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Teaching trust’s staff ‘utterly rinsed and completely wiped out’ by elective targets

A major London trust’s critical care staff have urged leaders to review elective work targets amid serious concerns over workload, safe staffing and burnout, HSJ  has learned.

In a letter to Guy’s and St Thomas’ Foundation Trust’s board, staff represented by trade union Unite said they had “repeatedly” raised concerns about the provider’s approach to elective work, as well as winter pressures and second wave planning, and the implications this has had for “the health, safety and wellbeing of both staff and patients”. 

The letter — which was also addressed to the trust’s health and safety committee and has been seen by HSJ —  said: “Our primary concern is that the trust’s endeavours, and understandable need to square these circles, may be unrealistic given the current pressures on staffing and the high rates of sickness and burnout the trust is continuing to experience.

“This is especially in critical care, where we are concerned this may compromise patient safety and is already damaging staff wellbeing and morale.”

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Source: HSJ, 18 December 2020

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Clapped-out kit, long delays, too few beds and staff: NHS enters 2021 in a sorry state

Think 2020 has been awful for the NHS? Next year is shaping up to be far worse – and most of the huge hole it’s in was dug long before Covid. The virus has merely finished off the job.

The health service does not have the beds, staff or equipment to recover the ground it lost during the first two waves of the coronavirus pandemic, but the government is blocking desperately needed improvements, and another round of organisational upheaval is on its way.

Roughly one in 11 clinical posts are vacant, and it would hardly be a surprise to see many staff rush for the retirement door once the worst of the pandemic is behind us. The NHS can’t solve the problem without long-term certainty over funding for staff.

Around 140,000 patients in England have been waiting more than a year for surgeries such as a hip replacements, up a hundredfold from a year ago. With the whole system beset by delays long before we had even heard of coronavirus, the lack of spare capacity means it will take years to help many patients.

Unprecedented interruptions and delays to cancer tests and treatments have been exacerbated by the pitiful state of diagnostic equipment. Access to CT and MRI scanners is far behind countries with a fraction of our wealth, such as Slovenia and Slovakia. Y

In the midst of all this turmoil, the NHS in England faces another round of legislative and organisational upheaval next year, the likely arrival of a new chief executive, and a potential fight with Downing Street over the extent of political control.

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Source: The Guardian, 18 December 2020

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Troubled children’s service taken out of special measures

An independent children’s and adolescents’ mental health service has been taken out of special measures after cutting beds by two-thirds.

The Care Quality Commission has rated St Andrew’s Healthcare’s CAMHS unit in Northamptonshire “requires improvement” but removed it from special measures. Among improvements noticed were a major change in the service’s leadership and staff raising concerns openly and honestly.

The unit was rated “inadequate” and served with a section 31 notice following inspections in June and December last year. 

After its December inspection, the charity reduced the number of beds within its CAMHS offering from 90 to 30. Around the same time, St Andrew’s Healthcare chief executive Katie Fisher also revealed plans to shrink its services by half to address the serious quality issues.

Speaking to HSJ, St Andrew’s Healthcare chief executive, Kate Fisher, who was appointed in 2018, said: “this isn’t just words, we are absolutely walking the walk and seeing through the strategy we set ourselves.”

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Source: HSJ, 18 December 2020

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Long COVID patients to get help at more than 60 clinics

Thousands of patients suffering with the long term symptoms of coronavirus can now access specialist help at more than 60 sites, NHS England announced today.

The assessment centres are taking referrals from GPs for people experiencing brain fog, anxiety, depression, breathlessness, fatigue and other debilitating symptoms.

NHS England has provided £10 million for the network of clinics, which started opening last month. There are now 69 operating across the country with hundreds of patients already getting help.

The new centres bring together doctors, nurses, physiotherapists and occupational therapists to offer both physical and psychological assessments and refer patients to the right treatment and rehabilitation services.

Ten sites are now operational in London, seven in the East of England, eight in the Midlands, South East and South West respectively, nine in the North West and a further 18 across the North East and Yorkshire.

A further 12 sites are earmarked to launch in January in the East Midlands, Lancashire, Cornwall and Isle of Wight.

The National Institute for Clinical Excellence (NICE) has today also issued official guidance on best practice for recognising, investigating and rehabilitating patients with long COVID.

Patients can access services if they are referred by a GP or another healthcare professional, so that doctors can first rule out other possible underlying causes for symptoms.

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Source: NHS England, 18 December 2020

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Nurses reissue call for safe staffing levels one year after strike

More needs to be done to tackle safe staffing levels in Northern Ireland's health service, according to the Royal College of Nursing (RCN).

A year on from the nurses' strike, the union has warned that problems caused by poor workforce planning and chronic underfunding have not been addressed.

Instead they have been exacerbated by the CoOVID-19 pandemic, said the RCN.

The Department of Health said dealing with staff shortfalls was a "key priority" for the health minister.

Pat Cullen, the Northern Ireland director of the RCN, said "very little has actually changed" since about 15,000 healthcare workers took to the picket line in December last year for a series of protests over pay and safe staffing levels.

"We need to remind the government that many of these issues have sadly not gone away," she added.

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Source: BBC News, 18 December 2020

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London hospitals cancel operations to free up staffing as critical care beds fill up

London’s hospitals are already beginning to run out of critical care beds ahead of the Christmas relaxation of rules – which is expected to increase cases further, a leaked NHS briefing has warned.

The update on the situation in the capital comes as major hospitals have already started to cancel operations for other patients in order to find enough staff to deal with the rise in patients as NHS trusts open up extra surge capacity.

More operations are expected to be cancelled in hospitals across London, with staff warned they could be redeployed at short notice.

On Wednesday, there were a total of 2,289 coronavirus patients in London hospitals, an increase of 2 per cent on the day before. But the numbers of coronavirus patients in critical care beds jumped 8.6% in a single day, increasing from 302 to 345 patients on Wednesday, while an additional 900 people who have tested positive were receiving oxygen.

Across London, there were just 49 adult critical care beds available on Wednesday. In total there were 904 beds occupied, 328 by patients with COVID-19. This meant the capital’s total critical care bed occupancy rate was almost 95%.

Although the number of patients is much lower than it was the first wave, many hospitals are still treating routine and non-Covid patients – meaning they are struggling to staff critical wards and keep other services running.

A briefing for NHS managers warned them: “A reduction of elective [routine] activity is likely to be needed in line with increasing acute activity.”

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Source: The Independent, 17 December 2020

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How patient safety and innovation can work hand in hand

The year 2020 has been extraordinary. It would have been inconceivable 12 months ago that the process of developing and testing medicines would be a topic of intense political and public interest. The UK pharmaceutical sector has taken centre stage, with more support than ever before for Britain’s gold-standard regulatory framework. 

After a difficult year, this winter has seen a steady drumbeat of positive news about COVID-19 vaccines, demonstrating that the pharmaceutical industry can deliver world-leading clinical research at pace and at scale within the UK’s regulatory system.

As the crisis of the COVID-19 pandemic hopefully eases over the coming months and the transition period for Britain’s exit of the EU comes to an end, we must seize the opportunity to strengthen this framework.   

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Source: New Statesmen, 14 December 2020

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'Great day for safety': Patients harmed by drugs and devices back commissioner role

An Independent Patients' Commissioner is set to be appointed to act as champion for people who have been harmed by medicines or medical devices.   

Baroness Cumberlege, who recommended the new role in a landmark report earlier this year, announced that the government had budged on the issue after initial resistance.

She welcomed the move saying: "Had there been a patient safety commissioner before now, much of the suffering we have witnessed could have been avoided."

But she added "the risk still remains" and further urgent action is needed to protect patients from potentially harmful drugs."

At an online meeting of parliamentarians, the baroness described the testimony of a victim of the medical device vaginal mesh, which has left some patients in chronic pain.

The woman had told her review team: "This device took everything from me. My health, my life, my job, my dignity, my marriage, my freedom."

Reflecting on this the baroness added: "The scale of suffering we witnessed means nothing short of profound change is necessary. Not necessary in a couple or three years, but necessary now."

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Source: Sky News, 16 December 2020

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NHS guidance ‘too long to read,’ say hospital staff as safety watchdog exposes systemic risks to patients

NHS guidance ‘too long to read,’ say hospital staff as safety watchdog exposes systemic risks to patients.

The Healthcare Safety Investigation Branch (HSIB) revealed some NHS staff had admitted not reading official guidance on how to avoid the ‘never event’ error as part of a new report identifying deeper systemic problems that it said left patients at an increased risk.

The independent body warned patients across the NHS remained vulnerable to being injured or even killed by the error that keeps happening in hospitals despite warnings and safety alerts over the last 15 years.

HSIB launched a national investigation into the problem of misplaced nasogastric (NG) tubes after a 26-year-old man had 1,450ml of liquid feed fed into his lungs in December 2018 after a bike accident.

The patient recovered but the error was not spotted, even after an X-ray.

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Source: The Independent, 17 December 2020

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Coronavirus: one in ten patients have symptoms lasting three months or more

One in 10 people infected with the coronavirus experience symptoms that last for three months or longer, the Office for National Statistics (ONS) has said.

A new analysis aimed at determining the extent of the “long Covid” problem among infected patients also found that one in five reported having symptoms that lasted for five weeks or longer.

The ONS said it estimated that during the week ending on 28 November, there were about 186,000 people in England living with COVID-19 symptoms that had lasted between five and 12 weeks.

This number could be as high as 221,000, the ONS warned. It said the data was experimental and based on the findings from its infection survey of households.

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Source: The Independent, 16 December 2020

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Major trust diverts ambulances and cancels electives after covid surge

One of England’s largest hospital trusts has been forced to divert ambulances and cancel operations, after seeing a very steep increase in covid-19 admissions over the past week.

Whipps Cross Hospital in north east London, part of Barts Health Trust, declared a critical incident over the weekend, the trust has confirmed. The trust has also declared a “high pressure phase” of covid response.

A well placed source said Whipps Cross had been forced to divert ambulances in recent days, because of pressure on its emergency services, while a message to staff said it was deferring some planned operations, along with other steps aimed at protecting safety.

It is also understood to be attempting to further speed up discharges from hospital.

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Source: HSJ, 16 December 2020

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Complex dental care 'threatened by NHS targets'

Patients needing complex dental work might have to wait longer under new NHS targets, dentists warn.

The British Dental Association (BDA) fears NHS England will impose penalties on practices that fail to reach 45% of their normal activity level, after negotiations broke down.

And practices may have to prioritise routine check-ups over more time-consuming treatments.

An NHS official said: "The NHS and the government are working to determine a safe and reasonable contractual arrangement with dentists, which recognises the constraints on practices and the need to maximise access for patients to see their dentist."

The waiting list for NHS dentistry could reach eight million by New Year's Eve, according to the Association of Dental Groups.

Dave Cottam, who chairs the BDA's General Dental Practice Committee, said: "This move will actively undermine patient care.

"Ministers are instructing dentists to churn through routine appointments against the clock, rather than deal with a huge backlog of urgent cases. Dentists wanting to do the right thing by their patients will now be punished for it."

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Source: BBC News, 16 December 2020

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Doctors claim major infection control ‘deficiencies’ at region’s hospitals

Research by a group of doctors has found ‘major deficiencies’ around infection control within hospitals in the North West region.

The study looked at trusts’ adherence to Public Health England guidance around limiting the spread of COVID-19 within orthopaedic services.

The study found patients were routinely being allocated to hospital beds before they had been confirmed as covid-negative, “thus allowing spread of COVID-19 not only between patients but also between nursing and medical staff”.

Fewer than half of patients were nursed with the appropriate screens in place, while it was uncommon for doctors to be tested regularly.

Separate statistics published by NHS England suggest almost 20 per cent of new covid cases in North West hospitals from August to December were likely to be nosocomial, meaning they were acquired on the wards.

This was a higher proportion than any other region.

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Source: HSJ (paywalled), 16 December 2020

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Pregnant women allowed support of partners during birth

Pregnant women should be allowed to have one person alongside them during scans, appointments, labour and birth, under new NHS guidance sent to trusts in England.

The chosen person should be regarded as "an integral part of both the woman and baby's care" - not just a visitor.

Previously, individual hospitals could draw up their own rules on partners being present.

This meant many women were left to give birth alone.

The guidance says pregnant women "value the support from a partner, relative, friend or other person through pregnancy and childbirth, as it facilitates emotional wellbeing".

Women should therefore have access to support "at all times during their maternity journey".

And trusts should make it easy for this to happen, while keeping the risk of coronavirus transmission within NHS maternity services as low as possible.

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Source: BBC News, 16 December 2020

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Major concerns over quality of care for those dying at home

A lack of face-to-face appointments during the coronavirus pandemic has significantly worsened the palliative care being provided to people at the end of their life, according to a survey of specialists.

The research, which the Association of Palliative Medicine and end of life charity Marie Curie shared exclusively with HSJ, found 95% of respondents said their ability to provide good quality end-of-life care had been affected because patients had not received their “usual contact” such as visits from GPs or social care staff. Three-quarters said this had a “great” or “massive” impact.

Significantly higher numbers of people have died at home since the start of the coronavirus pandemic, compared to previous years.

Two-thirds of respondents said health professionals had missed opportunities to refer patients into palliative care and, once they had done, four fifths thought they had not done so in a “timely manner.”

Dr Iain Lawrie, president of APM, said a lack of face-to-face appointments meant “red flags” about patients’ conditions were missed, as these clues are easier to gather in person.

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Source: HSJ, 16 December 2020

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Cancer waiting list has almost doubled, leak reveals

The waiting list for cancer patients has almost doubled over the last seven months, according to internal NHS data which has never been made public.

A slide set seen by HSJ suggests the total number of patients waiting for cancer treatment on the 62-day pathway has increased from around 90,000 in mid-May, to around 160,000 at the start of December.

However, the data suggests the NHS has made good progress in treating patients waiting the longest.

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Source: HSJ, 15 December 2020

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Shropshire baby deaths: Hospitals must adopt new safety steps

All NHS trusts in England have been given a deadline of Monday to enact safety improvements in maternity care amid Shropshire's baby deaths scandal.

Heath chiefs have told hospitals they must have the 12 "urgent clinical priorities" in place by 17:00 GMT. The move is to address "too much variation" in outcomes for families.

It comes during a probe into the maternity care of more than 1,800 families in Shropshire.

The inquiry, launched amid concerns of repeated failings at Shrewsbury and Telford Hospital NHS Trust (SaTH), focuses on the experience of 1,862 in total, and includes instances of infant fatality.

An interim report published last week found poor care over nearly two decades had harmed dozens of women and their babies.

The report called for seven "essential actions" to be implemented at maternity units across England. But that has since been transformed into 12 clinical tasks, including giving women with complex pregnancies a named consultant, ensuring regular training of fetal heart rate monitoring, and developing a proper process to gather the views of families.

The directions are revealed in a letter in which NHS England says there is "too much variation in experience and outcomes for women and their families".

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Source: BBC News, 15 December 2020

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Christmas mixing ‘will cost many lives’, warn top medical journals

The government’s plan to allow up to three households to mix at Christmas is a “major error that will cost many lives” and should be stopped, the editors of two leading medical journals have said.

In a rare joint editorial, the editors of the British Medical Journal and Health Service Journal have said the government’s plan to relax coronavirus restrictions for five days between 23 and 27 December is a serious “blunder” that will put more pressure on the NHS and cause thousands of operations to be cancelled.

The article published jointly on Tuesday says: “The government was too slow to introduce restrictions in the spring and again in the autumn. It should now reverse its rash decision to allow household mixing and instead extend the tiers over the five-day Christmas period in order to bring numbers down in the advance of a likely third wave.”

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Source: The Independent, 15 December 2020

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People with learning disabilities should be prioritised for a Covid vaccine

Throughout the pandemic, people with learning disabilities and autism have consistently been let down. A lack of clear, easy-to-understand guidance, unequal access to care and illegal “do not resuscitate” instructions have exacerbated the inequalities many people have long faced. It is crucial we do not forget those who have constantly been at the back of the queue: people with learning disabilities and autism.

The impact cannot be ignored: research shows that 76% of people with learning disabilities feel they do not matter to the government, compared with the general public, during the pandemic. And data shows the danger of contracting COVID-19 for people with learning disabilities and autism is much higher than for the wider population.

Public Health England has said the registered COVID-19 death rate for people with learning disabilities in England is more than four times times higher than the general population. But experts estimate the true rate is likely to be even higher, since not all deaths of people with learning disabilities are registered in the databases used to collate the findings.

The reasons the pandemic has impacted people with learning disabilities so disproportionately are systemic, and a result of inequalities in healthcare services experienced for generations. Yes, some individuals are more clinically vulnerable, on account of the co-morbidities and complications associated with their learning disability. For many people, however, poorer outcomes after contracting the virus are due to non-clinical issues and inequalities in accessing healthcare services. This is inexcusable.

The government must prioritise vaccinations for the 1.5 million people with learning disabilities and 700,000 with autism. Putting this long-overlooked group at the top of the vaccine queue would help address the systemic health inequalities learning disabled people face.

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Source: The Guardian, 15 December 2020

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CQC to ramp up inspections of trusts’ infection control

Trusts’ infection control measures will be put under greater scrutiny by the Care Quality Commission (CQC), HSJ has been told. 

In an effort to cut hospital-acquired COVID-19, the CQC will carry out focused inspections which will assess “in more detail the leadership and delivery of infection prevention control”.

According to NHS England/Improvement figures, around 9% of covid inpatients definitely caught the virus in hospital. However, the number could be higher as NHSE/I figures — released on Friday — showed 21% of COVID-19 patients in hospitals were “probably” acquired in hospitals. 

HSJ understands the CQC plans to carry out up to 20 infection control focused inspections in the early part of 2021. 

The CQC told HSJ it is reviewing local nosocomial infection rates on a weekly basis, using the data alongside “wider intelligence” from other sources to monitor trusts’ risk, with inspections carried out at providers where specific concerns are picked up.

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Source: HSJ, 14 December 2020

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Pre-existing inequality led to record UK Covid death rate, says health chief

Pre-existing social inequalities contributed to the UK recording the highest death rates from Covid in Europe, a leading authority on public health has said, warning that many children’s lives would be permanently blighted if the problem is not tackled.

Sir Michael Marmot, known for his landmark work on the social determinants of health, argued in a new report that families at the bottom of the social and economic scale were missing out before the pandemic, and were now suffering even more, losing health, jobs, lives and educational opportunities.

In the report, Build Back Fairer, Marmot said these social inequalities must be addressed whatever the cost and it was not enough to revert to how things before the pandemic. “We can’t afford not to do it,” he said.

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Source: The Guardian, 15 December 2020

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'New variant' of coronavirus identified in England

A new variant of coronavirus has been found which is growing faster in some parts of England, MPs have been told.

Health Secretary Matt Hancock said at least 60 different local authorities had recorded Covid infections caused by the new variant.

He said the World Health Organization had been notified and UK scientists were doing detailed studies.

He said there was "nothing to suggest" it caused worse disease or that vaccines would no longer work.

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Source: BBC News, 14 December 2020

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Coronavirus: Health checks recommended for ethnic minorities from age 25

Health checks should be offered to people from black, Asian and minority ethnic backgrounds from the age of 25, a report has recommended.

MPs examined the disproportionate impact of the Covid pandemic on people from black and Asian backgrounds. They said NHS checks, currently available to 40-70-year-olds in England, could pick up conditions which are linked to severe coronavirus.

The role of inequalities in employment and housing was also emphasised. The report, produced by the Women and Equalities Committee, said the government should act to tackle these wider causes of poor health.

The committee heard evidence during the course of its investigation that showed 63% of healthcare workers who died after contracting the virus had come from black, Asian or other ethnic minority backgrounds.

And during the first peak of the virus, data from the Intensive Care National Audit and Research Centre showed 34% of coronavirus patients in ICUs were from an ethnic minority background, whereas they made up 12% of viral pneumonia admissions.

Office for National Statistics (ONS) data has also shown that black people were almost twice as likely to die from Covid-19 as white people, with those of Bangladeshi and Pakistani ethnicity about 1.7 times as likely.

The report raised concerns the pandemic was entrenching "existing health inequalities".

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Source: BBC News, 15December 2020

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Patient Safety Movement: the Lewis Blackman Leadership Award

In honor and recognition of the 20th anniversary of Lewis Blackman’s death on 6 November 2000, an award has been established with the goal of recognising outstanding leadership in patient safety by students pursuing a health profession and residents in training. Lewis Blackman was an outstanding student himself and because his mother, Helen Haskell, has dedicated her life to improving patient safety, especially through education, the Lewis Blackman Leadership Award has been created.

You can find all the details and nomination requirements here. Application submissions will be accepted starting 15 December 15 and will close on 31 January.

If you have any additional questions, please email contact@patientsafetymovement.org

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‘We don't have enough nurses to keep all our patients safe,’ says RCN leader

There are not enough nurses to safely care for patients in the UK, according to the body that represents the profession, and many of those who are working are suffering from anxiety and burnout after a gruelling nine months treating Covid patients.

A year after the prime minister pledged during the 2019 election campaign to add 50,000 nurses to the NHS, the Royal College of Nursing has accused Boris Johnson of being “disingenuous” for claiming the government is meeting this 2025 target.

Johnson claimed last week that the government had “14,800 of the 50,000 nurses already” during prime minister’s questions in the Commons.

Yet the latest NHS figures show there were 36,655 vacancies for nursing staff in England in September, with the worst shortages affecting mental health care and acute hospitals. Staff in some intensive care units (ICUs) have quit since the pandemic, with those whom the Observer spoke to choosing to work instead in supermarkets or as dog-walkers.

Dame Donna Kinnair, the RCN’s chief executive and general secretary, said: “The simple, inescapable truth is that we do not have enough nursing staff in the UK to safely care for patients in hospitals, clinics, their own homes or anywhere else.”

She said that even before the pandemic, “heavy demand” was rising faster than the “modest increases” in staff numbers.

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Source: The Guardian, 12 December 2020

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