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Patient Safety Learning

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  1. Patient Safety Learning
    Ministers have effectively ditched NHS England’s planned new bundle of A&E targets and want trusts to be firmly regulated on the existing four-hour standard and 12-hour breaches, HSJ understands.
    Multiple senior figures familiar with the process, from inside the NHS and government, said the performance focus for the next two years will be on the two existing accident and emergency waiting time measures, as well as ambulance handover delays.
    For the last three years, NHS England has been lobbying government to scrap the headline four-hour target, and replace it with a bundle of measures which have been trialled at around a dozen providers. This work has been led by medical director Steve Powis.
    HSJ understands the decision to continue using the existing four-hour target was driven by concerns among ministers and senior NHS figures that the bundle of measures was too confusing, both for patients and as a means for government to hold the service to account.
    Read full story (paywalled)
    Source: HSJ, 23 November 2022
  2. Patient Safety Learning
    A report by the Scottish Public Services Ombudsman (SPSO) said the health board's own investigation into the patient's complaint was of "poor quality" and "failed to acknowledge the significant and unreasonable delays" suffered.
    The delays led 'Patient C' to develop a severe hernia which left them unable to work, reliant on welfare benefits, and requiring riskier and more complex surgery than originally planned.
    The watchdog criticised NHS bosses for blaming Covid for the delays when the patient had been ready for surgery since December 2018, and said there had been "no sense of urgency" despite "the gravity of C's situation".
    The report said: "It is of significant concern that the Board has failed to fully acknowledge the consequences of the delays and the adverse effects upon C's physical and mental health as a result.
    "The consequences for C of these delays cannot and should not be underestimated."
    Read full story
    Source: The Herald, 24 November 2022
  3. Patient Safety Learning
    For the first time, more than 2.5 million people in the UK are out of work because of a long-term health problem. The number has jumped by half a million since the start of the pandemic - but, BBC News analysis reveals, the impact is spread unevenly across the country, with some regions and types of job far more affected.
    For Mary Starling, there are good days and bad days.
    The 61-year-old is on strong painkillers, for arthritis. She needs a knee replacement - but that could mean another 18 months on an NHS waiting list.
    Mary is keen to return to that work - but needs her operation first.
    "I feel despair - but I'm resigned to it," she says. "I understand it isn't possible to magic up something, though it's wearing not being able to plan my life."
    The UK is in its fourth year of sharply rising chronic illness. The highest rates are among 50- to 64-year-olds, but there have also been significant increases in some younger groups.
    Although the link is not conclusive, the Bank of England has said record NHS waiting lists are likely to be playing a "significant role".
    Some of the largest increases are in people reporting mobility difficulties, such as leg and back problems, or heart and blood-pressure problems. More younger people, in particular, say they are not in work because of different forms of mental illness.
    But the largest increase in long-term sickness is in the catch-all "other health problems" category, likely to include some of those with "long Covid" symptoms.
    Read full story
    Source: BBC News, 23 November 2022
  4. Patient Safety Learning
    The NHS staffing crisis will be solved only if doctors and nurses get more flexible about their job descriptions and break down barriers between roles, according to Rishi Sunak’s health adviser.
    Bill Morgan argues that training times for doctors and nurses may have to be reduced, and suggests developing “sub-consultants” and entirely new medical professions, He wants ministers to create an Office for Budget Responsibility-style body to predict future workforce needs.
    The Treasury has held down the numbers of doctors and nurses Britain trains to prevent “supply-induced demand”, which encourages people to seek appointments that are not needed, Morgan argues.
    Chronic shortages of qualified staff are the biggest problem facing the health service, which has more than 130,000 vacancies. Morgan acknowledges that this means “some of the government’s key manifesto commitments will not be met”, citing the promise of 6,000 extra GPs.
    Sunak said this week that the government was “thinking creatively about what new roles and capabilities we need in the healthcare workforce of the future”. He urged the NHS to shed “conventional wisdom”.
    Read full story (paywalled)
    Source: The Times, 24 November 2022
  5. Patient Safety Learning
    Ministers are considering the use of body cameras within mental health units as part of the government’s response to NHS abuse scandals, The Independent has learned.
    Senior sources with knowledge of the conversation between the Department for Health and Social Care and the NHS have raised concerns about the plans. There are fears that using the technology in mental health units could have implications for human rights and patient confidentiality.
    One senior figure criticised the proposals and said: “The DHSC are all talking about body-worn cameras, closed circuit TV, etc... The whole thing is fraught with huge difficulties regarding human rights, about confidentiality. They are thinking about it [cameras] and it is ridiculous.”
    The DHSC’s mental health minister Maria Caulfield said in parliament earlier this month that she and health secretary Steve Barclay were due to meet with NHS officials to discuss what response was needed to recent exposes of abuse within mental health services.
    It comes after a string of reports from The Independent, BBC Panorama and Dispatches revealing abuse of inpatients. The Panorama and Dispatches reports included video evidence of abuse captured by hidden cameras.
    Following a scathing independent review into the deaths of three young women, Tees, Esk and Wear Valleys NHS Trust said it is piloting the use of body-worn cameras across 10 inpatient wards “to support post incident reviews for staff and patients.”
    Read full story
    Source: The Independent, 23 November 2022
  6. Patient Safety Learning
    Ambulance crews could not respond to almost one in four 999 calls last month – the most ever – because so many were tied up outside A&Es waiting to hand patients over, dramatic new NHS figures show.
    An estimated 5,000 patients in England – also the highest number on record – potentially suffered “severe harm” through waiting so long either to be admitted to A&E or just to get an ambulance to turn up to help them.
    Ambulance officers warned that patients were dying every day directly because of the delays since the service could no longer perform its role as a “safety net” for people needing urgent medical help.
    “The life-saving safety net that NHS ambulance services provide is being severely compromised by these unnecessary delays and patients are dying and coming to harm as a result on a daily basis,” said Martin Flaherty, managing director of the Association of Ambulance Chief Executives (AACE), which represents the heads of England’s 10 regional NHS ambulance services.
    Flaherty added: “Our national data for hospital handover delays during October 2022 is extremely worrying and underlines the fact that in some parts of the country efforts to reduce or eradicate these devastating and unnecessary delays are simply not working.”
    Read full story
    Source: The Guardian, 23 November 2022
  7. Patient Safety Learning
    Greater Manchester’s mental health trust has been placed into the ‘equivalent of special measures’, the Manchester Evening News can reveal. The crisis measures enforced by the NHS come after allegations that patients were abused at a mental health unit run by the beleaguered trust.
    The Edenfield Centre is a mental health care facility in the grounds of the former Prestwich Hospital and was the subject of a BBC Panorama programme that claims patients were abused. Since the episode aired, 30 staff are facing disciplinary action and a dozen have already been sacked, the Manchester Evening News understands.
    The chair of the trust, Rupert Nichols, resigned last week after 'inexcusable behaviour and examples of unacceptable care' were 'exposed' at a mental health unit, he said. Now, NHS England is placing the Recovery Support Programme, the 'equivalent to the former special measures', multiple senior NHS sources say.
    Greater Manchester Mental Health NHS Foundation Trust (GMMH) is now under the highest level of NHS England intervention, the M.E.N. can confirm. Every trust is part of the NHS' Oversight Framework, those placed into its highest level are identified as experiencing the most significant and complex challenges in achieving financial sustainability and/or high-quality care receive intensive mandatory support.
    Read full story
    Source: 23 November 2022, Manchester Evening News
  8. Patient Safety Learning
    Attending physicians and advanced practice clinicians in US emergency departments are more concerned about medical errors resulting in patient harm than in malpractice litigation, according to a study published JAMA Network Open.
    The findings are based on an online survey of 1,222 ED clinicians across acute care hospitals in Massachusetts from January to September 2020. Respondents used a Likert scale of 1 (strongly disagree) to 6 (strongly agree) to indicate their degree of agreement with statements on how fearful they are of making a mistake that leads to a patient harm in their day-to-day practice, and how fearful they are of an error that results in being sued. 
    The mean score was greater for fear of harm (4.40) than fear of being sued (3.40), the findings showed. Researchers said the mean scores for both fear of harm and fear of suit were similar regardless of whether the survey was completed before or after onset of the COVID-19 pandemic.
    Although previous studies have associated clinicians' fear of legal concerns with "excessive healthcare use through defensive medicine," the role fear of patient harm may play in clinical decision-making is less documented, researchers said. 
    "Although the study did not delineate the association between this concern and potential overuse of testing, it suggested that fear of harm should be considered with, and may be more consequential, than fear of suit in medical decision-making," researchers said. 
    Read full story
    Source: Becker's Hospital Review, 21 November 2022
  9. Patient Safety Learning
    A young mother lost both her feet and all 10 fingers to sepsis after a significant delay in treatment, an investigation has found.
    Sadie Kemp has been left permanently disabled from the “dangerous condition”, whilst an NHS hospital probe found a 3.5 hour delay in starting her care.
    Sadie is now calling for lessons to be learned after the internal report found numerous concerns in her treatment that ultimately led to her needing multiple amputations.
    The 35-year-old mother-of-two first attended A&E with agonising back pain caused by a kidney stone on Christmas night 2021.
    She was given pain relief at Hinchingbrooke Hospital, Cambridgeshire, and sent home to return the following morning for a kidney scan.
    She returned the same night at 4am as her pain endured.
    An assessment at 5.40am found she may have also been suffering from sepsis, but the step-by-step guide to chart and treat the illness was not found in her notes as being done at the time.
    The investigation found not only should the sepsis have been discovered and treated sooner, but the “lack of effective treatment” of the sepsis prior to the surgery meant she needed prolonged critical care.
    Read full story
    Source: The Independent, 22 November 2022
  10. Patient Safety Learning
    Performance failings at NHS Supply Chain are impacting patient care, staff wellbeing and retention, and local procurement teams are struggling to mitigate their impact, local procurement chiefs have claimed.
    The group of senior NHS buyers have raised their concerns in a highly critical letter to NHS Supply Chain chief executive Andrew New and NHS England’s chief commercial officer Jacqui Rock.
    The letter, seen by HSJ, was signed by 22 heads of procurement at trusts and integrated care systems. It raises concerns about the NHSSC’s core functions, like delivering products on time and in full, its governance, and highlights unanswered questions about how it interacts with NHSE’s new central commercial function.
    Read full story (paywalled)
    Source: HSJ, 22 November 2022
  11. Patient Safety Learning
    Ill patients are refusing sicknotes from their GP because they cannot afford time off work, while doctors suffer “moral distress” at their powerlessness to do more to help the most vulnerable, the new leader of Britain’s family doctors has revealed.
    More patients are experiencing asthma attacks or other serious breathing problems because they cannot afford to heat their homes, said Dr Kamila Hawthorne, the chair of the Royal College of GPs, while many have reported deteriorating mental health due to financial stress.
    Soaring food costs are also leading to a rise in fatigue, mouth ulcers and weak muscles, with people deficient in key vitamins because they cannot afford to eat anything other than a poor diet.
    So many patients are presenting with complex physical and psychological problems related to poverty, domestic violence, childhood abuse or poor housing that GPs are suffering psychologically from their inability to take the requisite action, she said.
    Hawthorne said: “Recently I’ve had patients refusing sicknotes because they can’t afford not to work. Quite often, when it’s clear that somebody needs some time off, they won’t take it.
    “These are people who ideally, medically, should not be at work [because] they have a chronic condition such as asthma or diabetes, but quite often mental health problems, quite severe mental health problems, I [see] some cases that really do require a bit of sicknote peace and quiet to try and help them get better.
    “I’ve been really surprised in the last year that when I’ve offered a sicknote they’ve said: ‘Oh no, no, I can’t take time off. I need the money from work.’ They’ve refused. They say: ‘I need to keep working to earn and to feed myself and my family.’ I don’t take it personally, of course, but I feel sad for people because for a few minutes you enter their lives and see that it’s really tough.”
    Read full story
    Source: The Guardian, 23 November 2022
  12. Patient Safety Learning
    A maternity unit criticised for the preventable stillbirth of a baby is under investigation after the unexpected death of a second baby.
    The newborn baby died in December last year after her birth at the standalone midwifery-led unit (MLU) at Lagan Valley Hospital in Lisburn.
    Despite this, the unit continued to operate as normal for another three months when the South Eastern Trust temporarily paused births at the MLU.
    The second tragedy came four years after Jaxon McVey was stillborn when his delivery at the unit went catastrophically wrong.
    A post-mortem found he died as a result of shoulder dystocia – an obstetric emergency where the head is born but the shoulder becomes trapped behind the pubic bone.
    Jaxon’s mum, Christine McCleery, has hit out at the South Eastern Trust and raised concerns over the measures put in place following his stillbirth on Mother’s Day 2017.
    “I feel like they didn’t learn from Jaxon,” she said.
    “I don’t know if any other babies died before Jaxon, but I know one died afterwards.
    Read full story (paywalled)
    Source: The Independent, 23 November 2022
  13. Patient Safety Learning
    An NHS England director says trusts should use ‘as robust triage as you can possibly do’ when deciding whether to accept referrals from GPs.
    Ian Eardley, NHSE’s joint national clinical director for elective recovery, was asked during an internal NHSE webinar how trusts can encourage GPs to work more closely with secondary care to make sure they only send appropriate referrals.
    He said: “There’s got to be as robust triage as you can possibly do, so if you’ve got referrals coming in which haven’t got the relevant or wrong information, then I think you need senior clinicians in a position to go back to the GP and say we need this bit of information or the other… Ultimately, it’s about robust front-end management.”
    However, he admitted it was a “difficult [issue and] really difficult to do anything centrally”.
    Read full story (paywalled)
    Source: HSJ, 23 November 2022
  14. Patient Safety Learning
    NHS therapy services won’t be able to manage increased demand driven by the cost of a living crisis as they are already thousands of therapists short, The Independent has been told.
    NHS counselling services in England are not meeting therapy access targets due to a shortfall of 2,000 workers, according to sources.
    The findings come as a poll by the UK Council for Psychotherapy (UKCP) and YouGov, shared with The Independent, found that almost one in two adults felt the cost of living crisis was affecting their mental health.
    According to the survey of more than 2,000 adults, 25 to 34 years old were most likely to say the cost of the living crisis was impacting their mental health.
    Adam Jones, policy and public affairs manager for the UKCP, said “I think what we’re concerned about is the fact that already, there is a record level of demand for mental health services. We also know there are record rates of prescription for antidepressant medication as well. We’re concerned the capacity currently is already falling short.
    “So with the rising demand going forward, we’re concerned that services are going to be stretched, waiting time is going to go up, average number of therapy sessions received is going to go down
    He warned that although the NHS is focussed on training new therapists, there was already an existing workforce of psychotherapists and counsellors who don’t work in the NHS.
    “We’d like to see more targeted recruitment of psychotherapists and counsellors who are already trained, and so that most would only require a short adaptive training to be able to work in an NHS context.”
    Read full story
    Source: The Independent, 23 November 2022
  15. Patient Safety Learning
    Menopausal women working in NHS England will be able to work flexibly should they need to under new guidance.
    Launching the first national NHS guidance on menopause, the NHS England chief executive, Amanda Pritchard, has called on other employers to follow suit to help “break the stigma”.
    She said many employees were “silently suffering” and were either too embarrassed to broach the subject or experience a “lack of support” when they did.
    No one should feel their only option is to “turn their back on their career” over menopausal symptoms, she added. “It’s our responsibility as leaders to ensure this doesn’t happen any longer.”
    The guidance aims to boost awareness as well as support the introduction of practical measures including flexible working patterns – including lighter duties, fans to make temperatures more comfortable, cooler uniforms and staff training.
    “Our guidance has been intentionally designed to be transferable to other workplaces too, so I hope organisations and women beyond the NHS can also benefit,” she said.
    Read full story
    Source: The Guardian, 23 November 2022
  16. Patient Safety Learning
    Contrary to current advice, getting pregnant within a few months of an abortion or a miscarriage does not appear to be extra risky for the mum and baby, say researchers who have looked at recent real-life data.
    The World Health Organization (WHO) recommends at least a six-month gap to give the woman time to recover.
    However, a study in PLoS Medicine, analysing 72,000 conceptions, suggests couples might safely try sooner for a baby.
    The baby loss support charity Tommy's says women who feel ready to try again immediately after a miscarriage should do so if there is no medical reason against it.
    The WHO says more research into pregnancy spacing is already under way and would inform any future updates to the advice.
    The research from Norway, spanning eight years from 2008 to 2016, found no major differences in outcomes when a new pregnancy happened sooner than a six-month delay.
    That is a different finding to earlier work in Latin America that - along with other studies - informed the WHO recommendations on pregnancy spacing.
    The authors of the latest Norwegian analysis say the advice needs reviewing so that couples can make an informed decision about when to try for a baby.
    Read full story
    Source: BBC News, 23 November 2022
  17. Patient Safety Learning
    Doctors are prescribing heating to patients with conditions that get worse in the cold as part of a health trial.
    The Warm Home Prescription pilot paid to heat the homes of 28 low-income patients to avoid the cost of hospital care if they became more ill.
    Michelle Davis, who has arthritis and serious pulmonary illness, had her energy bills paid for and said the difference was "mind-blowing".
    "When the weather turns cold, I tend to seize up," she told the BBC. "It's very painful, my joints ache and my bones are like hot pokers."
    In 2020 Ms Davis spent most of the winter in bed, trying to keep warm and was admitted to hospital with pneumonia and pleurisy. But not in winter 2021.
    "You're not stuck in bed, you're not going to hospital, my children were able to have a life, they were able to go out and play and get cold," she said.
    Academics estimate that cold homes cost NHS England £860m a year and that 10,000 people die every year due a cold home. But that research was completed before the current cost of living crisis took hold.
    This first trial achieved such good results, that it's being expanded to 150 households in NHS Gloucestershire's area, plus about 1,000 in Aberdeen and Teesside.
    Dr Matt Lipson helped design the pilot programme and feels like this preventative step is a no-brainer for the health service.
    "If we buy the energy people need but can't afford, they can keep warm at home and stay out of hospital," he said. "That would target support to where it's needed, save money overall and take pressure off the health service."
    The change in patients was swift: "The NHS were telling us they were seeing a benefit much more quickly than pills and potions," Dr Lipson added. "It was taking days, not weeks and months."
    Read full story
    Source: BBC News, 22 November 2022
  18. Patient Safety Learning
    A major acute trust says it plans to move away from its significant use of agency doctors from overseas, who have been reported to be working on terms and conditions far below their NHS-employed counterparts.
    East Kent Hospitals University Foundation Trust has a contract with the NES Healthcare agency to supply 47 “resident medical officers (RMO)” across its three main sites to cover trauma and orthopaedics, medical and surgical rotas.
    HSJ has been told of concerns that RMO's are reporting substantial overworking, and poor terms and conditions, although some of these claims are disputed by NES.
    East Kent chief medical officer Rebecca Martin has told HSJ: “The well-being of all our colleagues is one of our top priorities and we are working with the agency about how they cover the rota safely".
    “We are committed to providing a safe workplace environment, where RMOs feel comfortable communicating their feedback and we review working patterns to ensure adequate rest periods between shifts. We are actively working to use substantive staff to fill vacancies, and have already been able to offer some of those positions to current RMOs.”
    Read full story (paywalled)
    Source: HSJ, 22 November 2022
  19. Patient Safety Learning
    The government has been urged to protect “catastrophically” under-resourced mental health social services after a vulnerable man was discharged from a hospital into a Travelodge.
    Will Mann, a 42-year-old with long-term mental health illness, was “abandoned” by social care services after he was discharged from an NHS hospital, his mother Jackie has said.
    Speaking with The Independent, Jackie Mann, explained how Will, who had to declare himself homeless before his discharge this year, was told the only available housing accommodation for him was a Travelodge.
    Mr Manns story has sparked warnings over the state of the shortage of social care and supported accommodation for those with severe mental illness, from the charity Rethink Mental Illness, which warned: “This is another reminder of how the crisis engulfing social care is impacting people’s lives, and why the government must protect mental health in the upcoming budget.”
    In an interview with The Independent, Jackie Mann, Mr Mann’s mother said: “He had to go straight from there to a Travelodge in Christchurch, which was a very unsuitable place because it was just a room, no cooking facilities.
    “During the time he was there, nobody came to visit him, he was just sort of abandoned there and during his time there, he was told he had to leave the Travelodge and go to another one because that Travelodge was overbooked.”
    According to our major charity Rethink, the shortage of “appropriate accommodation” is one of the biggest drivers of delayed discharges for mental health patients.
    Read full story
    Source: The Independent, 21 November 2022
  20. Patient Safety Learning
    A coroner has written to the health secretary warning a lack of guidance around a bacteria that could contaminate new hospitals' water supply may lead to future deaths.
    It follows inquests into the deaths of Anne Martinez, 65, and Karen Starling, 54, who died a year after undergoing double lung transplants at the Royal Papworth Hospital in Cambridge in 2019.
    Both were exposed to Mycobacterium abscessus, likely to have come from the site's water supply.
    The coroner said there was evidence the risks of similar contamination was "especially acute for new hospitals".
    In a prevention of future deaths report, external, Keith Morton KC, assistant coroner for Cambridgeshire and Peterborough, said 34 people had contracted the bacteria at the hospital since it opened at its new site in 2019.
    He said the bacteria "poses a risk of death to those who are immuno-suppressed" and there was a "lack of understanding" about how it entered the water system.
    There was "no guidance on the identification and control" of mycobacterium abscesses, the coroner said.
    Mr Morton said documentation on safe water in hospitals needed "urgent review and amendment".
    "Consideration needs to be given to whether special or additional measures are required in respect of the design, installation, commissioning and operation of hospital water systems in new hospitals," he said.
    Read full story
    Source: BBC News, 22 November 2022
  21. Patient Safety Learning
    When David Morganti’s case notes landed on Andrew Cox’s desk this autumn they told a devastating story — but one which was depressingly familiar to the senior coroner for Cornwall.
    The 87-year-old RAF veteran had fallen and hit his head in the bathroom of the house he shared with his wife, Valerie, in April. It took nine hours for paramedics to reach their home near St Austell, Cornwall. As they waited, the bleeding on his brain became gradually worse until he lost consciousness. By the time he reached hospital it was too late. An expert neurosurgeon told Cox that had he reached hospital faster, Morganti might have survived.
    The coroner said the effects of the injuries he suffered were likely to have been exacerbated “by a delay in the arrival of an ambulance and his subsequent admission into hospital.”
    It was the latest in a series of similar deaths the coroner had encountered. 
    After Morganti’s inquest, Cox resolved to carry out a wider investigation into what appeared to be a broken system. He has now sent his findings to Steve Barclay, the health secretary, and demanded he act to prevent more deaths.
    Read full story (paywalled)
    Source: The Times, 19 November 2022
  22. Patient Safety Learning
    At a time when it feels like the world’s perpetually on fire, we all need a therapist – but trying to find one in the USA is difficult.
    A study from the American Psychological Association (APA) found that 6 in 10 psychologists “no longer have openings for new patients” in America. The shortage comes as demand for therapy soars: since the beginning of the pandemic, about three-quarters of practitioners have seen their waiting lists expand. In the same period, almost 80% of practitioners report an increase in patients with anxiety disorders and 66% have seen an increase in those needing treatment for depression.
    “I started my private practice just before Covid hit, and it was certainly filling up then,” says Dr Jennifer Reid, a psychiatrist, writer and podcast host in Philadelphia. “But the numbers have exponentially risen since that time.”
    Reid focuses on anxiety and insomnia, which have been “major players” in the pandemic. Early on, people with anxiety, phobias or obsessive-compulsive disorder related to germs had particular trouble, she says. Then there was the isolation and the doomscrolling. And now, she says, people are struggling to re-enter the world. “People are finding they’re having anxiety trying to re-engage in social settings in situations that were previously not as safe” at Covid’s peak, she says. 
    Often, she says, people may need to return to their primary care doctor for a period of time, “or they just end up going without and waiting on waitlists, unfortunately”. The APA study found that the average psychologist reported being contacted by 15 potential patients every month; Reid, who combines therapy and medical approaches, says she generally has space for about one new patient every few weeks.
    Read full story
    Source: The Guardian, 21 November 2022
  23. Patient Safety Learning
    GP practices can block abusive patients from gaining automatic access to their records online if they pose a ‘risk of harm’ to staff, the Royal College of General Practice has said.
    Automatic access to patients’ prospective patient records is due to be switched on by the end of this month, following delays related to concerns about patient safety.
    But the RCGP’s toolkit on access to records said practices can refuse access to online records for patients that pose a risk of harm to others too.
    The guidance said access should "be refused where there is a clear risk of serious harm to the safety of the patient or members of the practice team, or to the privacy of a third party".
    It added: "If potentially harmful information cannot be successfully redacted and the practice remains concerned about the safety of record access for an individual patient – or in extreme cases, remains concerned that the patient may react violently to information in the record – then the practice may refuse to give the patient record access or restrict the level of access.
    "It may be possible to give them access to a reduced part of the record such as the Summary Care Record or restrict access to appointments and repeat prescriptions."
    The guidance said that records access should only be refused or restricted "after discussion with the practice leads for GP Online Services and Safeguarding or after seeking further professional advice from a local relevant agency or national medical indemnity organisation".
    Read full story
    Source: Pulse, 18 November 2022
  24. Patient Safety Learning
    Patients in Oklahoma, USA, who get their prescription medications by mail may soon have better protections for the safety of those drugs than any other state. On Wednesday, Oklahoma regulators proposed the nation’s first detailed rule to control temperatures during shipping, according to pharmacy experts. 
    “This is a huge step,” said Marty Hendrick, executive director of the Oklahoma State Board of Pharmacy, after the board voted to approve the rule Wednesday. “We’ve got a tremendous amount of prescriptions that get mailed to patients. … What we did today was make sure our patients in Oklahoma are receiving safe products.”
    Exposure to extreme temperatures can degrade or weaken drugs, potentially changing their dosage or chemical makeup and rendering them ineffective or unsafe for patients. But while government oversight of how pharmacies store medications to keep them in defined safe temperature ranges is very detailed, an NBC News investigation in 2020 found oversight of shipping to patients — during which drugs might be exposed to heat waves and below-freezing temperatures — is largely a system of blind trust. Mail-order pharmacy is a booming business, with soaring profits for some of the nation’s largest companies last year and more than 26 million people receiving their medication by mail in 2017 — more than double the number two decades earlier, according to federal data.
    NBC News found that most state pharmacy boards, the regulators responsible for pharmacy safety, did not have specific rules for how pharmacies should ship customers’ medication, few asked about this process in their inspections, and many said it was simply up to the pharmacy to ensure safe shipping. 
    Read full story
    Source: NBC News, 17 November 2022
  25. Patient Safety Learning
    Health spending over the next two years will grow less than during the austerity era of the last decade, according to a new analysis of the autumn statement.
    The chancellor, Jeremy Hunt, a former health secretary who previously campaigned for greater resources from the backbenches, announced last week that the NHS would receive an extra £3.3bn in each of the next two years. With severe pressures growing on the service, he said it would be one of his “key priorities”.
    However, research by the Health Foundation charity has found that when the whole health budget is included – covering the NHS, training, public health services and capital investment – it will only increase by 1.2% in real terms over the next two years. That is below the 2% average seen in the decade preceding the pandemic, as well as the historical average of about 3.8%.
    The research comes as NHS trusts face almost impossible decisions over staff wages, waiting lists and keeping buildings and equipment up to date. The Health Foundation analysis highlighted the continued “significant uncertainty” facing the delivery of health services over the remainder of this parliament. It said there were now “difficult trade-offs” on issues such as pay and the backlog.
    Anita Charlesworth, director of the Real (Research and economic analysis for the long term) Centre at the Health Foundation, said that there had been “short-term relief” for the health service, especially when compared with the cuts made to non-protected departments.
    However, she said it would be “treading water at best as inflation bites and it faces rising pressures from an ageing population, pay, addressing the backlog and continuing Covid costs”.
    “If other parts of the system – especially social care and community care – are also struggling with cost pressures, this makes it harder to deliver healthcare and the 2% will buy less,” she said. “Efficiency can only take the NHS so far. Since 2010, if we had kept up with German health spending we’d have spent £73bn more each year, and £40bn more if we’d kept up with France.”
    Read full story
    Source: The Guardian, 19 November 2022
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