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Using Twitter to assess patient takes on patient experience

A qualitative study of Twitter hashtags revealed power hierarchies can damage the patient experience and clinician relationship.

In an analysis of a popular Twitter hashtag, researchers found that patients largely take umbrage when they feel their doctor does not believe their ailment or knowledge about their healthcare, and when they perceive a power hierarchy between themselves and their clinician.

Although not as many patients are using Twitter to get peer feedback on certain providers (the Binary Fountain poll showed only 21% of patients do this), the social media website still holds a lot of power, researchers from the University of California system explained. Twitter is a large platform that hosts social discourse. Healthcare professionals use Twitter to disseminate public health and patient education messages and to network, while 61% of patients use Twitter to learn more about their health, as well.

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Source: Patient Engagement HIT, 29 October 2020

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New inquiry: NHS Leadership, performance and patient safety

The Health and Social Care Committee has launched a new inquiry to examine leadership, performance and patient safety in the NHS.

Inquiry: NHS leadership, performance and patient safety

MPs will consider the work of the Messenger review (2022) which examined the state of leadership and management in the NHS and social care, and the Kark review (2019) which assessed how effectively the fit and proper persons test prevents unsuitable staff from being redeployed or re-employed in health and social care settings.

The Committee’s inquiry will also consider how effectively leadership supports whistleblowers and what is learnt from patient safety issues.

An ongoing evaluation by the Committee’s Expert Panel on progress by government in meeting recommendations on patient safety will provide further information to the inquiry.

Health and Social Care Committee Chair Steve Brine MP said:

The role of leadership within the NHS is crucial whether that be a driver of productivity that delivers efficient services for patients and in particular when it comes to patient safety.

Five years ago, Tom Kark QC led a review to ensure that directors in the NHS responsible for quality and safety of care are ‘fit and proper’ to be in their roles. We’ll be questioning what impact that has made.

We’ll also look at recommendations from the Messenger review to strengthen leadership and management and we will ask whether NHS leadership structures provide enough support to whistleblowers.

Our Expert Panel has already begun its work to evaluate government progress on accepted recommendations to improve patient safety so this will build on that. We owe it to those who rely on the NHS – and the tax-payers who pay for it – to know whether the service is well led and those who have been failed on patient safety need to find out whether real change has resulted from promises made.

Terms of Reference

  • The Committee invites written submissions addressing any, or all, of the following points, but please note that the Committee does not investigate individual cases and will not be pursuing matters on behalf of individuals.  
  • Evidence should be submitted by Friday 8 March. Written evidence can be submitted here of no more than 3,000 words.  
  • How effectively does NHS leadership encourage a culture in which staff feel confident raising patient safety concerns, and what more could be done to support this?
  • What has been the impact of the 2019 Kark Review on leadership in the NHS as it relates to patient safety?
  • What progress has been made to date on recommendations from the 2022 Messenger Review?
  • How effectively have leadership recommendations from previous reviews of patient safety crises been implemented?
  • How could better regulation of health service managers and application of agreed professional standards support improvements in patient safety?
  • How effectively do NHS leadership structures provide a supportive and fair approach to whistleblowers, and how could this be improved?
  • How could investigations into whistleblowing complaints be improved?
  • How effectively does the NHS complaints system prevent patient safety incidents from escalating and what would be the impact of proposed measures to improve patient safety, such as Martha’s Rule?
  • What can the NHS learn from the leadership culture in other safety-critical sectors e.g. aviation, nuclear?

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Source: UK Parliament, 25 January 2024

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Toddlers died after NHS 111 helpline said they were not in danger

The NHS 111 helpline for urgent medical care is facing calls for an investigation after poor decision-making was linked to more than 20 deaths.

Experts say that inexperienced call handlers and the software used to highlight life-threatening emergencies may not always be safe for young children. At least five have died in potentially avoidable incidents.

Professor Carrie MacEwen, Chairwoman of the Academy of Medical Royal Colleges, said: “These distressing reports suggest that existing processes did not safeguard the needs of the children in these instances.”

Since 2014 coroners have written 15 reports involving NHS 111 to try to prevent further deaths. There have been five other cases where inquests heard of missed chances to save lives by NHS 111 staff; two other cases are continuing and one was subject to an NHS England investigation.

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Source: The Times, 5 January 2020

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Child deaths 'not properly investigated' at top hospital

Great Ormond Street Hospital (GOSH) failed to properly investigate child deaths, suggests evidence uncovered by the BBC.

The source of one fatal infection was never examined and in another case GOSH concealed internal doubts over care. Amid claims GOSH put reputation above patient care, former Health Secretary Jeremy Hunt urged it to consider a possible "profound cultural problem".

Responding, the central London hospital said it rejected all suggestions that it treated any child's death lightly.

BBC Radio 4's File on 4 programme has spoken to several families whose children were treated at the world-famous hospital. All said that while care at one point had been excellent, when things went wrong GOSH appeared to have little interest in fully understanding what had happened.

The concerns over how Great Ormond Street is run are shared by staff. A staff survey, published last month, made grim reading for management.

On two aspects, including whether there is a safety culture, it received the lowest score of all trusts in its category, while on three other questions, including how bad bullying and harassment were, and how good the quality of care was, its own staff rated it as among the worst.

"If we want the NHS to offer the highest quality care in the world, then we have to change a blame culture and sometimes a bullying culture, for a learning and an improvement culture," the former Health Secretary Jeremy Hunt told File on 4.

"That staff survey would indicate they don't have that culture at Great Ormond Street."

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Source: BBC News, 17 March 2020

Read Joanne Hughes' response to this news in her blog shared on the hub.

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Patient Safety Learning launches Oscar, the friendly health chatbot

We’re living in an unprecedented time and facing new challenges. We’re asking questions we’ve never had to ask before – questions that differ according to our unique circumstances, concerns and needs.

With an increasingly complex health and social care system, Patient Safety Learning wants to continue working towards a future that is safe for both patients and staff.

It’s for this reason that we’ve launched Oscar, the friendly health chatbot. Available on the hub, Oscar answers the public’s question about their safety – or that of their family members and friends – during the coronavirus pandemic.

Oscar is not a diagnostic tool. We at Patient Safety Learning are not medical experts ourselves, but we want to connect patients to the best guidance currently in the public domain. This is what Oscar seeks to do, in pointing visitors to helpful and trustworthy answers, relevant to their specific situations.

Whether you’re a well adult seeking general information about how to stay safe from coronavirus, a concerned woman about to give birth and wanting to know your options, or a carer looking for advice, Oscar is here to help you find the answers you need. In time, as we see how the public uses Oscar – and especially as we hear your feedback – we plan to build on the range of information Oscar currently offers. 

Like everything else on the hub, Oscar is free to use.

Please do send us any feedback, including information you’d like Oscar to provide, by emailing feedback@pslhub.org

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Coronavirus: Risk higher for pregnant BAME women

The high proportion of pregnant women from black and ethnic minority (BAME) groups admitted to hospital with COVID-19 "needs urgent investigation", says a study in the British Medical Journal.

Out of 427 pregnant women studied between March and April, more than half were from these backgrounds - nearly three times the expected number. Most were admitted late in pregnancy and did not become seriously ill. Although babies can be infected, the researchers said this was "uncommon".

When other factors such as obesity and age were taken into account, there was still a much higher proportion from ethnic minority groups than expected, the authors said.

But the explanation for why BAME pregnant women are disproportionately affected by coronavirus is not simple "or easily solved," says Professor Knight, lead author.

"We have to talk to women themselves, as well as health professionals, to give us more of a clue."

Gill Walton from the Royal College of Midwives says, "Even before the pandemic, women from black, Asian or ethnic minority backgrounds were more likely to die in and around their pregnancy,"

She said they were "still at unacceptable risk" and getting help and support to affected communities was crucial. 

Ms Walton added: "The system is failing them and that has got to change quickly, because they matter, their lives matter and they deserve the best and safest care."

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Source: BBC News, 8 June 2020

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‘Long covid’ clinics still not operating despite Hancock claim

The government and NHS England appear unable to identify units set up to treat ‘long covid’, contrary to a claim by Matt Hancock in Parliament that the NHS had ‘set up clinics and announced them in July’. 

There are growing calls for wider services to support people who have had COVID-19 and continue to suffer serious follow-up illness for weeks or months. Hospitals run follow-up clinics for those who were previously admitted with the virus, but these are not generally open to those who were never admitted.

Earlier this month the health secretary told the Commons health committee: “The NHS set up long covid clinics and announced them in July and I am concerned by reports from Royal College of General Practitioners that not all GPs know how to get into those services.”

Asked by HSJ for details, DHSC and NHS England declined to comment on how many clinics had been set up to date, where they were located, how they were funded or how many more clinics were expected to be “rolled out”.

However, two charities and support groups — Patient Safety Learning and the Long Covid Support Group — told HSJ they were not aware of dedicated long covid clinics for community patients. An enquiry from Patient Safety Learning to NHS England has not been answered.

The number of people affected by long covid is unclear due to a lack of research but there are suggestions it could be half a million or more. Symptoms can include fatigue, sleeplessness, night-time hypoxia, “brain fog” and cardiac problems. It appears to affect more people who were not hospitalised with coronavirus than those who were were. There is some evidence that small clinics have been set up locally on a piecemeal basis, without national funding.

HSJ has only been able to identify only one genuine “long covid clinics” open to those who have never been in hospital with covid. 

Trisha Greenhalgh, an Oxford University professor of primary care health sciences who has interviewed around 100 long covid sufferers, told HSJ: “Nobody I have interviewed had been seen in a long covid clinic but there is an awful lot of people who would like to be referred and who sound like the need to be but they haven’t.”

Read full story (paywalled)

Source: HSJ, 23 September 2020

Read the letter Patient Safety Learning sent to NHS England

hub Community thread - Long Covid: Where are these clinics?

 

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Head of NHS inquiry warns other families could be victims of cover-ups

The chairman of an inquiry that has confirmed a 20-year cover-up over the avoidable death of a baby has warned there are other families who may have suffered a similar ordeal.

Publishing the findings of his investigation into the 2001 death of Elizabeth Dixon, Dr Bill Kirkup said he wanted to see action taken to prevent harmed families having to battle for years to get answers.

Dr Kirkup, who has been involved in multiple high-profile investigations of NHS failures in recent years, said: “There has been considerable difficulty in establishing investigations, where events are regarded as historic. I don't like the term historic investigations. I think that these things remain current for the people who've suffered harm, until they're resolved, it’s not historic for them.  

“There has been significant reluctance to look at a variety of cases. Mr and Mrs Dixon were courageous and very persistent and they were given help by others and were successful in securing the investigation and it worries me that other people haven't been.

“I do think we should look at how we can establish a proper mechanism that will make sure that such cases are heard."

“It's impossible to rule out there being other people who are in a similar position. In fact, I know of some who are. I think it's as important for them that they get heard, and that they get things that should have been looked at from the start looked at now, if that's the best that we can do.”

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Source: The Independent, 27 November 2020

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Gosport hospital deaths: Families 'need Hillsborough-style inquests'

Relatives of patients who died after receiving "dangerous" levels of painkillers at Gosport War Memorial Hospital have called for new inquests. 

An inquiry found 456 patients died after being given opiate drugs at the hospital between 1987 and 2001, but no charges have ever been brought.

Four families told the BBC they have requested judge-led "Hillsborough-style" hearings with a jury. The Attorney General's Office said it was reviewing the application.

Police began a fresh inquiry in 2019 into 700 deaths after the Gosport Independent Review Panel found there was a "disregard for human life" at the hospital in Hampshire.

Coroner-led inquests in 2009 found drugs administered at the hospital contributed to five deaths.

However, lawyers representing some of the families told the BBC more wide-ranging inquests similar to those that examined the events of the Hillsborough disaster should be undertaken.

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Source: BBC News, 5 February 2021

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NHS whistleblower wins £500,000 for unfair dismissal

A “commended” NHS nurse has been awarded nearly £500,000 for being wrongly sacked after she claimed that high workloads led to a patient’s death.

Linda Fairhall, 62, a 44-year veteran of the health service, said she made 13 separate pleas to bosses warning that her colleagues were overburdened, but she was ignored each time.

Fairhal told officials at the University Hospital of North Tees and Hartlepool that she was worried about a recently imposed policy that obliged nurses to monitor patients who took prescribed medicines and maintained that it led to nurses having to conduct 1,000 extra patient visits a month without extra resources.

She said nurses were overwhelmed by the additional responsibility, which resulted in rising “anxiety” among staff and higher rates of absence. However, Fairhall told the tribunal in Teesside that nothing was done in response to her concerns, and ultimately a patient died.

The tribunal heard that the nurse raised her last warning with officials just before she went on annual leave. On her return she was suspended and investigated for “bullying and harassment”, then sacked for gross misconduct.

A tribunal has now ruled that the decision to dismiss Fairhall was “materially influenced” by her complaints regarding patient safety, with the panel adding that it could not “genuinely believe” that she was guilty of misconduct.

Read full story (paywalled)

Source: The Times, 4 January 2023

Read the full tribunal decision: Ms L Fairhall v University Hospital of North Tees and Hartlepool Foundation Trust

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The Care Quality Commission’s annual in-patient survey reveals an increase in patient safety risks

PRESS RELEASE - 1 July 2019

Patient Safety Learning identifies that reduced performance in two aspects of patient experience may increase the safety risks patients face as in-patients.

The Care Quality Commission’s (CQC) recently published 2018 annual in-patient survey shows that improvement in two areas of patient experience has stalled while a range of issues that matter to patients have worsened. The charity, Patient Safety Learning, has identified that deteriorating performance in two of these issues is likely to make patient safety risks worse.

Fewer patients informed properly when discharged home
The CQC’s sixteenth annual survey of people who stayed as an in-patient in hospital was published on 20 June 2019. It shows that most people had confidence in the doctors and nurses treating them, and felt that staff answered their questions clearly.

However, the survey reports that 40% of patients were discharged from hospital without written information about how to look after themselves following treatment. This is up 2% from 2017. Of patients who had been given medication to take home, 44% were not told of possible side effects for which they should watch.

Fewer patients report being involved in their own care
Only 54% of patients report that they are involved as much as they want to be in decisions about their care and treatment, down from 56% in 2017. The number of patients reporting that their views had been sought on the quality of care they received was down by a quarter compared with 2017, from 20% to 15%.

An increasing challenge to safety
Giving patients written information about how to look after themselves on discharge is clearly a patient safety issue. If this practice is reducing, then the inherent risk to patients must be increasing.

Patient Safety Learning’s recent report, A Blueprint for Action, cited a wide range of evidence that communication with patients – listening to them and acting on what is heard – has a demonstrable effect on improving patient safety. The evidence from the CQC survey indicates, however, that such practice is reducing, not increasing, with corresponding implications for patient safety.

Patient Safety Learning Chief Executive, Helen Hughes, said, “Effective communication and engagement with patients is essential for safe care. The CQC’s survey is a valuable tool for assessing this. It is concerning that their report evidences that communication with patients is reducing in ways that have the potential to increase the risk to patient safety. Patient safety is a core part of the purpose of healthcare and action is needed to share good practice across the wider health system.”   /ENDS

Note to editors

Patient Safety Learning is a charity. We help transform safety in health and social care, creating a world where patients are free from harm.

We identify the critical factors that affect patient safety and analyse the systemic reasons they fail. We use what we learn to envision safer care. We recommend how to get there. Then we act to help make it happen. 

Patient Safety Learning’s latest report, A Blueprint for Action, can be downloaded here: www.patientsafetylearning.org/resources/blueprint.

For more information, contact

Margot Knight, Marketing and Communications Manager, Patient Safety Learning
E: margot@patientsafetylearning.org

Or

Helen Hughes, Chief Executive, Patient Safety Learning
T: +44 (0) 7793 550855
E: helen@patientsafetylearning.org

Patient Safety Learning
SB 220
China Works
100 Black Prince Road
London SE1 7SJ

www.patientsafetylearning.org

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NHS patients will be able to log anonymous complaints via smartphones under safety plans

Patients will be able to anonymously log concerns about their NHS treatment, via a phone app, as part of efforts to boost safety. The new strategy will see the creation of a centralised portal, allowing patients, their families and staff to record problems with medical devices, errors in medicines administration, or difficulties in spotting a patient’s condition deteriorating. Officials said that swift recording of such information would enable them to alert the rest of the NHS more quickly to risks of serious harm, and prevent tragedies being repeated.

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Source: The Telegraph, 29 June 2019

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Record numbers struggle to see GP

Most patients who want to see their own GP can no longer get an appointment with them, according to new figures suggesting the days of the family doctor are over. The statistics show record numbers of patients struggling to even get through on the telephone, and increasingly long waits for an appointment. For the first time, the majority of patients who wanted to see a particular doctor were unable to do so, the survey of more than 770,000 patients shows. The research comes amid mounting evidence of a wider NHS crisis, with waiting lists reaching an all-time high.  

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Source: The Telegraph, 11 July 2019

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Only 15% of healthcare apps meet safety standards, research reveals

Only 15% of healthcare apps meet minimum safety standards, highlighting a “desperate need” for a proper review process, new research has concluded.

Health app evaluation organisation ORCHA evaluated more than 5,000 apps against 260 performance and compliance factors and found that majority do not meet the minimum safety requirements.

Liz Ashall-Payne, ORCHA’s Chief Executive, said: “We believe that digital health apps are one of the most important tools available to help tackle health issues in an ageing population that’s facing more complex, long-term problems. The fact that only 15% of apps that we review meet the minimum standards show there is a desperate need to regularly and properly assess the apps available to ensure that people are protected against the serious risks associated with downloading ineffective or even harmful apps.”

Helen Hughes, Chief Executive of Patient Safety Learning, which is working with ORCHA to improve the safety of apps, said the research reiterated the need for consistent regulatory standards and accreditation frameworks to be applied to healthcare apps.

“One of the areas we are beginning to explore with ORCHA is whether or not we can consider what patient safety would be in part of the review process,” she said. “Essentially what we want is patient safety embedded in all of the review processes so that we can inform and guide clinicians and inform and guide patients."

“And that there is appropriate research on their use and their impact so that information can feed the improvement of standards.”

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Source: Digital Health. 9 October 2019

 

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Clean hands for all

Today is Global Handwashing Day, a global advocacy day dedicated to increasing awareness and understanding about the importance of handwashing with soap as an effective and affordable way to prevent diseases and save lives.

hub content on handwashing:

WHO: Guidance on engaging patients and patient organisations in hand hygiene initiatives

Safety and Health Practitioner: Tips for hand hygiene 

Hand washing dance - this is how we do it

What initiatives are in your hospital to ensure "clean hands for all"? Share your tips on the hub.

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Surgical objects left in patients on the rise in Canada

More than 550 objects have been unintentionally left in Canadian medical and surgery patients between 2016 and 2018, and the problem appears to be getting worse.

A new report released by the Canadian Institute for Health Information says 553 foreign items – such as sponges and medical instruments – were left behind over that two-year period. That's a 14%  increase between the most recent data collected in 2017–2018 and statistics collected five years earlier.

It's also more than two times the average rate of 12 reporting countries, including Sweden, the Netherlands and Norway, which had the next highest rates.

The information was examined as part of a broad look at how Canada's health-care system compares to other member nations of the Organisation for Economic Co-operation and Development.

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Source: CTV News, 7 November 2019

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The cost of patient safety inaction: Why doing more of the same is unsustainable

On January 2020, Patient Safety will be on the G20 agenda (among other five health key priorities), but Abdulelah M. Alhawsawi, Saudi Patient Safety Center, asks "what is patient safety doing on an economic forum like the G20?"

Patient harm is estimated to be the 14th leading cause of the global disease burden. This is comparable to medical conditions such as tuberculosis and malaria. In both US and Canada, patient safety adverse events represent the 3rd leading cause of death, preceded only by cancer and heart disease. In the US alone, 440,000 patients die annually from healthcare associated infections. In Canada, there are more than 28,000 deaths a year due to patient safety adverse events. In low-middle income countries,  134 million adverse events take place every year, resulting in 2.6 million deaths annually. 

In addition to lives lost and harm inflicted, unsafe medical practice results in money loss. Nearly, 15 % of the health expenditure across Organization of Economic Cooperative Development countries is attributed to patient safety failures each year, but if we add the indirect and opportunity cost (economic and social), the cost of harm could amount to trillions of dollars globally.

When a patient is harmed, the country loses twice. The individual will be lost as a revenue generating source for society and the individual will become a burden on the healthcare system because he or she will require more treatment. Unless we do something different about patient safety, we would risk the sustainability of healthcare systems and the overall economies. 

Alhawsaw proposed establishing a G20 Patient Safety Network (Group) that will combine Safety experts from healthcare and other leading industries (like aviation, nuclear, oil and gas, other), and economy and fFinancial experts

This will function as a platform to prioritise and come up with innovative patient safety solutions to solve global challenges while highlighting the return on investment (ROI) aspects. 

This multidisciplinary group of experts can work with each state that adopts the addressed global challenge to ensure correct implementation of proposed solution.

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Source: The G20 Health & Development Partnersip, 10 February 2020

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Covid-19: Doctors are told not to perform CPR on patients in cardiac arrest

Healthcare staff in the West Midlands have been told not to start chest compressions or ventilation in patients who are in cardiac arrest if they have suspected or diagnosed covid-19 unless they are in the emergency department and staff are wearing full personal protective equipment (PPE).

The guidance from the University Hospitals Birmingham NHS Foundation Trust says that patients in cardiac arrest outside the emergency department can be given defibrillator treatment if they have a “shockable” rhythm. But if this fails to restart the heart “further resuscitation is futile,” it says.

If a patient with suspected covid-19 is in cardiac arrest they should be given cardiac compressions and be ventilated only if they are in the emergency department and the person attending them is wearing aerosol generating procedures (AGP) PPE. That means wearing an FFP3 mask, full gown with long sleeves, gloves, and eye protection.

The advice rests on the premise that performing cardiac compressions risks virus particles being released into the air that could infect staff.

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Source: BMJ, 29 March 2020

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NHS staff coronavirus inquests told not to look at PPE shortages

Inquests into coronavirus deaths among NHS workers should avoid examining systemic failures in provision of personal protective equipment (PPE), coroners have been told, in a move described by Labour as “very worrying”.

The chief coroner for England and Wales, Mark Lucraft QC, has issued guidance that “an inquest would not be a satisfactory means of deciding whether adequate general policies and arrangements were in place for provision of PPE to healthcare workers”.

Lucraft said that “if there were reason to suspect that some human failure contributed to the person being infected with the virus”, an inquest may be required. The coroner “may need to consider whether any failures of precautions in a particular workplace caused the deceased to contract the virus and so contributed to death”.

But he added: “An inquest is not the right forum for addressing concerns about high-level government or public policy.”

Labour warned the advice could limit the scope of investigations into the impact of PPE shortages on frontline staff who have died from COVID-19.

“I am very worried that an impression is being given that coroners will never investigate whether a failure to provide PPE led to the death of a key worker,” said Lord Falconer, the shadow attorney general. “This guidance may have an unduly restricting effect on the width of inquests arising out of Covid-19-related deaths.”

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Source: The Guardian, 29 April 2020

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‘Fundamental’ changes to London’s NHS in wake of COVID-19

The NHS in London is planning to “fundamentally shift the way we deliver health and care” in the wake of coronavirus, according to documents obtained by HSJ.

The plans from NHS England and Improvement’s London office say leaders should:

  • Plan for elective waiting times to be measured at integrated care system level, rather than trust level.
  • Accept “a different kind of risk appetite than the one we are used to”.
  • Expect decisions from the centre on the location of cancer, paediatric, renal, cardiac, and neurosurgical services.
  • Plan for a permanent increase in critical care capacity.
  • Transform to a “provider system able to be commissioned and funded on a population health basis”.
  • Work towards “a radical shift away from hospital care”.
  • Expect “governance and regulatory landscape implications” plus “streamlined decision-making”.

The document, titled Journey to a New Health and Care System, says there are three “likely” phases, with the final new system in place “from November 2021”.

The preceding two phases are “action programmes” over the next 12 to 15 months which will be about reconfiguring services to deal with “immediate covid, non-covid and elective need”, and “transition” when the move to new configurations is evaluated and “public consent” sought.

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Source: HSJ, 11 May 2020

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Coronavirus: Half a million access suicide prevention course

More than half a million people have accessed online training that aims to prevent suicide in the last three weeks alone, a charity has said.

The Zero Suicide Alliance said 503,000 users completed its online course during lockdown. It aims to help spot the signs that a person may need help.

It comes as health leaders warned front-line workers tackling coronavirus could suffer from mental ill health.

NHS England launched a mental health hotline to support staff last month.

The alliance's Joe Rafferty said the true impact of the coronavirus on mental health will not be known until the pandemic ends, but he said "the stress and worry of the coronavirus is bound to have impacted people's mental health".

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Source: BBC News, 18 May 2020

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CQC reveals some patients have spent a decade in seclusion

The Care Quality Commission (CQC) has called for ‘ministerial ownership’ to end the ‘inhumane’ care of patients with learning difficulties and autism in hospital – after finding some cases where people had been held in long-term segregation for more than 10 years.

Following its second review into the uses of restraint and segregation on people with a learning difficulty, autism and mental health problems, the CQC has warned it “cannot be confident that their human rights are upheld, let alone be confident that they are supported to live fulfilling lives”.

The review was ordered by health and social care secretary Matt Hancock in late 2018 in response to mounting concerns about the quality of care in these areas.

According to the report, published today, inspectors found examples people being in long-term segregation for at least 13 years, and in hospital for up to 25 years. It also found evidence showing the proportion of children from a black or black British background subjected to prolonged seclusion on child and adolescent mental health wards was almost four times that of other ethnicities.

Looking at care received in hospital the CQC found many care plans were “generic” and “meaningless” and patients did not have access to any therapeutic care.

Reviewers also found people’s physical healthcare needs were overlooked. One women was left in pain for several months due to her provider failing to get medical treatment.

The regulator also reviewed the use of restrictive practices within community settings. While it found higher quality care, and the use of restrictive practices was less common, it said there was no national reporting system for this sector.

Read full story (paywalled)

Source: HSJ, 22 October 2020

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Twenty-two junior doctors under investigation after covid outbreak

A trust is investigating after two junior doctors developed covid following an offsite event attended by 22 juniors where social distancing rules were allegedly ignored.

The cases, involving doctors from the Royal Surrey Foundation Trust in Guildford, have been declared an outbreak by Public Health England and police have investigated the incident.

But HSJ understands that contact tracing has concluded no patients needed to be tested because staff had worn appropriate PPE at all times and those involved had swiftly self-isolated once they realised they might have covid or had been at risk of exposure to it.

It is not known whether any of the doctors had returned to work after the event before realising they might have been exposed to covid.

Dr Mark Evans, deputy medical director, said: “Protecting our patients is our priority and we are committed to ensuring that all of our staff follow government guidance. This incident took place outside of work and has been reported appropriately, and there was no disruption to our services for patients.”

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Source: HSJ, 22 October 2020

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Coronavirus: Government throwing ‘lit match into a haystack’ by discharging Covid patients to care homes

The government has been warned it is throwing “a lit match into a haystack” by discharging Covid-positive patients to care homes, with politicians demanding that the safety of residents and staff is guaranteed under the new policy.

During the first wave of the pandemic, approximately 25,000 hospital patients were sent to care homes – many of whom were not tested – which helped spread the virus among residents. Around 16,000 care home deaths have been linked to COVID-19 since the start of the crisis.

The strategy was one of the government’s “biggest and most devastating mistakes” of the crisis, says Amnesty International, and questions have been raised over the decision to introduce a similar policy as the UK’s second wave intensifies.

As part of the 2020 adult social care winter plan, the government has called on local authorities and care providers to establish “stand-alone units” – so-called “hot homes” – that would be able to receive and treat Covid hospital patients while they recover from the disease.

There is also an expectation that, due to housing pressures and a shortage of suitable facilities, some patients may be discharged to “zoned accommodation” within a home, before being allowed to return to normal living settings once they test negative for the virus.

Councils have been told to start identifying and notifying the Care Quality Commission of appropriate accommodation, and to ensure high infection prevention standards are met.

Under the requirements outlined by the government, discharged patients “must have a reported Covid test result". However, The Independent revealed on Monday that these rules have not been followed in some cases, with a recent British Red Cross survey finding that 26 per cent of respondents had not been tested before being discharged to a care home.

There is also concern whether care homes possess enough adequate personal protective equipment to prevent outbreaks, with the CQC revealing last month that PPE was still not being worn in some sites.

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Source: The Independent, 27 0ctober 2020

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