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Private providers targeted in NHSE crackdown on poor quality care

NHS England has revealed plans to crack down on poor care being provided by mental health service providers. 

There will be a particular focus on independent units treating NHS patients, as just over a quarter of these providers are failing to meet quality standards. 

Official data shared with HSJ shows that of the 238 independent NHS mental health providers licensed by the Care Quality Commission in England, 174 (73 per cent) are classed as “good” or “outstanding”. The remaining 64 (27 per cent) either “require improvement” or are considered “inadequate”. 

There have been been national concerns about repeated service failures within the sector. Independent units are often used by NHS trusts for out of area placements – a practice it is trying to end – or to cope with the lack of acute mental health beds.

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Source: HSJ, 11 August 2022

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"I've been let down - I shouldn't have stage-4 cancer"

A woman with fast-growing stage-four breast cancer says the NHS has let her down, with delays at every stage of her treatment.

Caroline Boulton, 56, had several appointments for a mammogram, which checks for early signs of cancer, cancelled because of Covid, in March and November 2020.

In late 2021, she found a small lump, went to her GP and was referred urgently to a specialist - but then the delays began.

"They haven't moved quickly enough," Ms Boulton says, who lives in Greater Manchester. "It's been really, really slow."

"Between each appointment, each scan, there's been four-, five-, six-, seven-, eight-week waiting times and delays every time."

The referral letter came through "very quickly" but then she waited three weeks, instead of the recommended two, to see a consultant.

"When I first found the lump, it was only pea-sized," Ms Boulton says. "By the time I got to see the consultant, it was the size of a tangerine."

Her cancer was growing quickly, she was told, but it would be eight weeks before a mastectomy could be scheduled to remove her breast.

"Considering it was fast-growing, that's a huge concern - you're living with that, waiting, knowing it's growing," Ms Boulton says.

When she finally saw an oncologist seven months after finding the lump, had another scan and received the results, the cancer had spread to her liver - and there was no longer any treatment they could offer.

"I've now got stage-four cancer that I shouldn't have - and two years to live."

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Source: BBC News, 10 August 2022

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Cyber attack: NHS staff unable to access patient notes for three weeks

A cyber attack that has caused a major outage of NHS IT systems is expected to last for more than three weeks, leaving doctors unable to see patients’ notes, The Independent has learned.

Mental health trusts across the country will be left unable to access patient notes for weeks, and possibly months.

Oxford Health Foundation Trust has declared a critical incident over the outage, which is believed to affect dozens of trusts, and has told staff it is putting emergency plans in place.

One NHS trust chief said the situation could possibly last for “months” with several mental health trusts, and there was concern among leaders that the problem is not being prioritised.

In an email to staff, Oxford Health Foundation Trust chief executive Nick Broughton, said: “The cyber attack targeted systems used to refer patients for care, including ambulances being dispatched, out-of-hours appointment bookings, triage, out-of-hours care, emergency prescriptions and safety alerts. It also targeted the finance system used by the Trust."

The NHS director said: “The whole thing is down. It’s really alarming…we’re carrying a lot of risk as a result of it because you can’t get records and details of assessments, prescribing, key observations, medical mental health act observations. You can’t see any of it…Staff are going to have to write everything down and input it later.”

They added: “There is increased risk to patients. We’re finding hard to discharge people, for example to housing providers, because we can’t access records.”

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Source: The Independent, 11 August 2022

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New capital fund to boost beds and A&E capacity

England’s mental health inpatient system is “running very hot” and operating well above recommended occupancy levels, HSJ has been told, as new funding to address the problem is revealed.

The move was announced by NHS England mental health director Claire Murdoch in an exclusive interview with HSJ. 

It comes amid a steep rise in mental health patients waiting more than 12 hours in accident and emergency. Last month, an HSJ investigation revealed 12-hour waits for people in crisis had ballooned by 150% in 2022 compared to pre-pandemic levels. Problems finding specialist beds have been cited by experts as one of the root causes of A&E breaches.

Ms Murdoch told HSJ the funds would not come from ”within the mental health service budget” and that they would be used to “help address any pressures where we think the answer is more of either beds or other urgent and emergency care which has a capital need.”

NHSE is now working with the 42 integrated care systems to determine where the money can best be used. Ms Murdoch said the money would be spent ”where there is a particular need” and that there was “no blanket approach” to its allocation. 

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Source: HSJ, 10 August 2022

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Urgent polio boosters for London children

All children aged one to nine and living in Greater London will be offered a polio vaccine after the virus was detected in sewage.

The virus, which can cause paralysis, has been found 116 times in London's wastewater since February.

The urgent immunisation campaign will see nearly a million children offered the vaccine - including those already up to date with their jabs.

Parents and carers will be contacted by their GP within the next month.

Polio is seen as a disease of the past in the UK after the whole of Europe was declared polio-free in 2003.

Dr Vanessa Saliba, a consultant epidemiologist at UKHSA, said: "All children aged one to nine years in London need to have a dose of polio vaccine now - whether it's an extra booster dose or just to catch up with their routine vaccinations."

She said the risk for the majority of the population who are vaccinated remains "low" but said it was "vital" parents ensure their children are fully vaccinated.

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Source: BBC News, 10 August 2022

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USA: The GOP blocked an insulin price cap - what it means for diabetics

The Senate passed a sweeping budget package Sunday intended to bring financial relief to Americans, but not before Republican senators voted to strip a proposal that would have capped the price of insulin at $35 per month for many patients.

A proposal that limits the monthly cost of insulin to $35 for Medicare patients was left untouched. But using a parliamentary rule, GOP lawmakers were able to jettison the part of the proposal that would apply to privately insured patients.

Lowering the price of drugs such as insulin, which is used by diabetics to manage their blood sugar levels, is broadly popular with voters, polling shows. Senate Democrats denounced Republicans for voting against relief for Americans struggling to pay for the lifesaving drug.

More than 30 million Americans have diabetes, and about 7 million require insulin daily to manage their blood sugar levels.

The insulin price cap, part of a larger package of proposals to cut prescription drug and other health-care costs, was intended to limit out-of-pocket monthly insulin costs to $35 for most Americans who use insulin.

More than 1 in 5 insulin users on private medical insurance pay more than $35 per month for the medicine, according to a recent analysis from the Kaiser Family Foundation. The same analysis found that the median monthly savings for those people would range from $19 to $27, depending on their type of insurance market.

A Yale University study found insulin is an “extreme financial burden” for more than 14% of Americans who use it. These people are spending more than 40% of their income after food and housing costs on the medicine.

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Source: The Washington Post, 8 August 2022

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Obese patients ‘being weight-shamed by doctors and nurses’

Doctors and nurses often “weight-shame” people who are overweight or obese, leaving them feeling anxious, depressed and wrongly blaming themselves for their condition, research has found.

Such behaviour, although usually the result of “unconscious weight bias”, leads to people not attending medical appointments, feeling humiliated and being more likely to put on weight.

Dr Anastasia Kalea and colleagues at University College London analysed 25 previous studies about “weight stigma”, undertaken in different countries, involving 3,554 health professionals. They found “extensive evidence [of] strong weight bias” among a wide range of health staff, including doctors, nurses, dieticians, psychologists and even obesity specialists.

Their analysis found that a number of health professionals “believe their patients are lazy, lack self-control, overindulge, are hostile, dishonest, have poor hygiene and do not follow guidance”, said Kalea, an associate professor in UCL’s division of medicine.

She added: “Sadly, healthcare, including general practice, is one of the most common settings for weight stigmatisation and we know this acts as a barrier to the services and treatments that can help people manage weight.

“An example is a GP that will unconsciously show that they do not believe that the patient complies with their eat less/exercise more regime they were asked to follow as they are not losing weight."

“The result is that patients are not coming back or they delay their follow-up appointments, they avoid healthcare prevention services or cancel appointments due to concerns of being stigmatised due to their weight.”

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Source: The Guardian, 10 August 2022

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Half of UK adults ‘don’t contact GP within six months of finding cancer symptom’

Half of UK adults with a possible cancer symptom do not contact their GP within six months, despite spotting changes to their body, research suggests.

A YouGov poll of 2,468 people for Cancer Research UK found that just 48% of those who had experienced a red flag symptom – including coughing up blood, unexplained weight loss and a new or unusual lump – contacted their GP within half a year.

Not telling a doctor about unusual health changes or possible cancer symptoms reduces the chances of an early cancer diagnosis, leading to potentially devastating outcomes.

Cancer Research UK’s chief executive Michelle Mitchell said: “Spotting cancer early is vital if more people are to survive, and the first step in that process is getting help for a possible cancer symptom.

“It’s really worrying to see such a large gap in accessing services between the UK’s most and least deprived groups.

“Earlier this year, the Government announced among its top priorities were improving early diagnosis of cancer and tackling health disparities.

“Cancer must remain a top priority and with the upcoming Health Disparities White Paper and 10-Year Plan for England, the new Health and Social Care Secretary has a huge opportunity to transform cancer survival with a clear and strong plan that works for all.”

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Source: The Independent, 10 August 2022

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Just four out of 1,100 lone worker alarms being used by trust workforce

A trust which rented 1,100 lone worker alarms has found just four were in use after a year.

Sussex Partnership Foundation Trust rented the system for five years, with the contract starting in early 2021. But a year later only 51 of the units were assigned to a user, and just four were being used.

Most of the users had not completed their training and 19 had not even logged into the system to set up a profile, according to an annual health and safety report covering 2021-22.

The health and safety report said: “Unfortunately the system has yet to demonstrate value for money as the uptake within services across the trust is very poor, despite the extensive work by the health and safety team to encourage uptake.” This had included demonstrating the system at multiple meetings and trying to raise awareness.

A spokesperson from Sussex Partnership Foundation Trust said: “The lone worker system is one of the ways we ensure the safety of our staff who work alone. It has taken time to embed the new system due to the changes in working practices during the pandemic. However, in recent months we have seen the number of staff actively using the system increasing."

“There is more we are doing to ensure wider take-up and implementation, through a programme of engagement and training.”

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Source: HSJ, 9 August 2022

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Birmingham: 'Action not reports' needed on healthcare racism

Action rather than reports is needed to tackle healthcare inequalities faced by black people in Birmingham, a charity says.

It follows a report which found people from black communities continued to face racism and discrimination when accessing treatment.

The city's director of public health said he was "horrified" by the finding. Dr Justin Varney said the system must be adapted to meet the needs of all.

Charity The First Class Foundation wants to see implementation of changes and says among the healthcare problems in need of tackling are "microaggressions" faced by communities.

The publication of the Birmingham and Lewisham African Health Inequalities Review followed an 18-month study commissioned by the areas' local authorities.

It found disadvantages among the communities in housing, pollution and availability of green space had "all contributed to worse health".

The report additionally highlighted how the communities were "exposed to structural racism and discrimination which leads to... chronic stress and trauma".

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Source: BBC News, 10 August 2022

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Doctors declare ‘lack of confidence’ in trust board

The medical body at Norfolk and Suffolk Foundation Trust has written to the trust’s chair saying that it is unable to provide safe care and expressing a lack of confidence in the board.

The letter, which has been seen by HSJ, is signed by 140 of doctors at the mental health provider. It claims the trust’s “clinical services are unable to provide good basic care and are unsafe”.

Significant criticism is reserved for the trust’s senior management, with the letter stating “there is a general dysfunction with perpetual changes of key staff in executive posts and ever increasing layers of management” and that “major decisions are frequently made by a handful of people at an executive level without clinical consultation”.

The letter continues: “Doctors are by and large used as clinical workhorses. Many carrying huge workloads and holding unacceptable clinical risks”.

The letter, first revealed by BBC Look East, asks for an urgent meeting with the chair and states that the medical body “lacks confidence in the executive board to resolve the plight of NSFT”.

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Source: HSJ, 10 August 2022

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Hospital asking nurses to clean wards ‘risky’ and shows ‘little respect’ for staff

Specialist nurses at an NHS hospital have been told they may be taken off clinical shifts to help clean wards, it has emerged.

Bedfordshire Hospitals NHS Foundation Trust has said it asked nursing staff to help clean wards as the hospital faced the “most challenging circumstances” it has ever faced.

Clinical specialist nurses, who are advanced nurses and can usually have hundreds of patients under their care, were among those asked to spend entire shifts helping other wards “cleaning”, “tidying” and “decluttering”.

The news has prompted criticism from unions, however, multiple nurses have reported that the requests happen “often” during winter.

Alison Leary professor of healthcare and workforce at South Bank University warned that asking specialist nurses to drop their work was “very risky”.

She said: “This problem keeps cropping up-as soon as there is pressure on wards they are expected to abandon their patients. It usually happens in winter and so it’s concerning that it has now started to happen in summer.

“This also shows very little respect for nursing generally and will not help retention. Trusts need to plan workforces accordingly and should ensure they have the right amount of cleaning, administrative and housekeeping staff-all staff groups which contribute to patient safety and care quality."

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Source: The Independent, 8 August 2022

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Virtual outpatient drive at heart of effort to end 78-week waits, says Mackey

Patients at trusts with long waiting lists should no longer think ‘they have to go to their local hospital’ for outpatient appointments, but should instead be offered virtual consultations elsewhere in the country where there is greater capacity, Sir Jim Mackey has told HSJ.

The NHS England elective chief said recent efforts to abolish two-year waiters by July had meant a “very big” surgical focus. However, the next phase of the elective recovery plan would see a major shift of emphasis onto reducing the wait for outpatient appointments.

Sir Jim said: “Providers have been split into tiers again with tier one having national oversight and tier two, regional oversight. Behind that we will be pairing up organisations so that organisations with capacity can help those with the biggest challenges from a virtual outpatient perspective.

He added: “There still is a lot to work through [on virtual outpatients], we’re going to be testing the concept… We need to work through how all the wiring and plumbing needs to work. For example, what happens if the patient needs a diagnostic locally, having seen a clinician virtually in another part of the country?

“It would be great also to try and stimulate more of a consumer drive on this – encouraging patients to ask about virtual outpatients when the waits locally may be too long, so they don’t just think they have to go to their local hospital. I think this could really help shift the model if we can get it right.”

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Source: HSJ, 9 August 2022

 

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US doctor issues warning of many undiagnosed polio cases

A health official in New York State has told the BBC there could be hundreds or even thousands of undiagnosed cases of polio there.

It follows an announcement last month that an unvaccinated man had been paralysed by the virus in Rockland County, New York. His case has been linked genetically to traces of polio virus found in sewage in London and Jerusalem.

Developed countries have been warned to boost vaccination rates.

Dr Patricia Schnabel Ruppert, health commissioner for Rockland County, said she was worried about polio circulating in her state undetected.

"There isn't just one case of polio if you see a paralytic case. The incidence of paralytic polio is less than 1%," she said.

"Most cases are asymptomatic or mildly symptomatic, and those symptoms are often missed. So there are hundreds, perhaps even thousands of cases that have occurred in order for us to see a paralytic case."

"This is a very serious issue for our global world - it's not just about New York. We all need to make sure all our populations are properly vaccinated," she said.

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Source: BBC News, 9 August 2022

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Patients to wait longer for routine checks so NHS can clear record backlogs

NHS patients will wait longer for routine checks as part of a national drive to clear record backlogs.

Health officials have instructed hospitals to “repurpose” resources to focus on those waiting the longest, who are yet to have their first appointment. 

Today the NHS claimed it had “virtually eliminated” two year waits, with less than 3,000 people enduring such delays, down from 22,500 at the end of January.

Hospitals are being urged to prioritise those waiting 18 months or more, with pledges to get rid of such waits by April next year.

NHS chiefs have instructed hospitals to focus on outpatient first appointments, rather than patients who have already had treatment, and are waiting for follow-up checks.

Senior officials have said many such appointments are a “a waste of time” saying there should be more use of systems where routine slots are scrapped, and patients instead told to contact their medical team if they have particular concerns. 

The drive - which health chiefs dubbed “Super September” - will see priority given to tackling the longest waits. 

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Source: The Telegraph, 9 August 2022

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One in 25 heart attack deaths in north-east of England ‘preventable in London’

One in 25 people who die of a heart attack in the north-east of England could have survived if the average cardiologist effectiveness was raised to the London level, research shows.

The research, undertaken by the Institute for Fiscal Studies (IFS), looked at the record of over 500,000 NHS patients in the UK, over 13 years. It highlights the stark “postcode lottery” of how people living in some parts of the country have access to lower quality healthcare.

The results found that while cardiologists treating patients in London and the south-east had the best survival rates among heart attack patients, patients being treated in the north-east and east of England had the worst.

Among 100 otherwise identical patients, an additional six patients living in the north-east and east of England would have survived for at least a year if they had instead been treated by a similar doctor in London.

Furthermore, if the effectiveness of doctors treating heart attacks in these areas of the country were just as effective as the cardiologists in London, an additional 80 people a year in each region would survive a heart attack.

The research also revealed a divide between rural and urban areas of England, with patients living in the former typically receiving treatment from less effective doctors compared with those in more urban areas.

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Source: The Guardian, 9 August 2022

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Child deaths expose mental health unit pressures

Deaths, staff shortages and a culture of life-threatening self-harm are exposing deep fears about the quality of mental health care in hospitals for children and young people.

Since 2019, at least 20 patients aged 18 or under have died in NHS or privately-run units, the BBC has found.

A further 26 have died within a year of leaving units, amid claims of a lack of ongoing community support.

The NHS said it had "invested record amounts... to meet record demand".

Child and Adolescent Mental Health Services (CAMHS) units look after about 4,000 patients with many different diagnoses each year. The aim is to help them recover over a period of weeks or months through specialist care. Some patients are in and out of the units for years.

The BBC has also heard serious claims regarding the unsafe discharge of patients sent home from CAMHS hospitals.

Several former patients told the BBC they had serious self-harm incidents or tried to take their own life within days of returning home.

Parents have described being on "suicide watch" 24 hours a day, to ensure their child's safety.

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Source: BBC News, 9 August 2022

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NHS backlog of two-year waits for routine surgery in England shrinks to below 200

The backlog of people waiting more than two years for a routine operation in England has shrunk from 22,500 at the start of the year to fewer than 200.

NHS England figures show the number of patients waiting that length of time has fallen to just 168, excluding more complex cases.

Staff have been praised for carrying out the NHS elective recovery plan, published this year to tackle backlogs built up during the coronavirus pandemic.

At the start of the year, more than 22,500 people had been waiting two years or longer for scans, checks and surgery. A further 51,000 who would have passed the two-year mark by the end of July have also been treated, figures show.

The NHS England chief executive, Amanda Pritchard, said: “It has only been possible because the NHS has continued to reform the way we deliver care, using innovative techniques and adopting pioneering technology like robot surgery, and through building new relationships and mutual aid arrangements across systems to offer patients the opportunity to be transferred elsewhere and get the care they need as quickly as possible.

“The next phase will focus on patients waiting longer than 18 months, building on the fantastic work already done, and, while it is a significant challenge, our remarkable staff have shown that, when we are given the tools and resources we need, the NHS delivers for our patients.”

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Source: The Guardian, 9 August 2022

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Britain really isn’t working – and the collapsing NHS is to blame

After lockdown raided the savings of hairdresser and gym instructor Lucie Wilby, a lengthy wait for a hip replacement dealt another blow to her family’s finances.

“We’re in a lot of debt because of it and that’s a combination of Covid and obviously surgery [and] waiting times,” the 53-year-old mother from Cornwall says. 

“If I hadn’t had to wait six months, we’d be nowhere near this issue.”

Like many of the 6.6 million people on an NHS waiting list, work had become painful and eventually impossible for Wilby as the backlog in treatment forces people to cut their hours or stop employment altogether. 

“By the time of the operation, I was barely walking and I’m self employed,” she says. 

“It took about three years to get diagnosed. That’s one of the major problems – it’s not just the waiting time for the operation once you’re on the list, it’s the waiting time for diagnosis.”

While tax cuts and even trans issues may have stolen the limelight in the Tory leadership race, the struggle to get a grip of record NHS backlogs post-Covid is having a huge economic, as well as human, cost.

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Source: The Times, 7 August 2022

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Man with diabetes died after GPs ‘failed to spot deteriorating health’

A 27-year-old man died from complications linked to diabetes after GPs failed to properly investigate his rapidly deteriorating health.

Lugano Mwakosya died on 3 October 2020 from diabetic ketoacidosis, a build-up of toxic acids in the blood arising from low insulin levels, two days before he could see a GP in person.

His mother, Petronella Mwasandube, believes his death could have been avoided if doctors at Strensham Road Surgery, in Birmingham, had given “adequate consideration” to Lugano’s diabetic history and offered face-to-face appointments following phone consultations on 31 July and 16 and 30 September.

An independent review commissioned by NHS England found two doctors who spoke to Lugano did not take into account his diabetes or “enquire in detail and substantiate the actual cause of the patient’s symptoms”.

The review raised concern over the “quality and brevity” of the phone assessments and said the surgery should have offered Lugano an in-person appointment sooner.

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Source: The Independent, 7 August 2022

 

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Ysbyty Glan Clwyd: Stroke patients would rather go to England

People would rather go to England if they had a stroke than use the A&E at a north Wales hospital, a health watchdog has said.

Inspectors said there was a "clear and significant risk to patient safety" after inspections at the department in Ysbyty Glan Clwyd, Denbighshire.

North Wales Community Health Council's Geoff Ryall-Harvey said it was the "worst situation" they had seen.

The report said inspectors found staff who were "working above and beyond in challenging conditions" during a period of "unrelenting demand". Many staff told them they were unhappy and struggling to cope. They said they did not feel supported by senior managers.

However inspectors said that the health board was not fully compliant with many of the health and care standards, and highlighted significant areas of concern, which could present an immediate risk to the safety of patients, including:

  • Doctors were left to "come across" high-risk patients instead of being alerted to them.
  • Patients were not monitored enough - including a suspected stroke patient and one considered a suicide risk.
  • Children were at serious risk of harm as the public could enter the paediatric area unchallenged.
  • Inspectors found evidence of children leaving unseen or being discharged against medical advice.

Betsi Cadwaladr health board said it was committed to improvements.

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Source: BBC News, 8 August 2022

 

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New IT system harms trust’s cancer performance for six months

A trust which is struggling with a new electronic patient record (EPR) is likely to see cancer performance affected for at least the rest of this year, it has said.

Ashford and St Peter’s Hospitals Foundation Trust has set up eight workstreams to ensure its EPR – supplied by Oracle Cerner – is “functioning safely, efficiently and as effectively as possible” after a host of problems since it went live in May. Cancer areas affected include breast, breast symptomatic two week waits, and dermatology.

“It is expected that the impact of the introduction of SSC [Surrey Safe Care, the name of the project] will be felt in aspects of our cancer performance until at least December 2022,” July’s board meeting was told.

The performance report warned the risk of delays causing harm to cancer patients – currently rated at 12 on the risk register – was being reviewed as a result of the introduction of SSC and was expected to rise. 

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Source: HSJ, 8 August 2022

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Armed police sent to heart attack patients as crisis-hit NHS buckles under surging demand

Armed police are being sent to save the lives of people in cardiac arrest because ambulances “can’t cope” with demand, The Independent has revealed.

Officers are spending up to a third of their time on non-policing matters, a watchdog has warned, including responding to mental health crises and transporting patients to A&E as ambulance services face a “chronic crisis situation”.

Andy Cooke, HM chief inspector of constabulary, said that firearms officers have been responding to pleas from struggling NHS colleagues to respond to cardiac arrests.

He told The Independent that police are becoming the “first, last and only resort” as NHS services buckle under strain, taking them away from tackling crime at a time when recorded offences are at a record high in England and Wales.

Mr Cooke, the former chief constable of Merseyside Police, added: “Recently, officers in armed response vehicles (ARVs) were being sent to reports of people who were having cardiac arrests because the ambulance service couldn’t cope with the demand, because they’re trained in first aid and to use defibrillators."

“The ambulance service contacted the police to say ‘we’ve got this heart patient and we haven’t got anyone to send’."

“Being first, last and only resort, the police will go. It’s right that they did go but that hides the problems we’ve got in the rest of the system.”

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Source: The Independent, 8 August 2022

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Multiple reporting systems undermine patient safety, says watchdog

A single system to report patient safety concerns would “keep people safer”, a newly appointed NHS watchdog has told HSJ.

Henrietta Hughes – who will take up the post of patient safety commissioner in September – said both clinicians and patients faced a bewildering choice when looking to raise a safety concern, and that there was a need for a “report once” system.

She said that when ”exhausted” clinicians “come to the end of a 12-hour shift, they don’t want to have to do a Datix report and a yellow card report, and if they’ve got a safeguarding concern or a concern about an individual condition, [to have to] send that somewhere else”.

Dr Hughes added: ”Wouldn’t it be better if we had one report that you do, and all the information that comes from that report just gets sent to the appropriate authority? That’s the type of change that I think we’d like to see. I know, as a GP myself, that’s what I would rather do as a professional. But also, I think, for all the organisations, we could get so much more richness of information, we would get more reporting, and we’d keep people safer as a result of it.”

She added that if a patient “wanted to report an individual clinician” they often ended getting bounced around the system, like a pinball. They get sent from pillar to post.”

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Source: HSJ, 8 August 2022

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