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Most foreign doctors in NHS face ‘racist microaggressions’, survey shows

Three in five foreign doctors in the NHS face “racist microaggressions” at work, such as patients refusing to be treated by them or having their abilities doubted because of their skin colour.

The widespread “thinly veiled, everyday instances of racism at work” experienced by medics trained overseas has been uncovered by a survey of more than 2,000 UK doctors and dentists.

Almost three in five (58%) said they had encountered such behaviour, from colleagues as well as patients, although most did not report it because they thought that no action would be taken. Doctors affected can feel upset, humiliated, marginalised and not taken seriously as a result.

The findings have raised fears that international medical graduates may choose not to work in the NHS, which is increasingly reliant on their skills given the service’s shortage of doctors.

Dr Naeem Nazem, the head of medical at the medical defence organisation MDDUS, which acts for doctors accused of wrongdoing, said: “These findings show us that a worryingly large number of overseas-trained doctors working in the NHS face racist microaggressions in the course of their work, from both patients and colleagues, and that many do so regularly.”

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Source: The Guardian, 8 November 2023

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Consultant carried out 'unnecessary' surgery for financial gain, tribunal hears

A doctor who worked for the same private healthcare company as rogue surgeon Ian Paterson performed unnecessary shoulder operations for financial gain, a medical tribunal has heard.

Orthopaedic consultant Michael Walsh worked at a Spire Healthcare hospital in Leeds from 1993 until 2018, when he was suspended after concerns were raised about his work.

Spire, which runs 38 hospitals around the UK, reported him to the General Medical Council (GMC) after an investigation found he carried out operations unnecessarily or badly, with many patients left suffering pain or trauma.

Mr Walsh, who also worked at another private hospital in Leeds run by Nuffield Health but is now retired, is facing dozens of medical negligence claims from patients, with some already having received payouts.

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Source: Medscape, 8 November 2023

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Indigestible and illegible: the sorry state of board safety reports

A report highlights that maternity and neonatal services are often regular agenda items at board meetings, but the quality and quantity of information that is presented and the subsequent discussion (or lack thereof) doesn’t lead to effective oversight.

The shocking and distressing stories emerging from the Lucy Letby case in August 2023 shone a light on the “cover-up culture” in the NHS. Although deliberate harming of babies is thankfully exceedingly rare, some of the issues raised in this case echo concerns that trusts are failing to react to signs of poor performance in maternity and neonatal services.

Responsibility ultimately lies with trust boards which have a statutory duty to ensure the safety of care. However, the actions (or inactions) of leadership have come up frequently in inquiries and reviews.

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Source: HSJ, 7 November 2023

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Three million callers fail to get through to GP every month, government research reveals

One in 10 people attempting to contact their GP practice do not manage to get in contact, while a further 6% are only told to try again another day, according to new official survey findings commissioned by the government.

The Office for National Statistics has been quietly carrying out the new regular GP access survey since the spring after ministers said they wanted to monitor the impact of their primary care recovery plan.

After a sign of slight improvement in the summer, the latest survey results – for October – show no significant change since May.

It also found, as did previous rounds, that of those who had tried to contact a GP practice in the past month, 10 per cent said they could not do so (see chart below, ‘Contact with GP practice’). Of those who did make contact, a further 6 per cent reported they were told to try again another day (see chart below, ‘Next step after contact’).

The government and NHS England have made it a high priority in recovery plans that patients should no longer be asked to call back another day to book an appointment and should know “on the day” how their request will be managed, which may mean being advised to use a different service.  

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Source: HSJ, 9 November 2023

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Covid inquiry: Ex-minister challenged on plan for disabled people

An ex-minister has defended the government's approach to disabled people during the pandemic, following claims they were "largely disregarded".

Justin Tomlinson, a former minister for disabled people, told the Covid inquiry the government recognised this group was at greater risk from the virus.

He added that work had been done "at pace" to address this.

The inquiry has previously been told that disabled people's views were not properly heard ahead of key decisions.

Nearly six out of 10 people who died with coronavirus in England from January to November 2020 were disabled, according to the Office for National Statistics (ONS).

In a witness statement published earlier this month, chief executive of charity Disability Rights UK, Kamran Mallik, said: "From the statements, decisions and actions of the UK government throughout the crisis, considerations relating to disabled people appeared to be largely disregarded."

In his evidence earlier this month, Mr Mallik of Disability Rights UK said there was a "shocking disregard" when it came to providing information in alternative formats for disabled people, including letters on shielding for clinically vulnerable groups.

He said his charity had also raised concerns about protections for care home residents, and help for disabled people who were not shielding but still needed support accessing food and essentials.

Mr Mallik added that there had been no consultation to allow the views of charities or disabled people to be "properly heard before decisions were made".

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Source: BBC News, 8 November 2023

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‘Controversial’ A&E policy 'showed we're all shouldering the pain', says CEO

A high-profile shift to admitting patients from A&E to wards irrespective of bed capacity has ‘turned the dial’ for an acute trust’s emergency care, its chief executive has told HSJ.

Since introducing the model in July last year North Bristol Trust has seen a significant improvement in its performance against the national target, with the number of patients seen within four hours rising from 51% to 72% in August 2023 – with a peak of 80% in April 2023.

The model attracted interest from NHS England last year, as well as some concern from the Nuffield Trust over patient safety – but NBT CEO Maria Kane said the trust was “happy, on balance” with the system.

She said the model “won’t be for everyone and we never claimed it would be” but she added: “Engendering whole hospital conversations about the principles of flow and understanding of [the emergency department] is something we could all do.”

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Source: HSJ, 8 November 2023

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NHS: Woman waited nine months for hospital discharge

A woman who spent nine months in hospital waiting for a suitable care home placement became a "shadow of her former self", her mother has said.

Jocelyn Ullmer, 60, from West Sussex, saw her health deteriorate after being admitted to hospital in June last year.

Her mother, Sylvia Hubbard, 86, said: "We tried to get her out of hospital, but no-one wanted her."

Across England, around 60% of patients classed as fit to leave remain in hospital at the end of an average day.

Figures show the biggest obstacle is a lack of beds in other settings, such as care homes and community hospitals.

The government said it was investing £1.6bn over the next two years to help improve the situation.

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Source: BBC News, 8 November 2023

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‘Excess deaths’ due to A&E delays rise by nearly a third in one year

Long waits in A&E departments may have caused around 30,000 ‘excess deaths’ last year, according to new estimates.

Using a methodology backed by experts, HSJ analysis of official data has produced an estimate of 29,145 ‘excess deaths’ related to long accident and emergency delays in 2022-23, up from 22,175 in 2021-22, and 9,783 related deaths in 2020-21.

For the first time, the analysis has also produced estimates of excess mortality related to long A&E delays for every acute trust.

The data suggests the rate of excess deaths from 2022-23 has so far continued into 2023-24.

The analysis followed a methodology used in a peer-reviewed study published in the Emergency Medicine Journal, which found delays to hospital admission for patients of more than five hours from time of arrival at A&E were associated with an increase in all-cause mortality within 30 days.

Data scientist Steve Black, one of the authors of the EMJ study, said: “Long waits in A&E should never happen and 12-hour waits should be something like a never event. They should be intolerable anywhere. If we want to fix them it’s helpful to know which trusts have the worst problems with long waits.”

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Source: HSJ, 7 November 2023

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NHSE failing to hold trusts to account on inequalities

NHS England ‘lacks a clear vision’ on a key part of its health inequalities agenda and is not holding trusts to account for delivering an ‘inclusive recovery’, a study by the King’s Fund has concluded.

The think-tank’s report, which represents one of the most comprehensive analyses on the subject to date, said system leaders had not made the case for change “strongly or clearly enough to convince clinicians and other staff to consider inequalities” when tackling elective backlogs.

The think-tank said it had undertaken the research to investigate to what extent local NHS organisations had taken an “inclusive approach” to managing waiting lists, as NHS England had ordered them to do in August 2020.

The research team said in a statement alongside the report: “There has been a lack of a clear vision from national leaders on why inclusive recovery is important for delivering better and fairer services for patients and the public.

“The report calls on the government to pay greater attention to inclusive recovery to ensure progress is made so that patients can be treated fairly, no matter their background.”

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Source: HSJ, 8 November 2023

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Birmingham's Priory Healthcare charged after patient's death 'contributed to by neglect'

Priory Healthcare faces legal action following the death of a vulnerable man who was hit by a train after leaving Birmingham’s Priory Hospital Woodbourne in September 2020.

Matthew Caseby, 23, detained under the Mental Health Act, escaped the hospital by climbing a 2.3-metre fence.

The inquest jury, which heard the University of Birmingham graduate should have been under constant observation but was left alone, reached a conclusion that his death “was contributed to by neglect”.

Concerns were raised about the hospital's record-keeping, risk assessments, and fence safety.

Following the inquest, the Care Quality Commission (CQC) charged Priory Healthcare with two offences under the Health and Safety Act 2008, related to failing to provide safe care and treatment, and exposing a patient to avoidable harm.

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Source: ITV, 6 November 2023

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Mouth-cancer deaths fear over NHS dentist shortage

Lack of access to dentists is costing lives because mouth cancers are not being spotted or treated early enough, a health charity has told BBC News.

The disease killed more than 3,000 people in 2021 - up 46%, from 2,075 a decade ago, latest figures obtained by the Oral Health Foundation show.

And last year, a BBC News investigation revealed 90% of UK NHS dental practices were not accepting new adult patients.

The government has announced plans to increase dental-training places by 40%. It also said the NHS was treating more people for cancer at an earlier stage than ever before.

Oral Health Foundation chief executive Nigel Carter says dental check-ups "are a key place for identifying the early stage of mouth cancer".

"With access to NHS dentistry in tatters, we fear that many people with mouth cancer will not receive a timely diagnosis," he adds.

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Source: BBC News, 8 November 2023

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NHS to offer 150,000 people with type 1 diabetes an artificial pancreas

More than 150,000 adults and children with type 1 diabetes in England and Wales are to be offered an artificial pancreas on the NHS, which experts are hailing as a “gamechanger” that will “save lives and heartbreak”.

The groundbreaking device, also called a hybrid closed-loop system, uses a hi-tech algorithm to determine the amount of insulin that should be administered and reads blood sugar levels to keep them steady. A world-first trial on the NHS showed it was more effective at managing diabetes than current devices and required far less input from patients.

Final draft guidance from the National Institute for Health and Care Excellence (NICE) recommends that people in England and Wales should benefit from the wearable device if their diabetes is not adequately controlled by their current pump or glucose monitor. The decision to give the go-ahead for widespread use of the artificial pancreas was announced on Tuesday at NICE’s annual conference in Manchester by Dr Sam Roberts, its chief executive.

The artificial pancreas has been found to be better at keeping blood sugar levels within a healthy range, cutting the risk of people suffering complications from diabetes. It works via a continuous glucose monitor sensor attached to the body which transmits data to a body-worn insulin pump.

This pump then calculates how much insulin is needed and delivers the precise amount to the body. Hybrid closed-loop systems mean people do not need to rely on finger-prick blood tests or injecting insulin to control their blood sugar levels.

Yasmin Hopkins, who took part in trials of the artificial pancreas, said: “From day one it was amazing. Before the closed-loop system, I would experience a lot of highs, which I’d then overcorrect, go low and eat a lot of sugar. All of that has been eradicated.

“This technology gives me the freedom to get on with my life and live without fear of what might happen in a few hours, days or years.”

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Source: The Guardian, 7 November 2023

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Record NHS drug shortages as HRT, contraceptives and ADHD medicines run low

Britain faces record shortages of medicines amid a row between drug makers and the NHS over payments. 

Patients face issues getting hold of drugs for epilepsy and ADHD, as well as hormone replacement therapy (HRT) for the menopause. 

A total of 111 drugs are currently facing supply issues, according to the British Generic Manufacturers Association (BGMA). This is the highest level on record and more than double the number of drugs facing shortages at the start of 2022. 

The BGMA blamed an NHS drugs levy for the supply issues, saying it was discouraging pharmaceutical companies from supplying the health service.

Dr Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies, said pharmacists were “spending long hours in the day trying to source medicines for patients and this is on top of all the other activities they do in a busy pharmacy”.

She said: “Our pharmacy teams see firsthand the anxiety and stress experienced by patients caused by medicines shortages.” Shortages have also led to more abuse and aggression towards pharmacists, she said.

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Source: The Telegraph, 

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US nurse charged with killing 2 patients admits to trying to kill 17 more

A former Pennsylvania nurse admitted she tried to kill 19 people at multiple different care facilities, piling dozens of new charges on the woman who allegedly administered lethal doses of insulin to numerous patients, killing two.

On Thursday, the state's attorney general's office announced the new charges against Heather Pressdee, who now faces two counts of first-degree murder, 17 counts of attempted murder and 19 counts of neglect of a care-dependent person.

The 41-year-old nurse was first arrested in May for killing two nursing home patients and injuring a third.

From 2020 up until her arrest, prosecutors say Pressdee gave 19 patients at five different care facilities excessive amounts of insulin, some of whom were diabetic and needed it and others who did not.

The plaintiff would typically administer these insulin doses overnight while fewer staff members were working and as "emergencies wouldn't prompt immediate hospitalization," Pennsylvania Attorney General Michelle Henry said.

"If Pressdee sensed the victim would 'pull through' there is a pattern of her taking additional measures to try to kill the victims before they could be sent to the hospital by either administering a second dose of insulin or the use of an air embolism to ensure death," the criminal complaint, which also said Pressdee admitted to harming patients with intent to kill, said.

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Source: Scripps News, 3 November 2023

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GP leaders in England call for a pause in recruitment of physician associates

The BMA’s GP committee for England (GPC England) has called for an immediate pause in the recruitment of physician associates (PAs) in general practice.

In an emergency motion passed on 2 November the committee expressed “concerns over the increasing trend of PAs being used to substitute GPs” and called on practices and primary care networks to stop PA recruitment “until appropriately safe regulatory processes and structures are in place.”

GPs and GP registrars were also reminded that they can refuse to sign prescriptions and turn down requests for investigations made by PAs.

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Source: BMJ, 3 November 2023

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Drug that can halve breast cancer risk offered to 289,000 women in England

Drug that can halve breast cancer risk offered to 289,000 women in England

Anastrozole to be made available to women who have been through the menopause and have family history of breast cancer

Almost 300,000 women at higher risk of developing breast cancer are being given access to a drug that can halve their risk in a “major step forward” in the fight against the disease.

An estimated 289,000 women in England who are at moderate or high risk of breast cancer will from Tuesday be able to take the tablet to try to prevent it from developing, NHS bosses said.

The drug, anastrozole, is being made available to women who are in greater danger because they have been through menopause and have a major family history of Britain’s commonest form of cancer. It displays “remarkable” potential to reduce the number of people who go on to develop the disease, the head of the NHS said last night.

Every year, around 56,000 women in the UK are diagnosed with breast cancer – about 150 a day. While survival rates have improved, it still claims about 11,500 lives each year.

“It’s fantastic that this vital risk-reducing option could now help thousands of women and their families avoid the distress of a breast cancer diagnosis,” said Amanda Pritchard, NHSC England’s chief executive. The drug will be taken as a 1mg tablet once a day for five years.

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Source: The Guardian, 7 November 2023

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Struggling trust CEO says provider has ‘turned dial’ following care scandals

A mental health trust at the centre of several care scandals has ‘turned the dial’ on improvement, its chief executive has said, following the Care Quality Commission noting some progress but retaining a ‘requires improvement’ rating

The CQC said earlier this month that improvements had been made at some services at Tees Esk and Wear Valleys Foundation Trust, including for its forensic secure inpatient service, where the rating was raised from “inadequate” to “good”. But the improvements were not enough to shift its overall “requires improvement” rating.

Chief executive officer Brent Kilmurray argued the CQC report was evidence the trust was going in the right direction following a number of highly critical reports relating to patient deaths, but he also told HSJ it was a “challenge” for the trust to “tell a balanced story around where we are making progress”.

TEWV has recently admitted care failings relating to the deaths of two inpatients in 2019 and 2020, following prosecution from the CQC. The trust will go on trial for alleged failings relating to another death in February next year.

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Source: HSJ, 6 November 2023

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Poor maternity care at Hull Royal Infirmary risked babies' lives, say mums

Maternity services at Hull Royal Infirmary have recently been described in a damning report by the health watchdog as chaotic, unsafe and not fit for purpose. Three mothers, who claim staff missed signs of life-threatening conditions that could have killed them or their babies, have spoken to the BBC about their harrowing experiences at the hospital.

One woman, a BBC journalist who does not want to be named, said she knew her newborn son was seriously ill within minutes of giving birth at the infirmary in 2021.

"As soon as they handed him to me, I noticed something was wrong. He was panting and his breathing wasn't right," she said.

Over the course of an hour, she said her concerns were dismissed by the newly-qualified midwife who said his breathing was "completely normal".

"She kept reassuring me over and over that's how babies breathe. I felt like I was drowning surrounded by lifeguards," she said.

But after being examined by a more experienced midwife, the baby was rushed to intensive care and diagnosed with potentially fatal sepsis.

"It was like time stood still. The midwife ripped him off me and she slammed an oxygen mask on his face, called the crash team and he was taken away to the neonatal intensive care unit.

"The anger I felt was overwhelming because I'd been saying for nearly an hour he was seriously ill. I was right and he had sepsis."

A few months after her son's birth, she read about an inquest into the death of a four-day-old baby who had sepsis and was born at Hull Royal Infirmary.

A coroner found that midwives had failed to respond to his infection quickly enough.

"My blood ran cold because it was exactly the same circumstances that happened to me and that baby died. I thought they clearly haven't learned anything," she said.

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Source: BBC News, 6 November 2023

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Patient safety at risk as pharmacists replace GPs, doctors warn

Doctors are warning that patient safety is being put at risk as podiatrists and pharmacists replace GPs “on the cheap”.

Dozens of family doctors have contacted The Telegraph claiming that talk of a GP shortage is “a big lie” and that they are being replaced by less qualified, cheaper staff, in a “crisis”.

Documents seen by The Telegraph show staff including podiatrists, pharmacists and physician associates being used in lieu of GPs to diagnose and treat patients with conditions they are not trained in.

In the most extreme cases, poorly children with viral infections, asthma-related issues and concerns about menstruation have been seen and diagnosed by a podiatrist – a healthcare professional trained exclusively to care for feet.

It is not clear what happened to any of the patients afterwards, or if their parents were aware they had seen a podiatrist rather than a doctor.

One GP said it was “a matter of patient safety” and the notion of “everything being supervised” did not work at a GP practice like it does in hospitals.

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Source: The Telegraph, 4 November 2023

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DRC offers free maternity care to cut death rate among mothers and babies

Pregnant women across the Democratic Republic of the Congo are to be offered free healthcare in an effort to cut the country’s high rates of maternal and neonatal deaths.

Women in 13 out of 26 regions in the country will, by the end of the year, be entitled to free services during pregnancy and for one month after childbirth. Babies will receive free healthcare for their first 28 days under the scheme, which the government plans to extend to the rest of DRC – although there is no timetable for that yet.

However, health workers have raised concerns that hospitals and medical centres are ill-equipped to cope with any increased demand on services. Some told the Guardian there were not enough staff, facilities or equipment to successfully introduce the $113m (£93m) programme, which is supported by the World Bank.

The rollout of the programme comes amid nationwide strikes by nurses, midwives, technicians and hospital administrative staff, who are calling for higher pay and better conditions.

Congo has one of the highest number of maternal and neonatal deaths in the world. Latest figures record the maternal morality ratio at 547 deaths for every 100,000 live births, and its neonatal rate – the number of babies dying before 28 days of life – at 27 per 1,000 live births. 

The minister of public health, Roger Kamba Mulamba, said the programme would free women from a “prison sentence”.

He said: “Mothers today get healthcare without fear when they are pregnant. Babies today do not die because they have no access to antibiotics. Mothers today do not die because they cannot afford to pay for a caesarean delivery.”

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Source: The Guardian, 6 November 2023

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Private health firm Sciensus fails to fix defects that led to UK patient’s death

A private health company paid millions by the NHS has failed to fix safety defects that led to the death of a cancer patient, the Guardian can reveal.

Three patients were hospitalised and a fourth died when they were given the wrong doses of a powerful chemotherapy drug after a catastrophic IT failure at the medicine manufacturing unit of Sciensus in April this year.

The incident, first revealed by the Guardian in July, prompted an investigation by the Medicines and Healthcare products Regulatory Agency (MHRA). Its inspectors found “significant deficiencies” at the Sciensus manufacturing facilities and ordered the partial suspension of its manufacturing licence.

However, six months after the IT blunder, Sciensus has not fixed the problems identified by the regulator, according to people familiar with the matter. As a result, the suspension of its licence – originally due to be lifted last month – has been extended until July next year.

Sciensus is the UK’s biggest provider of medicines services to NHS and private patients at home. It is contracted by the NHS and other organisations to deliver and administer medicines to more than 200,000 people with conditions such as heart disease, diabetes, dementia, HIV and cancer.

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Source: The Guardian, 5 November 2023

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Stevens hits out at raft of ‘pound foolish’ government decisions

‘Chronic short-termism’ by government is undermining the nation’s ability to respond to another pandemic, a previous NHS England chief executive has said. 

In his first written statement to the covid public inquiry, Lord Stevens said ministers had failed to upgrade NHS infrastructure and modernise social care, delayed public health improvements, and cut testing and research programmes.

This is despite the 2023 national risk register identifying a further pandemic as the highest risk, with “5-25%pa

Lord Stevens – NHSE CEO from 2014 to summer 2021 – said it was “encouraging the government has now permitted NHS England to publish a funded long-term workforce plan”, but added: “There is also a strong case for revisiting several other national decisions.

“These include the dismantling of some community infection surveillance infrastructure; cancelling some scientific and clinical research programmes developed during the pandemic; postponing various preventative health measures; deferring reform of social care; and further delaying upgrades of health buildings, equipment and technology.”

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Source: HSJ, 3 November 2023

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Maternity care ‘in crisis’ as pregnant women are forced to delay induced deliveries

Pregnant women are being forced to wait days longer than expected for “urgent” inductions of labour as NHS staff shortages and a lack of beds lead to severe delays.

New mothers told i the delays, which the health watchdog has found can last up to five days, increased the anxiety they felt during labour.

One first-time mother, who wanted to remain anonymous, said that her ordeal has put her off having any more children. The woman, who gave birth to a son in August, said she was “pushed” to book an induction when her waters broke and her baby was almost two weeks overdue. Despite being told by multiple healthcare professionals she needed to “give birth within 24 hours” due to a risk of infection, she did not end up delivering her baby for another 49 hours – without being induced.

A birthing expert told i she has “never seen a crisis in maternity” like it during her almost 10 years working in the sector.

It comes after it was revealed that the Care Quality Commission (CQC) watchdog has issued warnings to seven hospitals due to delays to the induction of labour since last year.

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Source: inews, 5 November 2023

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Martha’s rule must be available 24/7, England’s patient safety commissioner says

Patients and their relatives will be able to request a second opinion from senior medics around the clock when the “Martha’s rule” system starts in hospitals in England.

The government’s patient safety commissioner, asked by the health secretary, Steve Barclay, to advise on how to implement the change, has said access to a medic’s opinion must operate 24/7.

Dr Henrietta Hughes made clear to Barclay in a letter that inpatients and families worried that their loved one’s health is deteriorating should be able to seek a second opinion at any time of day or night.

In her letter, which she published on Wednesday, Hughes also said the availability of that service must be widely advertised in hospitals, so patients know they can use it.

She told Barclay that all staff in acute and specialist medical NHS trusts in England “must have 24/7 access to a rapid review from a critical care outreach team who they can contact should they have concerns about a patient”.

Hughes added: “All patients, their families, carers and advocates must also have access to the same 24/7 rapid review from a critical care outreach team which they can contact via mechanisms advertised around the hospital and more widely if they are worried about the patient’s condition. This is Martha’s rule.”

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Source: The Guardian, 3 November 2023

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Hospital management criticised over helipad death

A trust failed to identify risks associated with a helipad in one of its car parks, contributing to the death of an elderly woman who was blown over as a heavy search and rescue helicopter came into land. 

The Air Accident Investigations Branch found multiple factors contributed to 87-year-old Jean Langan’s death at Derriford Hospital in Plymouth in March 2022. Ms Langan was on her way to an appointment when she was blown over and another person seriously injured.

Crispin Orr, chief inspector of air accidents, said: “Our in-depth investigation revealed systemic safety issues around the design and operation of hospital helicopter landing sites which need to be addressed at a national level.”

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Source: HSJ, 2 November 2023

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