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Mother blames scandal-hit hospital for daughter’s death after eating disorder struggles

A young woman “traumatised” by a stay in a scandal-hit hospital as a teenager died after trying to take her own life years later, an inquest has heard.

Melissa Parrish was admitted to Huntercombe Hospital in Maidenhead in 2009 for an eating disorder when she was 15 years old, but the experience left her terrified of being admitted to hospital.

In 2018, aged 24, she was admitted to Vincent Square Eating Disorder Service (VSEDS), run by the Central and North West London NHS Foundation Trust, after struggling with her mental health. Four hours later she tried to take her own life; the failed attempt left her in a vegetative state for three years until she died of pneumonia in July 2021.

The inquest held this week was not directed to examine her stay at the Huntercombe Hospital and did not link her death with the 2009 admission.

However, Melissa’s mother Melanie told The Independent, after the jury returned its verdict on Thursday, that she thought her daughter’s 18-month experience at the Huntercombe Hospital had “destroyed” her.

“She got trapped,” Ms Parrish explained. “We saw how Melissa disappeared. She stopped having a relationship with us. She started self-harming, and when she was told it would be longer than 12 weeks, she just died. She stopped eating... she was just traumatised.”

Although the remit of the inquest was not to examine Melissa’s care before 2021, doctors who assessed her before her death gave evidence in which they noted that she was terrified of being admitted to hospital.

One doctor’s notes recorded that they believed “the terror of being admitted, which arose from a past admission, increased the risk [of harm]”.

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Source: The Independent, 23 September 2024

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NHS pilot uses virtual reality to tackle racism and discrimination among staff

In one scene, a black nurse called Tunde is told by his manager that personal protective equipment (PPE) was being locked away at night to prevent its theft during night shifts, during the pandemic when ethnic minorities were more likely to work these hours.

In another, an Asian female doctor called Jasmine is dismissed by an HR manager after raising a double standard regarding requests for shift changes during the pandemic over childcare, something which her white colleagues were granted.

These are some of the scenarios of discrimination depicted in a new form of training for NHS staff that has been designed to create better understanding of the experiences of colleagues from ethnic minority backgrounds.

The training, called “Walking in the shoes of …”, involves participants wearing a virtual reality (VR) headset and watching videos depicting instances of racism and discrimination by actors within an NHS setting.

The clips are based on the transcripts of 133 interviews with NHS employees describing their own experiences of racism while working, collected during the Tides study, a project by academics at Kings’ College London that researches how instances of discrimination within the NHS are related to existing health inequalities.

The training was developed after warnings that the NHS faces a mass exodus of black, Asian and minority ethnic doctors due to “persistent” and “intolerable” levels of racism in the workplace, while research shows that white nurses are twice as likely than their black and Asian colleagues to be promoted.

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Source: Guardian, 22 September 2024

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Top A&E doctor accuses NHS leaders of normalising treatment in corridors

The UK’s most senior A&E doctor has accused NHS leaders of normalising corridor care with major plans for winter this year, The Independent can reveal.

Dr Adrian Boyle, president of the Royal College of Emergency Medicine, has warned NHS guidance published this week also blasted national leaders’ guidance, warning that it will be “insufficient” to tackle “dangerous” 12-hour waits in A&E.

NHS England has published guidance for hospitals on how to manage patients in corridors, where previously it would advise corridor care is not acceptable.

Dr Boyle said: “In its guidance for providing ‘safe’ corridor care, NHS England has said the practice ‘is not acceptable and should not be considered as standard’, however anyone working in an Emergency Department across the country knows that it very much is the standard, and not just in winter.

“Publishing this document is an explicit acknowledgement, and a normalisation, of an unacceptable situation.”

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Source: The Independent, 21 September 2024

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NHS electronic health records pose ‘serious safety risks’

There are “serious safety risks” for patients in the rollout of electronic health records in hospitals across England, Patient Safety Learning has warned.

Patient Safety Learning said incidents involving new systems were likely to be under-reported and must be flagged. It has urged the government to ensure adverse-incident reports are monitored more effectively. One trust reported more than 900 incidents, including potential patient harms after it rolled out new software.

Helen Hughes, chief executive of Patient Safety Learning, said electronic patient record systems had significant potential to improve people’s care and treatment, but there were cases where implementation of the new systems had resulted in “direct and indirect harms to patients”. A report published by Patient Safety Learning in July warned of “significant patient safety risks” associated with the implementation and use of electronic records.

Electronic patient record systems: Putting patient safety at the heart of implementation

Electronic patient records replace paper notes and are intended to be a more reliable system, providing an integrated pathway with access from any screen in a hospital.

The NHS hopes that all healthcare trusts will have an electronic patient-record system in place by March 2026. While it offers several benefits, safety issues can arise owing to the systems being unable to work with other information-technology systems. There can also be staff errors in using new and unfamiliar technology.

Hughes said: “Electronic patient-record systems are increasingly commonplace in healthcare, and are integral to plans to digitally transform the NHS. It is vital that patient safety is at the core of their implementation to secure the benefits that [patient record] systems can bring and not unintentionally lead to avoidable harm.

“Patient Safety Learning believes there must be transparency in reporting of unintended harm.”

Two trusts, Royal Surrey NHS foundation trust and Ashford and St Peter’s hospitals NHS foundation trust launched a new electronic patient-record system known as Surrey Safe Care in May 2022 and reported various incidents involving patient harm. Royal Surrey reported 927 incidents on a reporting system used to flag potential risk, some of which involved patient harm. Ashford and St Peter’s reported 269, with eight incidents of low harm and three of moderate harm, according to a Health Services Journal report.

The Royal Surrey NHS foundation trust said “over 99%” of incidents reported during the implementation of its new patient record system had resulted in “low or no harm to patients”.

The trust said: “Implementing an electronic patient record is challenging for any workforce and it takes some time to embed. Patient safety is our priority which is why we actively encouraged staff to proactively report issues and opportunities to improve through our incident-reporting system.”

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Source: The Observer, 22 September 2024

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Drug-resistant infections are on the rise – so why aren’t we getting any new antibiotics?

Infections that were once easy to cure with antibiotics are becoming untreatable, and a novel treatment for bacterial infection is the holy grail for teams of researchers around the world.

However, severe financial challenges have left the pipeline of new antibiotics thin and fragile – and treatments are unavailable in many of the places they are most needed. Big pharmaceutical companies have left the field in search of greater profits elsewhere, and talented researchers have opted for new jobs in more stable sectors.

The number of deaths caused by drug-resistant bacteria in 2019 was 1.27 million, and economic costs are on track to exceed $1tn (£765bn) by 2030. The death rate is highest in sub-Saharan Africa, where children under five are particularly affected.

“This is a problem which truly affects the whole world, rich and poor countries alike,” says Jeremy Knox, the head of infectious disease policy at Wellcome. “[But] the impact is definitely asymmetrical. People in low and middle-income countries are bearing a far greater burden.”

Global leaders will gather in New York this month to discuss antimicrobial resistance (AMR) at the UN general assembly. They will consider how to convince researchers and companies it is worth their while to create new replacement drugs, and how to improve access to tests and treatments.

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Source: The Guardian, 16 September 2024

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Carer caught on CCTV tormenting patient with learning difficulties for hours

A carer who was caught on camera tormenting his vulnerable patient over several hours has been jailed.

Enow Tambe was one of two carers responsible for looking after a man, aged 60, with learning difficulties and blindness. The man required constant care and lived in supported accommodation, as heard in Manchester Crown Court. The man's sister, worried about his care, installed CCTV which revealed the shocking nature of 33-year-old's Tambe's treatment.

He was seen shouting in the man's face, threatening to shave his head, poking him repeatedly and laughing at him when he had no choice but to urinate on the floor. After pleading guilty to being a carer causing ill-treatment of an individual, Tambe was sentenced to 11 months in prison.

Upon sentencing, Recorder Phillip Barnes said: "He was being bullied, harassed, belittled and abused for a number of hours. He was ignored and refused help when he asked for it. He was blind and couldn't see what was going on about him. He was shouted at in close quarters, he was threatened to have his head shaved. He was poked and prodded, not to harm but to intimidate, upset and bully."

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Source: Mirror, 18 September 2024

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Little progress made on endometriosis, say experts

There has been "little progress" in improving the experiences of people living with endometriosis in the past 25 years, according to Leeds researchers.

Endometriosis is a disease in which tissue like that in the lining of the womb grows elsewhere in the body, causing debilitating pain.

Endometriosis UK and researchers at Leeds Beckett University (LBU) surveyed 1,800 patients, with many saying they felt "powerless" over their illness.

Lead researcher Prof Georgina Jones said the results were "troubling", and showed how living with endometriosis could "fundamentally impact a person’s sense of identity and place in the world".

She said: "We asked respondents to provide some words summarising their experience of endometriosis.

"While most of these were negative, for example, they described the debilitating pain, the frustration and loneliness they feel, a number described the sense of community felt by those living with the disease.

"This underlines how important peer support, both informally and in the way organised by Endometriosis UK, is to those with endometriosis."

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Source: BBC News, 20 September 2024

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The cancers with longest treatment waits revealed

There is an unacceptable variation in waits for treatment of different cancers in England, an exclusive analysis for BBC News by Cancer Research UK shows.

Patients with cancers affecting the head and neck and bowel are the most likely to face long waits – just over half are seen within the target of 62 days.

In comparison, patients with blood, bone marrow and skin cancers are the most likely to start treatment in time.

The charity said the differences were putting lives at risk, highlighting a study, external suggesting a four-week delay to surgery increases the risk of dying by 6-8% for many cancers.

Jayne Gray, from Leicestershire, died in 2021, aged 64, after bladder cancer led to kidney failure.

Despite a history of cancer, Jayne had waited 74 days for treatment to start, after an urgent referral from her GP.

Cancer Research UK said various factors were behind the differences in waiting times, including more acute shortages of specialist staff for some cancers and the fact some could take longer and were more complex to diagnose.

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Source: BBC News, 20 September 2024

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Call for greater protection for girls as FGM cases rise by 15% in England

Hospital and GP attendances about female genital mutilation (FGM) in England have risen by 15%, according to NHS figures, prompting a call for greater protection for girls.

There were 14,355 attendances about FGM in the 2023-24 financial year, according to NHS Digital statistics, compared with 12,475 the previous year.

There was also a rise in the number of individual women and girls who visited NHS services in regards to FGM, from 5,870 in 2022-23 to 6,655 in 2023-24. Attendances are a different measurement as an individual can have several attendances in a year.

The head of Barnardo’s National FGM Centre said FGM was a form of child abuse. “More needs to be done to protect girls – and to offer support for all those affected,” Rohma Ullah said. “That support just isn’t available at the moment.”

The prevention of FGM needed to be treated as a public health issue, she said.

“Change must come from working within communities who are affected by it, and local authorities need to develop strategies that allow for dialogue with their communities.

“It is also vital to introduce mandatory training for anyone who works to support children and vulnerable adults. That training should focus on how to spot the signs of girls who might be at risk or who have undergone FGM – as well as how to alert the relevant support services.”

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Source: The Guardian, 19 September 2024

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Trans people in England missing out on vital cancer screening, experts warn

Thousands of transgender patients in England are missing out on vital cancer screening because of the way their GP records are drawn up, experts have warned.

Everyone registered as female with their GP is automatically invited to breast screening from the age of 50 to 70, and to regular cervical screenings from 25 to 64.

But warnings from experts at the World Cancer Congress in Geneva this week, underscored by official NHS guidance, show that many trans patients are not invited to undergo the tests.

In England, trans men who were registered female at birth and have changed the gender on their patient record to male are not offered breast or cervical screening, regardless of whether they have had chest reconstruction or a hysterectomy.

Trans women who are still registered male with their GP are also not offered routine breast screening, even if they have been on longterm hormone therapy, which puts them at added risk of breast cancer.

Experts say the problem is the way GP electronic records in England are updated when patients change their gender.

NHS England stipulates that when a patient changes their registered gender, they are given a new NHS number and must be registered as a new patient at their GP practice. All their previous medical history is transferred into their new medical record and their previous name, sex at birth, any other gender-specific terms and old NHS number are removed.

Because the breast and cervical screening programmes use patients’ current gender to generate appointment invitations, many trans patients are missing out.

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Source: The Guardian, 19 September 2024

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High-grade masks evidence weak, Covid inquiry told

There is only “weak evidence” that high-grade face masks better protected health workers than surgical ones in the pandemic, the Covid inquiry has been told.

Prof Susan Hopkins, chief medical adviser at the UK Health Security Agency (UKHSA), said respirator masks – known as FFP3s – may have performed no better than thin surgical masks in real-life situations.

She said there could be “significant harms” from wearing tight-fitting FFP3s, including blisters and breathing difficulties.

“If the evidence was strong that FFP3s really protected people, and we saw a definitive reduction [in infections], they would have been recommended,” she said.

National guidance on face masks from April 2020 was drawn up by a group of experts from across the United Kingdom known as the IP (Infection Prevention) Cell.

The inquiry was shown minutes from an IP Cell meeting on 22 December 2020, just after the new Alpha variant of Covid had been detected, which appeared to show disagreement about the use of higher-grade FFP3 masks.

The records quote Dr Colin Brown, now the deputy director of clinical and emerging infections at UKHSA but at the time with PHE, as saying: "Our understanding of aerosol transmission has changed. A precautionary approach to move to FFP3 masks [in all healthcare settings] whilst we are awaiting evidence should be advised."

However, the wider IP Cell decided that no upgrading of the guidance was warranted at the time, and NHS trusts were told to continue to supply staff with standard surgical masks in almost all cases outside intensive care.

It was not until January 2022 that the advice changed, saying that FFP3 respirators "must be worn" by all staff if they are caring for patients with a virus such as Covid, and should be offered to other staff depending on a risk assessment.

By that point, the World Health Organization, and other health bodies, had recognised Covid could be spread in tiny airborne particles over distances longer than 6.5ft (2m), something officials said was impossible at the start of the pandemic.

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Source: BBC News, 19 September 2024

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NHS consultant wins £90k after bosses ‘turned blind eye’ to 13-hour shifts

An NHS consultant has been awarded almost £90,000 in compensation after working “extremely long hours” at a mental health trust that she claimed was on its knees.

Dr Pippa Stallworthy, a consultant clinical psychologist, worked between 11 and 13 hours every day for eight months, which she described as “neither sustainable nor safe”, before her resignation in November 2019.

From 2009 she had been the clinical lead for the Traumatic Stress Service at South West London & St George’s Mental Health NHS Trust, which assessed and treated vulnerable patients with complex post-traumatic stress disorder arising from a traumatic event in adulthood.

An employment tribunal was told that referrals to the unit increased by about 35% in early 2019, putting the small team under strain.

Stallworthy felt “totally unsupported” by bosses after requesting more help and resigned after numerous warnings that patients were at risk, the hearing in Croydon was told.

In her resignation letter, she said she had lost all “trust and confidence” in managers, accusing them of failing to address her safety concerns and “neglect” in making sure there were enough doctors.

“In my opinion the fact that both I and the service are on our knees is largely due to systematic management failure,” she wrote.

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Source: The Times, 18 September 2024

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Sepsis errors caused 'preventable' death of girl

The death of a three-year-old girl could have been prevented if hospital staff had followed sepsis guidelines, a coroner ruled.

Zadie Ajetunmobi was taken to Broomfield Hospital, Essex, with a temperature of 40 degrees (104F) on 10 November 2022.

She died less than 10 hours later after suffering a cardiac arrest, with post-mortem tests showing her death was from complications associated with sepsis.

Senior coroner Lincoln Brookes said if staff had adhered to the sepsis pathway immediately, "her death would likely have been prevented".

In a later report provided to the family by the Mid and South Essex NHS Foundation Trust, it was disclosed that staff had failed to update local sepsis guidance since 2017.

Zadie's parents, Theo and Rhiannon, said that if the correct procedure had been followed, she would have had a potentially life-saving dose of intravenous antibiotics.

Instead, the medicine was not administered for more than seven hours following her arrival, an inquest at Essex Coroner's Court heard.

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Source: BBC News, 19 September 2024

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'Like ripping my insides' - fears hysteroscopy guidelines not enough

Wendy McLean was due to start her seventh round of IVF when her doctor said she needed a hysteroscopy – a procedure to examine the inside of her uterus.

“It was sold to me as a smear test, basically. A thin narrow camera up through your cervix.

"It’ll take minutes. You won’t need pain relief. You’ll be absolutely fine,” she said.

Wendy, 38, took over-the-counter pain killers before the outpatient procedure at Aberdeen Royal Infirmary in case it was uncomfortable, but this did not prepare her for what happened.

“It felt like getting a hot poker, like getting my insides ripped out. I think I described it to somebody before as like being clawed, like sharp nails, just ripping at my insides.”

Wendy said she lost consciousness twice, vomited and asked for the procedure to be stopped.

It was only when searching online she discovered thousands of other women had had similar experiences of painful hysteroscopies without anaesthetic.

According to the Royal College of Obstetricians and Gynaecologists (RCOG), a third of those undergoing a hysteroscopy report pain levels of seven or above out of 10.

It says patients should be offered local or general anaesthesia for the procedure and their medical history should be taken into account, including trauma or difficulty with smear tests.

But despite RCOG producing new clinical guidelines promoting pain relief and choice, many women say they are not being offered it.

Dr Geeta Kumar, consultant gynaecologist and vice president of RCOG, said they had listened to patients’ concerns.

“Clear accurate written and verbal information must be provided, both at the time of referral, and at the procedure appointment,” she said.

“This will support a woman to make an informed choice, including whether they want to proceed with the procedure and if so, their preferences for treatment setting and pain relief options.”

Katharine Tylko, from the Campaign Against Painful Hysteroscopy, said: “It will have no impact whatsoever, apart from a few very conscientious and compassionate fighting-types of gynaecologist - young women who will say – ‘We want decent care for our patients.’

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Source: BBC News, 18 September 2024

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Poor NHS maternity care in danger of becoming normalised, regulator warns

Maternity services in England are so inadequate that cases of women receiving poor care and being harmed in childbirth are in danger of becoming “normalised”, the NHS regulator has said.

A Care Quality Commission (CQC) report based on inspections of 131 maternity units sets out an array of problems, adding to the sense of crisis that has enveloped an NHS service that cares for the 600,000 women a year who give birth and their babies.

The watchdog’s grim findings came as Wes Streeting, the health secretary, admitted he felt acute anxiety about “the risk of disaster greeting women in labour tomorrow”.

In its report, the CQC says problems in maternity care are so ingrained that:

  • Some women, frustrated at facing such long delays in being assessed at triage, discharge themselves before they are seen.
  • 65% of units are not safe for women to give birth in, 47% of trusts are rated as requiring improvement on safety and another 18% are rated as inadequate.
  • Some hospitals do not record incidents that have resulted in serious harm.
  • There is a widespread lack of staff and in some places a lack of potentially life-saving equipment.
  • Hospitals do not always consider women’s suffering after receiving poor care.

Nicola Wise, the CQC’s director of secondary and specialist care, said: “We cannot allow an acceptance of shortfalls that are not tolerated in other services.”

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Source: The Guardian, 19 September 2024

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NHS junior doctors to be known as resident doctors after job title change

Junior doctors working across the NHS will now be called resident doctors instead - in a change intended to better reflect their expertise.

The doctors union, the British Medical Association (BMA), which called for the change, called the term junior "infantilising and demeaning".

"Resident doctor" will refer to more than 50,000 qualified doctors working in GP practices and hospitals - some recently out of medical school and others with a decade of experience.

Health ministers say they have accepted the new name as part of a drive to "reset the relationship" between NHS doctors and the government.

The BMA says many of its members said the term "junior" was confusing and wrongly implied doctors were unqualified.

BMA member Dr Lily Huang, who works in London and specialises in ear, nose and throat surgery, has been a qualified doctor working in NHS hospitals for seven years.

"When I say, 'junior doctor', my friends and family interpret that to mean I am still at medical school.

"It takes a lot of explaining to say I'm still in training to be a consultant but am not a student."

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Source: BBC News, 18 September 2024

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I’ll reject ‘status quo’ proposals, Streeting warns officials

Wes Streeting has warned NHS England and departmental officials he will reject any proposals “that suggest sticking with the status quo, or bids for more money without reform”.

The health and social care secretary was speaking alongside NHSE chief executive Amanda Pritchard at a joint briefing of NHSE and Department of Health and Social Care staff yesterday.

They both spoke about last week’s Darzi review findings and, in comments shared with HSJ, Mr Streeting said: “I want this report taken as gospel. Our response must be: to take it on the chin, pull up our sleeves, and begin the hard work of reform.”

It would be “major surgery, not sticking plasters”, he said, and told officials he wanted “bold, radical reform proposals”, warning he would “reject anything that suggests sticking with the status quo, or bids for more money without reform”.

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Source: HSJ, 17 September 2024

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Nurses bore the brunt of Covid, ex-chief nurse says

Nurses bore the brunt of the pandemic, with low staffing levels and difficulties accessing protective equipment, according to England’s former chief nurse.

Dame Ruth May told the Covid inquiry the NHS had been understaffed in 2020, in part because of the “catastrophic decision” to cut financial support for student nurses in 2015.

Resources had been "stretched", particularly in intensive care, she said, with a knock-on effect on the care some Covid patients received.

And she had been aware of widespread reports of problems supplying personal protective equipment (PPE) in March 2020, including a shortage of plastic gowns that had left front-line nurses living "in fear".

And she criticised a “catastrophic decision”, in 2015, to replace the grant or bursary paid to student midwives and nurses with loans.

It had led to reduction of about 5,700 trainees in England by 2020, Dame Ruth said, which “would have made a difference” in the pandemic.

“There would have been less burnout - there would have been less psychological impact,” she said.

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Source: BBC News, 17 September 2024

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One in five GPs use AI such as ChatGPT for daily tasks, survey finds

A fifth of GPs are using artificial intelligence (AI) tools such as ChatGPT to help with tasks such as writing letters for their patients after appointments, according to a survey.

The survey, published in the journal BMJ Health and Care Informatics, spoke to 1,006 GPs. They were asked whether they had ever used any form of AI chatbot in their clinical practice, such as ChatGPT, Bing AI or Google’s Gemini, and were then asked what they used these tools for.

One in five of the respondents said that they had used generative AI tools in their clinical practice and, of these, almost a third (29%) said that they had used them to generate documentation after patient appointments, while 28% said that they had used the tools to suggest a different diagnosis.

A quarter of respondents said they had used the AI tools to suggest treatment options for their patients. These AI tools, such as ChatGPT, work by generating a written answer to a question posed to the software.

The researchers said that the findings showed that “GPs may derive value from these tools, particularly with administrative tasks and to support clinical reasoning”.

However, the researchers went on to question whether these AI tools being used could risk harming and undermining patient privacy “since it is not clear how the internet companies behind generative AI use the information they gather”.

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Source: The Guardian, 17 September 2024

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UK facing ‘tsunami of missed cancers’ in wake of pandemic, experts say

The UK can expect a “tsunami of missed cancers”, leading experts have said, after an international study found that diagnoses fell sharply during the pandemic.

Preliminary figures from the International Cancer Benchmarking Partnership, presented to delegates at the World Cancer Congress in Geneva, compared data on the instance and stage of cancer diagnosis in Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK, before and during the pandemic.

The results showed that UK nations had the biggest and most sustained falls in the diagnosis of lung, breast, colorectal and skin cancers during 2020. Particular data for Northern Ireland and Wales showed how badly they did compared with other countries studied.

While all countries reported a drop in cases diagnosed at the peak of the pandemic, most had caught up again within the year. In contrast, Wales and Northern Ireland still had not recovered their diagnosis rates by the end of 2020.

The study calculated that between April and July 2020, breast diagnoses dropped by 35% in Northern Ireland and Wales, compared with 24% in Norway and 14% in Denmark. For lung cancer, over the same time period the decline was 16% in Northern Ireland and Wales, compared with 10% in Norway or 1% in New Zealand.

For the most affected month, 44% of breast cancer cases and 30% of lung cancer cases were missed in Northern Ireland and Wales. There were also sharp declines in colorectal cancer diagnoses.

Cancer experts said that as a result of such large drops in diagnoses, they are expecting to see many more patients presenting with more advanced, late stage cancers.

“These data are a shocking wake-up call, providing the key evidence that the UK can expect a tsunami of missed cancers and a potential shift in stage that may lead to more aggressive cancers that are more difficult to treat,” said Mark Lawler, professor of digital health at Queen’s University Belfast and chair of the International Cancer Benchmarking Partnership. “And the fact we are still way off meeting the 62-day target to treat cancer can only compound the issue.”

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Source: The Guardian, 17 September 2024

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Letby managers: We weren’t slow to act

Former senior managers at the Countess of Chester Hospital have told the public inquiry into murders of babies that “given the information with which we were provided, we acted appropriately at the time”.

A joint written statement from the former chief executive, medical, nursing and HR directors at the Cheshire Hospital was published on Friday by the Thirwall Inquiry into the circumstances surrounding the deaths of seven newborn babies between 2015 and 2016.

Neonatal nurse Lucy Letby was convicted of seven counts of murder and seven of attempted murder in August 2023.

The statement set out the various steps the directors had taken after the spate of deaths came to light, including commissioning experts from the Royal College of Paediatrics and Child Health.

The management team has faced criticism that it was too slow to act in response to deaths on the unit, as it pushed back on concerns raised by clinicians about Letby.

But the four directors – former chief executive Tony Chambers, medical director Ian Harvey, nursing director Alison Kelly and HR director Susan Hodkinson – argued the RCPCH team had failed to pass on concerns.

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Source: HSJ, 18 September 2024

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Children’s hospital where staff ‘dragged patients across floor’ to close as parents warn of ‘brutal’ treatment

A hospital where staff allegedly physically abused patients is set to close as parents come forward describing the “brutal” treatment of their children, The Independent can reveal.

Joyce Parker Hospital, a children’s mental health unit run by Cygnet Health Care in Coventry, will shut following allegations by the national care watchdog, first highlighted by The Independent, that staff were found dragging patients across the floor.

Parents of children who are in the unit, whose care is NHS-funded, have been told this week that Cygnet Health Care intends to shut and reopen the hospital for adults just weeks later.

“From day one, it’s been really brutal,” said the mother of a teenage girl still in the hospital. “She [daughter] was covered in bruises. She was really distressed. I keep thinking this is my child, who is really unwell, and you trust people will look after her. She’s been pushed against walls, had her arms put around the back, she’s been put on the floor. My daughter is so much worse than she was when she got there.”

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Source: The Independent, 18 September 2024

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Man, 27, dies weeks after receiving Covid vaccine he was wrongly invited to take by NHS

A man who died three weeks after receiving the AstraZeneca Covid-19 jab was given the vaccine despite not being eligible, an independent investigation has found.

A probe into failings linked to the death of Jack Last, a young man who died in April 2021 from a blood clot linked to the Oxford-AstraZeneca jab, revealed the 27-year-old was wrongly called up early for the vaccine by his GP - and so, did not receive a jab deemed safer for under 30s.

The report found his death was “a consequence of a combination of system shortcomings, human error, and tragic unfortunate timing”.

His family have accused the NHS of a “litany of errors” that cost a “fit and healthy” young man his life.

They said: “Sharing the horrific ordeal that Jack was put through is something that must be done to highlight the litany of errors that have cost Jack his life…Jack died following days of agony, with immense internal damage throughout his body, bleeding and clots in his brain.”

These failures, according to the report, also included a “lack of urgency” in getting him a CT head scan treatment for possible blood clots and a misdiagnosis of his scan once it had been done.

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Source: The Independent, 18 September 2024

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IHI marks World Patient Safety Day with patient safety certification milestone and commitment to diagnostic excellence

For World Patient Safety Day, the Institute for Healthcare Improvement (IHI) is celebrating the milestone of 7,000 healthcare professionals who have earned the Certified Professional in Patient SafetyTM (CPPS) credential. Certification requires a combination of education, experience, and successful completion of the evidence-based certification exam. This includes more than 1,000 students, staff, and faculty from the University of North Texas Health Science Center’s Texas College of Osteopathic Medicine, which is the first medical education program in the world to incorporate the CPPS review course and exam as a required part of the curriculum.

“These are 7,000 health care professionals across the world who are changemakers in safety, and their expertise and commitment to safer care for all is saving lives each and every day,” said Patricia McGaffigan, RN, MS, CPPS, IHI Senior Advisor, Safety, and President of the Certification Board of Professionals in Patient Safety (CBPPS). “The impressive growth of the CPPS program in recent years has resulted in a larger, more diverse health care workforce with competencies in safety. This is concurrent with the call to action for health care leaders to use the National Action Plan to Advance Patient Safety Organizational Assessment Tool to identify opportunities to improve foundational areas for safety across many elements that are aligned with the new CMS Patient Safety Structure Measure that will take effect next year.”

The 7,000 certificants span clinical settings and include safety, quality, and risk managers and leaders, nurses, physicians, pharmacists, health care executives, medical students and residents, academic faculty, and many more clinical and non-clinical professionals. IHI offers scholarships that cover the full cost of the CPPS review course, practice exam, and CPPS exam. A full day CPPS review course will be held December 8 at the 2024 IHI Forum. Learn more about the full Forum agenda and how to register here.

In addition to the CPPS review course, the Forum’s Patient and Workforce Safety track offers nearly 20 unique sessions for onsite learners, including multiple workshops that align with the theme for this year’s World Patient Safety Day: “Improving diagnosis for patient safety.” IHI is steadfastly committed to diagnostic excellence and continues to advance this critical component of safe and effective care through educational offerings, fellowships, projects, and tools, including the Safer Dx Checklist: 10 High-Priority Practices for Diagnostic Excellence. 

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Junior doctors bring dispute to end by voting to accept Streeting’s pay offer

Junior doctors in England have voted to accept the government’s pay offer, bringing to an end one of the longest and bitterest disputes in recent NHS history.

Just under two-thirds (66%) of the 45,830 junior doctors who voted backed the deal, which will see them receiving an average salary increase of 22.3% over two years.

It ends 18 months of strikes during which junior doctors stopped work on 44 days – sometimes for five days at a time – causing huge disruption to the NHS.

The 22.3% increase was less than the 35% rise the British Medical Association’s junior doctors committee (JDC) had been seeking for the last two years as “full pay restoration” for the fall in their earnings they have experienced since 2008. But it proved enough to persuade a sizeable majority of that branch of the medical profession to call off their campaign of stoppages.

Danny Mortimer, the chief executive of NHS Employers, welcomed the news. “Health leaders will breathe a massive sigh of relief to know that the ongoing pay dispute between resident doctors and government has come to a successful resolution. The last thing our members wanted was the threat of more strikes over what is expected to be a very difficult winter,” he said.

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Source: Guardian, 16 September 2024

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