A nurse-led trial has found that a new electronic tool could reduce the number of preventable injuries and deaths caused by wrongly inserting nasogastric tubes.
The study, led by Tracy Earley, a consultant nutrition nurse at Royal Preston Hospital, tested a new fibre-optic device which can tell clinicians definitively if a nasogastric tube – which is inserted through the nose and delivers food, hydration and medicine into the stomach – has been placed correctly.
Currently, to check if nasogastric tubes – also referred to as NG tubes – are in the right place, nurses have to extract bodily fluid from the patient through the tube. Clinicians then test this fluid on a pH strip to judge whether the placement is correct.
Studies show that interpreting the pH level results in mistakes 12-30% of the time, and that in 46% of cases nurses are unable to draw aspirate at all. This means patients have to undergo x-rays, leaving them without nutrition or treatment for longer.
The study tested a device called NGPod, which uses a fibre-optic sensor to retrieve the pH reading from the tip of the NG tube leading to a definitive 'yes' or 'no' result in terms of whether it has been placed correctly – removing the need for aspirate or interpretation from the health professional.
It found that the device was as accurate as pH strip testing, and removed all of the risks associated with making subjective pH strip judgements.
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Source: Nursing Times, 18 July 2023
NHS mental health services are stuck in a “vicious cycle” of short staffing and overwhelming pressures, a government committee has warned.
Rising demand for mental health services has “outstripped” the number of staff working within NHS organisations, according to the public accounts committee.
A report from the committee warned that ministers must act to get services out of a “doom loop” in which staff shortages is hitting morale and leading people to quit the already-stretched services.
It found staffing across mental health services has increased by 22% between 2016 and 17 and 2021 and 22 while referrals for care have increased by 44% over the same period.
Healthcare leaders warned there are 1.8 million people on the waiting list for NHS mental health care with hospital bosses “deeply concerned”.
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Source: The Independent, 21 July 2023
The government has admitted that many ‘vulnerable’ hospitals ‘suffer with a lack of permanence of leadership’, but said that chiefs are only sacked by NHS England ‘in extreme and exceptional circumstances’.
The comments were included in the government’s response to the independent investigation into major maternity care failures at East Kent Hospitals University Foundation Trust, which highlighted how the practice of repeatedly hiring and firing leaders had contributed to its problems.
The investigation said successive chairs and CEOs at the FT were “wrong” to believe it provided adequate care, and urged that they be held accountable. But it said senior management churn had been “wholly counterproductive”, and that it had “found at chief executive, chair and other levels a pattern of hiring and firing, initiated by NHS England” which would “never have been an explicit policy, but [had] become institutionalised”.
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Source: HSJ, 21 July 2023
More than 250,000 dementia patients could miss out on new treatments for the disease because they do not have a formal diagnosis, according to government figures.
NHS data published for the first time shows the prevalence of different types of dementia with which people in England have been diagnosed.
Dementia is an umbrella term for many different conditions, affecting more than 55 million people worldwide.
This week, health regulators were urged to approve two new game-changing dementia drugs, after a landmark study confirmed that donanemab slowed cognitive decline in Alzheimer’s patients by 35%, while last year, a second drug, lecanemab, was found to reduce the rate by 27%.
The NHS primary care dementia figures estimate that there are about 708,000 people over 65 with dementia in England, but only about 450,000 have a recorded diagnosis. That means that more than 250,000 are missing out on these potential new treatments.
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Source: The Guardian, 20 July 2023
The adoption of artificial intelligence (AI) by the NHS should be faster, and more frameworks should be in place to get emerging technologies to as many patients as possible, experts have told MPs.
A number of senior figures from medicine and biotechnology gave evidence to the Health and Social Care Committee as part of its inquiry into cancer technology.
Stephen Duffy, a professor of cancer screening at the Wolfson Institute of Population Health at Queen Mary University of London, told MPs there is “strong potential” for AI, particularly in areas such as reading mammograms for the breast screening programme.
However, he warned that there will be “staff issues in terms of the number of staff needed to double-read mammograms”.
He added: “Those issues aren’t going away. It seems to me that AI systems have already been shown to be very good in terms of detection of cancer on from mammograms, so they’re safe in that respect.
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Source: The Independent, 19 July 2023
A trust has been accused of presiding over the deterioration of a key service amid communication problems between senior leaders and a ‘worrying series of resignations’ which has left the department with ‘no doctors’.
The British Association of Dermatologists wrote to Worcestershire Acute Hospitals Trust on 13 July to request an urgent meeting with the provider’s management to discuss the matter.
The letter, seen by HSJ, outlines fundamental patient safety and staffing concerns about the trust’s dermatology service and accuses the trust of putting “continued communication barriers” between clinicians and management.
The letter, signed by BAD president Mabs Chowdhury, says there are now “no doctors in the department” after two consultants and a locum consultant resigned “due to apparent unhappiness with the running of services [and in] a continuation of a worrying series of resignations”.
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Source: HSJ, 19 July 2023
The majority of trust leaders have reported an increase in the ‘burden’ put on them by regulators, citing more demanding ‘ad hoc’ requests during heightened operational pressure.
In NHS Providers’ latest survey of NHS trust leaders’ experiences of regulation, a little over half of respondents – 52% – said the burden from NHS England and the Care Quality Commission had increased in the past year.
The percentage was higher among acute/community and community trusts, and all ambulance and specialist trust respondents said the burden had increased.
An even higher overall share of trusts – 59% – said “ad hoc requests” from regulators had increased during the same time period. This includes requests for information or meetings at short notice, diverting staff from day-to-day operational duties.
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Source: HSJ, 20 July 2023
The trust at the centre of a maternity scandal insists it has been providing immediate anaesthetic cover for obstetric emergencies, contrary to an NHS England report suggesting it had not and had been potentially breaching safety standards.
Health Education England – now part of NHSE – visited William Harvey Hospital in March and was told senior doctors in training who were covering obstetrics could also be covering the cath lab – which deals with patients who have had a heart attack, and could receive trauma, paediatric emergency and cardiac arrest calls. This suggested the trust was in conflict with Royal College guidelines which state an anaesthetist should always be “immediately available” for obstetrics.
East Kent Hospitals University Foundation Trust, which runs the hospital, originally told HSJ its rota had very recently been changed and that an anaesthetist with primary responsibility for maternity could leave any other work to attend to a maternity emergency immediately. However, it has since said it has been the case for a long time that an anaesthetist is available to return to maternity in case of an emergency.
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Source: HSJ, 17 June 2023
Staff fell asleep while on duty at a mental health trust, inspectors found.
The Care Quality Commission (CQC) said it was "very disappointed" to find patient safety being affected by the same issues it had seen previously.
It said on acute wards for adults of working age and psychiatric intensive care units, five patients described staff falling asleep at night.
Despite CCTV being available, managers told the CQC they could not always immediately prove staff had been sleeping as accessing the pictures could take up to a fortnight.
The CQC report added trust data from June to December 2022 recorded 20 incidents of staff falling asleep while on duty but no action was taken because the video evidence had not been viewed.
Rob Assall, the CQC's director of operations in London and the East of England, said: "When we inspected the trust, we were very disappointed to find people's safety being affected by many of the same issues we told the trust about at previous inspections.
"This is because leaders weren't always creating a culture of learning across all levels of the organisation, meaning they didn't ensure people's care was continuously improving or that they were learning from events to ensure they didn't happen again."
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Source: BBC News, 12 July 2023
A scheme in which ‘category 2’ 999 calls are validated by clinicians will be extended nationally after reducing journeys by 4%in a pilot, with no adverse incidents, NHS England has told HSJ.
NHSE also confirmed that one ambulance trust in the scheme, the West Midlands, has begun delaying the dispatch of ambulances for some category 2 calls by up to 23 minutes so that the validation can take place.
At three other trusts – London, South Western and the East Midlands – about 40% of category 2 calls receive clinical validation, but an ambulance is dispatched to them as soon it is available, as normal.
Officials said they believe the demand benefit could be greater if ambulance trusts are able to devote more clinical capacity to the validation process. About 40% of category 2 calls are judged suitable for validation, but not all of them complete the process before an ambulance arrives.
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Source: HSJ, 11 July 2023
An inspection of an ‘outstanding’ hospital has revealed concerns about unsafe staffing, as well as bullying and undermining behaviour.
The then Health Education England issued Frimley Health Foundation Trust 14 mandatory requirements after visiting its Frimley Park Hospital in March to look at training in medical specialties. The risk-based review followed concerns in the 2022 national training survey and previous quality interventions by HEE.
Among the problems HEE was told about were:
Junior doctors feeling staffing on some shifts was unsafe. Foundation year one doctors were sometimes the only doctors on a ward, while one foundation doctor spent their first weekend on call looking after two wards by themselves.
Concerns about bullying and undermining behaviour in an unnamed department, and consultant behaviour during weekend handover which left some staff feeling “uncomfortable”.
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Source: HSJ, 11 July 2023
Pharmaceutical giants are pouring tens of millions of pounds into struggling NHS services – including paying the salaries of medical staff and funding the redesign of patient treatment – as they seek to boost drug sales in the UK, the Observer can reveal.
The spending is revealed in an investigation that lays bare the growing role of Big Pharma in the UK’s health sector, with analysis of more than 300,000 drug company transactions since 2015 showing a surge in spending on activities other than research and development (R&D).
Payments to UK health professionals and organisations, including donations, sponsorship, consultancy fees and expenses, reached a record £200m in 2022, excluding R&D with companies seeking to promote lucrative drugs for obesity, diabetes and heart conditions among the biggest spenders.
The rise in spending raises concerns about the growing influence of pharmaceutical companies in the NHS as it reaches its 75th anniversary milestone. Amid record pressure on services, drug giants say closer collaboration can help deliver major benefits to patients.
NHS England said collaborations with industry helped patients “benefit from faster access to innovative treatments” and that it was “not unusual for industry to provide funding to support service delivery in areas such as improving cardiovascular health, tackling infectious disease or rolling out innovative cancer therapies”. It added that “strict safeguards” were in place for managing conflicts of interest.
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Source: The Guardian, 8 July 2023
Nearly half of all NHS hospital maternity services covered so far by a national inspection programme have been rated as substandard, the Observer can reveal.
The Care Quality Commission (CQC), which regulates health and care providers in England, began its maternity inspection programme last August after the Ockenden review into the Shropshire maternity scandal, which saw 300 babies left dead or brain damaged by inadequate NHS care.
Of the services inspected under the programme, which focuses on safety and leadership, about two-thirds have been found to have insufficient staffing, including some services that were rated as good overall. Eleven services saw their rating fall from their previous inspection.
Dr Suzanne Tyler of the Royal College of Midwives said: “Report after report has made a direct connection between staffing levels and safety, yet the midwife shortage is worsening. Midwives are desperately trying to plug the gaps – in England alone we estimate that midwives work around 100,000 extra unpaid hours a week to keep maternity services safe. This is clearly unsustainable and now is the time for the chancellor to put his hand in the Treasury pocket and give maternity services the funding that is so desperately needed.”
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Source: The Guardian, 9 July 2023
A struggling trust has been warned by regulators that it could see its junior doctors removed, after concerns about clinical supervision and safety at a hospital whose A&E closes at night.
NHS England inspectors who visited Cheltenham General Hospital found emergency patients – including potential surgical patients – became the responsibility of the overnight medical team when its accident and emergency closed in the evening.
One night, 26 patients had been handed across, the inspectors were told, and some patients were felt to be inappropriate for medical referral. A surgical registrar could be telephoned at Gloucester Royal Hospital about surgical patients.
They were told that although there were no incidents of serious harm, there had been many “near misses” and juniors felt “unsafe and unsupported in terms of consultant clinical supervision, overall clinical/nursing staffing support or logistically in managing patients in this setting or arranging transfers”.
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Source: HSJ, 7 July 2023
Daniel was about to get the fright of his life.
He was sitting in a consulting room at the Royal Free hospital in London, speaking to doctors with his limited English.
The 21-year-old street trader from Lagos, Nigeria, had come to the UK days earlier for what he had been told was a "life-changing opportunity". He thought he was going to get a better job.
But now doctors were talking to him about the risks of the operation and the need for lifelong medical care.
It was at that moment, Daniel told investigators, that he realised there was no job opportunity and he had been brought to the UK to give a kidney to a stranger.
"He was going to literally be cut up like a piece of meat, take what they wanted out of him and then stitch him back up," according to Cristina Huddleston, from the anti modern slavery group Justice and Care.
Luckily for Daniel, the doctors had become suspicious that he didn't know what was going on and feared he was being coerced. So they halted the process.
The BBC's File on 4 has learned that his ground-breaking case alerted UK authorities to other instances of organ trafficking.
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Source: BBC News, 4 July 2023
The head of NHS England has warned that July's planned strikes in the health service could be the worst yet for patients.
Amanda Pritchard said industrial action across the NHS had already caused "significant" disruption - and that patients were paying the price.
This month's consultant strike will bring a "different level of challenge" than previous strikes, she said.
Junior doctors and consultants will strike for a combined seven days.
Ms Pritchard told the BBC's Sunday with Laura Kuenssberg programme that the work of consultants - who are striking for the first time in a decade - cannot be covered "in the same way" as junior doctors.
"The hard truth is that it is patients that are paying the price for the fact that all sides have not yet managed to reach a resolution," she said.
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Source: BBC News, 2 July 2023
NHS whistleblowers need stronger legal protection to prevent hospitals using unfair disciplinary procedures to force out doctors who flag problems, the British Medical Association has said.
Doctors are being “actively vilified” for speaking out, which has resulted in threats to patient safety, including unnecessary deaths, according to the council chair of the doctors’ union, Phil Banfield.
Despite a series of scandals in recent years, it is becoming more common for hospitals to use legal tactics and “phoney investigations” to undermine or force out whistleblowers rather than address their concerns, he warned.
Banfield said: “Someone who raises concerns is automatically labelled a troublemaker. We have an NHS that operates in a culture of fear and blame. That has to stop because we should be welcoming concerns, we should be investigating when things are not right.
“Whistleblowers are pilloried because some NHS organisations believe the reputational hit is more dangerous than unsafe care,” he added. “Whereas the safety culture in aviation took off after some high-profile airplane crashes in the 70s, the difference is that the aviation industry embraced the need to put things right and understand the systems that led to the disaster – the NHS has not invested in solving the system, it’s been bogged down in blaming the individual instead of the mistake.”
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Source: The Guardian, 2 July 2023
Nearly 170,000 workers left their jobs in the NHS in England last year, in a record exodus of staff struggling to cope with some of the worst pressures ever seen in the country’s health system, the Observer can reveal.
More than 41,000 nurses were among those who left their jobs in NHS hospitals and community health services, with the highest leaving rate for at least a decade. The number of staff leaving overall rose by more than a quarter in 2022, compared to 2019.
The figures in NHS workforce statistics of those leaving active service since 2010 analysed by the Observer show the scale of the challenge facing prime minister Rishi Sunak. He launched a new workforce plan on Friday to train and keep more staff.
Sir Julian Hartley, chief executive of NHS Providers, said: “Staff did brilliant work during the pandemic, but there has been no respite. The data on people leaving is worrying and we need to see it reversed.
“We need to focus on staff wellbeing and continued professional development, showing the employers really do care about their frontline teams.”
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Source: The Guardian, 1 July 2023
A Colorado surgeon has been convicted of manslaughter in the death of a teenage patient who went into a coma during breast augmentation surgery and died a year later.
Emmalyn Nguyen, who was 18 when she underwent the procedure 1 August 2019, at Colorado Aesthetic and Plastic Surgery in Greenfield Village, near Denver, fell into a coma and went into cardiac arrest after she received anaesthesia, officials said.
She died at a nursing home in October 2020.
Dr. Geoffrey Kim, 54, a plastic surgeon, was found guilty of attempted reckless manslaughter and obstruction of telephone service.
At Kim’s trial, a nurse anesthetist testified that he advised Kim that the patient needed immediate medical attention in a hospital setting and that 911 should be called, prosecutors said.
An investigation determined Kim failed to call for help for five hours after the patient went into cardiac arrest, prosecutors said. The obstruction charge was linked to testimony that multiple medical professionals, including two nurses, requested permission to call 911 to transfer care for Nguyen, but Kim, the owner of the surgery centre, denied the request, prosecutors said.
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Source: ABC News, 15 June 2023
An inquiry investigating deaths of mental health patients in Essex has been given extra powers, in a victory for campaigners.
Health Secretary Steve Barclay told Parliament that the probe would be placed on a statutory footing. It means the inquiry can force witnesses to give evidence, including former staff who have previously worked for services within the county.
Mr Barclay said he was committed to getting answers for the families.
He told the Commons: "I hope today's announcement will come as some comfort to the brave families who have done so much to raise awareness."
The Secretary of State added that under the new powers anyone refusing to give evidence could be fined.
Melanie Leahy, whose son Matthew died while an inpatient at the Linden Centre in Chelmsford in 2012, is among those who have long campaigned for the inquiry to be upgraded.
"Today's announcement marks the start of the next chapter in our mission to find out how our loved ones could be so badly failed by those who were meant to care for them," said Ms Leahy.
"I welcome today's long overdue government announcement and I look forward to working with the inquiry team as they look to shape their terms of reference."
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Source: BBC News, 28 June 2023
Today it was announced by the Secretary of State for Health and Social Care that the future Health Services Safety Investigations Body (HSSIB) will undertake a series of investigations focused on mental health inpatient settings.
The investigations will commence when HSSIB is formally established on 1 October 2023. The HSSIB will conduct investigations around:
How providers learn from deaths in their care and use that learning to improve their services, including post-discharge.
How young people with mental health needs are cared for in inpatient services and how their care could be improved.
How out-of-area placements are handled.
How to develop a safe, therapeutic staffing model for all mental health inpatient services.
Rosie Benneyworth, Chief Investigator at HSIB, says: “We welcome the announcement by the Secretary of State and see this as a significant opportunity to use our expertise, and the wider remit that HSSIB will have, to improve safety for those being cared for in mental health inpatient settings across England. The evidence we have gathered through HSIB investigations has helped shed light on some of the wider challenges faced by patients with mental health needs, and the expertise we will carry through from HSIB to HSSIB will help us to further understand these concerns in inpatient settings, and contribute to a system level understanding of the challenges in providing care in mental health hospitals.
“HSSIB will be able to look at inpatient mental health care in both the NHS and the independent sector and any evidence we gather during the investigations is given full protection from disclosure. It is crucial that those impacted by poor care and those working on the frontlines of the inpatient settings can share their experiences, reassured that HSSIB will use this information to improve care and not apportion blame or liability.
“At HSIB we will begin conversations with our national partners across the system, as well as talking to staff, patients and families. This will ensure that when investigations are launched in October, we have identified and will address the most serious risks to mental health inpatients within these areas and will identify recommendations and other safety learning that will lead to changes in the safety culture and how safety is managed within mental health services.”
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Source: HSIB, 28 June 2023
NHS trusts across England are scrambling to trace thousands of children for urgent hearing tests amid fears that cases of infant deafness may have been missed for years.
An internal NHS report has exposed poor-quality testing within paediatric audiology departments at five hospitals and warned of systemic failings. At another NHS trust, almost 1,500 children were found to have missed out on appointments dating back to 2012.
Vital quality inspections of departments checking infants for hearing loss were stopped ten years ago. Whistleblowers who previously worked for the NHS’s newborn hearing screening programme have revealed that concerns were raised shortly before they were told to stop carrying out checks.
They say that thousands of children may have been mistreated for deafness and hearing loss in the past decade.
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Source: The Times, 25 June 2023
The Home Office has been accused of abandoning 55 asylum seekers with a range of severe disabilities and life-limiting conditions at a former care home in an Essex seaside town.
The asylum seekers, who fled various conflict zones including Sudan and Afghanistan, are struggling with a range of health conditions they have suffered from since childhood or life-changing injuries suffered in war zones.
One told the Guardian: “Everybody is suffering in this place. It used to be a care home but now there is no care. We are free to come and go but to me, this place feels like an open prison. We have just been left here and abandoned.”
Those living in the former care home are struggling with health conditions including loss of limbs, blindness, deafness and mobility issues requiring a wheelchair – although not all have been able to access one. At least eight are paraplegic.
They were placed in the former care home, which opened in November, by Home Office officials. It is staffed like a standard Home Office asylum seeker hotel with security guards and reception staff but does not have trained care workers or nurses there as part of the contract.
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Source: The Guardian, 23 June 2023
Shrewsbury and Telford Hospital Trust temporarily suspended admissions to the women’s and children’s centre at Princess Royal Hospital – which houses the provider’s consultant-led maternity services – earlier this week due to an issue with a generator.
HSJ understands a power cut occurred and estates chiefs were concerned about running solely on battery power, hence suspending admissions while the problem was fixed.
Five inductions of labour were diverted to neighbouring trusts, while fewer than five caesarean sections were rescheduled during the outage.
Meanwhile, 56 patients accessing the trust’s telephone triage service were advised by medical chiefs to attend nearby hospitals.
Following the incident, a learning review is taking place, and HSJ understands this will investigate whether any women came to harm. HSJ has also been told the generator has been fixed “as good as permanently”.
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Source: HSJ, 23 June 2023
Junior doctors will take part in what is “thought to be the longest single period of industrial action in the history of the health service” for five days next month.
The British Medical Association junior doctor committee announced this morning there would be a walkout from 7am on Thursday 13 July and 7am on Tuesday 18 July in its ongoing pay dispute with government.
It comes amid growing expectation that a Royal College of Nursing ballot on further strike action over the Agenda for Change pay award, which ends this week, is likely to fail to secure a mandate.
But junior doctors’ strikes are continuing to hit elective recovery, and strain relationships, with workload on other groups increased as they are asked to provide cover.
Junior doctors have allowed no “derogations” (exemptions) from the action, as they say other staff groups can cover emergency care, and one move to call them in to a busy hospital in the south west, in an earlier round, was abandoned.
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Source: HSJ, 23 June 2023
