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NHSE announces £16m procurement of teams to support EPR delivery

NHS England said it had opened a tender worth £16 million to support provider organisations as they seek to improve their digital maturity and get electronic patient records in place by the end of March 2026. 

NHSE said its frontline digitisation programme is working with NHS secondary care trusts providing acute specialist, community, mental health and ambulance services to help them reach a minimum level of digital capability as defined by the Digital Capabilities Framework. 

To fulfil this ambition, NHSE is seeking a partner to create an experienced, multi-skilled, rapid response intervention service, also known as a Tiger Teams service, capable of supporting EPR delivery across England.

This service will be an expansion to an existing comprehensive support offer available to providers, designed to support the national demand for resource, expertise, and information necessary to successfully rollout EPRs. 

NHSE said: “Often during EPR delivery, there is a requirement for either a planned, or unplanned, specific, time-bound skill set, capable of providing a set of deliverables, problem rectification or other specialist intervention for an element of the EPR Programme.

“Trusts are finding it increasingly challenging to obtain good quality, skilled short-term resources, both from the recruitment and contingent labour market.” 

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Source: Digital Health, 22 January 2024

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Bullying 'normal occurrence' at Newcastle NHS trust, say CQC

A "significant deterioration" in leadership at an NHS trust probably had a "knock-on effect" on its standard of services, a watchdog has found.

Inspectors found staff felt encouraged to "turn a blind eye" to bullying in hospitals run by the Newcastle Hospitals NHS Foundation Trust.

The Care Quality Commission (CQC) downgraded the trust's overall rating to "requires improvement".

The trust said it "fully accepts" the report and that recommendations were being worked on "as a matter of urgency".

Ann Ford, CQC's director of operations in the north, said: "We found a significant deterioration in how well the trust was being led.

"Our experience tells us that when a trust isn't well led, this has a knock-on effect on the standard of services being provided to people.

"Some staff told us that bullying was a normal occurrence, and they were encouraged to 'turn a blind eye' and not report this behaviour.

"This is completely unacceptable."

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Source: BBC News, 25 January 2024

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New inquiry: NHS Leadership, performance and patient safety

The Health and Social Care Committee has launched a new inquiry to examine leadership, performance and patient safety in the NHS.

Inquiry: NHS leadership, performance and patient safety

MPs will consider the work of the Messenger review (2022) which examined the state of leadership and management in the NHS and social care, and the Kark review (2019) which assessed how effectively the fit and proper persons test prevents unsuitable staff from being redeployed or re-employed in health and social care settings.

The Committee’s inquiry will also consider how effectively leadership supports whistleblowers and what is learnt from patient safety issues.

An ongoing evaluation by the Committee’s Expert Panel on progress by government in meeting recommendations on patient safety will provide further information to the inquiry.

Health and Social Care Committee Chair Steve Brine MP said:

“The role of leadership within the NHS is crucial whether that be a driver of productivity that delivers efficient services for patients and in particular when it comes to patient safety.

Five years ago, Tom Kark QC led a review to ensure that directors in the NHS responsible for quality and safety of care are ‘fit and proper’ to be in their roles. We’ll be questioning what impact that has made.

We’ll also look at recommendations from the Messenger review to strengthen leadership and management and we will ask whether NHS leadership structures provide enough support to whistleblowers.

Our Expert Panel has already begun its work to evaluate government progress on accepted recommendations to improve patient safety so this will build on that. We owe it to those who rely on the NHS – and the tax-payers who pay for it – to know whether the service is well led and those who have been failed on patient safety need to find out whether real change has resulted from promises made.”

Terms of Reference

  • The Committee invites written submissions addressing any, or all, of the following points, but please note that the Committee does not investigate individual cases and will not be pursuing matters on behalf of individuals.  
  • Evidence should be submitted by Friday 8 March. Written evidence can be submitted here of no more than 3,000 words.  
  • How effectively does NHS leadership encourage a culture in which staff feel confident raising patient safety concerns, and what more could be done to support this?
  • What has been the impact of the 2019 Kark Review on leadership in the NHS as it relates to patient safety?
  • What progress has been made to date on recommendations from the 2022 Messenger Review?
  • How effectively have leadership recommendations from previous reviews of patient safety crises been implemented?
  • How could better regulation of health service managers and application of agreed professional standards support improvements in patient safety?
  • How effectively do NHS leadership structures provide a supportive and fair approach to whistleblowers, and how could this be improved?
  • How could investigations into whistleblowing complaints be improved?
  • How effectively does the NHS complaints system prevent patient safety incidents from escalating and what would be the impact of proposed measures to improve patient safety, such as Martha’s Rule?
  • What can the NHS learn from the leadership culture in other safety-critical sectors e.g. aviation, nuclear?

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Source: UK Parliament, 25 January 2024

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Virtual ward costs twice that of inpatient care, study finds

Researchers have found the costs of treating patients in a 40-bed virtual ward were double that of traditional inpatient care.

The study’s authors said the findings should raise concerns over a flagship NHS England policy, which has driven the establishment of 10,000 virtual ward beds.

Virtual wards, sometimes described as “hospital at home”, are cited as a safe way to reduce pressure on hospitals, by reducing length of stay and enabling quicker recovery.

The study at Wrightington Wigan and Leigh Teaching Hospitals, in Greater Manchester, found a clear reduction in length of stay but also found higher rates of readmission.

The authors said this led to additional costs, with the cost of a bed day in the virtual ward estimated at £1,077, compared to £536 in a general inpatient hospital bed. 

“This raises concerns [over] the deployment of large-scale virtual wards without the existence of policies and plans for their cost-effective management. This evidence should be taken into consideration by [the] NHS in planning the next large deployment of virtual wards within the UK…

“Virtual wards must be cost effective if they are to replace traditional inpatient care, the costs must be comparable or lower than the costs of hospital stay to be economically sustainable in the medium to long terms.”

To break even, the paper said the virtual ward would need to double its throughput, but warned this would risk lowering the standard of care.

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Source: HSJ, 25 January 2024

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Covid-19: Doctors instruct law firm in bid for compensation after developing Long Covid

A group of doctors with Long Covid are preparing to launch a class action for compensation after contracting SARS-CoV-2 at work.

The campaign and advocacy group Long Covid Doctors for Action (LCD4A) has engaged the law firm Bond Turner to bring claims for any physical injuries and financial losses sustained by frontline workers who were not properly protected at work.

On 25 January Bond Turner, which specialises in negligence cases, complex litigation, and group actions, launched a call to action inviting doctors and other healthcare workers in England and Wales to make contact if they believe that they contracted covid-19 as a result of occupational exposure.1

Sara Stanger, the firm’s director and head of clinical negligence and serious injury claims, said that the ultimate aim was to achieve “legal accountability and justice for those injured.”

She told The BMJ, “I’ve spoken to hundreds of doctors with long covid, and many of them have had their lives derailed. Some have lost their jobs and their homes; they are in financial ruin. Their illnesses have had far reaching consequences in all areas of their lives.”

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Source: BMJ, 25 January 2024

Nurses, midwives, and any other healthcare workers who are suffering with Long Covid and which they believe they contracted through their work and who wish to join the action should visit the Bond Turner website here: https://www.bondturner.com/services/covid-group-claim/. Although this action has been initiated by doctors in the first instance, it is not limited to doctors.

Further reading on the hub:

 

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NHSE drive on follow-ups only delivers marginal reduction

NHS England’s drive to encourage patient-initiated appointments is only having a marginal impact on reducing overall outpatient follow-ups, a major study suggests.

NHS England currently has a target to have 5% of outpatients on patient-initiated follow-up pathways, and hopes this can be increased substantially in future years.

The headline finding in a study by the Nuffield Trust think tank, which analysed almost 60 million cases, was that for every 5% on PIFU pathways, this roughly corresponded to 2% fewer outpatient follow-up attendances overall.

It suggests PIFU implementation would need to be dramatically expanded to get anywhere close to a 25% reduction in total follow-up activity, which NHSE had previously targeted by March 2023. As previously reported, there has been little to no reduction so far.

Chris Sherlaw-Johnson, senior fellow at the Nuffield Trust, said: “As few patients are currently on PIFU pathways at present, it’s not going to have that noticeable impact on the overall number of follow ups.”

He also stressed it was not clear whether the reduction was caused by the genuine elimination of unnecessary follow-ups or if patients were not returning for care despite needing it.

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Source: HSJ, 25 January 2024

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ICB maternity plan risks increasing deaths, senior medics claim

The medical leaders of the maternity unit of a flagship hospital threatened with closure have written to their chief executive saying the downgrade would not be safe, HSJ has learned.

Nineteen obstetric and gynaecological staff, including the clinical director, wrote to the chair and CEO of the Royal Free London Foundation Trust this week saying the proposals to shutter services at the trust’s main site in Hampstead would increase the risk of harm to mothers.

Their letter said: “Whilst we accept, and support, the need to review provision of maternity and neonatal services across [north central London], aiming for care excellence and best outcomes, we have significant concerns about the current proposals.”

The letter said the Royal Free was the only unit in NCL to offer a “range of supporting specialist services for complex maternity care”, including rheumatology and neurology and is the “only hospital in NCL to provide both 24-hour interventional radiology and on-site acute vascular surgery and urology support”.

The medics’ letter said co-morbidities from cardiac, renal, haematological and neurological conditions had driven an increase in maternal mortality over the past decade and that RFH’s services were well-equipped to manage these complex cases.

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Source: HSJ, 24 January 2024

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Scotland: Mother wrongly downgraded to low risk

Doctors "failed to realise" that a first-time mother's pregnancy had become "much higher risk" because crucial warning signs were not properly highlighted in her medical records, an inquiry has heard.

Nicola McCormick was obese and had experienced repeated episodes of bleeding and reduced foetal movement, but was wrongly downgraded from a high to low risk patient weeks before she went into labour.

Her daughter, Ellie McCormick, had to be resuscitated after being born "floppy" with "no signs of life" at Wishaw General hospital on March 4 2019 following an emergency caesarean.

She had suffered severe brain damage and multi-organ failure due to oxygen deprivation, and was just five hours old when her life support was switched off.

A fatal accident inquiry (FAI) at Glasgow Sheriff Court was told that Ms McCormick, who was 20 and lived with her parents in Uddingston, should have been booked for an induction of labour "no later" than her due date of 26 February.

Had this occurred, she would have been in hospital for the duration of the birth with Ellie's foetal heartbeat "continuously" monitored.

In the event, Ms McCormick had been in labour for more than nine hours by the time she was admitted to hospital at 8.29pm on 4 March.

A midwife raised the alarm after detecting a dangerously low foetal heartbeat, and Ms McCormick was rushed into theatre for an emergency C-section.

Dr Rhona Hughes, a retired consultant obstetrician who gave evidence as an expert witness, told the FAI that Ellie might have survived had there been different guidelines in place in relation to the dangers of bleeding late in pregnancy, or had her medical history been more obvious in computer records.

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Source: The Herald, 24 January 2024

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Department of Education updates National Framework for Children’s Social Care

The Department of Education has recently provided an update to the national framework for Children’s Social Care. The key point to be aware of is the increased focus on sharing responsibility and strengthening multi-agency working to safeguard children.

This change is likely to impact a wide variety of stakeholders involved in children’s care, including NHS Trusts, ICBs, education partners, local authorities, voluntary, charitable and community sectors and the police. 

The focus continues to be on a child-centred approach with the intention of keeping children within the care of their families wherever possible; this collaborative working may include working with parents, carers or other family but the wishes and feelings of the child alongside what is in the child’s best interests remain paramount. Joined up working is to be viewed as the norm.

For health professionals, you will be expected to have lead roles for children with health needs, such as children who are identified as having special educational needs or disabilities. 

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Source: Bevan Brittan, 23 January 2024

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US midwife fined $300k for faking vaccine records for 1,500 children after giving them ‘homeopathic pellets’

A midwife in New York who reportedly gave 1,500 children homeopathic pellets rather than the vaccinations required by the state has been fined $300,000 by the state's health department.

The midwife was identified as Jeanette Breen, who operates the Long Island-based Baldwin Midwifery.

Ms Breen reportedly gave the pellets as an alternative to required vaccinations and then proceeded to falsify the children's immunisation records, according to the New York Department of Health.

The midwife reportedly began giving the pellets during the Covid-19 pandemic, specifically during the 2019-2020 school year. The majority of the affected children live in Long Island, according to the Associated Press.

The health department said that the false records have since been voided, and that the families will have to ensure their students are up-to-date with their shots before they can return to school.

“Misrepresenting or falsifying vaccine records puts lives in jeopardy and undermines the system that exists to protect public health,” State Health Commissioner James McDonald said in a statement.

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Source: The Independent, 24 January 2024

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UK records highest annual cardiovascular deaths since 2008

The rate at which people are dying early from heart and circulatory diseases has risen to its highest level in more than a decade, figures show.

Data analysed by the British Heart Foundation (BHF) shows a reverse of previous falling trends when it comes to people dying from heart problems before the age of 75 in England.

Since 2020, the premature death rate for cardiovascular disease has risen year-on-year, with the latest figures for 2022 showing it reached 80 per 100,000 people in England in 2022 – the highest rate since 2011 when it was 83.

This is the first time there has been a clear reversal in the trend for almost 60 years.

Between 2012 and 2019 progress slowed and, from 2020, premature death rates began to clearly rise, the data reveals.

Dr Sonya Babu-Narayan, associate medical director at the BHF and a consultant cardiologist, said: “We’re in the grip of the worst heart care crisis in living memory.

“Every part of the system providing heart care is damaged, from prevention, diagnosis, treatment, and recovery; to crucial research that could give us faster and better treatments.

“This is happening at a time when more people are getting sicker and need the NHS more than ever.

“I find it tragic that we’ve lost hard-won progress to reduce early death from cardiovascular disease.”

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Source: Medscape, 22 January 2024

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People awaiting ear wax removal in England face NHS ‘postcode lottery’

People with buildups of ear wax are being left with hearing loss and socially isolated because of an NHS “postcode lottery” in removing it, a new report claims.

Ear wax removal services have declined so dramatically that 9.8 million people in England now cannot access help on the NHS, forcing some to pay a “tax on wax” for private treatment.

The report, from the RNID hearing loss charity, also found that more than half of NHS commissioners are breaching official guidelines by not ensuring that all adults can access care.

The RNID, formerly the Royal National Institute for Deaf People, said its “horrifying” findings highlighted the misery people who cannot get wax removed are suffering.

“Ear wax buildup can cause painful and distressing symptoms – such as hearing loss, tinnitus and earache – and lead to social isolation and poor mental health,” the RNID said.

“With a patchy service across England, many people are left living in silence or forced to pay for private removal,” it added. Non-NHS providers charge £50-£100 a visit to suction wax out. Older people and those who wear hearing aids are most likely to experience buildups.

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Source: The Guardian, 24 January 2024

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Hundreds of rheumatology patients wrongly prescribed drugs or misdiagnosed

Hundreds of rheumatology patients have stopped receiving drugs they did not need or had their diagnosis changed after a damning review of the service found the standard of care was “well below” what would be considered acceptable.

Jersey’s Health and Community services department has said it will be contacting some of the affected patients “over the coming weeks” and would also be seeking legal advice on “an appropriate approach to compensation”.

The independent review by the Royal College of Physicians also noted there was “no evidence” of standard operating procedures for most aspects of routine rheumatological care and, in some cases, “no evidence of clinical examinations”.

It also found that there had been incorrect diagnosis and wrongly prescribed drugs, describing the standard of care as “well below what the review team would consider acceptable” for a contemporary rheumatological service.

The review was commissioned by HCS medical director Patrick Armstrong, following concerns raised by a junior doctor in January 2022.

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Source: Jersey Evening Post, 22 January 2024

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More than 30 staff suspended from NHS hospital over allegations of falsifying records and harming patients

More than 30 members of staff at a major NHS mental health hospital have been suspended over claims of serious misconduct including falsifying medical records and mistreating patients, The Independent has learned.

The suspensions come after an internal investigation into serious conduct allegations at Highbury Hospital in Nottinghamshire, which employs hundreds of staff members.

The suspended employees include registered professionals – such as doctors, nurses and nursing associates – and non-registered professionals, which would cover healthcare assistants and non-clinical staff.

It comes just a week after the same trust – Nottinghamshire Healthcare Foundation Trust – was issued with a warning by the safety watchdog over concerns about the safety of patients at Rampton Hospital, a high secure hospital which has housed patients such as Charles Bronson and Ian Huntley.

In an email leaked to The Independent, the trust told staff: “We are saddened to report that over recent weeks it has been necessary to suspend over 30 colleagues due to very serious conduct allegations.

“These allegations have included falsifying mental health observations, as well as maltreatment of patients in our care.

“We hope we have your understanding in taking action when the conduct of colleagues falls so far outside of what patients deserve.”

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Source: The Independent, 23 January 2024

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Blood test could revolutionise diagnosis of Alzheimer’s, experts say

A blood test for detecting Alzheimer’s disease could be just as accurate as painful and invasive lumbar punctures and could revolutionise diagnosis of the condition, research suggests.

Measuring levels of a protein called p-tau217 in the blood could be just as good as lumbar punctures at detecting the signs of Alzheimer’s, and better than a range of other tests under development, experts say.

The protein is a marker for biological changes that happen in the brain with Alzheimer’s disease.

Dr Richard Oakley, an associate director of research and innovation at the Alzheimer’s Society, said: “This study is a hugely welcome step in the right direction as it shows that blood tests can be just as accurate as more invasive and expensive tests at predicting if someone has features of Alzheimer’s disease in their brain.

“Furthermore, it suggests results from these tests could be clear enough to not require further follow-up investigations for some people living with Alzheimer’s disease, which could speed up the diagnosis pathway significantly in future. However, we still need to see more research across different communities to understand how effective these blood tests are across everyone who lives with Alzheimer’s disease.”

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Source: The Guardian, 23 January 2024

 

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USA: ED boarding at crisis levels, Mass General says

Boston-based Massachusetts General Hospital is requesting permission from the state to add more than 90 inpatient beds amid what it says is an "unprecedented capacity crisis." 

The hospital's emergency department has experienced critical levels of overcrowding nearly every day for the past six months, Massachusetts General said in a news release. The hospital boards between 50 to 80 ED patients every night who are waiting for a hospital bed to open. On 11 January, Massachusetts General had 103 patients boarding in the ED, representing one of the most crowded days in the hospital's more than 200-year history.

"While hospital overcrowding has significantly affected patient care for many years, COVID-19 and the post-pandemic demand for care has escalated this challenge into a full-blown crisis – for patients seeking necessary emergency care, as well as for staff who are required to work under these increasingly stressful conditions," David F.M. Brown, president of Massachusetts General, said in a news release.

Massachusetts General's request comes as hospitals across the state grapple with capacity issues, workforce shortages and a jump in respiratory illnesses this winter. On 9 January. the Massachusetts Department of Public Health issued a memo urging hospitals to expedite discharge planning amid the capacity crunch. Some health plans have also waived the need to obtain prior authorisation for short stays in post-acute care facilities. 

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Source: Becker Hospital Review, 19 January 2024

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Ambulance transfer delays are 'matter of concern', coroner warns

The availability of ambulances to transfer patients to specialist units is a "matter of concern", a coroner has warned.

Darren Stewart, area coroner for Suffolk, made the comments in a Prevention of Future Deaths report.

It followed the death of 84-year-old Dennis King, who waited three hours to be transferred from West Suffolk Hospital to Royal Papworth in 2022.

Mr King had made his own way to the West Suffolk Hospital's accident and emergency department in December 2022, after being told an ambulance could take six hours to arrive at his home due to high demand in the area, the report said.

His call had been graded as category two, which should have led to a response within 40 minutes - or a target of 18 minutes.

After tests at West Suffolk Hospital showed Mr King had suffered a STEMI heart attack, emergency clinicians liaised with experts from the regional heart unit and decided he needed an urgent transfer to Royal Papworth in Cambridgeshire.

The report said a matron at West Suffolk told ambulance call handlers they needed an urgent transfer - but because Mr King was classed as being in a "place of safety", control room staff said the delay would be "several hours".

Mr Stewart said: "the availability of ambulances to carry out transfers in a timely manner, in urgent cases" was "a matter of concern".

In the report, Mr Stewart said the circumstances of the case "raised concerns about the NHS approach to centralising care in regional centres" if the means to deliver it were "inadequate".

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Source: BBC News, 23 January 2024

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National shortage of epilepsy medication putting thousands at risk

A national shortage of epilepsy medication is putting patients' safety at risk, consultants have said.

Medical professionals are becoming genuinely concerned as ever more frequent supply issues continue to bite tens of thousands of sufferers.

According to the Epilepsy Society charity, over 600,000 people in the UK have the condition, or about one in every 100 people.

Among them is Charlotte Kelly, a mother of two living in London who has had epilepsy for over 20 years. She must take two tablets a day to manage her condition but issues with supply have forced her to start rationing her medication.

Speaking to Sky News, Ms Kelly told us of the fear surrounding the restricted access to the medicate she needs to survive.

"I'm scared. If I'm truly honest, I'm scared knowing that I might not get any medication for a few weeks, or a couple of months, I just don't know when.

"It's scary to know that I have to worry about getting hold of medication. I do believe that something needs to happen very quickly because even if it's pre-ordered there's no guarantee you're going to get it.

Speaking to Sky News, Professor Ley Sander, director of medical services at the Epilepsy Society, says the supply concern is not just on the minds of patients but those in the industry too.

"It might be that we need a strategic reserve for storage of drugs, we might have to bring drugs over from other parts of the world to avoid this from recurring.

"We're not at that point yet, but this is an urgent issue."

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Source: Sky News, 21 January 2024

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‘Gaslit by doctors’: UK women with endometriosis told it is ‘all in their head

Women with endometriosis who have endured years of excruciating pain are being “fobbed off” by doctors and told their symptoms are “all in their head”, leading them to give up seeking NHS treatment, new research has found.

A study carried out by academics at Manchester Metropolitan University found women with the disease felt “gaslit” by doctors due to their lack of understanding of the condition.

The paper, due to be published in the Journal of Health Communication later this month, also found that treatment was subject to a postcode lottery. Patients in rural areas reported travelling for hours to access a specialist with full training in the complex gynaecological condition.

Endometriosis is a painful condition in which tissue similar to the lining of the womb grows around other organs inside the abdomen. It affects 1.5 million women in the UK. The study looked at the experiences of treatment and diagnosis of 33 patients and revealed how doctors’ lack of understanding of the symptoms meant women often spent years in pain before their condition was diagnosed. During this period participants were told they were exaggerating their symptoms, or their pain was dismissed as psychological.

As one 27-year-old participant reported: “I feel a lot of mistrust towards the healthcare system in general, simply because I have been told that the pain was in my head, that I must have a low pain threshold or that I was in pain because I was fat.”

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Source: The Guardian, 21 January 2024

Share your experience of endometriosis: The Guardian newspaper would like to hear how you have been affected by endometriosis and your experience of being diagnosed and treated.

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Deaths unexplained, lives devastated: here’s another national tragedy hidden in plain sight

The Campaign to Save Mental Health Services in Norfolk and Suffolk is calling for a criminal investigation into an apparent scandal that decisively surfaced over the summer, centred on the Norfolk and Suffolk NHS foundation trust (or NSFT), which sees to mental health provision across those two very large English counties.

It is centred on the “unexpected” deaths of 8,440 people between April 2019 and October 2022, all of whom were either under the care of the trust, or had been up to six months before they died. The story of the failures that led to that statistic date back at least a decade; the campaign says it amounts to nothing less than “the largest deaths crisis in the history of the NHS”.

The figure of 8,440 was the key finding of a report by the accounting and consultancy firm Grant Thornton – commissioned by the trust, ironically enough, to respond to anxious claims by campaigners, disputed by the trust, that there had been 1,000 unexpected deaths over nine years.

There are no consistent national statistics for such deaths, and no universal definition of “unexpected”: in Norfolk and Suffolk, a death will be recorded as such if the person concerned was not identified by NHS staff as critically or terminally ill; the term includes deaths from natural causes as well as suicide, homicide, abuse and neglect. The period in question includes the worst of the pandemic, although the trust’s own annual deaths figures did not reach a peak until 2022-23. But the numbers still seem jaw-dropping: they represent an average of about 45 deaths a week.

To put that in some kind of perspective, earlier reports about the trust’s deaths record had raised the alarm about a similar number of people dying every month. And the Grant Thornton report included another key revelation: the fact that the trust’s record-keeping was so chaotic that in about three-quarters of cases, it did not know the specifics of how or why the people concerned had died. After its publication, moreover, there were more revelations about the trust, and its culture and practices. 

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Source: The Guardian, 21 January 2024

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USA: Massachusetts will designate hospital “Levels of Maternal Care” to improve health outcomes for higher-risk patients

To help patients with high-risk pregnancies receive care at hospitals that are staffed and equipped to deliver care appropriate to their needs, the Department of Public Health will require licensed birthing hospitals to use a system called Levels of Maternal Care. The system classifies hospitals based on their capacity to meet the needs of patients with a range of potential complications during childbirth.

The impetus is the rising levels of severe maternal morbidity, large racial disparities in outcomes, and concerns that higher-risk patients who deliver in hospitals that over-estimate the level of care they are able to provide are more likely to experience complications.

Levels of care describe a hospital’s physical facilities, capabilities and staffing, indicating its ability to serve people giving birth across a range of medical needs. For example, Level 1 is appropriate for low-risk patients with uncomplicated pregnancies, including twins and labor after cesarean delivery. To that group, Level II adds patients with poorly controlled asthma or hypertension and other higher-risk conditions. Subsequent levels include patients at increasingly high risk of complications, up to Level IV, which is appropriate for patients with severe cardiac disease, those who need organ transplant and others.

Established by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine in 2015, the classification system is one tool used by states across the country to improve maternal health and birthing outcomes.

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Source: Betsy Lehman Center. 17 January 2024

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England's sexual health services 'at breaking point'

Sexual health services in England are at breaking point, according to local councils who are responsible for running the clinics.

They say that soaring rates of infections are threatening to overwhelm services and the government needs to provide extra funding.

Since 2017, more than two-thirds of council areas saw infection climb.

The Department of Health said more than £3.5bn has been allocated to local public health services this year.

The Local Government Association (LGA) - representing the councils that provide sexual health clinics - is warning that demand is soaring and services are struggling to keep up.

It is calling on the government to provide extra funding, as well as to publish a long-term plan to help prevent and treat sexually transmitted infections.

Nearly three-quarters of councils have seen a rise in rates of syphilis cases, and chlamydia infections are up in more than a third of areas.

Many of the new cases are younger people, and involve gay, bisexual and other men who have sex with men, but rates have also increased in heterosexual people.

Experts believe there has been a rebound effect after the restrictions connected to Covid, but infections were rising well before the pandemic hit.

There has also been a greater effort to test more people and improve access to services which may have led to more cases being identified.

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Source: BBC News, 20 January 2024

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One in 20 patients in England wait at least four weeks to see GP, figures show

One in 20 patients has to wait at least four weeks to see a GP at a time when funding for family doctor services is falling, NHS figures show.

In November 2023, 1.5m appointments in England at a GP surgery took place four weeks or more after they were booked, 4.8% of the 31.9m held that month.

In one in six appointments, 5.4m (17.3%), the patient was forced to wait at least two weeks after booking it to see a GP, practice nurse or other health professional.

“Millions of people are being left anxious or waiting in pain because they can’t get an appointment with their GP,” said Ed Davey, the leader of the Liberal Democrats, who highlighted the latest evidence underlining the long delays that many patients face to see a GP.

“Staggering” numbers of patients now have to wait a long time, he said.

GP leaders blamed the situation on the widespread shortage of family doctors, which they said was making it impossible to keep up with the rising demand for appointments. Burnout due to intense workloads is prompting more GPs to work part time.

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Source: The Guardian, 22 January 2024

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Medics told not to report illegal abortions to police

Healthcare workers are being told not to report women to the police if they believe their patients may have illegally ended their own pregnancy.

The Royal College of Gynaecologists and Obstetricians (RCOG) says "deeply traumatised" women are being prosecuted following abortions.

By law, patients' data must not be disclosed without their consent.

The new guidance follows a recent rise in police investigations into abortions.

NHS staff can breach confidentiality rules to give information to the police about possible crimes, but only if it is in the "public interest". The RCOG says it is "never" in the public interest to report women who have abortions, and that they must be safeguarded.

In the first official guidance issued of its kind, a healthcare worker must "justify" any disclosure of patient data or "face potential fitness to practice proceedings".

The organisation says it is "concerned" by the rising number of police investigations following abortions and pregnancy loss, and the effect this might have on "especially vulnerable" patients.

Dr Jonathan Lord, RCOG's medical director, told the BBC: "A law that was originally designed to protect a woman is now being used against her.

"We have witnessed life-changing harm to women and their wider families as a direct result of NHS staff reporting women suspected of crimes, and we just don't think that would happen in other areas of healthcare.

"We deal with the most vulnerable groups who may be concerned about turning to regulated healthcare at all, and we need them to trust us".

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Source: BBC News, 22 January 2024

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Whorlton Hall: Four carers sentenced for abusing hospital patients

Four carers who were convicted of abusing patients at a secure hospital have been given suspended sentences.

An undercover BBC Panorama investigation showed patients being mocked by staff at Whorlton Hall in County Durham between 2018 and 2019.

The four former staff, who are all men, were sentenced on Friday after being convicted by a jury last year.

Judge Chris Smith said Whorlton Hall was an "unpredictable and inherently frightening place to live".

The specialist hospital for people with complex needs was privately run by Cygnet, but funded by the NHS.

It has since closed.

Judge Smith said Whorlton Hall had a "malign culture" and was an "unpredictable and inherently frightening place to live."

He added: "Each of you failed those patients and their families. It was a fundamental breach of trust."

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Source: BBC New, 20 January 2024

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