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England’s Covid test and trace relying on inexperienced and poorly trained staff

England’s test and trace service is being sub-contracted to a myriad of private companies employing inexperienced contact tracers under pressure to meet targets, a Guardian investigation has found.

Under a complex system, firms are being paid to carry out work under the government’s £22bn test and trace programme. Serco, the outsourcing firm, is being paid up to £400m for its work on test and trace, but it has subcontracted a bulk of contact tracing to 21 other companies.

Contact tracers working for these companies told the Guardian they had received little training, with one saying they were doing sensitive work while sitting beside colleagues making sales calls for gambling websites.

One contact-tracer, earning £8.72 an hour, said he was having to interview extremely vulnerable people in a “target driven” office that encouraged staff to make 20 calls a day, despite NHS guidance saying each call should take 45 to 60 minutes.

Another call centre worker, who had no experience in healthcare or emotional support, said she suffered a nervous breakdown during an online tutorial about phoning the loved ones of coronavirus victims in order to trace their final movements.

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Source: The Guardian, 14 December 2020

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‘Fundamental’ changes to London’s NHS in wake of COVID-19

The NHS in London is planning to “fundamentally shift the way we deliver health and care” in the wake of coronavirus, according to documents obtained by HSJ.

The plans from NHS England and Improvement’s London office say leaders should:

  • Plan for elective waiting times to be measured at integrated care system level, rather than trust level.
  • Accept “a different kind of risk appetite than the one we are used to”.
  • Expect decisions from the centre on the location of cancer, paediatric, renal, cardiac, and neurosurgical services.
  • Plan for a permanent increase in critical care capacity.
  • Transform to a “provider system able to be commissioned and funded on a population health basis”.
  • Work towards “a radical shift away from hospital care”.
  • Expect “governance and regulatory landscape implications” plus “streamlined decision-making”.

The document, titled Journey to a New Health and Care System, says there are three “likely” phases, with the final new system in place “from November 2021”.

The preceding two phases are “action programmes” over the next 12 to 15 months which will be about reconfiguring services to deal with “immediate covid, non-covid and elective need”, and “transition” when the move to new configurations is evaluated and “public consent” sought.

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Source: HSJ, 11 May 2020

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Thousands of NHS-funded appointments still carried out by unaccredited practitioners

Thousands of NHS-funded talking therapy sessions are still being carried out by unaccredited practitioners every month, despite NHS England trying to stop the practice for at least five years.

NHS Digital data for January this year showed 44,170 sessions involved practitioners who were neither in training nor had done an accredited course. The actual figure could be higher as, of the 517,027 sessions in total carried out, data about who was involved was missing for more than half (328,433).

Since last June, practitioners delivering NHS-funded “low intensity” talking therapies – previously known as Improving Access to Psychological Therapies – are required to be part of either the British Psychological Society or the British Association for Cognitive and Behavioural Psychotherapies’ registers. The registers, which were set up in 2021, confirm practitioners have completed an accredited course, ensure continuous professional development and provide a framework for striking off. 

Meanwhile, NHSE’s IAPT manual – first published in 2018 – states all clinicians should have completed an accredited training programme and a “robust and urgent” plan should be in place to train those who have not, including the possibility of those without accreditation being prevented from working alone. 

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Source: HSJ, 3 May 2023

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Patient Safety Learning calls for urgent action to ensure Long COVID patients are heard and supported

PRESS RELEASE

 (London, UK, 6 July 2020) – Thousands of ‘Long COVID’ patients are feeling unheard and unsupported. The charity Patient Safety Learning is giving these patients a voice to ensure urgent action is taken by leaders in health and social care.

 Helen Hughes, Chief Executive of Patient Safety Learning, said: “There is growing evidence that there are many patients recovering in the community with long-lasting symptoms who are feeling abandoned, confused and without support. We must take action to better understand the needs of these patients and provide them with safe and effective care.”

 Although Patient Safety Learning welcomes the recent government announcement of an online patient recovery portal and treatment plans, questions remain around whether this will meet the specific health needs of Long COVID patients. “These patients have felt unheard for too long; we must make sure they do not slip through the net,” adds Hughes.

 Long COVID patients are those with confirmed or suspected COVID-19 who continue to struggle with prolonged, debilitating and sometimes severe symptoms months later*.

 It is crucial that Long COVID patients are heard and supported, and that research is undertaken to better understand Long COVID and its long-term effects on physical and mental health. 

 Long COVID patient Barbara Melville told Patient Safety Learning, “the worst part is that I’ve had to fight so hard to get the referrals I need” and another, Dr Jake Suett, said that, after joining the ‘Long Covid Support Group’ on Facebook, he “was suddenly faced with the realisation that there were thousands of us in the same position” and that it confronted him “with the tremendous volume of genuine human suffering that was going unrecorded and unnoticed”.

 Patient Safety Learning is calling for leaders in health and social care to act urgently by funding research into Long COVID and ensuring that patients are given a platform to raise concerns and receive appropriate support.

 The charity has identified the current key issues as being:

 There is a lack of guidance and support for Long COVID patients who have been managing their illness and recovery from home (to date, much of the guidance has been designed specifically for patients who have been acutely unwell and in hospital).

  • There is a lack of understanding around the effects of Long COVID on patients’ mental health and wellbeing.
  • There is a risk that symptoms of other serious conditions are being overlooked for individuals with Long COVID and, instead, are being attributed simply as after-effects of COVID-19.

 Patient Safety Learning’s proposed actions to address the safety issues concerning Long COVID care can be found on our website.

Notes to editors:

*The symptoms for those with Long COVID vary greatly but many are experiencing rashes, shortness of breath, neurological and gastrointestinal problems, abnormal temperatures, cardiac symptoms and extreme fatigue.

  1. Patient Safety Learning is a charity, which helps transform safety in health and social care, creating a world where patients are free from harm. We identify the critical factors that affect patient safety and analyse the systemic reasons they fail. We use what we learn to envision safer care. We recommend how to get there. Then we act to help make it happen. For more information: www.patientsafetylearning.org 
  2. Patient Safety Learning’s blog published today on patient safety concerns for Long COVID patients outlining these issues in more detail can be found here. 
  3. A blog by Dr Jake Suett published today in which he outlines his experience of suspect Long COVID calls needed can be found here. 
  4. An open letter from Dr Jake Suett to MPs to make clear the needs of this group can be found here.
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Man who died after heart problem was dismissed as anxiety was seen by physician’s associate

A 25-year-old who died from a heart haemorrhage after being diagnosed with a panic attack had been seen by a non-medical school trained physician associate (PA) but not a doctor, it has emerged.

Ben Peters, 25, attended the emergency department at Manchester Royal Infirmary on the morning of 11 Nov 2022 with chest pain, arm ache, a sore throat and shortness of breath.

While waiting, he endured a “severe episode of vomiting”.

Peters was diagnosed with a panic attack and gastric inflammation by the PA and sent home with two medications, after a supervising consultant, who the coroner found never reviewed the patient in person, agreed with the diagnosis.

Less than 24 hours later, Peters died from a rare complication of the heart that had resulted in a tear of the heart’s major artery, known as aortic dissection, and led to a fatal haemorrhage.

The Aortic Dissection Charitable Trust (TADCT) says around 2,000 people in Britain die from the condition each year, which can be “reliably diagnosed or excluded” using a CT scan, but “misdiagnosis affects one-third of patients”.

A prevention of future deaths notice issued by Chris Morris, the area coroner for Greater Manchester South, written to Manchester University Foundation Trust, said: “It is a matter of concern that despite the patient’s reported symptoms, in view of his age and extensive family history of cardiac problems, Mr Peters was discharged from the Ambulatory Care Unit without being examined or reviewed in person by a doctor."

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Source: The Telegraph, 21 October 2023

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Trusts offering controversial trauma ‘treatment’ to new mums

Several NHS trusts are offering a ‘treatment’ for birth trauma which uses a technique which lies outside national guidelines and which is criticised by specialists as potentially causing ‘more harm than good’.

The ‘Rewind’ technique is promoted as a fast treatment for post-natal post-traumatic stress disorder (PTSD) – also known as birth trauma - which involves the “reprocessing” of painful memories.

HSJ has learned of several trusts, including East and North Herts Trust, Chelsea and Westminster Hospital Foundation Trust and James Paget University Hospital FT, where the therapy is being offered. It is thought there are other trusts which are providing it or have explored it. Typically, it is provided by midwives who have undergone training in the technique.

But Nick Grey, a clinical psychologist who was on the National Institute for Health and Care Excellence panel which looked at PTSD, said it was “absolutely clear cut” that it was bad practice to offer the technique as a branded therapy for PTSD, although he said it could be embedded as part of other treatments.

He told HSJ: “It should not be offered to mothers with PTSD… they are being done a disservice if they are not given evidence-based treatment. There is no evidence that this [provides] treatment for sub-clinical PTSD or trauma,” he said.

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Source: HSJ, 11 November 2020

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Intervention at major trust as junior doctors flag patient safety risks

Trainee medics in a troubled maternity department have flagged concerns with national regulators over the safety of patients, it has emerged.

Last year the General Medical Council said it had concerns about the treatment of obstetric and gynaecology trainees at University Hospitals Birmingham and placed medics at Good Hope Hospital and Heartlands Hospital under intensive support known as “enhanced monitoring”.

The GMC’s review flagged serious concerns about emergency gynaecology cover arrangements and said there was a real risk trainees would become hesitant and reluctant to call on consultant support. In September it placed additional restrictions on training, due to “ongoing significant concerns about the learning environment and patient safety”.

Now it has emerged in board papers for Birmingham and Solihull integrated care board that Health Education England, now part of NHS England, and the GMC carried out a follow-up visit to UHB in late March to review progress. 

Board documents state that “several patient safety concerns [were] reported by postgraduate doctors in training to the visiting team”, with a subsequent feedback letter from HEE urging immediate changes to dedicated consultant time and job plans.

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Source: HSJ, 17 May 2023

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Child deaths 'not properly investigated' at top hospital

Great Ormond Street Hospital (GOSH) failed to properly investigate child deaths, suggests evidence uncovered by the BBC.

The source of one fatal infection was never examined and in another case GOSH concealed internal doubts over care. Amid claims GOSH put reputation above patient care, former Health Secretary Jeremy Hunt urged it to consider a possible "profound cultural problem".

Responding, the central London hospital said it rejected all suggestions that it treated any child's death lightly.

BBC Radio 4's File on 4 programme has spoken to several families whose children were treated at the world-famous hospital. All said that while care at one point had been excellent, when things went wrong GOSH appeared to have little interest in fully understanding what had happened.

The concerns over how Great Ormond Street is run are shared by staff. A staff survey, published last month, made grim reading for management.

On two aspects, including whether there is a safety culture, it received the lowest score of all trusts in its category, while on three other questions, including how bad bullying and harassment were, and how good the quality of care was, its own staff rated it as among the worst.

"If we want the NHS to offer the highest quality care in the world, then we have to change a blame culture and sometimes a bullying culture, for a learning and an improvement culture," the former Health Secretary Jeremy Hunt told File on 4.

"That staff survey would indicate they don't have that culture at Great Ormond Street."

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Source: BBC News, 17 March 2020

Read Joanne Hughes' response to this news in her blog shared on the hub.

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Secret footage reveals abuse of woman with dementia at luxury UK care home

An 88-year-old woman with dementia was physically and mentally abused at a luxury care home charging residents close to £100,000 a year, the Guardian can reveal.

Staff misconduct was exposed by secret filming inside the home run by Signature Senior Lifestyle, which operates 36 luxury facilities mostly in the south of England.

It has admitted that Ann King was mistreated at Reigate Grange in Surrey earlier this year.

Distressing footage from a covert camera inside her room shows:

  •  Care staff handling King roughly, causing her to cry out in distress. On one occasion she was left on the floor for 50 minutes.
  •  King being taunted, mocked and sworn at when she was confused and frightened.
  •  The retired nurse being assaulted by a cleaner, who hits her with a rag used to clean a toilet while she is lying in bed.
  •  The cleaner threatening to empty a bin on the pensioner’s head and making indecent sexual gestures in her face.

The abuse was exposed by King’s children, Richard Last and Clare Miller. They became so concerned about her wellbeing at the care home, where she lived from January 2021 to March 2022, that they installed a hidden camera on her bedside table.

They have shared the footage because they fear what happened to their mother may not be an isolated incident, and because: “She has always been horrified by this type of thing and we felt she would have wanted us to show this is going on.”

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Source: The Guardian, 13 October 2022

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Chief executive of prestigious hospital loses whistleblowing case

The chief executive of one of England’s most prestigious private hospitals has lost her employment tribunal claim that she was dismissed for whistle blowing over patient safety issues.

Aida Yousefi ran the Portland Hospital in central London from January 2017 until her dismissal in December 2019 on two counts of gross misconduct. She was also in charge of The Harley Street Clinic and a specialist cancer centre. 

Ms Yousefi’s argument that she was removed after raising concerns about the patient safety was rejected by central London employment tribunal in a judgment published last week.

The judge instead ruled that while other senior staff had raised patient safety concerns over cost-cutting, there was no evidence that Ms Yousefi had done so.

In their judgment the tribunal panel said: “In oral evidence the claimant further accepted that, as CQC-registered manager, if patient safety concerns were not being dealt with she should have raised it with CQC. She did not do so at any point during her employment.”

Staffing concerns were raised by The Harley Street Centre chief nursing officer Claire Champion and others. However, the tribunal heard evidence that doing so could be frowned upon by senior management at HCA International.

The tribunal was shown an email from then vice president of financial operations at THSC and the Portland Enda O’Meara saying “Frankly – we are starting to piss some very senior people off in appearing that we can’t [make savings]. We can’t always cite patient safety. Because the response will always be other facilities are doing it”. 

Another email from Mr O’Meara said: “Please don’t cite ’patient safety’ unless you truly believe it to be the case. This term is particularly sensitive and nothing winds them up more”.

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Source: HSJ, 28 March 2022

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NHS waiting list hits record 6.4 million

A new high of 6.4 million people in England were waiting for routine NHS treatment in March 2022, as 12 hours waits in A&E hit an all time high last month and ambulance services continued to struggle.

This is up from 6.2 million in February and is the highest number since records began in August 2007.

A new record of 24,138 people had to wait more than 12 hours in A&E after a decision to admit them had been made in April.

The figure is up from 22,506 in March, and is the highest for any calendar month in records going back to August 2010.

However the number of patients being seen within four hours in April improved compared to March, with 72.3% of patients seen in this time compared to 71.6%.

Professor Stephen Powis, national medical director for NHS England, said: “Today’s figures show our hardworking teams across the NHS are making good progress in tackling the backlogs that have built up with record numbers of diagnostic tests and cancer checks taking place in March, as part of the most ambitious catch up plan in NHS history.

“We always knew the waiting list would initially continue to grow as more people come forward for care who may have held off during the pandemic, but today’s data show the number of people waiting more than two years has fallen for the second month in a row, and the number waiting more than 18 months has gone down for the first time."

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Source: The Independent, 12 May 2022

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Staff shortages leaving women in ‘barbaric’ pain

Patient safety campaigners have said ‘too many women’ are still not being offered a general anaesthetic for a diagnostic test because of staff shortages, leaving them in severe pain.

A survey by the Campaign Against Painful Hysteroscopies found around 240 women – which equates to 80 per cent of respondents – who had a hysteroscopy since the start of 2021 said they were not told they could have a general anaesthetic prior to the procedure.

This suggests the situation has only improved marginally since 2019, when the campaign group first started collecting data. A spokeswoman from the campaign group called the pain being endured by women “barbaric” and said staffing shortages need to be addressed.

Guidance from the Royal College of Obstetricians and Gynaecologists said all pain relief options, including general anaesthetic, should be discussed.

Helen Hughes, chief executive of Patient Safety Learning, said: “We are hearing from too many women that they are not being given the full information about the procedure. It damages their trust and makes them worry about accessing future services.”

She said: “It’s distressing that despite what we know, [the guidance] is not being implemented properly. Informed consent is essential for patient safety as well as a legal requirement.”

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Source: HSJ, 7 June 2022

What is your experience of having a hysteroscopy? Share your experiences on the hub in our community forum.

Further reading:

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Norfolk and Suffolk NHS Foundation Trust warned by CQC over failures

An NHS mental health trust that has been the worst performing in England has been warned it must improve after failing another inspection.

Norfolk and Suffolk NHS Foundation Trust (NSFT) has been rated "inadequate" in the latest Care Quality Commission (CQC) report.

The CQC said it had served the trust with a warning notice that it had to act on to improve patient care.

The trust has been rated "inadequate" on three previous occasions by the health watchdog, as well as being the only one currently within the NHS's improvement regime for not meeting standards.

Following the latest inspection, its overall rating was downgraded from "requires improvement" - and three out of five measures assessed by the CQC, for safety, leadership and effectiveness, met its lowest grading.

The report said two wards were immediately closed to new patients following a CQC visit in November, after the trust was threatened with enforcement action if urgent measures were not taken.

Significant staffing problems, including an annual nurse vacancy rate of more than 17%, were also highlighted.

Staff at an adult long stay ward did not complete regular checks on patients supposed to happen every 30 to 60 minutes, which meant they were unaware if somebody needed help for periods of up to seven hours.

Inspectors also said there had been a severe deterioration on the trust's inpatient ward for children and young people - the Dragonfly Unit in Carlton Colville, Suffolk.

They found it was reliant on agency workers and lacked a permanent doctor.

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Source: BBC News, 27 April 2022

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Coronavirus: Government throwing ‘lit match into a haystack’ by discharging Covid patients to care homes

The government has been warned it is throwing “a lit match into a haystack” by discharging Covid-positive patients to care homes, with politicians demanding that the safety of residents and staff is guaranteed under the new policy.

During the first wave of the pandemic, approximately 25,000 hospital patients were sent to care homes – many of whom were not tested – which helped spread the virus among residents. Around 16,000 care home deaths have been linked to COVID-19 since the start of the crisis.

The strategy was one of the government’s “biggest and most devastating mistakes” of the crisis, says Amnesty International, and questions have been raised over the decision to introduce a similar policy as the UK’s second wave intensifies.

As part of the 2020 adult social care winter plan, the government has called on local authorities and care providers to establish “stand-alone units” – so-called “hot homes” – that would be able to receive and treat Covid hospital patients while they recover from the disease.

There is also an expectation that, due to housing pressures and a shortage of suitable facilities, some patients may be discharged to “zoned accommodation” within a home, before being allowed to return to normal living settings once they test negative for the virus.

Councils have been told to start identifying and notifying the Care Quality Commission of appropriate accommodation, and to ensure high infection prevention standards are met.

Under the requirements outlined by the government, discharged patients “must have a reported Covid test result". However, The Independent revealed on Monday that these rules have not been followed in some cases, with a recent British Red Cross survey finding that 26 per cent of respondents had not been tested before being discharged to a care home.

There is also concern whether care homes possess enough adequate personal protective equipment to prevent outbreaks, with the CQC revealing last month that PPE was still not being worn in some sites.

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Source: The Independent, 27 0ctober 2020

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NHS to offer ‘Long Covid’ sufferers help at specialist centres

People suffering 'Long Covid’ symptoms will be offered specialist help at clinics across England, the head of the NHS announced today.

Respiratory consultants, physiotherapists, other specialists and GPs will all help assess, diagnose and treat thousands of sufferers who have reported symptoms ranging from breathlessness, chronic fatigue, 'brain fog', anxiety and stress.

Speaking at the NHS Providers conference today (Wednesday), NHS chief executive Sir Simon Stevens will announce that £10 million is be invested this year in additional local funding to help kick start and designate Long Covid clinics in every area across England, to complement existing primary, community and rehabilitation care.

Sir Simon said new network will be a core element of a five-part package of measures to boost NHS support for Long Covid patients:

  1. New guidance commissioned by NHS England from NICE by the end of October on the medical ‘case definition’ of Long Covid. This will include patients who have had covid who may not have had a hospital admission or a previous positive test. It will be followed by evidence-based NICE clinical guidelines in November on the support that Long Covid patients should receive, enabling NHS doctors, therapists and staff to provide a clear and personalised treatment plan. This will include education materials for GPs and other health professionals to help them refer and signpost patients to the right support.
  2. The ‘Your Covid Recovery’ – an online rehab service to provide personalised support to patients. Over 100,000 people have used the online hub since it launched in July, which gives people general information and advice on living with Long Covid. Phase 2 of the digital platform will see people able to access a tailored rehabilitation plan. This service will be available to anyone suffering symptoms that are likely due to COVID-19, regardless of location or whether they have spent time in hospital. 
  3. Designated Long Covid clinics, as announced today. This will involve each part of the country designating expert one-stop services in line with an agreed national specification. Post-covid services will provide joined up care for physical and mental health, with patients having access to a physical assessment, a cognitive assessment and a psychological assessment. Patients could also then be referred from designated clinics into specialist lung disease services, sleep clinics, cardiac services, rehabilitation services, or signposted into IAPT and other mental health services.
  4. NIHR- funded research on Long Covid which is working with 10,000 patients to better understand the condition and refine appropriate treatment.
  5. The NHS’s support will be overseen by a new NHS England Long Covid taskforce which will include Long Covid patients, medical specialists and researchers.

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Source: NHS England, 7 October 2020

Read Patient Safety Learning's response to this news

Please share your thoughts with us on the support that is needed on our patient safety platform, the hub.

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Trust CEO ‘behaved poorly’ and chair was ‘complicit’, NHS England review concludes

An NHS England review into the behaviour of high-profile senior leaders who took over a Midlands trust has concluded that the interim CEO “behaved poorly and inappropriately” while its chair was “complicit with” and failed to address problems.

NHS England had commissioned an independent probe into allegations about the behaviour of new executives, who had recently been appointed to the board of Walsall Healthcare Trust.

David Loughton and Professor Steve Field, who hold the same roles at the Royal Wolverhampton Trust, were brought in as interim chief executive and chair respectively in spring 2021.

Walsall has faced care quality concerns for some years and it was hoped the pair from neighbouring Wolverhampton would bring improvements. 

Dr McLean wrote in her review: “Leadership changes can, understandably, represent a period of anxiety for those affected but this can be minimised if changes are made in line with appropriate values and processes. 

“Whilst I conclude that the joint chair and interim CEO were motivated to act in the best interests of patients, I was saddened by much of what I heard.

”In the narratives I heard, there was a consistent lack of compassion or respect for people.”

She concluded: “The interim CEO, while motivated by the safety and care of patients, has behaved poorly and inappropriately … the joint chair has been complicit with and failed to address this behaviour.”

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Source: HSJ, 2 February 2022

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Hundreds of women left ‘distressed’ by hysteroscopies

Hundreds of women have said they’ve undergone “distressing” diagnostic tests at NHS hospitals which were not carried out in line with recommended practice.

Around 520 women who attended NHS hospitals in England to undergo hysteroscopies — a procedure which uses narrow telescopes to examine the womb to diagnose the cause of heavy or abnormal bleeding — have told a survey their doctors carried on with their procedures even when they were in severe pain.

This is despite the Royal College of Obstetricians and Gynaecologists advising clinicians should offer to reschedule with the use of general anaesthetic, epidural or sedation if the pain becomes unbearable. 

The Campaign Against Painful Hysteroscopy patient group has surveyed 860 women who had had the procedure at an English NHS hospital, and shared the results with HSJ. Of them, 750 said they were left distressed, tearful or shaken by the procedure, with around 466 of them saying that feeling remained for longer than a day.

Many of the women said their painful hysteroscopies damaged their trust in healthcare professionals, had made cervical smears more painful and had a negative impact on sexual relationships.

Patient Safety Learning have connected with the campaigning group 'Hysteroscopy Action' on this issue. We have seen stories and comments posted on the hub from patients who have suffered similar distressing experiences. We are using this feedback and evidence to help campaign for safer, harm-free care. We welcome others to join in the conversation.

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Source: HSJ, 2 March 2020

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Wall Street Journal: How the Swiss Cheese Model can help us beat COVID-19

No single solution will stop the virus’s spread, but combining different layers of public measures and personal actions can make a big difference.

It’s im­por­tant to un­der­stand that a vac­cine, on its own, won’t be enough to rapidly ex­tin­guish a pan­demic as per­ni­cious as Covid-19. The pan­demic can­not be stopped through just one in­ter­ven­tion, be­cause even vac­cines are im­per­fect. Once in­tro­duced into the hu­man pop­u­la­tion, viruses con­tinue to cir­cu­late among us for a long time. Fur­ther­more, it’s likely to be as long as a year be­fore a Covid-19 vac­cine is in wide-spread use, given in­evitable dif­fi­cul­ties with man­u­fac­tur­ing, dis­tri­b­u­tion and pub­lic ac­ceptance.

 Con­trol­ling Covid-19 will take a good deal more than a vac­cine. For at least an­other year, the world will have to rely on a mul­ti­pronged ap­proach, one that goes be­yond sim­plis­tic bro­mides and all-or-noth­ing re­sponses. In­di­vid­u­als, work-places and gov­ern­ments will need to con­sider a di­verse and some­times dis­rup­tive range of in­ter­ven­tions. It helps to think of these in terms of lay­ers of de­fence, with each layer pro­vid­ing a bar­rier that isn’t fully im­per­vi­ous, like slices of Swiss cheese in a stack.

 The ‘Swiss cheese model’ is a clas­sic way to con­cep­tu­al­ize deal­ing with a haz­ard that in­volves a mix­ture of hu­man, tech­no­log­i­cal and nat­ural el­e­ments.

This article can be read in full on the WSJ website, but is paywalled. 

The illustration showing the swiss cheese pandemic model is hyperlinked to this hub Learn post.

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Patients given wrong air in oxygen mix-up at hospital

A hospital has made changes after two patients were accidentally given medical air instead of oxygen.

The two incidents, which took place at the Norfolk and Norwich University Hospital (NNUH), were classed as "never events" meaning they were serious but preventable.

They happened to patients in November who were being handed over to the hospital by the East of England Ambulance Service.

The patients should have been given oxygen but were given medical air instead which only contains 20pc oxygen.

The ambulance service said in a message to staff: "Severe harm or death can occur, if medical air is accidentally administered to patients instead of oxygen. As per NNUH's request, with immediate effect, when handing over at the NNUH, all medical equipment and oxygen should be swapped only by an emergency department doctor or registered nurse."

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Source: Eastern Daily Press, 2 December 2019

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Toddlers died after NHS 111 helpline said they were not in danger

The NHS 111 helpline for urgent medical care is facing calls for an investigation after poor decision-making was linked to more than 20 deaths.

Experts say that inexperienced call handlers and the software used to highlight life-threatening emergencies may not always be safe for young children. At least five have died in potentially avoidable incidents.

Professor Carrie MacEwen, Chairwoman of the Academy of Medical Royal Colleges, said: “These distressing reports suggest that existing processes did not safeguard the needs of the children in these instances.”

Since 2014 coroners have written 15 reports involving NHS 111 to try to prevent further deaths. There have been five other cases where inquests heard of missed chances to save lives by NHS 111 staff; two other cases are continuing and one was subject to an NHS England investigation.

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Source: The Times, 5 January 2020

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Trust’s directors scapegoated psychiatrist over patient’s death, tribunal finds

A mental health trust ‘scapegoated’ a psychiatrist over the death of a patient amid systemic issues, an employment tribunal has found.

Judges called the conduct of two senior directors — one of whom is a current NHS trust medical director — into question after ruling they had colluded to scapegoat Bernadette McInerney for issues that would have damaged the trust’s reputation.

Nottinghamshire Healthcare Foundation Trust was found unanimously to have unfairly sacked and victimised Dr McInerney, a former consultant forensic psychiatrist at Rampton secure hospital, in a decision published last week.

The judgement was critical of both Chris Packham, a GP at Rampton hospital, and NHFT’s then-executive medical director Julie Hankin, but it also strongly condemned the trust’s former executive director for forensic services Peter Wright. Dr Hankin is now medical director at Cambridgeshire and Peterborough FT.

Read full article here (paywalled)
Original source: Health Service Journal

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Trust boss warns region faces ‘absolute crisis’ with trusts ‘hanging on by their fingernails’

Hospital chiefs in the South West have warned the region will not avoid the extreme pressures felt by other parts of the NHS amid rapidly rising numbers of COVID-19 inpatients.

The region was the least affected area of England during the pandemic’s first wave, but the medical director of two acute trusts yesterday predicted a “tidal wave” of COVID-19 coming to the West Country.

Adrian Harris, medical director at Royal Devon and Exeter Foundation Trust and Northern Devon Healthcare Trust (NDHT), said the region faced an “absolute crisis” and individual trusts would be “hanging on by their fingernails”.

His comments, made at NDHT’s board meeting, came on the same day HSJ revealed the South West region now has the fastest growth in COVID-19 inpatients. Although the region is England’s least densely populated, it also has the lowest hospital capacity per capita in the country.

Dr Harris said: “We hope and we pray that the lockdown has come in time for Devon. My personal view — and of my colleagues around the country — is that there’s a tidal wave of COVID-19 coming to the West Country."

“We are preparing to be hit as hard as the East of England. If we are hit as hard, we will be hanging on by our fingernails and we are planning accordingly.”

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Source: HSJ, 8 January 2021

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‘Humiliated’ trust staff complain of ‘unprofessional behaviour’ and ‘lack of compassion’

‘Unprofessional’ behaviours, a lack of compassion, and tension among staff and managers are all contributing to pockets of ‘poor culture’ at an acute trust.

A Freedom to Speak Up report presented to the board of Buckinghamshire Healthcare Trust found there had been an increase in bullying and reports of staff members being “humiliated” during the last three months.

The report, which covers the first two quarters of 2021-22, highlighted a “lack of compassion, kindness, and understanding” between colleagues and noted “increasing levels of frustration” that people are not being held to account for “unprofessional” poor behaviours.

The report added the findings were not surprising due to the pressures of the pandemic experienced by staff.

It found: “There appears to be an increase in the proportion of concerns around interpersonal behaviours and communication issues as well as levels of frustration and tension amongst staff and managers.”

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Source: HSJ, 24 November 2021

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Brain fog, phantom smells and tinnitus: my experience as a Covid 'long hauler'

 I fell sick on 25 March. Four months later, I’m still dealing with fever, cognitive dysfunction, memory issues and much more

I just passed the four-month mark of being sick with Covid. I am young, and I had considered myself healthy.

My first symptom was that I couldn’t read a text message. It wasn’t about anything complex – just trying to arrange a video call – but it was a few sentences longer than normal, and I couldn’t wrap my head around it. It was the end of the night so I thought I was tired, but an hour later I took my temperature and realized I had a fever. I had been isolating for 11 days at that point; the only place I had been was the grocery store.

My Day 1 – a term people with Long Covid use to mark the first day of symptoms – was 25 March.

Four months later, I’m still dealing with a near-daily fever, cognitive dysfunction and memory issues, GI issues, severe headaches, a heart rate of 150+ from minimal activity, severe muscle and joint pain, and a feeling like my body has forgotten how to breathe. Over the past 131 days, I’ve intermittently lost all feeling in my arms and hands, had essential tremors, extreme back, kidney and rib pain, phantom smells (like someone BBQing bad meat), tinnitus, difficulty reading text, difficulty understanding people in conversations, difficulty following movie and TV plots, sensitivity to noise and light, bruising, and petechiae – a rash that shows up with Covid. These on top of the CDC-listed symptoms of cough, chills and difficulty breathing.

Read the full article here.

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Nurses to retrain as doctors ‘more quickly’ without EU red tape

Leaving the EU means the UK has greater control over the training of healthcare professionals. The Department of Health and Social Care (DHSC) has announced that nurses and other allied healthcare professionals will be able to retrain as doctors ‘more quickly’ now the UK has left the EU.

Under training standards set by the EU, existing healthcare professionals wishing to move into another area would have to complete a set standard of training, regardless of any existing health background or qualifications. Under the potential new system, a nurse who has been in the job for 10 years could benefit from training standards based upon experience and qualifications, rather than strict time-frames.

Health Secretary Matt Hancock said: “Our incredible NHS is full of highly-qualified and dedicated professionals – and I want to do everything I can to help them fulfil their ambitions and provide the best possible care for patients. Without being bound by EU regulations, we can focus on ensuring our workforce has the necessary training which is best suited to them and their experience, without ever compromising on our high standards of care or on patient safety. The plans we are setting out today mean that we can retrain healthcare workers and get them back to the frontline faster. This is good for patients, and good for our NHS."

Nursing leaders warn that the move needs to come without compromising patient care. Andrea Sutcliffe CBE, Chief Executive and Registrar at the Nursing and Midwifery Council (NMC) said: “Having enough health and care professionals with the right knowledge, skills and values is vital to meet the individual needs of people across all four countries of the UK now and in the future."

“The NMC supports the wish to explore how education and training for registered nurses and midwives may be achieved in more flexible ways while ensuring our high standards are maintained and not compromised. Every nursing and midwifery professional must be safe and competent to provide the best care and support possible."

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Source: Nursing Notes, 9 February 2020

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