to long-term care, and “lost” to health and care services, due to the rush to discharge from full hospitals and a lack of community rehab services, leaders have warned.
    Several senior figures in community and social care have raised the issue with HSJ, warning it has been a growing concern over the past 18 months of severe system pressure following on from acute covid peaks.
    The Health and Safety Investigation Branch has also raised the issue, telling HSJ inappropriate care placements are leading to harm and readmissions, while a major accountability gap remained over the safety of discharges.
    The average length of hospital stay has increased compared to pre-Covid, with a big jump in those staying more than three weeks. Many in the NHS put this down to a lack of social care capacity meaning more medically fit people are stuck in hospital. 
    Senior staff in community health and social care services told HSJ hospitals were increasingly demanding rapid discharges, often as part of “surge” measures when they are very full and under pressure to reduce ambulance queues. Homecare cannot be organised, and with suitable step-down and care beds also full, trusts are instead “spot purchasing” space in unsuitable homes which may be a long journey from the person’s home area, and in a different council area.
    Read full story (paywalled)
    Source: HSJ, 5 January 2023
    Further reading
    HSIB interim bulletin - Harm caused by delays in transferring patients to the right place of care
  13. Patient Safety Learning
    Rishi Sunak has held emergency talks over the weekend with NHS and care leaders in an attempt to tackle the winter healthcare crisis in England.
    The NHS Recovery Forum at No 10 on Saturday focused on four key issues: social care and delayed discharge, urgent and emergency care, elective care and primary care.
    A Downing Street spokesperson said the aim was “to help share knowledge and practical solutions so that we can tackle the most crucial challenges such as delayed discharge and emergency care”.
    But Sunak has been warned that the meeting is unlikely to reverse the NHS’s fortunes. Labour said patients deserved more than a “talking shop” and the Liberal Democrats said it was “too little, too late”.
    Senior doctors say the NHS is on a knife-edge, with many A&E units struggling to keep up with demand and trusts and ambulance services declaring critical incidents.
    Matthew Taylor, the chief executive of the NHS Confederation, said there were “no silver bullets” to solving the crisis at hospitals and other care centres.
    “This crisis has been a decade or more in the making and we are now paying the high price for years of inaction and managed decline,” he said. “Patients are experiencing delays that we haven’t seen for years".
    Read full story
    Source: The Guardian, 7 January 2023
  14. Patient Safety Learning
    Patient safety is at risk “every single day”, with patients in desperate need of intensive care waiting hours in Accident and Emergency departments across Scotland, the deputy chair of British Medical Association Scotland has said.
    The harrowing description of the scenes in hospitals came as health secretary Humza Yousaf admitted patients were receiving care he would not want to receive himself as the NHS continues to battle intense winter pressures.
    Dr Lailah Peel, deputy chair of the Scottish arm of the British Medical Association (BMA), told the BBC’s Sunday Show the crisis was “years in the making”. She blamed a creaking social care system and increased delayed discharges.
    The comments come after details of a January 2021 briefing from the Royal College of Emergency Medicine (RCEM) and the College of Paramedics to the health secretary warned of an unacceptable situation in Scotland’s hospitals.
    Reported in the Sunday Times, the briefing also specified the actions needed to avoid a similar situation during the current winter crisis, warning an increase of at least 1,000 new beds was needed as well as more doctors and nurses.
    Dr Peel said it was the case patients were “absolutely” dying in hospitals in Scotland due to the ongoing crisis in the health service. "There’s no shadow of a doubt that that is happening,” she told the BBC.
    Read full story
    Source: The Scotsman, 8 January 2023
  15. Patient Safety Learning
    The US Food and Drug Administration (FDA) has granted accelerated approval for the Alzheimer’s disease drug lecanemab, one of the first experimental dementia drugs to appear to slow the progression of cognitive decline.
    Lecanemab will be marketed as Leqembi, the FDA statement said. It has shown “potential” as an Alzheimer’s disease treatment by appearing to slow progression, according to Phase 3 trial results, but it has raised safety concerns due to its association with certain serious adverse events, including brain swelling and bleeding.
    In July, the FDA accepted Eisai’s Biologics License Application for lecanemab under the accelerated approval pathway and granted the drug priority review, according to the company. The accelerated approval programme allows for earlier approval of medications that treat serious conditions and “fill an unmet medical need” while the drugs continue to be studied in larger and longer trials.
    If those trials confirm that the drug provides a clinical benefit, the FDA could grant traditional approval. But if the confirmatory trial does not show benefit, the FDA has the regulatory procedures that could lead to taking the drug off the market.
    Read full story
    Source: CNN Health, 7 January 2023
  16. Patient Safety Learning
    A man plans to sue a nursing home because, he says, during the pandemic his mother was put on end-of-life care without her family being told.
    Antonia Stowell, 87, did not have the mental capacity to consent because she had dementia, say the family's lawyers. Her son, Tony Stowell, said if end-of-life care had been discussed, he would not have agreed to it.
    Rose Villa nursing home in Hull says all proper process in Mrs Stowell's care was followed with precision.
    As a prelude to legal action, Mr Stowell's lawyers have obtained his mother's hospital records which, they say, show she was diagnosed with suspected pneumonia while living in the home. End-of-life drugs were then prescribed and ordered by medical professionals.
    In a statement, Rose Villa said: "We believe that our dedicated and professional team provided Antonia with the very best care under the direction of her GP and medical team, and all proper process in the delivery of this care was followed with precision."
    Mr Stowell's lawyers, Gulbenkian Andonian solicitors, said his mother's hospital records reveal the decision to put her on end-of-life care was made two days before the family was told.
    In their letter to the home announcing the planned legal action, they said Mrs Stowell could have had "48 additional hours on a ventilator with treatment… with the necessary implication that Antonia Stowell could still be with us today or at least survived".
    The lawyer dealing with the case, Fadi Farhat, told the BBC: "As a matter of law, there is a presumption in favour of treatment which would preserve life and prolong life, irrespective of one's age or condition.
    "Therefore to deviate from that presumption means a patient, or family members, should be consulted as soon as that decision is made or contemplated."
    He adds: "What is particularly concerning for me is this case occurred at the height of the pandemic. That should worry everybody because it demonstrates that rights can be suspended in times of crisis, when the very purpose of legal rights is to protect us during times of crisis."
    Read full story
    Source: BBC News, 9 January 2023
  17. Patient Safety Learning
    Care providers are demanding double the usual fees to look after thousands of people who need to be discharged from hospitals to ease the crisis in the NHS.
    Care England, which represents the largest private care home providers, said on Sunday it wanted the government to pay them £1,500 a week per person, citing the need to pay care workers more and hire rehabilitation specialists so people languishing in hospital can eventually be sent home.
    The rate is about double what most local authorities currently pay for care home beds, an amount Martin Green, the chief executive of Care England, described as “inadequate”.
    The demand comes as the health secretary, Steve Barclay promised “urgent action” with up to £250m in new funding for the NHS to buy care beds to clear wards of medically fit patients. The money will be used to buy beds in care homes, hospices and hotels where people are looked after by homecare providers, as well as pay for hospital upgrades. Stays will be no longer than four weeks until the end of March.
    The use of hotels as care homes began during the pandemic and has been controversial, with reports of problems with hygiene and supplies of specialist equipment. The charity Age UK last week criticised their renewed use as “not an appropriate place to provide high-quality care for older people in need of support to recuperate after a spell in hospital”.
    Read full story
    Source: The Guardian, 9 January 2023
  18. Patient Safety Learning
    NHS trusts in England have increased recruitment from low-income “red list” countries to make up for the post-Brexit loss of EU staff, despite a code of practice to safeguard health services in those developing countries.
    A report by the Nuffield Trust thinktank also identified shortages in vital specialist areas since Brexit, including dentistry, cardiothoracic surgery and anaesthesiology.
    It found that Brexit is still causing issues with the supply of medicines in Northern Ireland despite a change in the arrangements put in place by the EU last April.
    The report says that since 2021, the Northern Ireland protocol obliging EU trade rules to be followed in the region has led to a different set of medicines being available compared with the rest of the UK.
    Of the 597 products specifically approved by the Medicines and Healthcare products Regulatory Agency since Brexit, “only eight were also approved for Northern Ireland under the same name and company”.
    It also found that since 2021, 52 products had been granted marketing authorisation for Northern Ireland but not in Great Britain under the EU approvals system, including a painkiller from the Slovenian company Sandoz Farmacevtska Druzba designed to stop people dying from opiate overdoses.
    The Democratic Unionist Party (DUP) described the report as “deeply alarming”.
    Read full story
    Source: The Guardian, 7 January 2023
  19. Patient Safety Learning
    With NHS staff being forced to witness our patients dying in corridors, in cupboards, on floors and in stranded ambulances, we can only thank our lucky stars that the country’s second most powerful politician is the man who last year published Zero: Eliminating Unnecessary Deaths in a Post-Pandemic NHS.
    Because the chancellor, Jeremy Hunt, cannot possibly stand back and permit these crisis conditions to continue, can he? He knows better than anyone – having written 320 pages on precisely this fact – that avoidable deaths are the very worst kinds of death, the ones that sicken families and clinicians to their core.
    Let’s remind ourselves of how strongly Hunt feels about this subject. The blurb of his book, published only last May, rings out with moral righteousness. “How many avoidable deaths are there in the NHS every week?” he asks. “150. What figure should we aim for? Zero. Mistakes happen. But nobody deserves to become a statistic in an NHS hospital. That’s why we need to aim for zero.”
    He even offers a road map towards achieving that end that, unusually for a politician, centres on radical candour. Don’t lie. Don’t deflect. Don’t spin. Don’t cover up. Be honest and open about mistakes and failures because this is the first, essential step to fixing them.
    To the collective despair of frontline staff, the government’s actual, as opposed to rhetorical, response to the humanitarian crisis gripping the NHS is a perverse inversion of everything the chancellor purports to hold dear.
    Read full story
    Source: The Guardian, 6 January 2023
  20. Patient Safety Learning
    The NHS is on the verge of collapse due to demand for healthcare rising significantly faster than funding levels, a consultant has warned. Peter Neville, a consultant for NHS Wales, took to social media to explain why, in his view, the system is failing.
    The consultant physician, who has been working in the NHS in Yorkshire and Wales for 32 years, set out the challenges facing the health service in a Twitter thread. He said he had experienced the NHS at its best, in 2008, and its worst, in 2022.
    He wrote: "Over at least the past 15 years, we have seen a relentless increase in demand, both in primary care and in hospital care. This has been absolutely predictable by social statisticians for decades and is based on the fact that our elderly are surviving much longer.
    "Our elderly use a very large percentage of NHS of resources, unsurprisingly because they are more prone to disease, frailty, and dementia. They need more social care and hospital care as they get older. And they are living longer. (Immigrants, by the way, use much less care).
    "Over this period NHS funding has, broadly speaking, risen about 1-2% over inflation. If NHS funding increases with inflation yet demand increases, then clearly spend per person will drop. Demand has increased considerably above 2%, which is why the NHS is failing to manage it."
    Read full story
    Source: Wales Online, 3 January 2023
  21. Patient Safety Learning
    Hours lost to ambulance handover delays, and the numbers of ambulances waiting more than an hour outside hospitals hit new highs in the week after Christmas.
    Data published this morning by NHS England revealed nearly 55,000 hours were lost to delays between 26 December and 1 January and 18,720 ambulances had to wait more than an hour to handover patients as emergency departments struggled, with many trusts declaring critical incidents.
    The number of hour-plus delays followed previous years’ trend of a slight dip in the week leading up to Christmas followed by an acceleration afterwards. However, levels this year were more than twice those seen in 2021 and three times those of the previous two years.
    Read full story (paywalled)
    Source: HSJ, 6 January 2023
  22. Patient Safety Learning
    Patients discharged from hospital without social care packages could die at home, doctors have warned.
    They said Welsh government advice to do this showed a system at breaking point.
    The British Medical Association (BMA) said it rejects the guidance to "change the risk threshold" for releasing people from hospital.
    The Welsh government said discharging patients could help them get better "by reducing the risk of infection and muscle wastage".
    Royal College of General Practitioners Wales chairwoman, Rowena Christmas, said the NHS was "unbelievably stretched".
    "A frail, elderly person coming home, who can't really safely get from their bed or their chair to the bathroom without risk of falling over, they're not going to be able to survive at home," Dr Christmas said.
    "I completely understand we need more beds, but that feels like a bad move."
    Read full story
    Source: BBC News, 6 January 2023
  23. Patient Safety Learning
    The extent of the gridlock in hospitals over Christmas has been revealed, with data in England showing record numbers of ambulances delayed dropping off patients at A&E.
    More than 40% of crews were forced to wait at least half an hour to hand over patients in the week up to 1 January.
    That is the highest level since records began a decade ago.
    But there is hope pressures could soon start easing, with flu and Covid admissions dropping last week.
    But the UK Health Security Agency is warning it is too early to say whether the flu season - the worst in a decade - has peaked, because reporting lags over the festive period may have affected the data.
    And Matthew Taylor, of the NHS Confederation, which represents hospitals, said wards were still incredibly full, which was creating delays in A&E and for ambulances.
    He said hospitals were facing "crisis conditions" that were presenting a risk to patients.
    Read full story
    Source: BBC News, 5 January 2023
  24. Patient Safety Learning
    An ICS chief has said the NHS workforce crisis is not the result of a ‘funding issue’ but caused by an inefficient use of resources.
    Patricia Miller, chief executive of Dorset Integrated Care Board, told a board meeting on Thursday that “constantly talking about the NHS needing more money” was undermining leaders’ case to government.
    She said: “We have got a workforce issue in the NHS, there is no doubt about that. I don’t actually believe we have got a funding issue. We just don’t use our resources very efficiently and I don’t think we do our case any positive favour with government when we’re constantly talking about the NHS needing more money when we can’t demonstrate that what we do is efficient.
    “So I don’t actually accept we’ve got a funding issue unless we start to work at the optimum and then we can absolutely demonstrate that.
    “I think what this comes down to is that our systems are too complicated and that starts at the centre, where every initiative we have is not about redesigning service models end-to-end but about layering on different solutions to different ends of the pathway and it just makes it more complicated.
    “I’ve no doubt that we’ve probably got 50-plus entrance and exit points to our urgent emergency care service, it’s ridiculous. I can’t navigate my way around 50 or 60, so there’s no way a patient can do it.”
    Read full story (paywalled)
    Source: HSJ, 6 January 2023
  25. Patient Safety Learning
    Junior doctors have threatened to stage a “full walkout” for three consecutive days in March in which they would not treat A&E patients.
    The British Medical Association told the government this morning that junior doctors would strike for 72 hours if it is supported in a ballot that opens next week. The association said that “doctors will not provide emergency care during the strike”, which is likely to worsen deadly accident and emergency delays.
    Hospital bosses said they were “deeply worried” by the BMA’s announcement, urging the government to start negotiating rather than “sitting back and letting more strikes happen”. NHS bosses fear that the BMA will co-ordinate strike action with the nursing and ambulance unions if the dispute is allowed to rumble on. Nurses will strike on January 18 and 19, and ambulance workers are due to walk out on January 11 and 23.
    Read full story (paywalled)
    Source: The Times, 6 January 2023
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