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Maternity units told to meet target staffing levels by next April

NHS maternity units have been told they have until next April to increase the numbers of midwives on wards to expected levels after a near £100 million investment.

NHS England has told hospitals they must bring staffing levels for midwives up the levels needed to meet their planned demand from mothers and to ensure women get safe care.

In a letter to NHS trusts, England’s chief nurse Ruth May said she expected hospitals to use their share of a recent £96 million investment by NHS England to boost staffing levels along with extra spending from local budgets.

NHS England has carried out an analysis of demand and supply with Health Education England as part of a four year plan to boost the number of midwives.

Hospitals are expected to set the level of midwives needed to deliver more one-to-one care and to try and ensure more than half of women see the same midwife throughout their pregnancy.

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Source: The Independent, 13 April 2021

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Review into series of ‘unexpected deaths’ identifies service shortcomings

A review sparked by the ‘unexpected’ deaths of 13 patients has found several shortcomings in the talking therapy services offered by a mental health trust.

The internal review at Tees, Esk and Wear Valleys Foundation Trust followed a series of deaths between October 2019 and September 2020.

The trust has said the key findings included a lack of family involvement in discussing risks, increased waiting times for face-to-face therapy, and a lack of contact or reassessment for patients on waiting lists.

Eight of the 13 deaths, six of which were suicides, were escalated to serious incident reviews, according to a freedom of information response received by HSJ.

However, when asked for the findings of the serious incident reviews, the trust said: “To break down the key issues and attribute any single one of them to an individual patient death would in itself lead to potentially identifying that person.”

The trust’s improving access to psychological therapies service assessed 11,839 people between October 2019 and September 2020.

It comes amid a series of separate investigations into concerns around the trust’s services.

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Source: HSJ, 13 April 2021

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Prescot care home investigated over resident's death rated inadequate

A care home under investigation over a resident's death has been rated inadequate for the second time.

Merseyside Police began investigating Prescot's Griffin House after the death of a 90-year-old man in June 2020.

The Care Quality Commission (CQC) rated it inadequate in September, highlighting safety concerns and a report from February, released on 9 April, found it had not improved.

The inspection on 24 February found management had failed to adequately address the problems previously identified by the CQC and there were new concerns relating to staff recruitment.

Inspectors found medicines were not always administered safely, COVID-19 guidance was not always followed and there was not always enough staff on duty.

They also noted some staff had not had proper background checks before starting work, but added that since the inspection, a new system had been introduced to ensure checks were carried out.

The report said the home's management "refused to follow government guidelines and participate in lateral flow testing for visitors to the home as they did not believe these tests were accurate".

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Source: BBC News, 13 April 2021

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Nine in 10 professional organisations say doctors should have to register their financial interests

Nearly 90% of organisations representing doctors agree that the UK should have a mandatory and public register of doctors’ interests, a survey by The BMJ has found.

Last year the Independent Medicines and Medical Devices Safety Review, chaired by Julia Cumberlege, called for the General Medical Council (GMC) to expand its register to include a list of financial and non-pecuniary interests for all doctors.

That review investigated harmful side effects caused by the hormone pregnancy test Primodos, the anti-epileptic drug sodium valproate, and surgical mesh. One of its key conclusions was that patients had a right to know if their doctor had financial or other links with pharmaceutical or medical device companies.

The BMJ wrote to six faculties, 14 royal medical colleges, and the Academy of Medical Royal Colleges about such a register. It received responses from two faculties, 12 colleges, and the academy, a 71% response rate.

Of the organisations that responded, 13 (87%) agreed that there should be a mandatory and public register of doctors’ interests in the UK.

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Source: BMJ. 8 April 2021

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Disabled woman who died in Sheffield hospital ‘ignored’, parents tell inquest

The parents of a young disabled woman who died after she went into hospital for a routine eye operation have told a coroner that doctors ignored their daughter’s attempts to communicate.

Laura Booth, 21, stopped eating after she was admitted to the Royal Hallamshire hospital in Sheffield, her mother told an inquest hearing in the city on Monday.

Patricia Booth, from Sheffield, said her daughter was ignored by clinicians after she went into the hospital in October 2016 despite her being able to communicate to some extent, including using Makaton signing. She said this was in contrast to her treatment at the Children’s hospital in the city.

Sitting next to her husband, Ken, on a remote link, Booth told the inquest: “They never discussed anything with Laura. They just ignored her. She couldn’t speak but she could understand everything.”

Booth explained how her daughter could make herself understood to her family and would hold her hands out to the doctors, but did not get a response.

“They never gave her a chance,” she said. “They never spoke to her.

“It’s really heartbreaking. Laura was trying to communicate with them but they just wouldn’t listen … It just upset Laura that the doctors ignored her.”

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Source: The Guardian, 12 April 2021

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‘I felt humiliated’: parents respond to NHS maternity care racial bias inquiry

Feeling manipulated into having medical procedures, dismissed by professionals and labelled with racial stereotypes are among the complaints of parents who responded to a national inquiry into racial injustice in UK maternity care.

A panel established by the charity Birthrights is investigating discrimination ranging from explicit racism to racial bias and microaggressions that amount to poorer care.

It comes as parliament is due on 19 April to debate the large racial disparity in maternal mortality in British hospitals, after a petition from the campaign group Five X More gathered 187,519 signatures. Black women are four times more likely than white women to die during pregnancy or childbirth in the UK.

Testimonies include that of a British Bangladeshi woman who said her labour concerns were dismissed. “I felt unsafe and like maternity professionals are not used to being challenged by brown women,” she said. “There is a stereotype of Asian women that we are tame, quiet and compliant people who have no voice and will be obedient.

“I was treated like a vessel, not like a human. The experience left me feeling humiliated, disempowered and ashamed.”

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Source: The Guardian, 13 April 2021

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‘Flurry’ of whistleblowers raise concerns at troubled trust

A ‘flurry’ of whistleblowers have raised concerns about the culture within an NHS trust which is grappling with finance and governance problems, its directors were told today.

Staff at Cornwall Partnership Foundation Trust have reported a “command and control” culture at the trust, which last week apologised to its employees for overtime payments made to board members for extra hours worked during the first peak of the pandemic.

It comes as the trust’s new chair and interim chief executive both pledged to communicate “openly and honestly” with staff.

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Source HSJ, 12 April 2021

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Covid: Asthma drug 'speeds up recovery at home'

A cheap drug, commonly used to treat asthma, can help people at home recover more quickly from COVID-19, a UK trial has found.

Two puffs of budesonide twice a day could benefit many over-50s with early symptoms around the world, said the University of Oxford research team. There are also early signs the drug could reduce hospital admissions.

The NHS says it can now be prescribed by GPs to treat Covid on a case-by-case basis from today.

At present, there are few options for treating people with Covid who are not in hospital, apart from paracetamol.

This widely-available asthma drug works in the lungs, where coronavirus can do serious damage, and could improve the recovery of at-risk patients who are unwell with Covid at home.

Prof Stephen Powis, national medical director of NHS England, said he was "delighted" by the trial results so far and he said GPs could prescribe it after "a shared decision conversation" with patients.

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Source: BBC News, 12 April 2021

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Women with chronic pain are already dismissed – new guidelines denying them painkillers are a disaster

New guidance from health officials on the treatment of chronic pain could be devastating for women already struggling to get doctors to take their pain seriously, write Sarah Graham, 

The guidelines, published last week by the National Institute for Health and Care Excellence (NICE), say that patients suffering from chronic pain that has no known underlying cause (known as chronic primary pain) should not be prescribed painkillers. Instead, it suggests, these patients should be offered exercise, antidepressants, talking therapies and acupuncture.

This has huge implications for the future treatment of anyone living with unexplained chronic pain – the majority of whom are women – and runs the risk of patients being viewed as hysterical until proven otherwise.

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Source: iNews, 7 April 2021

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For many sufferers of long Covid, proving they are sick is a big part of the battle

Lyth Hishmeh kept feeling ill months after contracting coronavirus a year ago in March. He had chest pain and couldn't concentrate. At 26 years old, the former regular runner was fatigued and breathless, struggling to function properly. Yet medical professionals kept telling him he simply could not still be ill.

"They were telling me it's all in my head," he said. For Hishmeh who lives in London and many sufferers of long Covid, proving they are sick has become a big part of trying to get better.

Another Londoner, Monique Jackson, has lost count of the number of times her pain was described as 'just anxiety.' The 32-year old illustrator was repeatedly told by medical professionals to go to the accidents and emergency, only to be discharged soon after. "I felt like I was wasting people's time, that people either didn't believe me ... or the ones who were sympathetic and supportive said 'we don't know, it's a new disease and we just don't know,'" she said.

Clinics are springing up around the country for what some call a potential second pandemic: Long Covid.

Learning that they were not alone, that other people were experiencing the same issues, was a huge revelation for both Hishmeh and Jackson. This was not just in their heads. They were not imagining the pain. They really were sick.

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Source: CNN Health, 11 April 2021

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Doctors raise concerns about NICE guidelines on chronic primary pain

Doctors in pain management have raised concerns about the National Institute of Health and Care Excellence’s guidance on treating chronic primary pain, which they said do not reflect clinical practice or current evidence.

Patients could be left in “despair,” said the British Pain Society, because of the recommendation that the only drugs that doctors should prescribe are certain antidepressants. Commonly prescribed drugs, including paracetamol, non-steroidal anti-inflammatory drugs, benzodiazepines, and opioids, should not be used to treat chronic primary pain, said NICE. Instead patients should be offered exercise programmes, therapy, and acupuncture.

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Source: BMJ, 9 April 2021

 

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Surge of patients hit A&Es over Oxford jab clot fears

Emergency clinicians have raised concerns and called for central guidance for dealing with a rush of unnecessary A&E attendances triggered by health anxiety over the Oxford covid vaccine’s safety.

HSJ has heard from numerous emergency clinicians who reported an increasing number of attendances from people with very mild symptoms, such as headaches, but who were concerned they might be having a potentially serious reaction to the Oxford-AstraZeneca jab.

The reports have come from London, the Midlands, the South, the North West and the East of England. Some expressed concerns about the impact of increased attendances on already busy accident and emergency departments.

Senior staff said patients were self-presenting at A&E and at their GPs. HSJ has also been told some emergency departments have been alarmed by the number of patients presenting with mild symptoms who said they were told to go to A&E by their GPs.

The concerns follow the announcement by government and regulators earlier this week that under-30s should be offered different covid vaccines where they are available, because of uncertain evidence of a very small risk of serious blood clotting linked to the Oxford/Az jab.

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Source: HSJ, 9 April 2021

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Children bearing brunt of ‘terrifying’ coronavirus mental health crisis

Britain is facing a “terrifying” mental health crisis with tens of thousands more children needing specialist help since the start of the coronavirus pandemic.

Experts from the Royal College of Psychiatrists have warned the problem facing the country will get worse before it gets better with new analysis revealing almost 400,000 children and 2.2 million adults sought help for mental health problems during the crisis.

While the effect of lockdown and coronavirus has affected people of all ages, children appear to be particularly susceptible.

Some 80,226 more children and young people were referred to specialist mental health services between April and December last year, up by 28% on the same months in 2019 to 372,438.

Dr Bernadka Dubicka, chairwoman of the child and adolescent faculty at the Royal College of Psychiatrists, said: "Our children and young people are bearing the brunt of the mental health crisis caused by the pandemic and are at risk of lifelong mental illness."

"As a frontline psychiatrist I've seen the devastating effect that school closures, disrupted friendships and the uncertainty caused by the pandemic have had on the mental health of our children and young people."

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Source: 9 April, 2021

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NHS staff are suffering from ‘moral injury’, a distress usually associated with war zones

With the latest UK government figures showing that there have been nearly 150,000 deaths where COVID-19 was mentioned on the death certificate, it’s understandable why some people compare the pandemic with a war. Indeed, daily life in the NHS is now peppered with military language: the frontline, gold command calls, redeployment, buddy systems and 'moral injury'

Moral injury can be defined as the distress that arises in response to actions or inactions that violate our moral code, our set of individual beliefs about what is right or wrong. In the medical literature, moral injury has historically been associated with the mental health needs of military personnel, arising from their traumatic experiences during active service.

Moral injury is generally thought to arise in high-stakes situations so it’s no surprise that the term has gained traction in healthcare settings over the course of the pandemic, given that healthcare staff have been faced with extreme and sustained pressure at work. In many ways, working in the NHS over the past year has felt like being some sort of circus acrobat, contorting ourselves to balance various competing realities: the desire to provide high-quality care for all our patients in the context of limited resources, looking after our own health needs alongside those of our patients, trying to make peace with the responsibility we feel towards our loved ones while still upholding our duty of care to patients.

If we fail to deliver, particularly in high-stakes situations where we think things should have been done differently, it can shake us to our core. Our moral code transcends the relatively superficial responsibilities of our professional role: it gets to the heart of who we are as human beings. If we feel like our core values have been attacked, it can leave us feeling devastated and disillusioned.

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Source: The Guardian, 12 April 2021

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Publish figures on long Covid to show ‘untold suffering’, MPs urge

The number of people suffering with long Covid should be published routinely, as happens with those infected with or hospitalised with coronavirus, MPs and peers are urging Boris Johnson.

The cross-party group of parliamentarians want the prime minister to ensure that the “untold human suffering” that the condition involves helps shape future government policy towards the pandemic.

Thirty-two MPs and 33 peers have signed a letter urging Johnson to give greater priority to the potential harm posed by long Covid following the Office for National Statistics’ finding last week that an estimated 1.1m people are suffering its effects – far more than previously thought.

The signatories come from eight parties and include the Tory MP Dr Dan Poulter, a former health minister; Lord Darzi, the surgeon and ex-health minister; and the SNP MP Dr Philippa Whitford, who is an NHS breast surgeon.

In the letter, coordinated by the all-party parliamentary group on coronavirus, they say: “Cases, hospitalisations and deaths are not the only measure of this pandemic. We urge the government to also count the number of people left with long Covid, many of them whose lives have been devastated by this pandemic.

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Source: The Guardian, 9 April 2021

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COVID-19 mental health support programme made free for all

SilverCloud, a digital mental health platform, has launched a new COVID-19 support programme – ‘Space from COVID-19’ – which it has made free and available to everyone in the UK over the age of 18 years, indefinitely.

The company hopes to improve access to digital mental health services during the pandemic and beyond, to help shoulder some of the demand that now faces health services in the UK and across the globe. 

SilverCloud’s new programme brings together a suite of digital resources and support that will assist users in managing and improving their mental health and wellbeing, specifically in regard to the impact of COVID-19. Crucially, it removes potential barriers by being open to all, with or without a clinical referral, and is fee-free for everyone.

Dr Lloyd Humphreys, Clinical Psychologist and Head of Europe for SilverCloud, told HTN: “For us, what is really important is to support people during this difficult time. Everyone is talking about the mental health impact of COVID-19, everyone is talking about the problem, but no-one is really offering a solution."

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Source: Health Tech Newspaper, 8 April 2021

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Hospitals using out-of-date sepsis triage tools put A&E patients at risk

Some hospitals are using an out of date triaging tool for emergency patients suffering from sepsis that could leave them at risk of harm.

A warning has been issued to NHS trusts to make sure their triage tools are up to date with the latest advice after several reported incidents in accident and emergency departments.

The Royal College of Emergency Medicine flagged the risk to NHS England in a letter seen by The Independent warning patients could come to harm if action wasn’t taken.

NHS England and NHS Digital has issued an alert to hospital chief executives warning of a potential safety risk.

It told members: “The latest version of the system has updated treatment priorities especially in relation to the treatment of adult and paediatric sepsis. It is therefore crucial that if your organisation uses the Manchester Triage System clinical risk management triage tool, please ensure that the most recent version is being used and where this is not the case, specific local mitigation for the risks is in place.”

It added that hospitals should ensure the latest versions of any clinical systems were being used to safeguard patient care.

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Source: The Independent, 8 April 2021

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UK vaccine rollout 'breaking link' between infections and death

Increasingly strong evidence shows that the UK's vaccination programme is breaking the link between COVID-19 cases and deaths, scientists tracking the epidemic have said.

A study found infections had fallen by roughly two-thirds since February, before beginning to level off. 

This is probably because people are beginning to mix more - but deaths have not followed the same pattern.

This was not the case before January, when the vaccine rollout began.

The research, commissioned by the government and run by Imperial College London, is based on swabs taken from 140,000 people selected to represent England's population. Of that group, who were tested for the virus between 11 and 30 March, 227 had a positive result, giving a rate of 0.2%, or one in 500 people. But in people over the age of 65, the infection rate was half that with one in 1,000 people testing positive for Covid.

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Source: BBC News, 8 April 2021

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Contraception blood-clot risk: ‘public need better access to advice’

Women need more information about contraceptive options, experts said, after concerns over rare blood clots linked to the AstraZeneca Covid jab prompted a debate over side-effects caused by certain forms of the pill.

On Wednesday the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) said that evidence that the jab could be causing a rare blood clotting syndrome was growing stronger. As a result the UK’s Joint Committee on Vaccination and Immunisation (JCVI) recommended that healthy people under the age of 30 who were at low risk of Covid should be offered a different vaccine if possible.

But the announcement prompted numerous posts on social media questioning why there had been little comment on combined hormonal contraceptives.

These methods, which include certain pills, vaginal rings and patches, contain forms of oestrogen and progesterone hormones and have been associated with increased risk of clots, including deep vein thrombosis, pulmonary embolism and cerebral venous sinus thrombosis (CVST) – a very rare clot on the brain.

Speaking on ITV’s Good Morning Britain Adam Finn, a professor who is part of the JCVI, confirmed the difference in risk.

“The risks of thrombosis that come with taking the pill are very much higher than the risks that we were just seeing on those slides [relating to the rare blood clots from the AstraZeneca vaccine],” he said.

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Source: The Guardian, 9 April 2021

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Covid: Unpaid carers 'struggled to get pain relief' for terminally ill

Unpaid carers looking after terminally ill friends and relatives during the pandemic struggled to access pain relief, with some patients dying in unnecessary pain, a survey has found.

The survey of 995 unpaid carers by Marie Curie also found people had difficulties getting personal care and respite nursing for loved ones.

Figures show the number of people dying at home rose by 42% in the past year.

Nearly two-thirds of carers surveyed by the charity said their loved one did not get all the pain relief they needed when they were dying.

Susan Lowe, from Solihull, cared for her mother Sheila before she died with bowel cancer in April last year, aged 74.

She said caring for her mum during lockdown was hard as "the system was just under so much pressure that we had to manage largely on our own".

The public health worker says she struggled to get the right pain relief medication for her mother in her final weeks and spent hours travelling to different chemists.

Susan, 50, told the BBC: "My biggest regret is that my mum died in pain - more pain than she needed to be. She really wanted to be comfortable at the end. She knew she was dying."

"What she really wanted - and this is what she was assured would happen - was to be comfortable. She was told she would get the drugs that she needed for it to be as bearable as possible... I remember breaking down in tears a couple of times in the pharmacy when I was told the medication mum needed wasn't in stock."

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Source: BBC News, 8 April 2021

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Weigh up risks of blood clots before giving AstraZeneca vaccine to certain patients, GPs told

GPs should only give the Oxford/AstraZeneca Covid vaccine to patients with medical conditions which put them at higher risk of developing blood clots if the benefits outweigh the risks, the UK medicines regulator has said.

The Medicines and Healthcare products Regulatory Agency (MHRA) has issued the advice to healthcare professionals regarding while it continues to review a link between the vaccine and rare blood clots.

It has also added to previous advice regarding symptoms for patients to look out for following their Covid vaccination with the AZ vaccine.

The new advice from the MHRA said:

  • Administration of Covid-19 Vaccine AstraZeneca in people of any age who are at higher risk of blood clots because of their medical condition should be considered only if benefits from the protection from COVID-19 infection outweighs potential risks.
  • Anyone who experienced cerebral or other major blood clots occurring with low levels of platelets after their first vaccine dose of Covid-19 Vaccine AstraZeneca should not have their second dose. Anyone who did not have these side effects should come forward for their second dose when invited.
  • Pregnancy predisposes to thrombosis, therefore women should discuss with their healthcare professional whether the benefits of having the vaccine outweigh the risks for them.

Meanwhile, ‘anyone who has symptoms four days or more after vaccination is advised to seek prompt medical advice’. These include:

  • a new onset of severe or persistent headache, blurred vision, confusion or seizures
  • develop shortness of breath, chest pain, leg swelling or persistent abdominal pain,
  • unusual skin bruising or pinpoint round spots beyond the injection site.

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Source: Pulse, 7 April 2021

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Consultants blow whistle on 10,000 ‘hidden’ follow-up cases amid trust merger

An acute trust is reviewing thousands of gastroenterology cases for possible patient harm, after details emerged of an ‘extremely concerning’ list of patients who have not had follow-up appointments for up to six years since being treated.

HSJ understands major concerns have been raised internally at Liverpool University Hospital Foundation Trust, over 9,500 patients who received treatment at Aintree University Hospital as far back as 2015, but have not had a follow-up appointment.

Whistleblowers have also contacted the Care Quality Commission, which has confirmed it is looking into the issues.

Well-placed sources said around 7,000 of the cases have “target dates” for an outpatient follow-up that are in the past. Around 20 of these cases were supposed to be seen in 2015 or 2016, with around 400 dating back to 2017, and around 900 to 2018, the sources said.

The remaining 2,500 cases either have no target date or have not yet had a follow-up appointment booked.

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Source: HSJ, 8 April 2021

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'Long Covid has destroyed me but I am fighting back'

Health coach Jasmine Hayer had to give up her life in London and move back in with her parents after catching Covid. Now she is focused on a twin goal - battling back to health while helping others get the right treatment for Long Covid.

Dr William Man, the head of the Royal Brompton Hospital's chest clinic, started treating her in December, as part of a clinic seeing 100 severe long Covid cases in the UK.

Jasmine describes it as a "complete game changer".

However, she worries that other so-called "long haulers" are not getting the help they need because they face "such a battle" to be taken seriously.

She decided to start a blog to document her symptoms and wants to share her story as widely as possible in the hope of helping others.

"I've had messages from around the world and I was so happy to hear that one girl has shown her doctor my blog and he is giving her more tests as a result," she says.

"I know how lonely and scary it is when you are fighting to be believed. You are literally on your own."

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Source: BBC News, 7 April 2021

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Rugby player develops device to track head trauma

A rugby player has developed a wearable device to monitor head trauma after a teammate was forced to stop playing the sport due to injury.

Euan Bowen, 28, played the game at university and in his final year in 2018, when a teammate suffered three concussion injuries in one season.

It spurred Mr Bowen to develop an idea for a device to track brain health into the HIT Impact technology, which detects g-force and records impact on an app.

After spending time at Heriot-Watt University’s Edinburgh Business School (EBS) Incubator, his product is expected to move into production within the next two months.

The sensor he developed can clip on to headguards, any helmet or halo headband and is accompanied by an app which has a 150-metre range capable of recording from multiple devices - with a "Team Play" recording function for sports like football and rugby.

It displays a graph showing the force threshold, set by a user, and severity, with a traffic light system and notifications enabling those monitoring to check on a user's injury.

Kallum Russell, EBS Incubator manager, said it is "much-needed technology", adding: "The current parliamentary inquiry into concussion recently heard evidence about the long-term implications of repetitive head trauma on sports people, with MPs asking how sports could be made safer.

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Source: The Independent, 8 April 2021

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UK's long Covid patients facing postcode lottery for support

Long Covid patients have voiced growing frustration at a “postcode lottery” in clinical support for debilitating symptoms, with some areas of the UK offering no specialist clinics more than a year after coronavirus took hold.

Other sufferers said they were disappointed by long Covid clinics investigating certain symptoms only, with no comprehensive treatment plan.

Official figures suggest there are almost 700,000 Britons with Covid symptoms lasting over three months. In October, NHS England announced more than £10m for a network of clinics bringing together doctors, nurses, therapists and other NHS staff to conduct physical and psychological assessments and recommend treatments for long Covid patients.

Additional local funding would also be available to help establish a clinic in every area, the NHS England chief executive, Simon Stevens, said. By December, 69 clinics had been set up in England with a further 12 sites earmarked to launch in January.

But Louise Barnes, founder of the Post Acute Covid Syndrome 19 (Pacs19) patient advocacy group, said a survey of 200 British members revealed about 90% had not been able to access a clinic because there wasn’t one available, their GP could not refer them or they were declined without explanation. Others were disappointed by the type of services on offer.

Barnes said: “Patients in the UK have waited going on a year to get support for the multitude of symptoms they’ve been experiencing. To finally think you are going to get referred to a clinic but your GP tells you they don’t have any information, or you get there to find it’s a ‘respiratory-only clinic’ or only staffed by physiotherapists leaves them feeling despondent. For the most part, sadly, patients are coming away massively feeling let down and with no viable treatment plan offered – even a rudimentary one, whilst a treatment is found."

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Source: The Guardian, 6 April 2021

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