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Weigh up risks of blood clots before giving AstraZeneca vaccine to certain patients, GPs told

GPs should only give the Oxford/AstraZeneca Covid vaccine to patients with medical conditions which put them at higher risk of developing blood clots if the benefits outweigh the risks, the UK medicines regulator has said.

The Medicines and Healthcare products Regulatory Agency (MHRA) has issued the advice to healthcare professionals regarding while it continues to review a link between the vaccine and rare blood clots.

It has also added to previous advice regarding symptoms for patients to look out for following their Covid vaccination with the AZ vaccine.

The new advice from the MHRA said:

  • Administration of Covid-19 Vaccine AstraZeneca in people of any age who are at higher risk of blood clots because of their medical condition should be considered only if benefits from the protection from COVID-19 infection outweighs potential risks.
  • Anyone who experienced cerebral or other major blood clots occurring with low levels of platelets after their first vaccine dose of Covid-19 Vaccine AstraZeneca should not have their second dose. Anyone who did not have these side effects should come forward for their second dose when invited.
  • Pregnancy predisposes to thrombosis, therefore women should discuss with their healthcare professional whether the benefits of having the vaccine outweigh the risks for them.

Meanwhile, ‘anyone who has symptoms four days or more after vaccination is advised to seek prompt medical advice’. These include:

  • a new onset of severe or persistent headache, blurred vision, confusion or seizures
  • develop shortness of breath, chest pain, leg swelling or persistent abdominal pain,
  • unusual skin bruising or pinpoint round spots beyond the injection site.

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Source: Pulse, 7 April 2021

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Weekly testing for care home staff to start on Monday

Staff working in care homes are to be tested every week starting on Monday, with residents tested every month, the government has said.

The expansion of testing comes as a whistleblower at one of the testing laboratories revealed dozens of shifts had been cancelled throughout May and June because of a lack of test samples.

Ministers hope that the expansion of testing will help to prevent the spread of infection to vulnerable residents.

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Source: The Independent, 3 July 2020

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Weekly Covid deaths at highest rate since early June, new statistics show

The number of weekly coronavirus deaths in England and Wales has risen to its highest figure since early June, new statistics show.

In the week ending 23 October, a total of 978 registered deaths mentioned COVID-19 on the death certificate, according to the Office for National Statistics (ONS). This marks a 46% increase on the number of deaths reported in the previous week, and is the highest figure on record since 12 June.

Of the 978 deaths that involved COVID-19, 874 had this recorded as the underlying cause of death (89.4 per cent), the ONS said.

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Source: The Independent, 3 November 2020

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Website to show NHS delays

A website that tells patients how long they are likely to wait for NHS treatment will be made available in Scotland this summer.

Humza Yousaf, the Scottish health secretary, said people queuing for tests and procedures and their doctors would be able to access information about any delays in their area using the software.

Many patients living in pain are waiting years to have common operations such as hip and knee replacements. In theory, the SNP guarantee hospital treatment within 12 weeks of patients joining the waiting list, but this law was broken extensively before the pandemic and has now been breached hundreds of thousands of times.

One orthopaedic surgeon, who did not wish to be named, said he was operating on patients whose joints had entirely collapsed after a two-year wait for a limb replacement made their case an emergency. Other patients who did not reach crisis faced even longer delays, he said.

Dr Sandesh Gulhane, a GP and health spokesman for the Scottish Conservative Party, asked Yousaf, during a meeting of the Scottish Parliament’s health committee yesterday: “Why can’t we have in the future, in the [recovery] plan, indicative waiting times which are relatively live so we can all go on a website and see how long we need to wait.”

Yousaf said it was fair for patients and NHS staff to expect to have information on waiting times, and that a website to provide this was being developed. 

“We are working closely with Public Health Scotland, we are working closely with boards to develop the infrastructure in order to collate and publish this data,” he said. “It’s an ambition of ours to have that available in a way that is easy to find, easy to understand, both for the patient but for the health professional too.”

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Source: The Times, 11 May 2022

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Webinar today @ 1pm: Responding to voices from the healthcare frontline

Join Animah Kosai, Founder of Speak Up at Work, Roger Kline, Trustee Patients First UK, and Kernan Manion Executive Director, Center for Physician Rights as we explore essential crisis communication principles to ensure staff safety, healthcare team cohesion, and effective care delivery. 

Few in our local and national communities have ever experienced a pandemic causing complete shutdown and emergency isolation measures.

With such an immense and unparalleled global catastrophe, despite play-acting disaster drills,  few corporations are truly prepared for the emergency response demands and the accompanying requirement for a Crisis Response Mindset and its communication principles. 

Fortunately, wisdom gleaned from knowledge-based science and on-the-ground experience in prior epidemics and natural catastrophes is available to guide us through this very unfamiliar turf.

A particular focus is on intra-organisational crisis management and communication with an aim toward sharing best practices.

Further information

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Wearable fitness trackers could interfere with cardiac devices, study finds

Wearable fitness and wellness trackers could interfere with some implanted cardiac devices such as pacemakers, according to a study.

Devices such as smartwatches, smart rings and smart scales used to monitor fitness-related activities could interfere with the functioning of cardiac implantable electronic devices (CIEDs) such as pacemakers, implantable cardioverter defibrillators (ICDs), and cardiac resynchronisation therapy (CRT) devices, the study published in the Heart Rhythm journal found.

Researchers found that the electrical current used in wearable smart gadgets during “bioimpedance sensing” interfered with proper functioning of some implanted cardiac devices from three leading manufacturers.

 Lead researcher, Dr Benjamin Sanchez Terrones, of the University of Utah. said the results did not convey any immediate or clear risks to patients who wear the trackers. However, the different levels of electrical current emitted by the wearable devices could result in pacing interruptions or unnecessary shocks to the heart. Further research was needed to determine the actual level of risk".

“Our research is the first to study devices that employ bioimpedance-sensing technology as well as discover potential interference problems with CIEDs such as CRT devices. We need to test across a broader cohort of devices and in patients with these devices. Collaborative investigation between researchers and industry would be helpful for keeping patients safe,” Sanchez said.

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Source: The Guardian, 22 February 2023

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Weaknesses that led to patients getting Covid in hospital remain

Almost as soon as the pandemic struck early last year, NHS England recognised that patients catching Covid-19 while they were in hospital for non-Covid care was a real risk and could lead to even more deaths than were already occurring. Unfortunately their fears have been borne out by events since – every acute hospital in England has been hit by this problem to some extent.

Over the last 15 months various NHS and medical bodies have looked into hospital-acquired Covid and published reports and detailed guidance to help hospitals stem its spread. They include the Healthcare Safety Investigation Branch (HSIB) and Public Health England (PHE). Last May, for example, PHE estimated that 20% of coronavirus infections in hospitalised patients and almost 90% of infections among healthcare staff may have been nosocomial, meaning they were caught in a hospital setting.

Before the pandemic the NHS was over-stretched and resources were limited. The crisis distorted it further out of shape and despite NHS staff making huge efforts to contain the virus in extremely challenging circumstances, too often they were overwhelmed.

There are many other reasons, including inadequate ventilation, the sharing of equipment, and nurses and doctors having to gather at nurses’ stations and in doctors’ messes. Some bereaved relatives also cite hospitals deciding – inexplicably – to put their Covid-free loved ones in a bay or ward with one or more people who had the disease, sometimes resulting in tragedy.

While some of these inherent weaknesses have been addressed, others remain, leaving further infections and even more deaths in this way a distinct possibility if the NHS is hit by another Covid surge.

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Source: The Guardian, 24 May 2021

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We’re being asked to save the NHS again. But isn’t it supposed to save us?

“Protect the NHS” sounds like the team name for an illegal Downing Street quiz, but it won’t be winning any prizes for patient safety, writes Dr Phil Hammond in The Times.

The fact is, the NHS, as was the case long before the pandemic, is woefully understaffed. Even more billions have been thrown at the system, but, as ever, so little of it finds its way to the frontline carers we all clapped for. The NHS is always fighting a losing battle.

When the government first asked us to protect the NHS, it may as well have said: “Stay at home, die alone, protect the NHS.” Thousands of people have done just that since the pandemic started, for reasons not fully understood. They may have had Covid or non-Covid diseases, or both. They didn’t ask for, or couldn’t find, help when they were seriously ill. They followed their “stay at home” orders. Many died.

"The NHS does some amazing things but the truth is it has never had the staff nor capacity — and sometimes not the culture — to provide safe, effective and timely care to all its citizens," says Hammond. 

"We also have appalling levels of public health inequality. The rich live a decade longer than the poor, and the poor suffer 20 more years of chronic disease and NHS dependency. No health service can cope with such high demands, many of them avoidable."

Today, many people can’t even access care, never mind the quality of it. But we don’t need to dismantle the NHS, we need to staff it safely. We need to start with a proper, costed workforce plan for now and the future. If we put even more money into healthcare, we need to prove it’s being spent on frontline care that is proven to work.

Just as we didn’t plan properly for Covid, we have never had a proper workforce plan for the NHS to estimate what staff increases we need to cope with an ageing, anxious and increasingly isolated population chock full of chronic diseases. How did we get in this mess?

There is good evidence that safe staffing levels deliver better care, and that continuity of care and a long-standing relationship with your GP or nurse is hugely beneficial to your health. It’s much more rewarding for health professionals too. Alas, they don’t grow on trees and there’s a global shortage. There’s a limit to how many we can steal from countries who may need them more. No matter how much money we throw at the NHS in a pandemic panic, this tanker won’t be turned around quickly.

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Source: The Times, 18 December 2021

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We're about to see a wave of long Covid. When will ministers take it seriously?

Long Covid is no respecter of youth, health or fitness. It afflicts more women than men but it can strike anyone down, including people whose initial infection seemed mild, or even asymptomatic. In some cases, long Covid could mean lifelong Covid.

The effects can be horrible. Among them are lung damage, heart damage and brain damage that can cause memory loss and brain fog, kidney damage, severe headaches, muscle and joint pain, loss of taste and smell, anxiety, depression and, above all, fatigue. We should all fear the lasting consequences of this pandemic.

Long Covid is shorthand for a range of conditions. Some scientists divide them into three broad categories, others into four. Of these, one seems to ring a bell. It’s a cluster of symptoms that bear a strong similarity to myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). This is a devastating condition that affects roughly a quarter of a million people in the UK, and is often caused, like long Covid, by viral infection.

Among the common symptoms of ME/CFS are extreme fatigue that is not relieved by rest, and “post-exertional malaise”: even mild physical or mental effort can make patients extremely unwell. Many sufferers are confined to their home or even their bed, with their working life, social life and family life truncated. There is, so far, no diagnostic test and no cure.

Yet ME/CFS has been disgracefully neglected by science and medicine. 

The NHS is now setting up specialist clinics to treat long Covid. But already, apparent mistakes are being made. Without the necessary caveats, the NHS recommends steadily increasing levels of exercise for people suffering from post-Covid fatigue. But as ME/CFS patients with post-exertional malaise know, this prescription, though it sounds intuitive, could be highly damaging.

We need massive research programmes into both long Covid and ME/CFS, coupled with better information for doctors. 

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Source: The Guardian, 21 January 2021

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We need to tell the public that hospitals are ‘horrible places’, urges trust CEO

Hospitals are ‘horrible’ and unsafe places, which should be avoided ‘unless you really need to be there’, a longstanding trust chief executive has argued.

East Suffolk and North Essex Foundation Trust boss Nick Hulme also said the NHS had to be honest about the state of its acute services.

Speaking at a public meeting of the East Suffolk and North Essex Integrated Care Board, he described hospitals as “awful” and “horrible”, and said NHS leaders had “got to get that message out” to the public. 

He added: “The food’s rubbish, we don’t let you sleep, we don’t let you know what’s going on” and that although he had stayed in some “fairly dodgy” hotels, none had forced him to share a bathroom with six people.

The trust CEO told the meeting he wanted to emphasise to the public that “the worst place you can possibly be in the health system is a hospital, unless you need to be there”, according to a report in the East Anglian Daily Times.  He added that hospitals were “not safe places”.

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Source: HSJ, 26 January 2023

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We need to stop calling NHS staff heroes – for a very important reason

When we put people on a pedestal, my experience is that they are less likely to be asked, ‘are you OK?’, writes Samantha Batt-Rawden, a senior registrar in intensive care medicine.

Like many she has been touched by the groundswell of support from the public. But there’s a problem with this hero image, she says. 

"It’s not just that many NHS staff are feeling increasingly uncomfortable with being hailed as heroes for what they see as simply doing their jobs. Of course, we were going to step up to the plate when the COVID-19 pandemic hit. As doctors it was our duty. There was never any question.

"But there’s something more than just feeling undeserving of the cape weighing heavily on our shoulders. The worst thing about being seen as a superhero? Very few think to ask if you’re OK.

And herein lies the problem. Because healthcare workers are not heroes, we are human. Completely, painstakingly, fallibly human."

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Source: The Independent, 2 May 2021

 

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We need to rethink our approach to patient safety

Dr Suzette Woodward describes in her latest book a more positive approach to patient safety that seeks to learn how things normally happen in order to understand why they failed in that instance.

"The book aims to provide a significantly more positive approach to patient safety because it moves people away from focusing people on their shortcomings, which doesn’t enable learning, it in fact impairs it.  It also moves us away from spending all of our time identifying failure as we see it and giving people feedback about how to avoid it, telling them to stop making mistakes."

"The book also provides examples of how we can move from the rhetoric to action including the extremely useful methods for how we can study work-as-done and the adjustments and adaptions people make every day."

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Source: HSJ, 7 October 2019

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We need to find alternatives to 999 for care homes and falls

The NHS needs to do more to support care homes and people who have fallen with alternatives to ambulance calls and hospital admissions, the NHS England chief executive has said. 

Speaking at the Ambulance Leadership Forum, Amanda Pritchard acknowledged this winter would be a difficult one for the health service, saying: “The scale of the current and potential challenge mean that we do need to continue to look further for what else we can do… We need to pull out all the stops to make sure that they [patients] get that treatment as safely as possible and as quickly as possible.”

She added one area of focus should be making sure certain patient groups can access other – more appropriate – forms of care, rather than calling an ambulance by default and often resulting in hospital admission.

On care homes, she said: “Can we wrap around even more care for these care homes so they get to the point where they don’t need to call for help at all or, if they do, there are alternatives pathways [to the emergency department]?”

She suggested another area where responses could be made more consistent was for patients who had fallen but without serious injuries, which she said made up a “really significant part of activity”. These patients took a long time to reach and, if admitted to hospital, risked long admissions, she said.

Some areas were working to find other ways of responding to non-injury falls patients and trying to keep them away from hospital, she said.

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Source: HSJ, 6 September 2022

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We need to be ‘really thoughtful’ about intervening with ICSs

NHS England needs to be ‘really thoughtful’ about how and when it intervenes as powers are devolved from the centre to integrated care systems, NHSE’s chief executive has said.  

Following her keynote speech at NHS ConfedExpo in Manchester today, Amanda Pritchard was asked about “her vision for the future” devolving powers to Integrated Care Systems (ICSs) as part of the NHS reforms and if “it changes the way leaders should behave”.

Ms Pritchard admitted “earned autonomy” in relation to ICSs – a phrase she has previously used but has jarred with many local leaders – was “not quite the right phrase”.

“It feels like we’re using yesterday’s language for today’s ways of working. I know it’s not quite the right word, but I can’t think of a better one at the moment,” she said.

“What I am asking my own organisation to do, is make sure that we are really thoughtful about all of those different things that we do, and we are increasingly really intentional about which of those [tools] you can use in different circumstances [in regards to performance and accountability].”

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Source: HSJ, 14 June 2023

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We need a Nightingale model for rehab after COVID-19

A major new model of post-acute care is needed for the discharge and rehabilitation of patients following COVID-19 infection, say Alice Murray, Clare Gerada, and Jackie Morris.

A comprehensive plan must be made for the 50% of COVID-19 patients who will require some form of ongoing care following admission to intensive care, with the goal of improving their long-term outcomes and freeing-up much-needed acute hospital capacity.

While the current focus is quite rightly on emergent cases, planning should be set in place to create post-acute care resources and facilities for the surge in numbers of people with the physical, psychological and functional consequences of prolonged ITU stays and or hospital admission following COVID-19 infection.

One potential solution is to provide mass facilities, on a scale to match the Nightingale Hospitals in so-called “Centres of Excellence”, requisitioned for those who survive but need care and cannot return to their own homes, with both residential and day care units available.

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Source: HSJ, 9 April 2020

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We must challenge 'doctor knows best' attitude, bereaved mother says

Merope Mills, an editor at the Guardian, has questioned doctors' attitudes after her 13-year-old daughter Martha's preventable death in hospital.

Martha had sustained a rare pancreatic trauma after falling off a bike on a family holiday, and spent weeks in a specialist unit where she developed sepsis.

An inquest concluded that her death was preventable, and the hospital apologised.

Ms Mills said her daughter would be alive today if doctors had not kept information from the parents about her condition, because they would have demanded a second opinion.

She added that doctors' attitudes "reeked of misogyny", citing a moment when her "anxiety" was used as an argument to not send critical care to Martha.

In a statement, Prof Clive Kay, chief executive of King’s College Hospital NHS Foundation Trust said he was "deeply sorry that we failed Martha when she needed us most".

"Our focus now is on ensuring the specific learnings from her case are used to improve the care our teams provide - and that is what we are committed to doing."

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Source: BBC News, 6 October 2022

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We face a pandemic of mental health

Currently we have a frightening, deadly viral pandemic, but there will another plague, one we are not hearing nearly enough about from our leaders, which will arrive in a wave just behind it, reports Paul Daley in the Guardian. 

There will be a pandemic of severe depression and anxiety that will sweep over the world as the unemployment rate pushes into previously unseen digits, families who’d prefer to be socially distant are thrust together and young people are denied the certainty and structure of school.

We will need to support – medically, financially, emotionally and psychiatrically – those who are going to do it hardest. Psychiatric support services will need to be dramatically bolstered to fight this mental health pandemic

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Source: The Guardian, 24 March 2020

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We can now prevent mental ill-health in the same way we fight cancer

A cutting-edge child and adolescent mental health centre hopes to help prevent young people from experiencing mental health problems.

As we look hopefully towards a June bonfire of pandemic regulations and restrictions, many recognise that soaring rates of mental health problems and distress amongst our children and young people must be near the top of a 21st century list of challenges in “building back better”.

School closures, uncertainty and being cut off from friends and social and sporting events have seen more children and young people referred to CAMHS — a service that was facing growing demand even before the pandemic.

The long-term impact is obviously still unknown.

However, a cutting-edge child and adolescent mental health centre opening in south London two years from now will play a big role in responding to the likely increased demand for ongoing support — and in developing innovative treatment responses.

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Source: HSJ, 27 April 2021

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We can now prevent mental ill-health in the same way we fight cancer

A cutting-edge child and adolescent mental health centre hopes to help prevent young people from experiencing mental health problems. 

As we look hopefully towards a June bonfire of pandemic regulations and restrictions, many recognise that soaring rates of mental health problems and distress amongst our children and young people must be near the top of a 21st century list of challenges in “building back better”.

School closures, uncertainty and being cut off from friends and social and sporting events have seen more children and young people referred to CAMHS — a service that was facing growing demand even before the pandemic.

The long-term impact is obviously still unknown.

However, a cutting-edge child and adolescent mental health centre opening in south London two years from now will play a big role in responding to the likely increased demand for ongoing support — and in developing innovative treatment responses.

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Source: HSJ, 27 April 2021

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Ways to identify EHR usability issues and reduce patient harm

An electronic health record (EHR) bug that transmits and medication order for 25 mg of a drug – not the prescribed 2.5 mg – could be the difference between life and death. And it’s that seemingly impossible reality that’s bringing more industry stakeholders to the table working to better understand EHR usability and its effects on patient safety.

“Often times when people think about usability, they think about design and then they think about the EHR vendor,” Raj Ratwani, PhD, Director of MedStar Health Human Factors Center, said in an interview with EHRIntelligence.

“In reality, it's a very complex space. The products that are being used by frontline clinicians are shaped by the vendor. But they are also shaped by how that product is implemented at that provider site, how it's customized, and how it’s configured. All of those things shape usability.”

EHR usability issues are an exceptionally common issue, Ratwani reported in a recent JAMA article. About 40% EHRs reported having an issue that can potentially lead to patient harm and about 786 hospitals and 37,365 individual providers may have used EHRs with potential safety issues based on required product use reporting.

Direct safety challenges typically come from EHR products that are sub-optimally designed, developed, or implemented. Usability issues stem from a very cluttered interface or a complex medication list. Seeing a cluttered list can lead to a clinician selecting the wrong medication.  

A major usability issue also comes from data entry. EHR users want that process to be as clean as possible. Consistency in the way information is entered is also key, Ratwani explained.

Ratwani also wants to ensure that certification testing is as realistic as possible.

He compared it to when a vehicle is certified to meet certain safety standards each year. This type of mechanism does not exist when it comes to EHRs because right when the product is certified, it then gets implemented, and there is no further certification of safety done at all after the initial testing.

“One way to do that, at least for hospitals, is to have that process be something that the Joint Commission looks to do as part of their accreditation standards,” Ratwani said.

“They could introduce some very basic accreditation standards that promote hospitals to do some very basic safety testing.”

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Source: EHR Intelligence, 13 January 2020

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Water jabs and burning herbs offered during natural births at NHS hospitals

Mothers are being offered water injections by the NHS to relieve pain during childbirth, while in some hospitals midwives are burning herbs to encourage breech babies to turn in the womb.

Safety campaigners have dubbed the practices dangerous and say that they amount to “pseudoscience” being offered by the health service. They have called on the chief executive of NHS England, Amanda Pritchard, to ban their use in a letter published over the weekend.

At least three trusts in England offer water injections for pain relief, including Newcastle upon Tyne Hospitals Trust, United Lincolnshire Hospitals Trust and North Tees and Hartlepool Trust.

Information on the Newcastle trust’s website describes the injections as an “alternative form of pain relief” while in Lincolnshire patients are told the body’s response to the injections “prevents pain signals from reaching the brain.”

The National Institute for Health and Care Excellence (NICE), which is responsible for setting out which treatments patients should receive, has said the NHS should not use injected water for pain relief.

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Source: The Times, 27 November 2022

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Watchdogs issue safety warnings after junior doctors left unsupervised on maternity wards

Two health watchdogs have issued safety warnings after junior staff were left to work unsupervised on maternity wards previously criticised after a baby’s death.

Training regulator, Health Education England (HEE), criticised the “unacceptable” behaviour of consultants who left junior doctors to work without any superiors at South Devon and Torbay Hospital Foundation Trust’s wards.

The maternity safety watchdog Healthcare Safety Investigation Branch (HSIB) also raised “urgent concerns” over student midwives and “unregistered midwives” providing care without supervision.

The latest criticism comes after the trust was condemned over the death of Arabella Sparkes, who lived just 17 days in May 2020 after she was starved of oxygen.

According to a report from December 2022, seen by The Independent, the HEE was forced to review how trainees were working at the trust’s maternity department after concerns were raised to the regulator. It was the second visit carried out following concerns about the department, and reviewers found there had been “slow progress” against concerns raised a year earlier.

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Source: The Independent, 16 February 2023

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Watchdog’s prosecution sends a strong message to safety laggards: Time’s up

The announcement on Friday by the Care Quality Commission (CQC) that it will bring criminal charges against an NHS trust for failing to provide safe care to a patient is a hugely significant milestone in efforts to bring about greater accountability and safer care in the health service.

The CQC has had the power to bring such prosecutions against hospitals since April 2015 when it was given a suite of new legal powers to hold hospitals to account on the care they give to their patients.

Bringing in the new laws, the so-called fundamental standards of care, was one of the most significant actions taken after the care disaster at the Mid Staffordshire NHS Trust, where hundreds of patients suffered shocking neglect, with some dying as a result.

Prosecuting East Kent Hospitals University Trust over the tragic 2017 death of baby Harry Richford is a big step for the CQC and a consequence of the long-forgotten battles of many patients and families in Stafford who were told they were wrong in their complaints against the hospital.

It will almost certainly lead to more calls for criminal charges against hospitals from families who have been failed.

There are countless examples of NHS trusts not acting on safety warnings and patients coming to harm as a result. Just this week an inquest into the case of baby Wynter Andrews at Nottingham University Trust revealed fears over safety had been highlighted to the trust board 10 months before her death.

At Shrewsbury and Telford Hospitals Trust there are hundreds of families asking the same questions as more evidence emerges of long-standing failures to learn from its mistakes.

CQC's chief executive, Ian Trenholm, has provoked anger among NHS leaders and clinicians when he advocated taking a tougher line when trusts break the law.  But it is unlikely the CQC will launch a slew of prosecutions. It has said it will bring cases only where it sees patterns of behaviour and systemic failings. That is the correct approach as healthcare is complex and single errors will sadly happen despite everyone doing their best.

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Source: The Independent, 10 October 2020

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Watchdog warns over medication risk to vulnerable

Vulnerable patients cared for in secure mental health units across England could miss out on vital medications due to a shortage of learning disability nurses, the Healthcare Safety Investigation Branch (HSIB) has  warned.

The report into medication omissions in learning disability secure units across the country highlights problems with retaining learning disability nurses, with the number recruited each year matching those leaving.

Figures quoted in the report suggest the number of learning disability nurses in the NHS nearly halved from 5,500 in 2016 to 3,000 in 2020.

The HSIB launched a national investigation after being alerted to the case of Luke, who spent time in NHS secure learning disability units but was not administered prescribed medication for diabetes and high cholesterol on several occasions. 

At Luke’s facility, which included low and medium secure wards, HSIB investigators considered that the quality and style of care provided to patients had been directly impacted by a lack of nurses with required skill sets.

Findings from HSIB’s wider national investigation link a shortfall of learning disability nurses to instances of patients missing their medication, with the report’s authors describing a “system in which medicines omissions were too common and prevention, identification and escalation processes were not robust”. 

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Source: HSJ, 23 June 2022

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Watchdog warns its powers will be weakened by Health and Care Bill reforms

The health service ombudsman has warned he will ‘be in no position to investigate’ the behaviour of another watchdog under the government’s health service reforms.

Rob Behrens, the Parliamentary and Health Service Ombudsman, said plans to create a “closed safe space” for the information provided by clinicians to the Healthcare Safety Investigation Branch (HSIB) will mean a reduction in his powers and he will not be able to hold HSIB to account.

Mr Behrens, speaking at HSJ’s Patient Safety Congress, said that although coroners would be able to access information gathered by HSIB investigations under the reforms, the ombudsman would not be able to access this “safe space” without the permission of the High Court.

The reforms would see HSIB become a new statutory independent organisation, the Health Service Safety Investigations Body, and prohibit the disclosure of “protected material” such as information or documents obtained during investigations.

However, this prohibition of disclosure would not apply to information required by coroners, ordered by the High Court or necessary to investigate an offence or address a “serious and continuing” safety risk to a patient or the public.

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Source: HSJ, 22 September 2021

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