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Thousands more women getting tested for autism after ‘being missed for decades’

Tens of thousands more women tested themselves for autism last year with numbers seeking tests now far outstripping men, new data shows.

Statistics seen by The Independent show around 150,000 women took an online test verified by health professionals to see if they have autism last year, up from about 49,000 in 2020.

Health professionals said the increase was a consequence of women not being diagnosed with the neurodevelopmental disorder as children and teens due to autism wrongly being viewed as a male disorder.

Experts told The Independent autistic women and girls are routinely overlooked and neglected by health services due to them being more likely to conceal or internalise symptoms.

Data from Clinical Partners, one of the UK’s leading mental health care providers which works closely with the NHS, shows women made up 56 per cent of those using their autism tests last year. This is substantially higher than the 46 per cent of women testing themselves for autism in 2020.

Hannah Hayward, neurodevelopmental specialist at Clinical Partners, who provided the exclusive data, explained: “Diagnosis is crucial – without which, women and men can be susceptible to symptoms of mental health conditions including anxiety and depression and it is common for them to be misdiagnosed with or develop other conditions such as anxiety, anorexia, depression or Borderline Personality Disorder,” 

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Source: The Independent, 23 March 2022

 

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Ambulance trust covered up paramedics’ fatal errors like a ‘criminal gang’

An ambulance trust has been accused of acting like a “criminal gang” and lying to dead patients’ families by an employee who repeatedly warned about paramedics’ mistakes being covered up.

Paul Calvert, a coroner’s officer whose job was to produce reports on deaths, tried to raise concerns about managers at the North East Ambulance Service (NEAS) for three years before walking out last year on the verge of a breakdown.

“My life was being made a misery,” said Calvert, who was previously a detective with Northumbria police. “They were basically like a criminal gang. I had tried everything I could to warn the proper authorities about how the service was destroying and concealing evidence meant for the coroner. I spoke to my managers, to human resources, to external auditors. I even made disclosures to the Care Quality Commission and Northumbria police. Nothing was done about it.”

Despite their denials of a large-scale cover-up of mistakes, the NEAS this year offered Calvert £41,000 as part of a non-disclosure agreement it asked him to sign. One of the clauses meant destroying all the evidence he had collected. Another tried to stop him making any further disclosures to police.

Reports and witness statements from ambulance staff were not being disclosed to the coroner “on a daily basis”, according to Calvert, amounting to key pieces of evidence relating to deaths being hidden from the public.

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Source: The Times, 29 May 2022

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NHS to benefit from digital 'Redbook' app

As part of the NHS Digital Child Health programme, Personal Child Health Records or “Redbook” will receive a digital makeover.

NHS Digital has considered the limitations of the physical Redbook and decided that digitalisation is the way forward for parents to easily access important health and development information.

Nurturey has been evolving its product to align with NHS' Digital Child Health programme. It aims to be an app that can make the digital Redbook vision a reality and currently in the process of completing all the necessary integrations and assurances.

It is hoped that by using smart digital records, parents will be more aware of their child’s health information like weight, dental records, appointments and other developmental milestones.  

Tushar Srivastava, Founder and CEO of Nurturey, said:

“Imagine receiving your child's immunisation alert/notification on the phone, clicking on it to book the immunisation appointment with the GP, and then being able to see all relevant immunisations details on the app itself. As a parent myself, I see the huge benefit of being able to manage my child’s health on my fingertips. We are working hard to deliver such powerful features to parents by this summer.”

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Source: National Health Executive, 5 February 2020

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Doctor shortages pushing Scottish NHS to ‘breaking point’

Doctor shortages are jeopardising patient safety and rota gaps are pushing the NHS to “breaking point”, Scottish physicians have warned.

A lack of doctors in NHS Scotland due to unfilled vacancies, sick leave and a shortage of staff is often putting patients’ welfare at risk, a survey of consultants has found. More than a third of Scottish doctors (34%) reported, in the Royal Colleges’ annual census, that trainee rota gaps occurred at least daily, while 16% warned they are causing “significant patient safety problems”.

A further 78% of those who responded said rota gaps potentially cause patient safety problems, but that there are solutions in place.

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Source: The Scotsman, 14 October 2019

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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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Coronavirus testing system 'falling over'

People across England have told BBC News they are struggling to access coronavirus tests.

Health Secretary Matt Hancock said last week that no-one should have to travel more than 75 miles for a test, after the BBC revealed some were being sent hundreds of miles away.

But dozens have now reported being unable to book a swab at all.

The Department of Health and Social Care (DHSC) said testing capacity was targeted at the hardest-hit areas.

A significant rise in demand for testing led the government to reduce the number of appointments available in areas of lower prevalence, to prioritise areas with outbreaks. This in turn led to people applying for tests being directed to centres sometimes hundreds of miles away.

But last Thursday Mr Hancock pledged to put in "immediate" solutions to make sure people did not have to travel more than 75 miles, effective from last Friday. Since then, postcodes entered into the government's booking system return a message suggesting there are no testing centres or home kits available - even if you are an essential worker with symptoms.

Frances, in Suffolk, tried to apply for a test when her daughter developed a high temperature. She didn't think it was coronavirus but "the rules are the rules". She had understood that anyone with a temperature should apply for a test, and was not able to send either of her children to school until she did.

"Their teachers need to be kept safe, their classmates need to be kept safe, we need to do the right thing," she said.

But Frances was also not able to get a home kit, and when she tried to get an appointment at a drive-through centre was told no test sites were found.

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Source: BBC News, 12 September 2020

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Trust fined £2.5m after deaths of two patients

An acute trust has been fined £2.5m after pleading guilty to charges of failing to provide safe care after the deaths of two patients.

The Care Quality Commission brought charges against The Dudley Group Foundation Trust earlier this year over care failings in two separate cases which the regulator said exposed two patients to “significant risk of avoidable harm”.

The trust pleaded guilty to the charges in July and was fined during a sentencing hearing today.

The cases, involving 33-year-old mother of six Natalie Billingham, and 14-year-old Kaysie-Jane Bland [also known as Kaysie-Jayne Robinson], were both in 2018 and  related to care at the trust’s Russells Hall Hospital in Dudley.

Ms Billingham was admitted to Dudley’s Russells Hall Hospital with numbness in her right foot on 28 February 2018 and died on 2 March of organ failure caused by a “time critical” infection.

The court was told she was initially thought to have a deep vein thrombosis after a three-minute triage that failed to identify "disordered" observations. The hospital then had multiple reasons to reconsider the initial diagnosis, but opportunities for review were "missed or ignored".

In the case of Kaysie-Jane, who had cerebral palsy, an "early warning score" was inaccurate, meaning a sepsis screening tool was not triggered.

The CQC said the care both patients received at Russells Hall Hospital was undermined by the Dudley Group’s failure to address known safety failings which the regulator repeatedly raised with the trust in the months before their deaths. The CQC said the trust did not take all reasonable steps to make improvements, despite its intervention. The trust has denied it did not react to the concerns raised. 

Failings included errors in the hospital’s initial assessments and monitoring of both patients, which hindered the timely escalation of concerns.

A lawyer acting on behalf of the Dudley Group NHS Foundation Trust had admitted the trust failed to provide treatment in a safe way, resulting in harm, in February and March 2018.

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Source: HSJ, 19 November 2021

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Australia’s health ministers agree to make 'Quality Use of Medicines' and medicines safety a National Health Priority Area

At last week’s meeting in Perth, Australia, the COAG Health Council discussed a number of national health issues, one of which was the Quality Use of Medicines.

The Council’s resulting communique highlights that medicines are the most common intervention in healthcare and can contribute to significant health gains – but can also be associated with harm.

“Half of all medication related harm is preventable and a coordinated national approach that identifies and promotes best practice models and measures progress towards reducing medication related harm has the potential to improve the health of Australians and create savings across the health care system,” it notes.

At the meeting, the Health Ministers agreed to make the Quality Use of Medicines and Medicines Safety the 10th National Health Priority Area

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Source: Australian Journal of Pharmacy, 4 November 2019

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Trust warned by CQC sees fourth inpatient death following ‘humongous’ problems

A fourth suspected suicide has occurred at a mental health trust which was recently warned by the Care Quality Commission after three other similar inpatient deaths in quick succession, HSJ can reveal.

All four deaths at Devon Partnership Trust had common themes, including the use of ligatures, and occurred amid a year-long delay to the trust’s plan to reduce ligature risks.

Figures obtained by HSJ under freedom of information laws also reveal the trust took nearly a year to investigate the first two deaths. The target is 90 days.

The trust told HSJ it had faced “humongous” problems addressing ligature risks and had been too “patient” with another trust which was helping to investigate the deaths.

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Source HSJ, 27 October 2020

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‘Bullying, intimidation and reprisals’ undermined patient care at trust, review concludes

A ‘culture of distrust’ between consultants and the use of incident reporting as a tool of ‘reprisal’ impacted patient care at a trust’s cardiology department, a review has concluded.

An external review undertaken for Hull University Teaching Hospitals Trust has made a series of recommendations after looking into allegations of bullying and several examples of poor care within its cardiology services.

In a report published in the trust’s board papers, the Royal College of Physicians reported a “perceived tendency to downplay clinical incidents, and, to undermine those who wanted to raise patient safety issues”.

It added: “We met a group of individual consultants who did not work well as a team. There is a culture of distrust, a lack of departmental cohesion and allegations of bullying in the department. All of which reinforce a clear divide between the interventional and non-interventional consultant cardiologists."

“There have been a number of allegations of belittling, intimidation and undermining…The review team heard accounts of a culture where datix has been used as a tool for possible personal reprisal along with ignoring/downplaying incidents that have been raised.”

The review concludes: “This behaviour is impacting on patient care and therefore, all medical staff should be reminded of good medical practice as the [General Medical Council] code of conduct of how doctors must work collaboratively with colleagues.”

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Source: HSJ, 16 November 2021

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Epilepsy drug that harms babies may damage their children too

An epilepsy drug that caused disabilities in thousands of babies after being prescribed to pregnant women could be more dangerous than previously thought.

Sodium valproate could be triggering genetic changes that mean disabilities are being passed on to second and even third generations, according to the UK’s medicines regulator.

The Medicines and Healthcare Products Regulatory Agency (MHRA) has also raised concerns that the drug can affect male sperm and fertility, and may be linked to miscarriages and stillbirths.

Ministers are already under pressure after it emerged in April that valproate was still being prescribed to women without the legally required warnings. Six babies a month are being born after having been exposed to the drug, the MHRA has said. It can cause deformities, autism and learning disabilities.

Cat Smith, the Labour chairwoman of the all-party parliamentary group on sodium valproate, said: “This transgenerational risk is very concerning. There have been rumours that this was a possibility, but I had never heard it was accepted until last week by the MHRA."

“The harm from sodium valproate was caused by successive failures of regulators and governments, and this news means it could be an order of magnitude worse than we first thought. It underlines the need for the Treasury to step up to their responsibilities around financial redress to those families.”

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Source: Sunday Times, 19 June 2022

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Doctors claim major infection control ‘deficiencies’ at region’s hospitals

Research by a group of doctors has found ‘major deficiencies’ around infection control within hospitals in the North West region.

The study looked at trusts’ adherence to Public Health England guidance around limiting the spread of COVID-19 within orthopaedic services.

The study found patients were routinely being allocated to hospital beds before they had been confirmed as covid-negative, “thus allowing spread of COVID-19 not only between patients but also between nursing and medical staff”.

Fewer than half of patients were nursed with the appropriate screens in place, while it was uncommon for doctors to be tested regularly.

Separate statistics published by NHS England suggest almost 20 per cent of new covid cases in North West hospitals from August to December were likely to be nosocomial, meaning they were acquired on the wards.

This was a higher proportion than any other region.

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Source: HSJ (paywalled), 16 December 2020

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Scottish mum told cancer stricken son, 5, ‘didn’t look ill’

A Scottish mum has made an emotional plea to other parents to push for blood tests for their children if they feel ‘something isn’t right’ after her son’s leukaemia symptoms were dismissed numerous times by doctors.

Jayke Steel, aged 5 years, was diagnosed with acute lymphoblastic leukaemia (cancer of the blood) in February after months of being ill.

His mum Cara took him to the doctor on various occasions but time and time again she was told he was fine and it was “probably just a virus”.

When he started getting night sweats,  instead of the doctor Cara him to Forth Valley Hospital where they ran tests and said they believed he was suffering from leukaemia.

“He was then transferred to Glasgow’s Queen Elizabeth Hospital where they immediately took a bone marrow test which showed he definitely had leuklaemia."

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Source: The Scotsman, 15 September 2019

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Coffey warned of ‘significant risk’ posed by CQC restructuring

Staff at the Care Quality Commission (CQC) have been left ‘in fear of speaking out’ against structural changes to the organisation which they believe ‘pose a significant risk’ to the CQC’s ability to regulate health services, trade unions have told the health and social care secretary.

A letter signed by senior officers of Unison, Royal College of Nursing, Unite, Prospect and the Public and Commercial Services union has called on Therese Coffey to urge the CQC to pause its organisational change and enter into “meaningful discussions” with the unions.

The unions have raised concerns that organisational changes to the CQC have been drawn up by consultants with no frontline experience in health and social care, or in regulation, and that staff have had limited input into the changes.

They allege that staff raising concerns about the changes have been dismissed as being “disruptive” or “negative”, and significant numbers of experienced staff have recently left the regulator.

The CQC said in response to the letter that the changes it was proposing were needed to enable the regulator to “work more effectively across the health and care system”, and that it has engaged with trade unions throughout the process.

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Source: HSJ. 23 September 2022

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U.S. life expectancy falls again in ‘historic’ setback

The average life expectancy of Americans fell precipitously in 2020 and 2021, the sharpest two-year decline in nearly 100 years and a stark reminder of the toll exacted on the nation by the continuing coronavirus pandemic.

In 2021, the average American could expect to live until the age of 76, federal health researchers reported on Wednesday. The figure represents a loss of almost three years since 2019, when Americans could expect to live, on average, nearly 79 years.

The reduction has been particularly steep among Native Americans and Alaska Natives, the National Center for Health Statistics (NCHS) reported. Average life expectancy in those groups was shortened by four years in 2020 alone.

“Even small declines in life expectancy of a tenth or two-tenths of a year mean that on a population level, a lot more people are dying prematurely than they really should be,” said Robert Anderson, chief of mortality statistics at the NCHS.

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Source: The New York Times (31 August 2022)

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‘We don't have enough nurses to keep all our patients safe,’ says RCN leader

There are not enough nurses to safely care for patients in the UK, according to the body that represents the profession, and many of those who are working are suffering from anxiety and burnout after a gruelling nine months treating Covid patients.

A year after the prime minister pledged during the 2019 election campaign to add 50,000 nurses to the NHS, the Royal College of Nursing has accused Boris Johnson of being “disingenuous” for claiming the government is meeting this 2025 target.

Johnson claimed last week that the government had “14,800 of the 50,000 nurses already” during prime minister’s questions in the Commons.

Yet the latest NHS figures show there were 36,655 vacancies for nursing staff in England in September, with the worst shortages affecting mental health care and acute hospitals. Staff in some intensive care units (ICUs) have quit since the pandemic, with those whom the Observer spoke to choosing to work instead in supermarkets or as dog-walkers.

Dame Donna Kinnair, the RCN’s chief executive and general secretary, said: “The simple, inescapable truth is that we do not have enough nursing staff in the UK to safely care for patients in hospitals, clinics, their own homes or anywhere else.”

She said that even before the pandemic, “heavy demand” was rising faster than the “modest increases” in staff numbers.

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Source: The Guardian, 12 December 2020

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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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The targets the NHS no longer has to meet

NHS England has shelved priorities on Long Covid and diversity and inclusion – as well as a wide range of other areas – in its latest slimmed down operational planning guidance, HSJ analysis shows.

NHSE published its planning guidance for 2023-24, which sets the national “must do” asks of trust and integrated care systems, shortly before Christmas.

HSJ has analysed objectives, targets and asks from the 2022-23 planning guidance which do not appear in the 2023-24 document.

The measures on which trusts and systems will no longer be held accountable for include improving the service’s black, Asian and minority ethnic disparity ratio by “delivering the six high-impact actions to overhaul recruitment and promotion practices”.

Another omission from the 2023-24 guidance compared to 2022-23 is a target to increase the number of patients referred to post-Covid services, who are then seen within six weeks of their referral.

Several requirements on staff have been removed, including to ”continue to support the health and wellbeing of our staff, including through effective health and wellbeing conversations” and ”continued funding of mental health hubs to enable staff access to enhanced occupational health and wellbeing and psychological support”. 

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Source: HSJ, 4 January 2022

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Nearly half of cancer patients don’t feel involved in treatment decisions, survey finds

Almost half (47%) of patients with cancer do not think that they have been sufficiently involved in deciding which treatment option is best for them, a new survey shows. The survey of nearly 4000 patients across 10 countries also found that around four in 10 (39%) said that they were never or only sometimes given enough support to deal with symptoms and side effects.

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Source: BMJ, 25 July 2019

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NHS guidance ‘too long to read,’ say hospital staff as safety watchdog exposes systemic risks to patients

NHS guidance ‘too long to read,’ say hospital staff as safety watchdog exposes systemic risks to patients.

The Healthcare Safety Investigation Branch (HSIB) revealed some NHS staff had admitted not reading official guidance on how to avoid the ‘never event’ error as part of a new report identifying deeper systemic problems that it said left patients at an increased risk.

The independent body warned patients across the NHS remained vulnerable to being injured or even killed by the error that keeps happening in hospitals despite warnings and safety alerts over the last 15 years.

HSIB launched a national investigation into the problem of misplaced nasogastric (NG) tubes after a 26-year-old man had 1,450ml of liquid feed fed into his lungs in December 2018 after a bike accident.

The patient recovered but the error was not spotted, even after an X-ray.

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Source: The Independent, 17 December 2020

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Prime Minister urged to give NHS 100 new hospitals plus an extra £7bn a year

NHS leaders have urged Boris Johnson’s government to build 100 new hospitals and give the service an extra £7bn a year for new facilities and equipment. They want the Prime Minister to commit to far more than the 40 new hospitals over the next decade that the Conservatives pledged during the general election.

So many hospitals, clinics and mental health units are dilapidated after years of underinvestment in the NHS’s capital budget that a spending splurge on new buildings is needed, bosses say. Too many facilities are cramped and growing numbers are unsafe for patients and staff, they claim.

Johnson has promised £2.7bn to rebuild six existing hospitals and pledged to build 40 in total and upgrade 20 others, although has been criticised for a lack of detail on the latter two pledges.

The call has come from NHS Providers, which represents the bosses of the 240 NHS trusts in England that provide acute, mental health, ambulance and community-based services.

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Source: The Guardian, 3 February 2020

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Women 32% more likely to die after operation by male surgeon, study reveals

Women who are operated on by a male surgeon are much more likely to die, experience complications and be readmitted to hospital than when a woman performs the procedure, research reveals.

Women are 15% more liable to suffer a bad outcome, and 32% more likely to die, when a man rather than a woman carries out the surgery, according to a study of 1.3 million patients.

The findings have sparked a debate about the fact that surgery in the UK remains a hugely male-dominated area of medicine and claims that “implicit sex biases” among male surgeons may help explain why women are at such greater risk when they have an operation.

“In our 1.3 million patient sample involving nearly 3,000 surgeons we found that female patients treated by male surgeons had 15% greater odds of worse outcomes than female patients treated by female surgeons,” said Dr Angela Jerath, an associate professor and clinical epidemiologist at the University of Toronto in Canada and a co-author of the findings.

“This result has real-world medical consequences for female patients and manifests itself in more complications, readmissions to hospital and death for females compared with males.

“We have demonstrated in our paper that we are failing some female patients and that some are unnecessarily falling through the cracks with adverse, and sometimes fatal, consequences.”

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Source: The Guardian, 4 January 2022

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NHS to treat 25,000 hospital patients at home in ‘virtual wards’

The NHS plans to treat up to 25,000 hospital patients at home in “virtual wards” to help clear the backlog caused by the pandemic, the “living with Covid” plan has revealed.

Patients will be offered acute clinical care at home, including remote monitoring and treatment, as an alternative to hospital stays.

Consultants or GPs will review patients daily via digital platforms and phone calls. In some cases, patients will be provided with a wearable device to continuously monitor and report their vital signs.

The NHS has set a national target of 40 to 50 virtual beds per 100,000 population, which equates to about 25,000 beds across England, according to the “living with Covid” plan published this week.

The document said: “The use of ‘virtual wards’ and ‘hospital at home’ models of care have ensured that patients can be safely cared for in their own homes and that additional bed capacity can be freed up in hospitals.” 

Commenting on the initial rollout of virtual wards, Dr Tim Cooksley, the president of the Society for Acute Medicine, warned a “hasty” rollout could risk patient safety.

He said: “Virtual wards do have the potential to be a model of the future. However, it is essential they are appropriately planned, resourced and staffed so they simply cannot be seen as a short-term mitigation measure which can be hastily rolled out mid-pandemic. Incorrect implementation could risk patient safety and significantly impact clinician and patient confidence.”

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Source: The Telegraph, 22 February 2022

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