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First-of-its-kind guidance aims to ensure safety and dignity of trans patients

A first-of-its-kind set of guidelines for the care of transgender people before and after general surgery has been created.

The guidelines recommend gender-inclusive language and consideration of whether a patient should be accommodated in a single room rather than on a ward.

The guidance, created independently of the NHS, is said to have been put together amid a “dearth of knowledge and confidence amongst anaesthetists when caring for transgender and gender-diverse patients”.

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Source: Independent, 24 July 2024

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Pregnant women suffer racist and discriminatory abuse at NHS trust, says inquiry head

Expectant mothers at a scandal-hit NHS trust have experienced “discriminatory and racist behaviour” including midwives mimicking their accents and refusing to provide interpreters, according to the head of an inquiry into its failings.

As part of the largest inquiry into a single service in the history of the NHS, Donna Ockenden is speaking with more than 1,900 families who have experienced stillbirth, neonatal death, maternal death or babies diagnosed with brain damage at Nottingham University hospitals NHS trust (NUH).

Ockenden, a senior midwife, said she had concerns about reports of racist behaviour uncovered during her interviews with families and 744 staff members who have come forward to participate in the review.

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Source: The Guardian, 24 July 2024

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Weight-loss drug approved for heart problems in UK

Weight-loss treatment Wegovy has been approved by the UK's medicines regulator, for reducing the risk of serious heart problems in overweight and obese people.

Wegovy contains the drug semaglutide, which is already prescribed on the NHS to help some people with a body-mass index (BMI) above 26 lose weight.

And it now becomes the first anti-obesity drug to be used to control heart attacks and strokes in people with established heart problems and a similar BMI.

A trial of 17,600 people suggested weekly semaglutide injections for up to five years reduced major cardiovascular events by 20%.

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Source: BBC News, 23 July 2024

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Exclusive: Lack of surgery capacity adding to risk for babies and mothers

A lack of surgery capacity at dozens of maternity units is adding to risk of serious harm to mothers and newborn babies, HSJ has found.

An investigation established that at least 33 units nationally have no second dedicated obstetric theatre for emergency Caesarean sections and found evidence this was delaying operations beyond the safe period in some cases.

HSJ also found multiple examples of safety incidents linked to C-sections delayed due to a lack of quick access to staffed theatres and regulatory concerns.

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Source: HSJ, 24 July 2024

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GP industrial action may hit all services, ICBs and trusts warned

Integrated care boards and trusts should develop plans to deal with potential “whole system” impact of GP “collective action” from next week, NHS England has warned.  

In a letter to ICB and trust leaders this evening, NHSE asked systems to make a “best estimate” of the knock-on effects across urgent and emergency care, electives and discharge, and community and mental health.

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Source: HSJ, 22 July 2024

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Dementia diagnoses in England hit a record high, NHS data reveals

The number of people in England being diagnosed with dementia is at a record high as the NHS begins to recover from a post-pandemic dip, according to figures.

The latest data shows a record 487,432 people had a diagnosis in June – up from 77,112 in the same month last year.

While diagnosis rates are at their highest since the start of the pandemic at 65 per cent, the health service said it still has more to do to meet its ambition of diagnosing 66.7 per cent of the total number of people estimates suggest are living with a form of the disease.

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Source: Independent, 22 July 2024

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Woman died after begging GP for help - inquest

A young woman died months after begging her GP for help with her chronic fatigue syndrome, an inquest heard.

Maeve Boothby-O’Neill, 27, had written to her doctor asking for help with feeding as she was hungry.

Ms Boothby-O’Neill had been diagnosed with myalgic encephalomyelitis (ME). She died at home in Exeter, Devon, in October 2021.

The inquest, which is scheduled to last two weeks, continues.

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Source: BBC News, 22 July 2024

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Babies died after hospital neglect - inquest jury

Two premature babies died within weeks of each other after neglect by a hospital, an inquest jury has found.

Westminster Coroners’ Court heard Elena Ali and Sunny Parker-Propst were both given sodium nitrite instead of sodium bicarbonate in 2020 while under the care of staff at Chelsea and Westminster Hospital.

On Monday they returned verdicts of unlawful killing contributed to by neglect for baby Sunny, and accidental death contributed to by neglect for baby Elena.

Lesley Watts, chief executive of Chelsea and Westminster Hospital NHS Foundation Trust, said: “We apologise unreservedly for the failings in care provided to Elena and Sunny."

Ms Watts added: “We took immediate action to put measures in place to prevent such tragic incidents from happening again.”

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Source: BBC News, 22 July 2024

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AI could solve ‘disgraceful’ structural problems, says minister

Artificial intelligence could be used to figure out the causes of “disgraceful” structural problems like the higher rates of maternal mortality for black women, a minister told a conference yesterday.

Health minister Karin Smyth said AI could be used not only for clinical and administrative functions but also to “diagnose” issues. She also said the way government funded AI adoption needed to change.

Ms Smyth, a former NHS manager, was giving her first speech as a minister at a Health Foundation conference on AI. The conference also heard from leading tech experts who said the UK was “exceptionally well placed for a global leadership role in health and AI”.

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Source: HSJ 

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One in five patients don’t know the difference between doctors and physician associates, watchdog warns

Almost a quarter of people do not know the difference between a physician associate and a doctor, according to a new poll.

While 52 per cent of people can differentiate between the two roles, some 23 per cent said they did not know the difference, the survey conducted for Healthwatch England has revealed.

The organisation, which represents the interests of patients across England, has called for more clarity around the role of physician associates (PAs).

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Source: Independent

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Suspended surgeon harmed hundreds of women

A surgeon has been suspended on the same day a hospital review concluded harm had been caused in hundreds of cases.

A tribunal ruled that Tony Dixon, who used artificial mesh to treat prolapsed bowels at Southmead Hospital, in Bristol, and the Spire Hospital, still posed a risk.

The Medical Practitioners Tribunal Service's hearing concluded on Thursday that a six-month suspension was "appropriate".

Spire Healthcare has now released its review of Mr Dixon, and found 259 cases where harm had been caused. Health bosses have "apologised sincerely".

The majority of harm was in three main areas: the failure to adequately investigate patients prior to offering the procedure; the failure to adequately offer alternative treatments; and poor consent with risks and benefits of the procedure not adequately discussed.

The tribunal found Mr Dixon’s fitness to practise is impaired and his suspension would allow him time to "to develop further insight and remediate his misconduct".

The General Medical Council brought the case against Mr Dixon, who denies all the allegations and maintains that the procedures were carried out in good faith.

His suspension will start immediately.

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Source: BBC News, 18 July 2024

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IT outages hit thousands of services

Thousands of GP practices — and some other localised services — are without their IT systems today, due to global outages also affecting banking, media and aviation.

All EMIS GP IT systems, which are used by more than half of the 8,000-odd GP practices in England, were down. It was leaving many practices unable to book appointments or consult with patients first thing on Friday morning.

This will quickly lead to a backlog of appointments and likely pressure on other urgent care.

Patient-facing digital services linked to EMIS also appeared to be down, such as records access via the NHS app.

The National Pharmacy Association said some community pharmacy services were down — such as “accessing of prescriptions from GPs and medicine deliveries” were disrupted. It’s unclear if that is also caused by EMIS, or other systems.

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Source: HSJ, 19 July 2024

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More than 5,000 early career nursing staff quit profession in one year

A fifth of the nursing and midwifery professionals who left the register in the last year did so within 10 years of joining, figures show.

Nursing leaders described the statistic as “deeply alarming” and called on ministers to “grasp the nettle and make nursing an attractive career”.

The latest Nursing and Midwifery Council (NMC) annual report on its register of nurses, midwives and nursing associates in the UK shows 27,168 staff left the profession between April 2023 and March 2024, a slight decrease on the previous 12 months.

However, 20.3% of the total - or 5,508 - did so within the first 10 years. This is compared to 18.8% in 2020/2021 and “reflects a rise over the last three years”, according to the report.

Professor Nicola Ranger, general secretary and chief executive of the Royal College of Nursing (RCN), said: “It is deeply alarming that over 5,000 young, early-career nursing staff chose to quit the profession last year, most vowing never to return.

“When the vacancy rate is high and care standards often poor due to staffing levels, the NHS cannot afford to lose a single individual.

“New ministers have to grasp the nettle and make nursing an attractive career.”

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Source: The Independent, 19 July 2024

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Patient care in hospital corridors is 'now normal'

BBC reporters are at Queens hospital in Romford, east London, and, like many across the capital it is busy. Really busy.

When filming, 17 patients from their A&E were being treated on beds in corridors.

Growing numbers of attendances have meant that what was once an emergency measure has now become the norm.

Ruth Green is the director of nursing for the emergency department and says corridor care has become "customary practice"

When the BBC last filmed the corridor treatments here back in January 2023, the department was seeing 1,400 patients arrive each month by ambulance. Now that number has risen to 2,100.

The number of ambulances arriving every day has gone up in a year too, from around 90 per day to around 120.

Ruth Green, the director of nursing for the emergency department said: "Unfortunately it is now customary practice to have patients treated on our corridors pretty much all of the time, not every day now it’s the summer, but still far too often."

They have had to install new plugs in the corridors so they can operate the hospital beds, new nurse call buttons and a new sink.

One patient in a bed in the corridor is Louis Vella.

He spent 18 hours in A&E after coming in with chest pains and was eventually transferred to a corridor to wait for a bed on a ward.

He said: "It’s not ideal, no, but they are working as best they can with what they’ve got and what else can one ask for?"

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Source: BBC News, 19 July 2024

Related reading on the hub:

A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift

Reflections on a clinical shift: "After 20 years of nursing, this is one of the worst shifts I have ever completed"

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Review finds 418 ‘unnatural, unexpected deaths’ linked to troubled trust

A troubled mental health trust’s internal mortality review has concluded 418 of an estimated 12,503 patient deaths over a four-and-a-half year period were “unexpected and unnatural”.

Norfolk and Suffolk Foundation Trust’s leaders said the findings showed there had been a “much, much smaller” number of avoidable deaths than had been implied by previous reviews and reported by the media in the past.

But the review’s findings were swiftly dismissed by campaigners, who said they had “no confidence” in the new figures, accused the trust of “corporate gaslighting” and renewed calls for a statutory public inquiry.

The review was initiated after a similar exercise by Grant Thornton last June concluded it was not possible to work out how many avoidable deaths there had been because of the trust’s poor data.

A month later, BBC Newsnight reported evidence it had watered down criticism in the Grant Thorton report, with allegations of “weak” and “inadequate” governance in earlier versions of the report removed from the final version. The trust and auditor said the changes were due to “fact checking”.

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Source: HSJ, 18 July 2024

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‘I developed ovarian cancer after my symptoms were dismissed as menopause’

A woman has said her ovarian cancer diagnosis was delayed after her symptoms were wrongly dismissed as menopause or irritable bowel syndrome (IBS) – accusing her doctor of misogyny and medically gaslighting her.

Sbba Siddique, a 55-year-old business owner, told The Independent that “unconscious bias and cultural incompetence” were also to blame for her delayed diagnosis.

Ms Siddique, who lives in Berkshire, said she began to feel unwell around October 2021 but did not get diagnosed with late-stage ovarian cancer until March the following year.

“I was feeling really tired all the time. I had no energy. I was piling on weight that wasn’t there previously despite not changing my eating habits. I was needing to wee more,” the mother of three recalled.

“I was going back and forth with my GP trying to get an appointment. I couldn’t get a face-to-face – every consultation was on the phone or via online forms. That was part of the problem of the misdiagnosis.”

Her GP was “very dismissive” of her symptoms and attributed them to IBS or the menopause, she added.

“At the end of the day, I’m not the expert, the GP is – I believed him,” she said.

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Source: The Independent, 14 July 2024

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Hancock and Hunt failed to prepare UK for pandemic, Covid inquiry finds

The former health secretaries Jeremy Hunt and Matt Hancock have been criticised for their failure to better prepare the UK for the pandemic, in a damning first report from the Covid inquiry that calls for an overhaul in how the government prepares for civil emergencies.

Hunt, who was the health secretary from 2012-18, and Hancock, who took over until 2021, were named by the chair to the inquiry, Heather Hallett, for failing to rectify flaws in contingency planning before the pandemic, which claimed more than 230,000 lives in the UK.

The government had focused largely on the threat of an influenza outbreak despite the fact that coronaviruses in Asia and the Middle East in the preceding years meant “another coronavirus outbreak at a pandemic scale was foreseeable”. Lady Hallett said that to overlook that was “a fundamental error”.

“It was not a black swan event,” Hallett said in a 240-page report. It concluded: “The processes, planning and policy of the civil contingency structures within the UK government and devolved administrations and civil services failed their citizens. Ministers and officials were guilty of ‘groupthink’ that led to a false consensus that the UK was well prepared for a pandemic. Never again can a disease be allowed to lead to so many deaths and so much suffering.”

In what families bereaved by Covid welcomed as a “hard-hitting, clear-sighted and damning analysis of how and why the UK found itself to be fatally underprepared”, Hallett said “preparedness and resilience for a whole-system emergency must be treated in much the same way as we treat a threat from a hostile state”.

The arrival of another pandemic – “potentially one that is even more transmissible and lethal” – was a question of when, not if, she said, and “unless we are better prepared” it would bring “immense suffering and huge financial cost and the most vulnerable in society will suffer most”.

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Source: Guardian, 18 July 2024

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NHS and social care ‘tripping over each other’ on staffing

The NHS should help social care recruit and retain nurses, including with better pay and conditions, particularly for new service models where care staff take on more health tasks.

This is among the recommendations in the first workforce plan for adult social care, published by Skills for Care today, which also warns government must not delay promised improvements in staff pay, standards and conditions, while it waits to decide on funding reform.

The report also recommends a pay uplift for care staff which it estimates would cost between about £2bn and £6bn a year – but it suggests there would be a significant net benefit overall due to reducing turnover costs and increasing care capacity.

The report says integrated care systems should develop joint “one workforce” plans, “align terms and conditions, training and wellbeing support”, and “create the pipeline for registered nurses and nursing associates” to go into care roles.

Nursing turnover in care providers is very high and it is thought nurses often leave for NHS jobs with better pay and conditions. However, nursing staff are increasingly needed to supervise “delegated healthcare tasks” for care users with rising acuity. It is an approach government, and many systems, want to grow as part of integrated teams, such as testing and monitoring in “virtual wards”.

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Source: HSJ, 18 July 2024

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NHSE sets new target for longest waiters

NHS England has tasked systems and providers with ending or significantly reducing 104-week waits for community mental health services by March 2025, following worsening performance.

It was announced in a webinar held by NHSE last week, in which mental health programme directors explained how the new metric would be implemented this autumn.

They confirmed that when an integrated care board or provider has a “small number” of 104-week waits, they should work to end them by March, and provide “trajectories” for 78-week and 52-week waits.

For those with a “larger number” of long waits, NHSE said ICBs should work with providers to agree an improvement plan throughout the rest of 2024-25. It said they would need to “detail ICB and provider-level trajectories” and submit these soon.

It said: “At a minimum, ICBs should ensure that less than 10 per cent of community mental health waits are over 104 weeks.”

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Source: HSJ, 18 July 2024

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Sharp fall in number of NHS IVF procedures across UK, report finds

The NHS has significantly reduced the amount of IVF procedures it provides across the UK, leaving infertile women either unable to access treatment or forced to pay for it privately.

Barely one in four (27%) of cycles of IVF during 2022 were paid for by the health service – the lowest figure since 2008 and a sharp fall on the 40% which it provided in 2012.

The sharp fall in recent years is revealed in the latest annual report by the Human Fertilisation and Embryology Authority (Hfea), which regulates fertility treatment in the four home nations.

The National Institute of Health and Care Excellence (Nice) has told the NHS in England to give all women who qualify three cycles of IVF. However, that rarely happens, with provision being patchy.

Dr Kevin McEleny, the chair of the British Fertility Society (BFS), said women are the casualties of a widespread variation in the availability of IVF which is “heartbreaking and so unfair”.

“Cost-cutting by NHS funding bodies who should implement the Nice IVF recommendations [means] patients in one part of the country are unable to access NHS-funded fertility treatments that people in a similar situation elsewhere in the country can.

“Infertility is recognised as a health problem. Yet many people still see involuntary childlessness as a lifestyle choice, and this attitude reflects why it doesn’t get the NHS funding it deserves,” he added.

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Source: The Guardian, 18 July 2024

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Obesity surgery to butt lifts: UK concern over unregulated plastic surgery expo

Organ replacement procedures to obesity surgery, Brazilian butt lifts to hair transplants and full body MOTs. This is not the body modification menu of a sci-fi novel, but packages for sale at the Health Tourism Expo – a two-day sales conference for surgical alterations held in London last month.

The event was teeming with doctors and hospital representatives staffing promotional stands, many of them from Turkey where clinics attract thousands of British tourists looking for surgical alterations at a lower price, with flights and accommodation thrown in.

There is no suggestion that any of the clinics exhibiting at the London expo have been involved in malpractice, but while the business of surgical tourism appears to be booming, one aspect of the industry seem to be missing entirely: regulation of promotional events such as this one.

According to data from the Foreign Office, six Britonsa died in Turkey in 2023 after medical procedures, while data from the British Association of Aesthetic and Plastic Surgeons (BAAPS) has revealed the number of people needing hospital treatment in the UK after getting cosmetic surgery abroad increased by 94% in three years, with 324 patients requiring surgery once they returned home in the four years to 2022.

Marc Pacifico, the president of BAAPS, said the lack of oversight of events such as the Health Tourism Expo was concerning. “I think it is truly remarkable that an exhibition like this seems to fall between the cracks of all the UK regulatory bodies that are responsible for healthcare and the safety of patients,” he said. “I would have thought it would be common sense for there to be some sort of oversight.”

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Source: The Guardian, 18 July 2024

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First Covid inquiry report to show UK plan failures

The failures and weaknesses in the UK's pandemic preparations are expected to be laid out in the first report published by the Covid inquiry.

Baroness Hallett, who is chairing the public inquiry, will set out her findings at lunchtime.

Her report will cover the state of the healthcare system, stockpiles of personal protective equipment (PPE) and the planning that was in place.

It is the first of at least nine reports covering everything from political decision-making to vaccines and the impact on children.

Trained army medic Dr Saleyha Ahsan, who worked in hospitals during the first two waves of Covid and is now part of the Covid-19 Bereaved Families for Justice UK group, after losing her father to the virus, said it felt like there had been “zero planning”, with doctors often struggling to get hold of the right PPE

“The rules were changing on a daily basis in the first few weeks - it was ridiculous,” she said.

“We were in the flimsiest of PPE, just a little surgical mask with a white apron.

“It felt like we were making do and the people who were being pushed to the front were healthcare workers."

“It's so, so important for those of us who worked through it, who lost through it, or who have suffered ill health because of it, to really appreciate where things went wrong and who was responsible.”

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Source: BBC News, 18 July 2024

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DIY kits may see million more cervical-cancer tests

More than one million extra women could have life-saving cervical-cancer checks if the NHS adopted do-it-yourself testing, researchers estimate.

The team at King’s College London said the results of its self-testing trial were “fantastic” and “gave power to women”.

The kits are like a Covid swab but longer and are posted to a lab for analysis.

The NHS called the findings extremely positive and is assessing whether to roll out the scheme.

There are more than 3,000 new cases of cervical cancer in the UK each year.

“Cervical cancer screening has been in decline for the last 20 years,” a senior consultant on the trial, Mairead Lyons, said.

"Many women will describe it as an uncomfortable experience [or they are] too busy, embarrassed or afraid of the physical experience of it."

NHS England screening and vaccination director Deborah Tomalin called the trial results “extremely promising”.

“The NHS will now be working with the UK National Screening Committee to consider the feasibility of rolling this out more widely across England,” she said.

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Source: BBC News, 17 July 2024

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Call for action on UK men’s health as 133,000 die early every year

More than 133,000 men die early every year in the UK, equating to 15 every hour, according to a report calling for urgent action to improve men’s health.

Two in five men are dying prematurely, before the age of 75 and often from entirely avoidable health conditions, research by the charity Movember found.

Almost two in three men – 64% – wait more than a week before visiting a doctor with symptoms, while 48% believe it is normal practice to avoid health check-ups. Less than 40% take up the offer of an NHS health check for which they are eligible.

“The report findings should serve as a wake-up call to the unacceptable state of men’s health across the UK,” said Michelle Terry, the chief executive of Movember. “For too long, men’s health has been relegated to the sidelines of broader health conversations. Men’s health doesn’t exist in a vacuum.”

The report found the health of men in the UK was worse than in many other wealthy countries, while those living in the UK’s most deprived regions are 81% more likely to die prematurely than those in the wealthiest.

William Roberts, the chief executive of the Royal Society for Public Health, said: “Too many men are dying too young and too many men experience poor health due to preventable conditions.

“It is critical that we address the underlying causes of poor men’s health. Men’s health affects us all and we need to see it as a critical part of a healthy nation.”

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Source: The Guardian, 17 July 2024

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