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Hormone replacement therapy to be offered over the counter in UK

Hormone replacement therapy is to be offered over the counter for the first time in the UK after the medicines watchdog gave the green light.

Millions of women go through the menopause every year, with the majority experiencing some symptoms that can be severe and have a negative impact on everyday life.

In a landmark move hailed as a “huge step forward” for women’s health, the first type of HRT to become available at pharmacies without a prescription will be Gina 10 microgram vaginal tablets (containing estradiol).

The Medicines and Healthcare products Regulatory Agency (MHRA) said the vaginal tablets would be available for post-menopausal women from September after a safety review.

Maria Caulfield, the minister for women’s health, said: “Menopause affects hundreds of thousands of women every year, but for some its symptoms can be debilitating and for many they can be misunderstood or ignored.

“Making Gina available over the counter is a huge step forward in enabling women to access HRT as easily as possible, ensuring they can continue living their life as they navigate the menopause.”

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Source: The Guardian, 20 July 2022

 

 

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25% of BAME non-executive directors in NHS ‘have seen discrimination’ at work

A quarter of Black, Asian and minority ethnic (BAME) non-executive directors of NHS trusts have seen or experienced discrimination in the course of their work, a report reveals.

While almost four out of five (79%) of these BAME non-executives said they challenged such behaviour when they encountered it, only half (50%) said that led to a change of policy or behaviour.

The other half felt they had been ‘fobbed off’ or subjected to actively hostile behaviour for having spoken up,” says a report commissioned by the Seacole Group, which represents most of the BAME non-executive board members of NHS trusts in England.

It adds: “This level of discrimination is unacceptable anywhere and even more so in the boardrooms of NHS organisations. Too many Black, Asian and other ethnic NEDs (non-executive directors) are being subjected to it and left to deal with it on their own.”

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Source: The Guardian, 21 July 2022

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Prehab: Getting patients fit for cancer treatment

Roy Cairns, 58, was diagnosed with liver cancer in 2019. Twelve months later a tumour was found on his lung.

Mr Cairns said taking part in the cancer prehab programme piloted by the Northern Ireland's South Eastern Health Trust after his second diagnosis was a "win-win", not only for himself but also his surgeons.

"I think when you get that diagnosis you are left floundering and with prehab the support you get gives you focus and a little bit of control back in your life," he said.

Prehabilitation (prehab) means getting ready for cancer treatment in whatever time you have before it starts.

Mr Cairns is one of 175 patients referred to the programme which involves the Belfast City Council and Macmillan Cancer Support.

Dr Cherith Semple said the point of the programme is to " improve people's physical well-being as much as possible before treatment and to offer emotional support at a time that can be traumatic".

Dr Semple, who is a leader in clinical cancer nursing, said this new approach to getting patients fit prior to their surgery was proving a success, both in the short and long-term.

She said: "We know that it can reduce a patient's hospital stay post-surgery and it can reduce your return to hospital with complications directly afterwards."

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Source: BBC News, 20 July 2022

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Nurse struck off after medication lies

A nurse who recorded she had given medication to care home residents when in fact she had delegated the task to unqualified staff has been struck off.

Adelaide Maloane was working a night shift at Somerleigh Court in Dorchester, Dorset, in August 2019 when the incident took place.

Ms Maloane delegated giving 16 medicines to residents to an unqualified healthcare assistant at the home.

The Nursing and Midwifery Council said Ms Maloane had "failed to acknowledge the seriousness of her misconduct and dishonesty and the implications of her actions for residents, colleagues and the reputation of the nursing profession".

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Source: BBC News, 21 July 2022

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Australia: Ambulance ramping is a signal the health system is floundering. Solutions need to extend beyond EDs

Healthcare systems across Australia are buckling in the wake of COVID waves and the flu season. Pictures of ambulances piling up outside hospitals have become commonplace in the media. Known as “ramping”, it’s the canary in the coalmine of a health system.

As a major symptom of a health system under stress, state governments across Australia are investing unprecedented amounts into ambulance services, emergency departments (EDs) and hospitals. South Australia has committed to an increased recruitment of 350 new paramedics. Likewise, New South Wales has committed to 1,850 extra paramedics.

Victoria, meanwhile, has committed an additional A$162 million for system-wide solutions to counter paramedic wait times, on top of the A$12 billion already committed to the wider health system. This could begin to alleviate the system pressures that lead to ambulance ramping.

But what happens when the paramedics return yet again to ED with another patient? Will they simply end up ramped again?

We also need to consider better care in the community – and paramedics could play a role in this too.

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Source: The Conversation, 21 July 2022

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Patient safety issues with VA Cerner EHR caused harm to veterans, federal watchdog says

A new patient medical records system at a Spokane Veterans Affairs hospital in the US has caused nearly 150 cases of patient harm, according to a federal watchdog agency.

An inspection by the VA Office of the Inspector General (OIG) found that a new Cerner electronic health record (EHR) system, now owned by Oracle, failed to deliver more than 11,000 orders for specialty care, lab work and other services at Mann-Grandstaff VA Medical Center, the first VA facility to roll out the new technology.

The OIG review found that the new EHR sent thousands of orders for medical care to an undetectable location, or unknown queue, instead of the intended care or service location, effectively causing the orders to disappear without letting clinicians know they weren't delivered.

The intent of the unknown queue is to capture orders entered by providers that the new EHR cannot deliver to the intended location because the orders were not recognized as a “match” by the system, according to the VA watchdog.

From facility go-live in October 2020 through June 2021, the new EHR failed to deliver more than 11,000 orders for requested clinical services.

Those lost orders, often called referrals, resulted in delayed care and what a VA patient safety team classified as dozens of cases of "moderate harm" and one case of "major harm."

The clinical reviewers conducted 1,286 facility event assessments and identified and classified 149 adverse events for patients.

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Source: Fierce Healthcare, 20 July 2022

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Bereaved families demand ‘core’ role in UK Covid inquiry as ‘investigative’ phase begins

Families who lost loved ones during the pandemic have demanded to play a central role in the UK’s Covid-19 inquiry, which launches its investigative phase tomorrow.

The inquiry has already consulted with different groups, businesses, academics and officials from a variety of sectors involved in the pandemic response to review which areas warrant scrutiny and how to structure proceedings.

This includes Covid-19 Bereaved Families for Justice, a campaign group of over 6,000 people who have lost a loved one to coronavirus.

The group has repeatedly sought assurances from the inquiry it will be granted a ‘core participant’ status once applications open. This which would allow families to give evidence, ask questions during proceedings, access all disclosed documents, and recommend people to be interviewed.

However, Elkan Abrahamson, a lawyer who is representing the group in the inquiry, said it was unclear how the inquiry would select core participants and expressed concern that the bereaved families won’t play a central role.

“The feeling from the bereaved at the consultation stage was that the chair was sympathetic. They were happy with how that went,” Mr Abrahamson said.

“[But] given we represent the largest group of bereaved in the UK, we’re not experiencing a sense of co-operation that we would normally expect to have reached by this stage. Their lawyers are happy to meet with us, but the questions we ask them aren’t being properly answered.”

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Source: The Independent, 20 July 2022

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NHS ‘shouting into the void’ with covid concerns

NHS leaders have sometimes been “shouting into the void” about their fears of the health service being overwhelmed by Covid because of the absence of a single national command centre for the pandemic response, a new report argues.

The Tony Blair Institute for Global Change has published a report which recommends short and long term actions for dealing with Covid and future health emergencies. 

It says the government should have previously, and should now, set up “a national centre for response” to have overriding national responsibility for managing Covid and future crises.

The government should also shift away from traditional methods of communication, to instead listen to “communities… beliefs and fears” about Covid, and adjust messages to respond to these.

The report has been authored by the institute’s head of health Henry Dowlen, who was seconded to work on several pandemic projects such as a setting up a Nightingale Hospital and coordinating regional and national response work.

He said that if government did not change course then the NHS, along with other services and parts of society, would remain in a “vicious cycle” of operational problems.

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Source: HSJ, 20 July 2022

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First Women's Health Strategy for England to tackle gender health gap

Women and girls across England will benefit from improved healthcare following the publication of the first ever government-led Women’s Health Strategy for England today.

Following a call for evidence which generated almost 100,000 responses from individuals across England, and building on 'Our Vision for Women’s Health', the strategy sets bold ambitions to tackle deep-rooted, systemic issues within the health and care system to improve the health and wellbeing of women, and reset how the health and care system listens to women.

The strategy includes key commitments around:

  • New research and data gathering.
  • The expansion of women’s health-focused education and training for incoming doctors.
  • Improvements to fertility services.
  • Ensuring women have access to high-quality health information.
  • Updating guidance for female-specific health conditions like endometriosis to ensure the latest evidence and advice is being used in treatment.

To support progress already underway in these areas, the strategy aims to:

  • Provide a new investment of £10 million for a breast screening programme, which will provide 25 new mobile breast screening units to be targeted at areas with the greatest challenges in uptake and coverage. This will:
  • - provide extra capacity for services to recover from the impact of the coronavirus (COVID-19) pandemic
  • - boost uptake of screening in areas where attendance is low
  • - tackle health disparities
  • - contribute towards higher early diagnosis rates in line with the NHS Long Term Plan.
  • Remove additional barriers to IVF for female same-sex couples. There will no longer be a requirement for them to pay for artificial insemination to prove their fertility status and NHS treatment for female same-sex couples will start with 6 cycles of artificial insemination, prior to accessing IVF services, if necessary.
  • Improve transparency on provision and availability of IVF so prospective parents can see how their local area performs to tackle the ‘postcode lottery’ in access to IVF treatment
  • Recognise parents who have lost a child before 24 weeks through the introduction of a pregnancy loss certificate in England.
  • Ensure specialist endometriosis services have the most up-to-date evidence and advice by updating the service specification for severe endometriosis, which defines the standards of care patients can expect. This sits alongside the National Institute for Health and Care Excellence (NICE) review of its guideline on endometriosis.

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Source: Gov.UK, 20 July 2022

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Half of all deaths of people with a learning disability ‘avoidable’

Nearly half (49%) of all deaths of people with a learning disability in 2021 were deemed to be avoidable, a major annual report has found.

By comparison, just 22% of deaths were classified as avoidable among the overall general population in 2020.

A new report, led by King’s College London and produced for NHS England – identified that of those avoidable deaths among people with learning disabilities, 65.5% died in hospital.

The learning from life and death reviews programme (LeDeR) report also revealed that the Midlands and North West showed the greatest difference in avoidable to unavoidable deaths at 53%, compared to 48% in London.

And when looking at individual long-term conditions, 8% of avoidable deaths were related to cancer, 17% to diabetes, 14% to hypertension, and 17% to respiratory conditions.

It also found that:

  • More than 50% of people with a learning disability died in areas rated as some of the most deprived in England
  • Around six out of 10 people with a learning disability die before age 65, compared to 1 in 10 from the general public
  • On average, men with a learning disability die 22 years younger than men from the general population.

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Source: Healthcare Leader, 18 July 2022

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Hospital has left my daughter in ME agony, claims mother

A mother has said an NHS hospital failed to offer her daughter adequate pain relief in a pattern of poor treatment that left the teenager suicidal.

Ella Copley, 17, from Tingley, West Yorkshire, has suffered from ME (myalgic encephalomyelitis), sometimes known as chronic fatigue syndrome, for seven years. She has been in Leeds General Infirmary since March, when she was taken there by ambulance with an infection later diagnosed as sepsis.

Her mother, Joanne McKee, 49, said the treatment Ella had received “feels like neglect and abuse”. She has posted videos on social media of the teenager screaming in pain when medicine is given by nasogastric tube. “I don’t think they believe that her pain is real at all,” she said.

McKee said doctors had told Ella she was “hypersensitive”, and suggested that she stroke a piece of material against her skin as part of a desensitisation programme. “I have just never, ever known anything so dismissive,” McKee said.

In an interview with Times Radio, she added: “No one has any understanding of her conditions. That really is the issue."

The charity Action for ME has written a letter to the hospital’s chief executive raising concerns over Ella’s case. In it, Sonya Chowdhury, chief executive of the charity, said she was “aware of several other situations that bear similarity with Ella’s illness and care”.

Questions have been raised over the treatment of Maeve Boothby-O’Neill, who died in October last year. Her death will be the subject of an inquest in Exeter next month.

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Source: The Times, 18 July 2022

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US abortion laws spark profound changes in other medical care

A sexual assault survivor chooses sterilization so that if she is ever attacked again, she won’t be forced to give birth to a rapist’s baby. An obstetrician delays inducing a miscarriage until a woman with severe pregnancy complications seems “sick enough.” A lupus patient must stop taking medication that controls her illness because it can also cause miscarriages.

Abortion restrictions in a number of states and the Supreme Court’s decision to overturn Roe v. Wade are having profound repercussions in reproductive medicine as well as in other areas of medical care.

“For physicians and patients alike, this is a frightening and fraught time, with new, unprecedented concerns about data privacy, access to contraception, and even when to begin lifesaving care,” said Dr. Jack Resneck, president of the American Medical Association.

Even in medical emergencies, doctors are sometimes declining immediate treatment. In the past week, an Ohio abortion clinic received calls from two women with ectopic pregnancies — when an embryo grows outside the uterus and can’t be saved — who said their doctors wouldn’t treat them. Ectopic pregnancies often become life-threatening emergencies and abortion clinics aren’t set up to treat them.

It’s just one example of “the horrible downstream effects of criminalizing abortion care,″ said Dr. Catherine Romanos, who works at the Dayton clinic.

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Source: AP News, 16 July 2022

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Are these Britain's most sexist surgeons? Offensive comments made to mesh surgery victims

Carole Davies and her partner, Malcolm, looked at each other in shocked silent horror as her surgeon spoke to them. 

Carole, 76, from Stevenage, Hertfordshire, had endured weeks of agony after an NHS surgeon had inserted a polypropylene mesh implant to treat a slight incontinence problem. The mesh was meant to act as a scaffold to support her leaking bladder.

Carole, then 60 and a recently retired personnel administrator, had returned to see the surgeon with her partner seven weeks after the surgery. She was in tears as she explained her debilitating pain.

'I told the surgeon that I could feel the mesh cutting into me, which was agonising,' Carole told Good Health.

'But he ignored this and said everything was OK. He told me: 'I just don't understand how you could be in pain. I will refer you to a psychiatrist.' Then he turned to Malcolm and said: 'I've made her nice and tight for you.' '

It was lewd and inappropriate but, as we can reveal, is shockingly by no means an isolated example — an insult, literally, not just to Carole but for many others, among the tens of thousands of British women who have suffered agonising complications from mesh-tape operations since they were first introduced in the late 1990s to treat incontinence or prolapse.

To add insult to injury, these women often struggled for years to have their complaints taken seriously, while surgeons dismissed the idea that there was anything wrong.

The Mail joined forces with campaigning group Sling The Mesh to highlight the issue, the Government set up an inquiry, led by Baroness Cumberlege, in July 2018.

This led initially to a pause in the use of surgical mesh for the treatment of urinary incontinence. The inquiry has since called for this pause to be extended until strict requirements on safety and recompense are met.

Nevertheless, an investigation by Good Health last month found that not only is mesh still being surgically implanted in women, but also that its use could well be on the rise again.

Sling The Mesh has received dozens of messages from women detailing similarly appalling responses, the majority in the past five years, that surgeons had made to deny, belittle and denigrate their agonising pain, emotional trauma and — in some cases — ruined sex lives.

You can read all the messages on the hub's community thread.

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Source: Mail Online, 18 July 2022

Further reading

Doctors’ shocking comments reveal institutional misogyny towards women harmed by pelvic mesh - a Patient Safety Learning blog

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Hospitals ordered to take action to stop ambulances waiting longer than half an hour

Doctors’ leaders have reacted with incredulity to demands that all hospitals in England take “immediate steps” to find extra space for patients so that no ambulance waits longer than 30 minutes.

A letter from NHS England sent to the heads of NHS trusts, integrated care boards, and ambulance trusts acknowledged that this will not be easy “and that it may place additional burden on staff at an already challenging time.

The letter was sent on 15 July, in response to the increased pressure on ambulance services over the past year and in light of the current heatwave. It said, “All systems that are currently unable to offload ambulances within 30 minutes should now take further steps to create capacity within acute hospitals to ensure the rapid release of vehicles. This will require risk based decisions to be made about both the use of estate and deployment of clinical workforce.”

Vishal Sharma, chair of the consultants committee at the BMA, said, “The government should be ashamed that it has come to this. If hospitals had the space or the staff to allow them to care for these patients, they wouldn’t be waiting in ambulances at the hospital door in the first place. The sad fact is that after decades of underinvestment, our hospitals are under-resourced, under-bedded, and understaffed.”

 

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Source: BMJ, 18 July 2022

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GPs to give patients with learning disability and autism ‘priority appointments’

NHS England will ask GP practices to make ‘reasonable adjustments’ for patients with a learning disability or autism such as giving them ‘priority appointments’.

They could also be asked to provide ‘easy-read appointment letters’ to the group, the Department of Health and Social Care (DHSC) said yesterday in a new strategy on strengthening support for autistic people and those with a learning disability.

It said the measures aim to support Government plans to reduce reliance on mental health inpatient care, with a target to reduce the number of those with a learning disability or autism in specialist inpatient care by 50% by March 2024 compared with March 2015.

The policy paper said: ‘We know that people experience challenges accessing reasonably adjusted support which may prevent them from having their needs met.’

It added: ‘To make it easier for people with a learning disability and autistic people to use health services, there is work underway in NHS England to make sure that staff in health settings know if they need to make reasonable adjustments for people."

NHS England is also developing a ‘reasonable adjustments digital flag’ that will signal that a patient may need reasonable adjustments on their health record, it said.

It plans to make this flag, which is currently being tested, available across all NHS services, it added.

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Source: Pulse 15 July 2022

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‘Outrageous’ long A&E waits for mental health patients increase 150%

Mental health patients who arrive at emergency departments (ED) in crisis are increasingly facing ‘outrageous’ long waits for an inpatient bed, with some being forced to wait several days.

HSJ research suggests ED waits of more than 12 hours have ballooned in 2022, and are now around two-and-a-half times as high as pre-Covid levels.

Early intervention for patients in mental health crisis is deemed to be crucial in their care and recovery.

The Royal College of Emergency Medicine said the findings are a “massive concern”, while the Royal College of Psychiatrists described them as “unacceptable”.

RCEM president Katherine Henderson said the experience of mental health patients in accident and emergency departments “is not what it should be from a caring healthcare system”.

She said: “We have massive concern for this patient group. We feel they are getting a really poor deal at the moment.

“The bottom line is there are not enough mental health beds. There are not enough community mental health services to support patients and perhaps therefore prevent a crisis and the need for beds in the first place.

“Mental health crisis first responder teams work – a mental health practitioner working with the ambulance service can prevent the need for an ED visit.”

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Source: HSJ, 19 July 2022

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Serious concerns raised about senior NHS leaders’ approach to patient safety

Press release: London, UK, 18 July 2022

In a letter shared with Patient Safety Learning, Keith Conradi, outgoing Chief Investigator at the Healthcare Safety Investigation Branch (HSIB), has raised serious concerns with the Secretary of State about the lack of interest shown in the patient safety activities of HSIB at the highest levels of the Department of Health and Social Care and NHS England.

Keith Conradi states that successive leaders of NHS England have shown “little interest” in the work of HSIB. He also highlights concerns about NHS England’s engagement in several HSIB investigations delayed by the pandemic, stating that a lack of participation has “reduced the safety impact of their output”.

The letter calls for the Department of Health and Social Care to take a safety management system approach to safety, like other safety critical industries such as aviation. Keith Conradi notes that currently where patient safety is done well in the NHS, this is “because of the drive and enthusiasm of individuals rather than through a state organised structured approach”.

Commenting on this letter, Patient Safety Learning’s Chief Executive Helen Hughes said:

“We believe that HSIB can play an important role in improving patient safety in the NHS, but not without system-wide commitment and support for their work. It is disappointing to hear of this apparent lack of interest in their activities by NHS England.

We were also deeply alarmed by concerns about a lack of engagement by NHS England in HSIB safety investigations reducing their impact. This is simply not acceptable and flies in the face of the NHS Patient Safety Strategy’s vision of seeking to continuously improve patient safety.

We hope that NHS England will seriously rethink its approach to how it works with the national patient safety investigator, and that the new Secretary of State and incoming new Prime Minister seek to reset and re-invigorate our national approach to improving patient safety.”

Notes to editors

  1. Patient Safety Learning is a charity and independent voice for improving patient safety. We harness the knowledge, enthusiasm and commitment of healthcare organisations, professionals and patients for system-wide change and the reduction of harm. We support safety improvement through policy, influencing and campaigning and the development of ‘how to’ resources such as the hub, our free award-winning platform to share learning for patient safety.
  2. HSIB is the independent national investigator for patient safety in England. It seeks to improve patient safety through professional safety investigations that do not apportion blame or liability.
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Doctor struck off for falsely diagnosing children with cancer

A paediatrician has been struck off for falsely diagnosing children with cancer to scare their parents into paying for expensive private treatment.

Dr Mina Chowdhury, 45, caused "undue alarm" to the parents of three young patients - one aged 15 months - by making the "unjustified" diagnoses so his company could cash in by arranging tests and scans, a medical tribunal found.

Chowdhury, who worked as a full-time consultant in paediatrics and neonatology at NHS Forth Valley, provided private treatment at his Meras Healthcare clinic in Glasgow. But the clinic made losses, despite "significant" potential income from third-party investigations and referrals for treatment – with patients charged a mark up fee of up to three times the actual cost. In all three cases, Chowdhury gave a false cancer diagnosis, without proper investigation, before recommending “unnecessary and expensive” private tests and treatment in London.

Parents previously told the tribunal of their shock and upset at receiving Chowdhury’s diagnoses during consultations between March and August 2017. He told the parents of a 15-month-old girl - known as Patient C - that a lump attached to the bone in her leg was a "soft tissue sarcoma" and a second lump had developed. Chowdhury urged them to see a doctor in London who could arrange an ultrasound scan, a MRI scan and biopsy in a couple of days, saying: "If things are happening it is best to get on top of them early." He also warned that it would be "confusing" to return to the NHS for treatment. But the parents spoke to an A&E doctor and an ultrasound scan revealed that the lumps were likely fat necrosis.

Patient C later was discharged after her bloods tests came back as normal. The child’s mother told the tribunal that she and her husband had been "very upset" at Chowdhury’s diagnosis. She was also left "angry" after she later read Dr Chowdhury’s consultation notes and realised they were a "total falsification" of what was discussed.

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Source: Medscape, 18 July 2022

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Hospital admits paper records putting patients at risk after man’s fatal cancer missed for 10 years

Patients are at risk of a missed cancer diagnosis due to a reliance on paper records, an NHS trust has admitted after a man died due to his tumour being overlooked.

Michael Lane, 50, from Shrewsbury, was “failed” by Shrewsbury and Telford Hospital Trust, his family has said after his cancer scan result was misplaced leaving him with a growing kidney tumour for 10 years.

The trust is yet to fully launch an electronic record system a year after an investigation into Mr Lane’s death warned other patients were at risk due to the gap in paper records.

Mr Lane went into Shrewsbury and Telford Hospital for a scan following a referral for suspected cancer in 2011. The radiographer flagged a small tumour but the scan was overlooked, placed within his paper records and never reported as being a concern.

In an investigation report carried out by the trust in May 2021, seen by The Independent, the hospital admitted that had his tumour been seen and operated on earlier he may have survived.

The report also admitted there were ongoing risks within the trust due to gaps in its electronic records system.

It said: “The implementation of an IT solution will not prevent sad cases such as that of Mr Lane where the scan report that was missed took place before the widespread availability of such systems, however, it is clear that until we have an electronic requesting and sign-off system we remain at risk of new cases of missed results and harm occurring as a result of the ongoing reliance of paper-based results.”

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Source: The Independent, 17 July 2022

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Medical expert witnesses ‘should not scapegoat doctors’

Medical experts in cases involving doctors should have a mandatory duty to consider systems issues such as inadequate staffing levels to avoid them being scapegoated for wider failures, the Medical Protection Society (MPS) has said.

The MPS, which supports the the professional interests of more than 300,000 healthcare professionals around the world, says medical expert reports focus on scrutinising the actions of the individual doctor even when failings are a result of the setting in which they work.

Its report on the issue, shared with the Guardian before publication, points out that for doctors “adverse opinion can lead to loss of career or liberty”.

It references the case of Dr Hadiza Bawa-Garba who was convicted of gross negligence manslaughter in 2015 and handed a 24-month suspended sentence for her part in the death of six-year-old Jack Adcock from sepsis. She was later struck off by the General Medical Council before the court of appeal overturned the GMC’s decision.

Dr Rob Hendry, the MPS medical director, said: “In giving an opinion on whether or not the care provided by a doctor has fallen short of a reasonable standard, it would seem fair to the doctor that the medical expert considers all relevant circumstances. Any individual performance concerns must of course be addressed, but doctors should not be scapegoats for the failings of the settings in which they work. Sadly, we see this all too often in cases against doctors …

“Many expert reports focus solely on the actions of the individual without considering the wider context. In reality, patient harm arising from medical error is rarely attributable to the actions of a single individual. Inadequate staffing levels, lack of resources, or faulty IT systems are just some issues which can contribute to adverse incidents. Doctors confront these issues every day and have little influence over them.”

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Source: The Guardian, 18 July 2022

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Surgeon branded bully faces review after patient, 17, dies

Catherine O’Connor, who was born with spina bifida and used a wheelchair all her life, was looking forward to the surgery to fix her twisted spine.

Tragically, after a catastrophic loss of blood, she died on the operating table at Salford Royal Hospital in Manchester.

She died in February 2007 but only now has an NHS-commissioned report concluded the “unacceptable and unjustifiable” actions of her surgeon, John Bradley Williamson, “directly contributed” to her death. Williamson pressed on with the surgery despite being explicitly told he needed a second consultant surgeon.

Her case is one of more than a hundred of Williamson’s being reviewed by Salford Royal Hospital amid allegations by whistleblowers of a cover-up by managers and a “toxic culture” within his surgery team.

An internal list produced by concerned clinicians as long ago as 2014 describes some of Williamson’s patients being left paralysed or in severe pain as a result of misplaced spinal screws and others being rushed back to theatre for life-saving surgery.

Separately, leaked minutes of a meeting between staff and the hospital’s new chief executive in December 2021 described a “snapshot” of five of Williamson’s patients which “clearly identified significant areas of clinical care, avoidable harm and avoidable death”. They added: “Concerns around Mr Williamson continue to be raised and remain unaddressed.”

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Source: The Times, 17 July 2022

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Norfolk and Norwich Hospital unable to discharge 180 patients

A senior hospital nurse said she could not discharge 180 patients due to a lack of "care and support" at home.

Norfolk and Norwich University Hospital said among the people that did not need to be in hospital was a patient who had been there for 145 days.

Claire Fare, senior discharge matron, said delays "impact on the whole of the flow" of patients.

Norfolk County Council's social care department blamed the "national care crisis" for the problems.

In June, the hospital, which has about 1,200 beds, pleaded for family and friends to help look after fit patients to ease demand.

Melanie Syson, the hospital's discharge coordinator, said there was a person in the hospital ready for discharge that had been there for more than four months.

"She is medically fit to be discharged but we are waiting for support to be ready at home," she said.

Ms Syson added: "The length of stay of the patients seems to be getting longer."

To help cope with the delays, the hospital opened a "home-first unit" in January for patients who did not need acute care but it was unable to discharge. The unit focuses on rehabilitation to try to prevent the patients coming back into hospital or requiring more care at home.

Stephanie Ward, the ward sister, said it aimed to "give patients the time they need to do things themselves as much as they can".

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Source: BBC News, 15 July 2022

 

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Ambulance serious incidents triple

Serious incidents causing patient harm have increased steeply compared to previous years at an ambulance service whose nursing director still expects will “fail” next month under mounting service pressures.

There were 98 patient harm incidents at West Midlands Ambulance Service in June, official data obtained by HSJ suggests, up from 49 in the same month last year.

The figures show that from April-June this year, 262 harm incidents have been logged – a 240% on 77 in the same period in 2019 and a 71% on 153 last year.

Nursing director Mark Docherty, who previously warned the service was facing a “Titanic moment” and would “all fail” around a specific date of 17 August, said much of the increase can be attributed to worsening hospital handover delays. 

More than 700 people at one time waited for ambulances “that were not going to turn up” on Monday, according to Mr Docherty, who described the situation as a “really dangerous place to be”.

Mr Docherty explained how the harm incidents, including deaths, resulted from growing delays: ”You can’t underplay the risk. If you’ve got 750 patients like we did on Monday waiting, none of those patients have been assessed.

“Sadly, amongst them there will have been patients with stroke who won’t be treated because they’ve waited too long."

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Source: HSJ, 15 July 2022

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Patients give up on 'difficult' appointments

Patients are increasingly avoiding seeing their GP because they find it too difficult to book an appointment, the latest data show.

Results from the 2022 GP Patient Survey also show that satisfaction with family doctors in England has dwindled since the previous year. The findings come as the Government and the NHS struggle to retain GPs and boost recruitment to meet rising patient demand and an ageing population.

The survey found that overall satisfaction ratings have declined over the past 2 years, although most patients who responded to a questionnaire reported a good overall experience with their GP practice, had confidence and trust in the healthcare professional who saw them, and considered they received good care and treatment.

The results also revealed an increase in the barriers patients faced in getting an appointment in the first place, with 55.4% who needed one in the last 12 months saying they had avoided making one – an increase of 13.1% since the last survey. The most common reason given was that they found it too difficult, cited by 26.5% of respondents, and a huge increase on last year's figure of 11.1%.

Commenting on the results, Beccy Baird, senior fellow at The King's Fund said: "For many of us, general practice is the front door to the NHS – these results show that patients are finding that door increasingly hard to push open.

"GPs are working harder than ever before, yet these findings show a dramatic fall in patients' experience of getting an appointment."

She said recruitment of GPs, nurses, and other professionals to meet rising levels of need was proving tough "because in many cases those staff simply don’t exist".

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Source: Medscape, 14 July 2022

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Ambulance services on fringe of collapse

Ambulance services are under intense pressure, with record numbers of callouts and the most urgent, category-one, calls last month.

BBC Two's Newsnight programme spent from 08:00 to 20:00 on Monday at six hospitals with the longest delays handing patients over from paramedics to accident and emergency staff.

This should take 15 minutes or less - but crews often wait many hours and sometimes whole 12-hour shifts, with ambulances queuing outside unable to respond to other emergency calls.

At Royal Cornwall, 25 ambulances were queuing by the afternoon, three for at least 10-and-a-half hours, at Derriford, in Plymouth, 20 were queuing up to 11 hours in an overflow car park and the longest wait at Heartlands was more than five hours.

"We're right on the fringe of collapse right now," a paramedic who has worked in emergency care for more than a decade said.

"People are phoning and being told that they're not going to get an ambulance for six or nine hours. And that's happening routinely - that is happening pretty much every shift."

"It would be wrong to say that there are times when I haven't shed a tear... for the people we haven't been able to help because it's been too late," the paramedic said. 

"They may have died anyway but there are definitely cases that I've been to where we should have been to them sooner and less harm would have come to them."

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Source: BBC News, 15 July 2022

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