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Patient Safety Learning

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  1. Patient Safety Learning
    Record levels of overheating and a sharp rise in flooding at England’s hospitals are putting vulnerable patients at risk, figures show.
    Analysis of NHS data by the Liberal Democrats found that the number of health trusts reporting overheating in clinical areas had doubled compared with six years ago, and floods had increased by nearly 60% from last year.
    An overheating incident is logged when an occupied ward or clinical area’s daily maximum temperature exceeds 26C, the temperature at which some patients become unable to cool themselves effectively.
    The latest government figures show that in the summer of 2022 there were an estimated 2,985 excess deaths due to heatwaves, the highest number on record. Heatwaves also forced a fifth of UK hospitals to cancel operations.
    The number of serious flooding incidents, where water caused disruption such as by breaching a building or flooding a road, rose from 176 to 279.
    The climate crisis is expected to increase these risks to hospitals and patients. Helen Buckingham, the director of strategy at the Nuffield Trust, said: “These figures are a cause for real concern about the resilience of the NHS’s estate to the growing threat from extreme weather in the UK. As temperatures have climbed, so too have the number of overheating incidents in NHS hospitals.”
    Read full story
    Source: The Guardian, 27 November 2023
  2. Patient Safety Learning
    The government should declare a national NHS major incident to rescue the healthcare system from the current crisis, a senior health official says.
    Dr Tim Cooksley, president of the Society for Acute Medicine (SAM), says that the pressures on the NHS seen over the festive period are not new. He added that a number of recommendations had been outlined since the pandemic that offer the “best hope” of a short-term solution.
    Declaring a national NHS major incident would mean all four UK nations would co-ordinate their response and allocate resources to help meet the overwhelming demand for care that is enveloping many hospitals around the country. Taking that step would help combat the current situation, Dr Cooksley says, which NHS chiefs believe is having a similar effect on the service to the first wave of the Covid-19 pandemic.
    “The current situation in urgent and emergency care is shocking. It is in a critical state for patients and it is an extremely difficult for healthcare staff who are unable to deliver the care they want to," Dr Cooksley said. “Political leaders across the UK need to listen, meet urgently and accept the need to declare a national NHS major incident.
    "The outcome must be a four-nation emergency strategy which results in short-term stabilisation, medium-term improvement and long-term growth – the grave situation we are in means it will be a long journey. Sustainable workforce and capacity plans are required urgently to boost morale among staff and patients – as we have long called for – and we now need to see action.”
    Read full story
    Source: Manchester Evening News, 1 January 2022
  3. Patient Safety Learning
    Up to 500 people are dying every week because of delays in emergency care, Britain’s top accident and emergency doctor has said.
    Dr Adrian Boyle, the president of the Royal College of Emergency Medicine (RCEM), said a bad flu season was compounding systemic problems, leading to hundreds of unnecessary deaths.
    NHS leaders warned last week that the health service is in the grip of a “twindemic”, with soaring flu admissions and the impact of Covid “hitting staff hard”.
    Dr Boyle told Times Radio: “If you look at the graphs they all are going the wrong way, and I think there needs to be a real reset. We need to be in a situation where we cannot just shrug our shoulders and say this winter was terrible, let’s do nothing until next winter.
    “We need to increase our capacity within our hospitals, we need to make sure that there are alternative ways so that people aren’t all just funnelled into the ambulance service and emergency department. We cannot continue like this – it is unsafe and it is undignified.”
    Read full story
    Source: The Telegraph, 1 January 2023
  4. Patient Safety Learning
    A hospital is investigating how a pair of metal surgical forceps were left inside a patient after they had been stitched up after abdominal surgery.
    Worcestershire Acute Hospitals NHS trust has apologised unreservedly and said the incident at Redditch’s Alexandra hospital was “exceptionally rare”.
    The medical blunder only became apparent after a seven-hour abdominal procedure last month, according to BBC Midlands, when the forceps were reported to be missing.
    The worst fears of medics were confirmed when the missing 15cm arterial clamp was found by an X-ray while the patient was still under anaesthetic.
    The surgical instrument could not be immediately removed and the patient was moved to intensive care overnight before another operation was performed the next day to retrieve the clamp.
    It is understood the trust’s investigation will look at whether the required double-checking of all instruments was conducted before the patient was stitched up after surgery. It will also examine the end of operation signing-out process, which is supposed to ensure such errors do not happen.
    Read full story
    Source: The Guardian, 23 December 2022
  5. Patient Safety Learning
    NHS England has revealed the latest list of trusts which it has identified as needing the most support to meet electives and cancer targets.
    The national body identified 15 trusts which have been assessed as being at most risk of not meeting the key targets of either having no patients waiting 78 weeks or more for elective treatment by April 2023, or returning their 62-day cancer waiting list backlog to pre-pandemic levels by March 2023.
    The 15 challenged trusts, which make up around 12% of acute trusts in England, are receiving “tier one” support which involves oversight from national teams, on-site expertise, extra funding and recruitment, and possible calls between their CEOs and government ministers.
    NHS England said it has recently added four trusts to “tier one” for electives and cancer – York and Scarborough Teaching Hospitals Foundation Trust, Sheffield Teaching Hospitals FT, North West Anglia FT, and Royal Devon and Exeter FT. York and Scarborough FT, Sheffield FT, and North West Anglia FT has previously been in tier two for cancer services only, while Royal Devon and Exeter FT had previously been in tier one for electives only but is now in tier one support for cancer as well.  
    Read full story (paywalled)
    Source: HSJ, 23 December 2022
  6. Patient Safety Learning
    Nurses will go on strike again on 18 and 19 January in England unless pay talks are opened, the Royal College of Nursing (RCN) has said.
    Nurses at more hospital trusts than before will be involved in the strike action in the new year, the union said.
    Meanwhile, the GMB union has called off a second day of ambulance strikes planned in England and Wales for 28 December.
    But it announced a new co-ordinated walkout on 11 January.
    Read full story
    Source: BBC News, 23 December 2022
  7. Patient Safety Learning
    England’s network of community pharmacies is “close to collapse”, with serious consequences for millions of patients, industry leaders have warned.
    In a letter sent to Steve Barclay, the health secretary, they cautioned that “as a sector we are now at a fork in the road”, and urged him to “make a critical choice about the role you want pharmacies to play”.
    The government has said it wants to make more use of community pharmacies in England to ease pressures on GP surgeries and accident and emergency departments. But the letter argues that funding cuts over the past seven years makes this goal unrealistic.
    It warns: “Many pharmacies are now dispensing at a loss and facing a serious cashflow crisis which we fear if not addressed, will rapidly move towards many permanent closures. We fear that once they start, closures will be hard to stop, as the sector is now so fragile other pharmacies would struggle to pick up the slack.
    “We are deeply concerned that this will put medicine supply at risk — with serious consequences for the millions of people who rely on dispensed prescriptions every year.” 
    Read full story (paywalled)
    Source: The Times, 23 December 2022
  8. Patient Safety Learning
    Ambulance staff in five areas of England are to stage two further strikes in January, union leaders say.
    The industrial action on 11 and 23 January is likely to heap more pressure on emergency care, which is already under serious strain.
    Health Secretary Steve Barclay said further strike action was in no one's best interest.
    Unison leaders say the action is a direct result of the government's refusal to negotiate over pay.
    Life-threatening calls to 999, as well as the most serious emergency calls, will still be responded to, they say.
    Services in London, Yorkshire, the North West, North East and South West will take action over pay and staffing.
    The January strikes will each last for 24 hours from midnight, Unison says, and will involve all ambulance employees - not just 999 response crews.
    Read full story
    Source: BBC News, 22 December 2022
  9. Patient Safety Learning
    Flu and Covid are on the rise in England, with experts stressing the importance of vaccination and warning that people who feel unwell should stay at home rather than mingling with others during the festive season.
    The figures come as cases of scarlet fever and strep A infections continue to rise.
    The UK Health Security Agency (UKHSA) added that while invasive strep A infections remain rare there have now been a total of 94 deaths in England, including 21 children.
    Dr Colin Brown, the deputy director at UKHSA, sought to reassure parents. “I understand how this large rise in scarlet fever and ‘strep throat’ may be concerning to parents, however the condition can be easily treated with antibiotics and it is very rare that a child will go on to become more seriously ill,” he said, adding that parents should visit NHS.UK, contact 111 online or their GP surgery if their child has symptoms so they can be assessed for treatment.
    Dr Mary Ramsay, the director of public health programmes at UKHSA, noted a link between indoor mixing and the rise in cases and hospital admissions for flu and Covid.
    “Both Covid and flu can cause severe illness or even death for those most vulnerable in our communities, and so it is also important to avoid contact with other people if you are unwell in order to help stop infections spreading over the Christmas and new year period,” she said.
    Read full story
    Source: The Guardian, 23 December 2022
  10. Patient Safety Learning
    The antiviral, molnupiravir, does not reduce coronavirus hospital admissions or deaths in vaccinated people at high risk, new research suggests.
    But the treatment was associated with a shorter recovery time, by four days, and reduced viral load.
    People who received molnupiravir reported feeling better compared to those who received usual care, the study found.
    Researchers suggest that while the drug could have some benefits in terms of symptom reduction, the cost of the drug may mean it is not the best choice for the general population, given the study findings.
    But it may be useful in reducing the pressure on UK health systems, they added.
    Chris Butler, professor of primary care in the Nuffield Department of Primary Care Health Sciences and co-chief investigator of Panoramic, said: “Finding effective, safe and scalable early treatments for Covid-19 in the community is the next major frontier in our research response to the ongoing worldwide pandemic.
    “It is in the community where treatments could have a massive reach and impact.
    “But decisions about who to treat should always be based on evidence from rigorous clinical trials that involve people who would most likely be prescribed the drugs.”
    Read full story
    Source: The Independent, 23 December 2022
  11. Patient Safety Learning
    A teaching hospital that was lauded for its culture and championed by ministers has been downgraded from ‘outstanding’ to ‘requires improvement’ by the Care Quality Commission.
    CQC inspectors found multiple issues at Salford Royal Hospital during an inspection in August and September. These included nurse staffing, governance, and some cultural concerns. The trust’s urgent and emergency services were rated “inadequate” for safety.
    The hospital in Greater Manchester had been rated “outstanding” since 2015, and was frequently hailed as a leader on the patient safety agenda, particularly by former health secretary Jeremy Hunt.
    Read full story (paywalled)
    Source: HSJ, 22 December 2022
  12. Patient Safety Learning
    Hospice charities providing end-of-life services in partnership with the NHS have warned they will have to shut beds and sack staff because of the catastrophic impact of rising energy bills on their day-to-day running costs.
    The UK’s network of independent, mainly voluntary-run palliative care providers said hospices were experiencing a perfect storm of soaring costs and rising demand just as revenues from traditional public fundraising methods are collapsing.
    They have also warned that many patients who receive palliative care at home are struggling to maintain optimal care standards because they can’t afford to run central heating and the electrical medical equipment used in their everyday clinical care.
    Hospices, which typically rely on charitable donations for 70%-80% of their running costs, and which are intensive users of gas and electricity, have reported facing energy bill rises of up to 350%.
    Rachel McMillan, the chief executive of one of the UK’s biggest hospices, St Ann’s, in Greater Manchester, said: “We are at the point where we will have to take some very difficult decisions in terms of our business model and our service provision. Closing beds would be a last resort, but we are seriously going to have to think about this.
    “The government needs to sit up and listen to hospices; we are an essential part of the care delivery system. We are not a luxury.”
    Read full story
    Source: 22 December 2022
  13. Patient Safety Learning
    The NHS entered the last six hours of the ambulance strike with a sense that the real test will be seen in the coming days.
    Call volumes were down and many A&Es quieter than in previous days. NHS111 was very busy.
    Despite the fears expressed by leaders ahead of the strike not yet coming to fruition, the day ended with eight integrated care systems declaring critical incidents, along with all striking ambulance trusts and a number of hospital trusts.
    Leaders across the country told HSJ they feared that those who stayed away today in response to pleas for “common sense” amid industrial action may come back tomorrow, seeing demand return strongly.
    A senior London source said: “The ambulances will have stacked some calls and we may have a flood of movement tomorrow.”
    Read full story (paywalled)
    Source: HSJ, 21 December 2022
  14. Patient Safety Learning
    Ambulance unions have reacted with anger after the health secretary said they had "taken a conscious choice to inflict harm on patients".
    Steve Barclay said unions had refused to work with the government at a national level on how they would cover emergency calls during strike action.
    Unison said it was "utterly shocked" by the comments, while the GMB union said they were "insulting".
    Paramedics are among those striking in England and Wales on Wednesday.
    Control room staff and support workers who are members of the Unison, GMB and Unite unions are also involved.
    NHS bosses are warning patient safety cannot be guaranteed during the action, although unions say life-threatening callouts will still be responded to by an ambulance.
    They also argue patients are already being put at risk due to waiting times and the pressure on the health service, made worse by staff shortages.
    Read full story
    Source: BBC News, 21 December 2022
  15. Patient Safety Learning
    The number of suspected scarlet fever cases since September has risen to nearly 30,000 after the UK Health Security Agency added almost 10,000 potential new infections in the last week.
    More than 27,000 people could have had infections since 12 September, according to the UKHSA, who revealed on Tuesday that there were more cases than first thought because of the “significant rise” in infections.
    The figures come from medical practitioners referring suspected cases to the local authority or health protection team.
    A total of 16 children aged under 18 have died from invasive group A streptococcus (iGAS), otherwise known as strep A.
    Parents are advised to contact 111 or a GP surgery if a child has symptoms. They can also include nausea and vomiting.
    New serious shortage protocols were issued to pharmacists last week in an attempt to help those experiencing supply issues with penicillin.
    Chemists had widely reported problems getting hold of liquid penicillin and amoxycillin due to the increase in demand. The antibiotics are often prescribed for children who have scarlet fever or strep A. People in the industry have also reported rising prices.
    Pharmacists are now able to prescribe an alternative antibiotic or formulation of penicillin, such as tablets.
    Read full story
    Source: The Guardian, 20 December 2022
  16. Patient Safety Learning
    The risk to patients will only get worse unless the government reaches an agreement to prevent further strikes, NHS leaders have warned.
    In a letter to the prime minister and health secretary, they said there was "deep worry" about today's strike.
    People are being asked to only call 999 in a life-threatening emergency, but NHS England says emergency care will continue to be provided.
    Ambulance response times are already twice as long as two years ago.
    The letter, signed by the leaders of NHS Confederation and NHS Providers, says the action being taken by ambulance workers "isn't just about pay but working conditions: many have said they are doing this because they no longer feel able to provide the level of care that their patients need and deserve."
    They urged ministers to "do all you can to bring about an agreed solution".
    Health Secretary Steve Barclay said the pay deal on offer to both ambulance staff and nurses had been agreed by an independent pay review body.
    In England, eight out of the 10 major ambulance services have declared critical incidents - a sign of the intense pressure they are already under.
    Ministers have urged the public to take extra care and suggested they avoid contact sports and unnecessary car journeys.
    Read full story
    Source: The Guardian, 21 December 2022
  17. Patient Safety Learning
    The Welsh ambulance service has apologised after a 93-year-old woman was left “screaming in pain” while lying on the floor with a broken hip during a 25-hour ambulance wait.
    Elizabeth Davies fell at her care home on Saturday and was finally picked up at 1.15pm on Sunday and admitted to Ysbyty Gwynedd hospital in Bangor on Monday, where she endured another 12-hour wait before being admitted to a ward. A hip fracture was later confirmed in surgery.
    Her family have said the incident, which occurred before a 24-hour strike on Wednesday by ambulance workers, was “unacceptable”. Her son, Ian Davies, from Pwllheli, said: “It was very upsetting to have to see her lying on the floor screaming in pain for over 24 hours.”
    After her injury, staff at the care home, where Davies has lived for 17 years, are understood to have propped a pillow under her head and tried to make her comfortable on the wooden floor, using a small heater to keep her warm in case she went into shock, as well as providing an absorbent pad so she could urinate.
    Her son, a community care worker, said: “They called for an ambulance but were advised an ambulance wouldn’t be available for six to eight hours as they were so busy.
    “They said my mother would be a priority because of her age. The care home then called us and we came immediately.
    “I don’t blame the ambulance staff because they are told what jobs to do and my mother wasn’t on the list.”
    It is understood the care home made nine calls, with a 10th made by Ian Davies.
    Read full story
    Source: The Guardian, 20 December 2022
  18. Patient Safety Learning
    The mother of a sick girl has confronted the health secretary during a hospital visit in London, telling him that NHS staff are “worked to the bone” and the government is doing “terrible damage” to families on waiting lists.
    Sarah Pinnington-Auld, whose three-year-old daughter, Lucy, has cystic fibrosis, rebuked Steve Barclay over NHS staff working conditions and long waits for treatment as he visited King’s College hospital.
    She told the Conservative cabinet minister how her daughter was pushed off an “absolutely horrific” waiting list because of “the obscene number of people who came through and the lack of resources”.
    “The damage that you’re doing to families like myself is terrible, because it was agony for us as a family waiting for that call,” she said. “Preparing our children, for their sister and her hospital visit, for then it to be cancelled. And I know you look and we’re all numbers, but actually they’re people waiting for care.”
    “The doctors, the nurses, everyone on the ward is just brilliant, considering what they’re under, considering the shortage of staff, considering the lack of resources,” she said.
    “That’s what’s really upsetting, actually, because we have a daughter with a life-limiting, life-shortening condition and we have some brilliant experts and they’re being worked to the bone, and actually the level of care they provide is amazing, but they are not being able to provide it in the way they want to provide it because the resourcing is not there.”
    Read full story
    Source: The Guardian, 19 December 2022
  19. Patient Safety Learning
    Some patients waiting for an endoscopy in Guernsey may be "at risk" because of a large backlog in procedures, the States medical director has warned.
    The government has announced a tender process to bring in clinicians to help clear the list, which is three times longer than before the Covid pandemic.
    More than 430 people were on the gastroenterology waiting list as of Tuesday, Dr Peter Rabey said.
    "We're worried that there is risk to patients in waiting too long," he said.
    "Although a lot of patients who get an endoscopy have completely normal results, and some have benign disease which can be treated with tablets and things, there will be some patients who might have cancer and we need to find out as best as possible".
    Read full story
    Source: BBC News, 20 December 2022
  20. Patient Safety Learning
    Health minister Will Quince has warned the public to avoid any “risky activities” on Wednesday as ambulance drivers stage strike action.
    The NHS is set to be hit by major disruption as ambulance workers including paramedics, control room workers and technicians walk out in England and Wales.
    During the strike, the military will not drive ambulances on blue lights for the most serious calls but are expected to provide support on other calls.
    Mr Quince urged the public to avoid anything risky on Wednesday, telling BBC Breakfast: “Where people are planning any risky activity, I would strongly encourage them not to do so because there will be disruption on the day.”
    The health minister did not offer examples of what might be defined as risky behaviour but told the public that in any emergency calling 999 should still be the first option.
    Read full story
    Source: The Independent, 20 December 2022
  21. Patient Safety Learning
    The Birmingham MP Preet Gill has called on the UK health secretary to launch a major public inquiry into allegations that a bullying and a toxic culture is risking patient safety at University Hospitals Birmingham (UHB).
    The MP for Edgbaston, where UHB is based, said she had received complaints from staff alleging elderly patients had been left on beds in corridors outside wards due to mismanagement, and medics were discouraged from speaking out about problems.
    In a letter to Steve Barclay, seen by the Guardian, Gill said: “I have been inundated by messages from UHB staff, past and present, who have contacted me to share their experience of what has been repeatedly described as a toxic culture that has had an alarming impact on staff and patient care.”
    After an investigation by BBC Newsnight earlier this month, which found that doctors at the trust were “punished” for raising safety concerns, the Birmingham and Solihull Integrated Care Board (ICB) announced a three-part review into the culture at UHB. The first report is expected at the end of January.
    But Gill criticised the plans, saying she did not think it would “be sufficient to adequately investigate this scandal”, and instead called for a major independent public inquiry, similar to the 2013 Francis inquiry into the Stafford hospital scandal.
    “We cannot rely on an ICB investigation to solve this issue. Many of those on the ICB are former members of the senior leadership team from UHB and would not offer the independence required to recommend the changes that are so needed or give confidence to whistleblowers,” she said.
    Read full story
    Source: The Guardian, 19 December 2022
  22. Patient Safety Learning
    The NHS in England has more funding and staff than before the pandemic - but in many types of care, it is treating fewer patients. Why?
    The Institute for Fiscal Studies (IFS) says this is a puzzle with no simple explanation - but the pandemic has dealt a lasting blow to the NHS and it could be costing more to treat patients, on average, than before.
    Despite higher staff sickness rates, compared with pre-pandemic levels, the NHS has available to work:
    8% more nurses 9% more consultants 15% more junior doctors. But - not counting those filled by patients who have tested positive for Covid, even though they may be there mainly for something else - there were 5% fewer beds available in the third quarter of this year than in 2019, the IFS says.
    IFS research economist Max Warner says: "The NHS is showing clear signs of strain heading into the winter and is treating fewer patients than it was pre-pandemic, across many types of care.
    "The real risk, almost three years on from the start of the pandemic, is that the Covid hit to NHS performance is not time-limited.
    "Going forward, we need to grapple with the possibility that the health service is just able to treat fewer patients with the same level of resources."
    A Department of Health spokesperson said: "As the IFS report acknowledges, Covid had a significant impact on the NHS, and we are focused on delivering the biggest catch-up programme in health history".
    Read full story
    Source: BBC News, 14 December 2022
  23. Patient Safety Learning
    Police are investigating allegations of rape of a child involving two staff members at a scandal-hit mental health hospital, The Independent can reveal.
    Thames Valley Police confirmed it has launched an investigation after a report last month of rape made by a former patient of Taplow Manor, a private hospital in Maidenhead, Berkshire, run by The Huntercombe Group.
    The incident was reported to have taken place in 2019. Mark McGhee, a solicitor for Hutcheon Law, who is representing the family of the patient in a clinical negligence claim, said the allegation had been raised to the police about the patient who was a child and that the allegation involves two staff members at the time.
    In October, The Independent and Sky News revealed allegations of “systemic abuse” from 20 patients across The Huntercombe Group’s children’s mental health hospitals – Taplow Manor, Ivetsey Bank near Stafford, Watcombe Hall in Torquay, and The Huntercombe Hospital Norwich.
    Since the report, 30 more patients have come forward with allegations of poor treatment and the provider now also faces nine legal claims from former patients.
    Thames Valley Police are also investigating an incident involving the death of a child at the Maidenhead hospital in February. The CQC is conducting a separate criminal investigation into the serious incident which resulted in the death of the young person.
    Read full story
    Source: The Independent, 19 December 2022
  24. Patient Safety Learning
    Nurses in England, Wales and Northern Ireland will strike today in an ongoing dispute with the government about pay and concerns about patient safety.
    Up to 100,000 members of the Royal College of Nursing (RCN) will take part after it balloted its members in October. It has said that low pay is the cause of chronic understaffing that is putting patients at risk and leaves NHS staff overworked.
    It will be the second day of strikes in December, after an initial day of industrial action on 15 December, the RCN’s biggest in its history. It meant the cancellation of thousands of outpatient appointments and non-urgent operations.
    More strikes have been threatened for January unless talks between union negotiators and the government takes place before Thursday, 48 hours after the strike on Tuesday.
    The RCN’s general secretary and chief executive, Pat Cullen, said: “For many of us, this is our first time striking and our emotions are really mixed. The NHS is in crisis, the nursing profession can’t take any more, our loved ones are already suffering.
    “It is not unreasonable to demand better. This is not something that can wait. We are committed to our patients and always will be.”
    Read full story
    Source: The Guardian, 20 December 2022
  25. Patient Safety Learning
    Nine ambulance trusts in England and Wales are expected to be affected by industrial action on Wednesday, coordinated by the GMB, Unison and Unite unions.
    The ambulance strikes will involve paramedics as well as control-room staff and support workers. The threat to patient safety on Wednesday will be exceptional.
    Under trade union laws, life-preserving care must be provided during the strikes. But there remains a lack of clarity about what will be offered. Even at this late stage, NHS leaders say negotiations are continuing between unions and ambulance services to agree which incidents will be exempt from strike action.
    All category 1 calls – the most life-threatening cases – will be responded to, while some ambulance trusts have agreed exemptions with unions for specific incidents within category 2 calls.
    However, in some cases, elderly people who fall during the strikes may not be sent help until they have spent several hours on the floor. Heart attack and stroke patients may get an ambulance only if treatment is deemed “time critical”.
    There is no doubt that many of those patients making 999 calls on Wednesday will not get the care they need. Some will probably die as a result.
    NHS leaders believe Wednesday’s strike will present a completely different magnitude of risk. Quite simply, patients not getting emergency treatment quickly enough can mean the difference between life and death.
    Read full story
    Source: The Guardian, 19 December 2022
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