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Measles warning for young children as MMR jab rate drops in England

More than 1 in 10 school entry-age children in England are at risk of measles because they have not had their vaccine jabs, data reveals.

Coverage for the two doses of MMR that helps protect five-year-olds against measles, mumps and rubella is currently at 85.5%.

That is the lowest for a decade, and well below the 95% target recommended to stop a resurgence of measles.

Measles is highly contagious, more than Covid, and can cause serious illness. Nine in every 10 people can catch it if they are unjabbed and exposed.

As well as a distinctive rash, measles can lead to severe complications, such as pneumonia and brain inflammation, and sometimes can be fatal.

Vaccination can remove almost all of these risks.

Two doses of the MMR vaccine give 99% protection against measles and rubella and about 88% protection against mumps.

When a high percentage of the population is protected through vaccination, it becomes harder for the disease to pass between people.

But since the start of the Covid pandemic, there has been a concerning drop in the number of children receiving these vaccines on time.

Experts say some parents may not have realised doctors were still offering appointments, or did not want to burden the NHS.

Coverage of the first dose of the MMR vaccine in two-year-olds has now fallen below 90%. This means that more than one in 10 children under the age of five are not fully protected from measles and are at risk of catching it.

Among all five-year-olds in England, 93.7% have had one dose and 85.5% have had the recommended two doses.

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Source: BBC News, 1 February 2022

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CQC to restart inspections today

The Care Quality Commission (CQC) will restart inspections from 1 February with a focus on the urgent and emergency care system, the regulator has announced.

In December, CQC postponed inspections of some services to support the acceleration of the vaccination booster programme. They also prioritised activity to help create more capacity in adult social care.

However, considering the current situation – including the easing of restrictions across the country – they have reviewed and updated their regulatory approach. From 1 February the CQC will inspect where:

  • there is evidence that people are at risk of harm. This applies to all health and social care services, including those where inspections were previously postponed except in cases where we had evidence of risk to life
  • CQC can support increasing capacity across the system, particularly in adult social care
  • a focus on the urgent and emergency care system will help us understand the pressures, where local or national support is needed, and share good practice to drive improvement.

Much of their approach is unchanged and remains in line with the update from the Chief Inspectors on 10 December 2021.

This includes:

  • achieving their ambition to complete 1,000 infection prevention and control (IPC) inspections in adult social care
  • rapid response to requests to set up new Designated Settings
  • activity to rate adult social care services that are registered and not yet rated
  • inspections of adult social care providers currently rated as Requires Improvement to identify where improvement has taken place and re-rate where possible.

Alongside their risk-based activity, CQC will undertake ongoing monitoring of services. This helps to identify where CQC may need to take further action to ensure people are receiving safe care and offer support to providers. It also remains important that people share concerns or examples of good practice, CQC said.

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Source: CQC, 27 January 2022

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If you don’t like it, go private: what my maternity clinic said over scans delay

After a raft of prenatal check-ups were cancelled because of Covid staff shortages, one mother asked how other mums fared. The replies shocked her.

Alison, 38, gave birth to her son in June 2021 at a busy London hospital.

“We had exemplary care during delivery, and the midwives looking after me during my antenatal care were likewise fantastic,” she recalls.

“However, I didn’t see a midwife face-to-face between my nine-week intake appointment and my 30th week of pregnancy. Then I saw nobody again until I was 34 weeks pregnant, and the next time I was seen was at 38 weeks, even though you’re supposed to be seen weekly at that stage.”

At Alison’s two-week postpartum check-up, she had to have her stitches examined in a chair as no other facilities were free.

“The ward was so full they’d had to close the birth centre; labour and delivery was full, and I met two women labouring in the early stages of their induction in the hallway. The midwives that came to do home visits were rushed and left me in tears every time,” she says.

When another mother found she was suffering from early pregnancy malaise, she reluctantly decided to go back to the London hospital where she had given birth eight years before.

Her high-risk twin pregnancy had ended in premature birth at 24 weeks and tragedy – with one baby dying after a three-month battle in intensive care. Throughout her antenatal journey, crucial appointments had been cancelled due to staffing issues, with the result that nobody picked up on early signs of premature labour, until it was too late for intervention.

Her hopes of receiving better care this time, assuming the trust would be aware of my history, evaporated quickly. By nearly 15 weeks of pregnancy, I had still not been seen by anyone, with text messages supposed to inform me of appointments failing to arrive.

When she queried why I had been given a date for a scan two weeks after the latest possible date such a screening could give a diagnosis of chromosomal abnormality, a clinic receptionist told me I should go private if I didn’t like my appointments. A complaint triggered an apology from the trust’s chief executive months later for protracted problems in the booking process, as well as an apology from the deputy head of midwifery for the receptionist’s “inappropriate” advice.

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Source: The Guardian, 30 January 2022

 

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Survey of Americans who attempted suicide finds many aren’t getting care

The number of people who try suicide has risen steadily in the U.S. But despite gains in health coverage, nearly half are not getting mental health treatment.

Suicide attempts in the United States showed a “substantial and alarming increase” over the last decade, but one number remained the same, a new study has found: Year in and year out, about 40% of people who had recently tried suicide said they were not receiving mental health services.

The study, published in JAMA Psychiatry, traces a rise in the incidence of suicide attempts, defined as “self-reported attempts to kill one’s self in the last 12 months,” from 2008 to 2019. During that period, the incidence rose to 564 in every 100,000 adults from 481.

The researchers drew on data from 484,732 responses to the federal government’s annual National Survey on Drug Use and Health, which includes people who lack insurance and have little contact with the health care system. They found the largest increase in suicide attempts among women; young adults between 18 and 25; unmarried people; people with less education; and people who regularly use substances like alcohol or cannabis. Only one group, adults 50 to 64 years old, saw a significant decrease in suicide attempts during that time.

Among the major findings was that there was no significant change in the use of mental health services by people who had tried suicide, despite the passage of the Affordable Care Act in 2010 and receding stigma around mental health care.

Over the 11-year period, a steady rate of about 40%t of people who tried suicide in the previous year said they were not receiving mental health care, said Greg Rhee, an assistant professor of psychiatry at the Yale School of Medicine and one of the authors of the study.

The Affordable Care Act, which took effect fully in 2014, required all health plans to cover mental health and substance abuse services, and also sharply reduced the number of uninsured people in the U.S. However, many respondents to the survey in the new report said the cost of mental health care was prohibitive; others said they were uncertain where to go for treatment or had no transportation.

“It is a huge public health problem,” Dr. Rhee said. “We know that mental health care in the U.S. is really fragmented and complicated, and we also know not everybody has equal access to mental health care. So, it’s somewhat not surprising.”

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Source: New York Times,19 January 2022

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Patient safety and the right of the sick to reject care from unvaccinated staff

The question of whether to impose a policy requiring mandatory vaccination for NHS staff has raised countless ethical and practical considerations, but with many healthcare workers still unvaccinated and the Government set for a U-turn over mandatory Covid jabs for NHS staff in England, has enough thought been given to the perspective of patients?

Various legal experts and health groups have argued that while doctors and nurses can reject the offer of vaccination, patients should also have the right to refuse treatment from a healthcare worker who is not jabbed, instead requesting that their care is placed in the hands of someone who is protected.

With the February deadline pushed back, could patients start to grow weary of staff who have not been vaccinated? Will they feel as though the chance for refuseniks to get jabbed has come and gone, and that it is therefore justified that they are stripped of their right to deliver treatment?

“Patients have a right to safe care, so it’s reasonable for patients to expect any health or social care professional caring for them to have had a Covid-19 vaccine,” says Rachel Power, chief executive of the Patients Association.

Most patients may not be overly concerned about the vaccination status of those caring for them, but in a world in which we’re expected to live alongside the threat posed by Covid, there are undoubtedly certain groups who will be more invested in these matters.

“A person who is ‘vulnerable’ by way of disability or chronic illness (eg immunocompromised) may well have an argument under the Equality Act that the NHS failing to provide vaccinated staff to them constitutes disability-based discrimination,” says one barrister who specialises in mental health capacity law.

After all, these individuals are most at risk from COVID-19 – and will be for years to come. Clinically vulnerable people who do find themselves in hospital for whatever reason will know that a Sars-CoV-2 infection could further exacerbate their condition, or endanger their lives.

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Source: The Independent, 30 January 2022

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‘Shocking’: cystic fibrosis patients should not have to pay for drugs that keep them alive, says MP

MPs will be asked this week to end the “shocking” practice of making cystic fibrosis patients in England pay prescription charges for the drugs that they need to stay alive. The condition is the nation’s most common inherited, life-threatening disease and affects more than 7,000 people.

Prescription charges, first introduced in 1952, were abolished in 1965; then, when they were reintroduced in 1968, exemptions were made for those suffering from long-lasting ailments such as cancers, diabetes and epilepsy. But children with cystic fibrosis were not expected to live to adulthood and so the condition was not exempted.

As a result of new medicines and the creation of special physiotherapy regimes, cystic fibrosis patients now live well into their 40s.

“Medicine and society have moved on, so should the exemption list to reflect modern-day experience,” said Paul Maynard, the Conservative MP for Blackpool North and Cleveleys, who will call for an end to prescription charges for the disease at a special Commons debate on the illness this week. “As someone who has a long-term medical condition – epilepsy – it has always amazed me that adults with cystic fibrosis have to pay for their prescriptions whilst I do not.”

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Source: The Guardian, 30 January 2022

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Legal costs for NHS negligence claims may be capped

Lawyers’ fees for clinical negligence claims against the NHS could be capped under proposals being considered by ministers.

Launching a consultation, the government said “tackling increasing and disproportionate legal fees” for cases worth less than £25,000 would protect NHS funding.

The Department of Health said claimants’ legal costs for “lower value claims” were “currently more than four times higher on average” than the NHS’s legal costs in defending the claims. It cited a case in which lawyers claimed £72,000 in legal costs when the patient was awarded £3,000.

Patient Safety Minister Maria Caulfield said: “I’m committed to making the NHS the safest healthcare system in the world. When harm does occur, it’s essential the NHS learns from what went wrong, and people who have been negligently harmed are entitled to claim compensation.

“Unfortunately, we are seeing some law firms profiting at the NHS’ expense through legal costs that far outweigh the actual compensation awarded to patients. This diverts resources from the NHS frontline as staff work hard to tackle the COVID-19 backlogs.

“Our proposals will cap legal costs for lower value claims to ensure they are fair and proportionate, and ensure patients’ claims are resolved as swiftly as possible without reducing the compensation they deserve.”

A spokesman for Thompson’s Solicitors, which acts for patients in such claims, told iNews: “Costs already have to be reasonable, proportionate and necessary in order to be recoverable. The answer is for the NHS to admit fault quicker and not cause cases to drag on for years."

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Source: iNews, 31 January 2022

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No 10 set for U-turn over mandatory Covid jabs for NHS staff in England

Downing Street appears likely to drop its policy of dismissing frontline NHS and care staff in England who refuse Covid vaccinations, a minister has strongly indicated, after nursing and care organisations called for this to happen.

A decision would be made “in the course of the next few days”, according to Simon Clarke, the chief secretary to the Treasury. He said the lower severity of the Omicron variant of Covid did “open a space” for the policy to be reversed.

The apparent imminent U-turn came as the Royal College of Nursing argued that both the change in severity from Omicron and the number of NHS vacancies meant the mandatory vaccination policy should be dropped.

The National Care Association said it would also welcome a change of policy, while warning that many unvaccinated care staff had already lost their jobs in the run-up to the 1 April deadline.

Asked about reports of a change to the policy, Clarke told Sky News that ministers had hoped to find “the right balance between having the maximum impact for measures that support public safety in the face of the virus, but also have the minimum impact in terms of our wider freedoms as a society”.

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Source: The Guardian, 31 January 2022

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Scots mum considered ending her life due to mesh hell after suffering hernia

A mum says her life has been destroyed following a hernia repaired with a mesh implant – with pain so severe she considered ending her life.

Roseanna Clarkin, 38, has suffered excruciating pain since medics used mesh products to repair the issue.

Now she wants the use of mesh in hernia operations to be suspended, as it has for vaginal mesh following years of suffering by thousands of women.

Revealing her own hell, Roseanna told how she was in so much pain last month she asked for ­guidance about how to legally end her own life.

She added: "When I was going to the doctor's after my op, I wasn't believed. They told me it was all in my head and even told my husband Brendan 'Don't get roped into this'".

Roseanna said: "I suspect the mesh has moved. But even the other week one of the GPs at my practice was suggesting it was in my head."

Roseanna launched a petition calling for the suspension of mesh in hernia ops. It is going through the public ­petitions committee at Holyrood.

To date, more than 70 patients or their families have written to the committee about their experiences with hernia mesh implants.

Labour's health spokeswoman, Jackie Baillie, who campaigned for vaginal mesh ops to be suspended, called for an urgent review of the uses of mesh for other procedures.

She said: "It has taken years for the serious problems caused for women who had transvaginal mesh used in their surgical treatment to be resolved but it appears to be affecting other conditions too."

She warned: "We can't repeat the mistakes of the past."

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Source: Daily Record, 31 January 2022

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More than 1,000 ‘definitely unvaccinated’ staff at one trust

At least 1,000 staff at the country’s largest NHS trust are still unvaccinated with a week to go until the deadline, it can be revealed.

Senior leaders at University Hospitals Birmingham Foundation Trust (UHB), which has a total workforce of over 20,000 people, told a board meeting that 9% of staff, including substantive and active bank workers, had an ‘unknown’ or ‘unvaccinated’ status as of yesterday.

Like many trusts, UHB is still working through hundreds of records manually, and seeking to contact staff, to establish which are truly ‘unvaccinated’ rather than ‘unknown’, the trust’s chief people officer, Cathi Shovlin, said.

But she confirmed to the board today that of approximately 1,799 substantive-only staff listed as unknown or unvaccinated, “at least” 1,171 of those in scope are definitely not vaccinated.

She said the mandatory vaccine programme was “having a significant impact on staff, who range in emotions from disbelief that this will go ahead through to fear of the vaccine, their job, their career, through to anger about the mandate itself”, Ms Shovlin told executives.

Low uptake has been found particularly among healthcare support workers, porters, housekeeping and cleaners, she said. Diagnostic services, outpatients and surgery, particularly operating departments, were among clinical areas with lower vaccination rates.

And there has also been reduced uptake in females, particularly women aged 20 to 35, and among Asian, Black British and Black Caribbean staff.

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Source: HSJ, 27 January 2022

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What are the new Covid rules for English care homes and are they safe?

The self-isolation period for positive cases is being cut and the limit on visitors lifted from next week. 

Residents who test positive will have to self-isolate for up to 10 days, with a minimum isolation period of five full days followed by two sequential negative lateral flow tests – as is already the case for the rest of the population.

Isolation periods for those having care after an emergency hospital visit will also be reduced to a maximum of 10 days, while a requirement for residents to test or self-isolate after normal visits out will be removed.

Care homes will have to follow outbreak management rules for 14 rather than 28 days, and by 16 February care workers will need to use lateral flow tests before work rather than taking a weekly PCR test.

The limit on visitors to care homes will be lifted. Visitors should still obtain a negative lateral flow test result earlier in the day of their visit, and guidance on the use by visitors of PPE such as face masks remains unchanged.

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Source: The Guardian, 27 January 2022

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Leak reveals details of mortuary sex assaults inquiry

The inquiry into sex offences carried out in a hospital mortuary will consider whether the trust board ‘received sufficient assurance’ about the issues raised by the assaults, documents shared with HSJ show.

The draft terms of reference for the independent inquiry have been shared with the families of women and girls abused by maintenance supervisor David Fuller for comment.

The inquiry will take place in two phases. The first phase – which will concentrate on Mr Fuller’s actions in Maidstone and Tunbridge Wells Trust – will look at his initial employment and access to the mortuary and other areas, and whether processes were appropriate.

It will also in this phase “consider whether the trust’s board received sufficient assurance on the issues raised by the case”.

But it will also seek to identify any evidence of “other inappropriate or unlawful activities” by Mr Fuller elsewhere on trust premises. It will review any evidence of concerns around his behaviour, and how the trust and the private contractors who later employed him addressed them.

In a letter to the families, inquiry chair Sir Jonathan Michael says it is intended that the evidence sessions will be held in private “primarily to protect and safeguard the dignity and anonymity of those people that Fuller abused” but also to encourage people to be “candid”. It is unclear whether families or their legal representatives will be able to attend these private sessions – other than when they are giving evidence – and to raise questions.

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Source: HSJ, 28 January 2022

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NHSE review accuses outstanding trust of ‘dismissive’ attitude to whistleblowers

The leadership of a prominent cancer trust acted in a ‘defensive and dismissive’ manner when serious concerns were raised about bullying behaviours and multiple failings in the handling of a major research contract, an external review has found.

As previously revealed by HSJ, NHS England commissioned the review into events at The Christie Foundation Trust after whistleblowers raised numerous concerns over a research project with pharmaceutical giant Roche, and about the way they were treated as a result of speaking out.

The NHSE review, which was led by Angela Schofield, chair of Harrogate and District FT, was published earlier today within trust board papers. It described the trust’s research division as “ineffective” and said it had “allowed inappropriate behaviours to continue without challenge”.

The review added: “It may… be thought to be surprising that NHSE/I found it necessary to commission an external rapid review to look into concerns which had been raised by colleagues within the research and innovation division."

“The root cause of this seems to be an apparent failure by those people in leadership positions who were aware of the concerns that had been raised, in the circumstances covered by the review, to listen to and take notice of a number of people who have some serious issues about the way they are treated and wish to contribute to an improvement in the culture."

It also summarised the experiences of 20 current and former staff members who said they suffered “detriment as a result of raising concerns”, although it did not make a clear judgement on whether their claims were justified.

They said: “An experience of bullying, harassment and racial prejudice was described along with lack of respect at work… Patronising behaviour, humiliation and verbal aggression by managers and clinicians in public and private spaces contributed to the perception that working environments were emotionally unsafe.”

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Source: HSJ, 27 January 2022

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HSIB launches investigation into community mental health care

The Healthcare Safety Investigation Branch (HSIB) has launched an investigation into community mental health care following the death of a 56-year-old woman.

HSIB has begun examining how patients in crisis with severe mental health needs are assessed by NHS services.

The investigation came after warnings from multiple coroners over the poor assessment of suicide risk in people in mental health crisis in the last year and followed the death of Frances Wellburn, who took her own life in August 2020 while under the care of Tees, Esk and Wear Valleys Foundation NHS Trust (TEWV).

Wellburn had long-term mental health problems but suffered a crisis and was admitted to hospital in September 2019.

Following discharge, she was not referred to a specialist NHS service for people experiencing psychosis because clinicians incorrectly believed she was too old for the service, according to a TEWV investigation report seen by The Independent.

Despite being assessed as a “medium risk”, Wellburn was not contacted by mental health teams for three months. In June 2020, she was admitted to an inpatient unit for three weeks, but her health deteriorated, and she later took her own life.

Separately, coroner warnings in three prevention of future deaths reports published last year found mental health staff failing to risk assess people who later took their own lives.

HSIB’s investigation will look into how patients’ risk is assessed when receiving care in the community and how services interact with families and other health services. It will also examine how mental health services consider menopause when assessing women’s mental health and referrals to early intervention psychosis services.

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Source: The Independent, 27 January 2022

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NHS officials took £70,000 drug company bribes, then ‘switched’ patients’ medication, court told

NHS officials who accepted £70,000 in bribes to promote prescription drugs visited GP surgeries to “switch” patients’ medication, a court has heard.

Paul Jerram and Dr David Turner have been accused of arriving at surgeries claiming to be on official business and changing a patient’s medication – a practice known as “switching”.

James Hines QC prosecuting, told a trial at Southampton Crown Court that the two men had used their positions with the medicine management team of Isle of Wight Clinical Commissioning Group (CCG) and that if the doctors at the surgeries had known it was “not an official visit, they would have not allowed them to [make the changes]”.

“They were effectively using their position with the NHS to farm out the services of the medicine management team and they received money to do so,” the court was told.

Mr Hines QC said: “The prosecution case is that it is completely improper for an NHS professional secretly to promote a particular drug within the NHS to his fellow NHS healthcare professionals when he is in effect in the position of a paid influencer for the pharma company that manufactures that drug.

“That is what was happening on the Isle of Wight for some years.

“If it is your job within the NHS to review medication and drugs, and make recommendations or suggestions for alternative medicines to fellow NHS healthcare professionals, you are acting improperly if you secretly accept money from pharma companies, either directly or indirectly, to promote a particular medicine.

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Source: The Telegraph, 27 January 2022

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NHS trust failings may have contributed to Bristol student’s death, inquest finds

A string of failings may have contributed to the death of a “deeply vulnerable” law student who killed herself while being treated in a psychiatric hospital in Bristol, an inquest jury has said.

Zoë Wilson, 22, had informed staff she was hearing voices in her head telling her to kill herself and 30 minutes before she died was seen by a nurse through an observation hatch looking frightened and behaving oddly but nobody went into her room to check her.

Speaking after the jury’s conclusions, Wilson’s family said that Avon and Wiltshire mental health partnership NHS trust (AWP) should face criminal charges over the case. AWP said it accepted it had fallen short in its care of Wilson.

Zoë on the 17 June 2019 she told staff she was hearing voices telling her to kill herself and handed over an item that she could have used to harm herself with. She was not moved to an acute ward and other items that she could have used were not removed.

At 1am on 19 June she was observed standing beside her bathroom door looking frightened but staff did not go to her. Thirty minutes later she was checked again and had harmed herself. Emergency services were called but she was pronounced dead.

Giving evidence to Avon coroner’s court, the nurse who saw Wilson at 1am said he had only worked in the unit a handful of times and had not met Wilson before that night.

The jury concluded that steps taken to keep her safe that night had been inadequate and also criticised communication and information sharing.

In a statement, her family, said: “Zoë was a wonderful, bright, and deeply vulnerable young woman. She was on a low-risk ward even when she told staff that voices in her head were telling her to kill herself.”

They called for AWP to face a criminal prosecution by the Care Quality Commission (CQC). “We will continue to fight for justice in her name,” they said. “She will never be forgotten.”

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Source: The Guardian, 27 January 2022

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Growing number of trusts defy system leaders on FFP3 guidance

Over 30 trusts are now mandating FFP3 masks are used beyond settings stipulated in national rules, amid calls for system leaders to clarify the national position on the key staff and patient safety issue.

Fresh Air NHS, a group of frontline staff who campaign for better protection against Covid-19, said it now knows of 32 trusts which have already introduced enhanced infection prevention control policies that mandate FFP3 use beyond national guidance.

News that a growing number of trusts are mandating more stringent PPE use comes amid fresh confusion around the national guidance after small but potentially significant alterations were made last week. A new line has been added to guidance which says:: “FFP3 respirator or equivalent must be worn by staff when caring for patients with a suspected or confirmed infection spread by the airborne route.”

David Tomlinson, consultant cardiologist and also a member of Fresh Air NHS, said NHS trusts were “in fear of going beyond the guidance and allowing non-ICU staff to wear FFP3 respirators”.

“The guidance doesn’t mandate respirators for staff in highest risk of transmission areas, for example, medical wards housing symptomatic patients at a time in their disease when they are releasing greatest amounts of infectious aerosols,” Dr Tomlinson said. “Real world data has consistently shown far greater rates of SARS2 infection comparing non-ICU healthcare workers to those on ICU.”

Alison Leary, chair of healthcare and workforce modelling at London Southbank University, said: “Trusts choosing to implement evidence based safety interventions is a positive move towards workforce safety.”

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Source: HSJ, 27 January 2022

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New report gives voice to “devastated” NHS patients

Injured NHS patients have spoken out about the human cost of clinical negligence in a new report published as MPs examine how to cut the health service’s bill for causing harm.

The House of Commons Health and Social Care Select Committee is gathering evidence for its inquiry on NHS litigation reform.

“There is a fixation on the financial cost of clinical negligence, rather than on the human cost and the reasons why injured patients have to make a claim for compensation at all,” said Guy Forster of the Association of Personal Injury Lawyers (APIL) a not-for-profit group which campaigns on behalf of injured patients and their families.

“There are a lot of voices and opinions in any debate which concerns the NHS and patient safety, but they are almost never the voices and opinions of the patients. This is why APIL has commissioned The Value of Compensation report,” said Mr Forster.

Patients who took part in the research cite mounting debt; uncertainty about their future health; isolation; abandoned careers; relationship breakdowns; and loss of independence, as some of the many far-reaching side effects of injuries sustained through failures in care.

“Patients are devastated to have trusted the NHS with their health and then have to live with the pain and suffering of an injury which should have been avoided,” said Mr Forster. “This report provides new insight on how compensation can help rebuild their lives.”

“None of them relish having to make a claim for compensation. I cannot stress enough that the money is never, ever a ‘windfall’ for an injured patient,” he went on.

“It is obvious that full and fair compensation is critical for injured patients. It should go without saying that the cost of compensation would be cut if the harm were not caused in the first place. But it is critical that when things go wrong, injured people are cared for properly and have the chance to get back on track.”

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Source: APIL, 12 January 2022

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Avoid “unproven and unethical” polygenic risk scores in embryo selection, say genetics experts

Geneticists have warned the public against buying polygenic risk score analyses, which some private fertility clinics claim can help parents using in vitro fertilisation in selecting embryos that carry the least risk of future disease.

It appears that at least one child has been born after such a procedure, but the use of polygenic risk score analysis in this respect is severely limited. No evidence shows that these tests can predict the likelihood of an unborn child being liable to a specific disease in the future, representatives from the European Society of Human Genetics wrote in the European Journal of Human Genetics.

Polygenic risk score analysis is mainly offered by fertility clinics in the US, although the practice is also being promoted in the UK.

Patients need to be properly informed on the limitations of its use and a societal debate, focused on what should be considered acceptable with regard to the selection of individual traits, should take place before any further implementation of the technique in this population.

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Source: BMJ, 26 January 2022

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"I’m dying" – Son shares desperate 999 calls

Bina Patel, aged 56, died after struggling to breathe and waiting almost an hour for an ambulance.

Her son Akshay Patel has shared the six phone calls he made to North West Ambulance Service on the night of her death.

North West Ambulance say they "can never say sorry enough" for Bina's death.

"The amount of time it took for help to arrive is unacceptable and not how we want to care for our patients," a spokesperson said.

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Source: BBC News, 26 January 2022

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Period changes after Covid jabs are short-lived

Small changes to periods can follow a Covid vaccine but they quickly return to normal, a leading UK menstruation expert has said.

Dr Victoria Male, from Imperial College London, called studies from the US and Norway which tracked women's cycles "reassuring".

And she blamed misinformation for fuelling concerns over infertility. The Medicines and Healthcare products Regulatory Agency (MHRA) says there is no evidence Covid vaccines affect the ability to have children.

The MHRA has received more than 37,000 reports of unexpected vaginal bleeding, heavier and delayed periods after a Covid jab. It has always said there is no evidence of a link to the vaccine, because women's cycles vary naturally - but scientists called for more research.

Dr Male said: "Changes to the menstrual cycle do occur following vaccination - but they are small compared with natural variation and quickly reverse."

Women's concerns arose "from misinformation that Covid-19 vaccines cause female infertility", she said.

And more studies of pregnancy rates in couples trying to conceive were needed to make it clear they do not.

A Covid infection, however, "may reduce sperm count and quality" - and understanding more about that would mean patients could be given the right advice.

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Source: BBC News, 27 January 2022

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Staff will quit if not given ‘time to recover’, says NHSE director

An NHS England director and trust chief says he ‘fears [the NHS] will see increasing numbers of resignations’ unless more is done to ensure burnt-out staff are given sufficient leave to recover mentally and physically.

Matthew Winn, NHSE’s director of community health and Cambridgeshire Community Services Trust chief executive, set out his concerns in a paper for discussion at his trust’s board meeting today.

While the service is grappling to keep tabs on the number of staff it is losing because of compulsory vaccination plans, the issue of staff leaving because of burnout is harder to quantify, but a huge concern to NHS leaders. Nearly two years of tackling coronavirus has taken a huge emotional and physical toll on a large proportion of the workforce and burnout was a growing issue even before the pandemic.

Mr Winn’s paper says: “As the NHS starts to focus on recovering from the current covid pressures, it is vital that the national, regional and local planning must take into consideration that our staff need time to recover and that they cannot (for example) be expected to catch up on the waiting lists that have accrued, without time and resources to support them.

“In the absence of such an approach, I fear that we will see increasing numbers of resignations and the care we will be able to provide will be far short of the standards we set ourselves and that the public expects from us.”

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Source: HSJ, 26 January 2022

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Review reveals trust’s ‘deep-seated’ cultural and governance issues

One of the NHS’ most high-profile mental health trusts has ‘multiple’ corporate governance problems and ‘deep-seated’ cultural issues, according to an external review.

Tavistock and Portman NHS Foundation Trust, which provides mental health, educational and training services in London, commissioned an external firm to look into its leadership amid a period of intense public scrutiny in the latter half of 2021.

Among cultural issues identified at the trust, which reviewers described as “deep seated”, was a reluctance of staff to speak up about concerns.

Assessors said a recent employment tribunal, which ruled the trust’s treatment of a whistleblower had damaged her professional reputation and “prevented her from proper work on safeguarding”, had impacted the ability of staff to raise concerns.

They urged leaders to review their Freedom to Speak Up and whistleblowing procedures. 

And while reviewers commended board members for commissioning an external review of race equality, they said it had “yielded an outpouring of emotion” which suggested many staff from minority ethnic groups do not feel consistently supported, respected or valued.

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Source: HSJ, 25 January 2022

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NHSE calls on systems and maternity leads to vaccinate more pregnant women

An NHS England letter has warned of “significant variation” in the uptake of the COVID-19 vaccine amongst pregnant women, and called on systems to enable more “spontaneous” antenatal vaccination.

In the letter, sent to integrated care system vaccination programme leads, ICS maternity leads and other NHS clinical directors, NHS England said that while the rates of women who had received at least two doses of the vaccine before giving birth was on the rise, there was “significant variation in uptake between regions and systems and in every system, between women of different ethnicities, decile of deprivation in their local area, and age groups”.

The letter asks that covid vaccines are made available within antenatal clinics “to maximise uptake” and that partially vaccinated women “are offered vaccine confidence conversations and advised antenatally on the nearest available walk-in vaccinations”.

Vaccination programme and maternity service leads have also been told to make use of resources and funding available to drive uptake in at-risk groups.

It said: “Vaccination and maternity leads should discuss how this resource could be used to provide in-reach clinics within every maternity service, without creating additional burden on midwifery staff.”

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Source: HSJ, 26 January 2022

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Number of patients 'medically fit' to leave hospital increases

The number of patients in hospitals who are ‘medically fit’ to leave has increased in January, despite NHS England targets for trusts to dramatically reduce the numbers.

Internal data seen by HSJ suggests there were an average of 12,819 patients who no longer met the ‘criteria to reside’ in NHS hospitals in the week to January 23 – up from around 10,500 before the Christmas period.

Last month, NHS England told local systems to dramatically reduce their numbers of medically fit patients who remained in hospital, as they aimed to free up beds amid a surge in covid-19 admissions fuelled by the omicron wave. It told local leaders “a significant proportion of discharge delays are within the gift of hospitals to solve”.

The message was reiterated by NHSE’s regional teams at the start of January, with systems told to reduce their numbers of medically fit patients by between 30 and 50 per cent.

Yet the proportion of ‘medically fit’ for discharge patients occupying NHS general, acute or critical care beds has also been rising, from around 12% in December to around 14% in mid-January.

Delayed discharges are frequently cited as the main cause of long delays for patients being admitted through hospitals’ emergency departments, which have significantly worsened in recent months.

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Source: HSJ, 26 January 2022

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