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Huge variation in referrals to flagship ‘urgent response’ service

Ground breaking new data on community services appears to show enormous variation between areas in the number of referrals for a “two-hour urgent response” being recorded. 

NHS England has published new provisional data on the performance of urgent community response services against a key NHS long-term plan target of reaching at least 70% of patients referred to them within two hours by December 2022.

It is the first time performance data has been published for community health services.

It also includes the number of referrals made which are reported as “in scope” of the target, and the total number of service contacts. There is huge variation in both referrals and contacts, not accounted for by the size of areas or population need. 

The publication of the first national performance data for community services was described as “an important moment for community providers” by Siobhan Melia, chair of the Community Network, which is part of NHS Providers and the NHS Confederation. She added it would “raise the profile of community services, and shine a light on the important work taking place in the sector”.

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Source: HSJ, 21 June 2022

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Surgical mesh: Proposed training pathway needs more patient input, say campaigners

A proposed new training pathway for treating complications of pelvic mesh implants needs more input from patients and more consistent supervision of surgical procedures being carried out, campaigners have urged.

The pathway proposed by the Royal College of Obstetricians and Gynaecologists (RCOG) aims to outline the skills required of doctors working in specialist mesh removal centres, which were set up after a recommendation in the Cumberlege review into avoidable harm among patients injured by implanted pelvic mesh.

But a joint blog published on 17 February by Patient Safety Learning and Sling the Mesh raised several concerns about the proposed pathway, including that the consultation for implementing it was too short and not well publicised, offering limited opportunities for patients and groups to comment.

The groups wrote, “While the development of the training pathway did involve a focus group of six women with mesh related issues, we believe that RCOG have missed an opportunity to engage much more widely."

“Patient engagement is key to improving patient safety, even more so when there has been a significant loss of trust for patients in healthcare professionals, such as in the case of surgical mesh. We believe it is vital that RCOG, further to its focus group, should be engaging directly with patient groups to hear their concerns and experiences and to genuinely co-produce this type of guidance.”

Jo Mountfield, vice president of the RCOG, said that the concerns raised by the groups would be considered as part of the review process. She acknowledged that the consultation period could have been longer.

She said, “There will be further opportunity to involve patient groups as part of our application to the General Medical Council for approval of the training pathway, and we will take the comments raised in this blog on board."

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Source: BMJ, 17 February 2022

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'More help needed' to make patient info accessible

People with disabilities must be helped more by health providers to access information, a report has found.

Over 300 people in North Yorkshire were asked about communication from GPs, hospitals, and healthcare providers in a survey by watchdog Healthwatch.

The report said there is "some good practice" but many patients are not being contacted in their preferred format. This leads to missed appointments which "costs time and money".

Since 2016, the Accessible Information Standard means health and care organisations must legally provide a "consistent approach to identifying, recording, flagging, sharing, and meeting the information and communication support needs of patients, service users, carers and parents with a disability, impairment, or sensory loss," Healthwatch said.

But the report said some people receive printed letters which they are unable to read meaning they have to ask for private and confidential information to be relayed.

Scarborough respondent Ian said it was "amazing" that in the 21st Century many are still facing such issues.

"The [GP booking] system doesn't anticipate that not everyone can use the phone," he said.

"The problem is a lot of organisations haven't moved with the times".

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Source: BBC News, 21 June 2022

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Hundreds of stillbirths wrongly certified as 'unexplained'

More than 80% of UK medical certificates recording stillbirths contain errors, research reveals.

More than half the inaccurate certificates contained a significant error that could cause medical staff to misinterpret what had happened.

The study, published in the International Journal of Epidemiology, also shows that three out of four stillbirths certified as having an "unknown cause of death" could, in fact, be explained.

A team from the Universities of Edinburgh and Manchester examined more than 1,120 medical certificates of stillbirths, which were issued at 76 UK obstetric units in 2018. 

Of the 421 which were resolved, 195 were re-designated as foetal growth restriction (FGR), and 184 as placental insufficiency.

Dr Michael Rimmer, clinical research fellow at Edinburgh University’s MRC Centre for Reproductive Health, said: “This study shows some medical certificates of stillbirths contain significant errors.

"Reducing these errors and accurately recording contributing factors to a stillbirth is important in shaping research and health policies aimed at reducing the number of stillbirths.

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Source: The Herald, 21 June 2022

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Government to pick ‘integration frontrunners’ to test ‘radical new approaches’

Government will pick five or six ‘integration frontrunner’ areas ‘to lead the way in developing and testing radical new approaches’ to speeding up discharge from acute hospitals.

Along with NHS England, ministers today wrote to local NHS and council directors asking for bids to take part by 30 June.

They said there was “a need to take a more fundamental look at [how the] system currently manages the discharge of patients, their post-acute care, and their access to high-quality social care”.

The “discharge integration frontrunner sites” will focus on exploring “new service models, such as the delivery of a more integrated model for intermediate care across existing health and social care”, and “designing and testing new enabling arrangements, which might include new funding models, more integrated workforce models, or the deployment of new technologies”, their letter said.

They said speeding up hospital discharge was “just one” potential benefit from integration and indicated that “future phases” of frontrunners may focus elsewhere.

But delayed discharge has been a major pressure on the system over the past year, particularly last winter, and the letter says: “Delayed discharges are one very visible signal that the health and care system remains fragmented and too often fails to deliver joined-up services that meet people’s needs.”

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Source: HSJ, 21 June 2022

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Dementia patients not allowed to use toilet

Heather Lawrence was shocked at the state she found her 90-year-old mother, Violet, in when she visited her in hospital.

"The bed was soaked in urine. The continence pad between her legs was also soaked in urine, the door wide open, no underwear on. It was a mixed ward as well," Heather says.

"I mean there were other people in there that could have been walking up and down seeing her, with the door wide open as well. My mum, she was a very proud woman, she wouldn't have been wanted to be seen like that at all."

Violet, who had dementia, was taken to Tameside General Hospital, in Greater Manchester, in May 2021, after a fall. Her health deteriorated in hospital and she developed an inflamed groin with a nasty rash stretching to her stomach - due to prolonged exposure to urine. She died a few weeks later.

Heather tells BBC News: "I don't really know how to put it into words about the dignity of care. I just feel like she wasn't allowed to be given that dignity. And that's with a lot of dementia patients. I think they just fade away and appear to be insignificant, when they're not."

New research, shown exclusively to BBC Radio 4's File on 4 programme, has found other dementia patients have had to endure similar indignity.

Dr Katie Featherstone, from the Geller Institute of Ageing and Memory, at the University of West London, observed the continence care of dementia patients in three hospitals in England and Wales over the course a year for a study funded by the National Institute for Health and Care Research.

She found patients who were not helped to go to the toilet and instead left to wet and soil themselves.

"We identified what we call pad cultures - the everyday use of continence pads in the care of all people with dementia, regardless of their continence but also regardless of their independence, as a standard practice," Dr Featherstone says.

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Source: BBC News, 21 June 2022

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Henrietta Hughes is preferred candidate for the role of Patient Safety Commissioner

Henrietta Hughes has been named as the government’s preferred candidate for the role of Patient Safety Commissioner.

Sajid Javid, the Secretary of State for Health and Social Care, has today, 20 June 2022, invited the Health and Social Care Committee to hold a pre-appointment scrutiny hearing with Henrietta.

Henrietta is a practising GP with a background in women’s health who was the National Guardian for the NHS until 2021. In addition to her clinical work, she is an appraiser for NHS England and Chair of Childhood First.

She was selected following an open public appointment process to appoint the first Patient Safety Commissioner.

Following the select committee hearing, the committee will set out its views on the candidate’s suitability for the role. The Secretary of State will then consider the committee’s report before making a final decision on the appointment.

Source: Gov.UK, 20 June 2022

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USA: Boston Scientific faces vaginal mesh lawsuit alleging Obtryx II exposed patients to unreasonable risk of problems

Women continue to file vaginal mesh lawsuits against Boston Scientific and other manufacturers, years after most products were removed from the market due to an alarming number of complications and health risks associated with the designs.

In a complaint (PDF) filed last month in the U.S. District Court for the Southern District of Indiana, Tanya Davis indicates that problems with Boston Scientific Obtryx II mesh placed in her body only four years ago has left her with severe injuries, including pelvic pain and dyspareunia, abdominal pain, urinary problems, prolapse and incontinence. The lawsuit names Boston Scientific Corporation as the defendant.

Transvaginal mesh products like the Obtryx II have been marketed and sold by Boston Scientific Corporation and a number of different companies over the past decade, for treatment of pelvic organ prolapse or female stress urinary incontinence. Most of the products were introduced under a controversial FDA “fast track” approval process, which allowed manufacturers to introduce new products based on the design of prior mesh, without conducting thorough research to evaluate the safety or effectiveness of the specific designs.

Following widespread reports of vaginal mesh complications, including infections, erosion of the mesh into the vagina and organ perforation, the FDA required manufacturers to conduct post-marketing research and most companies decided to withdraw their products.

According to the lawsuit, Davis received an Obtryx II System in May 2018, to treat her urinary incontinence. However, after experiencing painful and debilitating complications, Davis had vaginal mesh explanted in May 2020; just two years after it was implanted.

“Neither Plaintiff nor her physicians and/or healthcare providers were warned that the Obtryx II was unreasonable dangerous or of the risks of the product, outlined herein, even when used exactly as intended and instructed by Defendant,” the lawsuit indicates. “To the contrary, Defendant promoted and sold the type of product implanted in the Plaintiff and thousands of women like Plaintiff, to healthcare providers as a safe alternative to other procedures that did incorporate Defendant’s products.”

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Source: About Lawsuits, 10 May 2022

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Patient safety incidents are the third leading cause of death in Canada

The COVID-19 crisis has both divided and galvanised Canadians on healthcare. While the last three years have presented new challenges to healthcare systems across the country, the pandemic has also exacerbated existing challenges, most notably the high levels of errors and mistreatment documented in Canadian health care.

According to a 2019 report from the Canadian Patient Safety Institute, Canada was already facing a public health crisis prior to the pandemic: a crisis of patient safety. As the report details, patient safety incidents are the third leading cause of death in Canada, following cancer and heart disease.

Few studies calculate national data on this topic, but a 2013 report found that patient safety events resulted in just under 28,000 deaths. Many Canadians who have experienced these errors have shared their experiences with media in an effort to raise awareness and demand change.

The impact of the COVID-19 pandemic has created a moment of dual crises. First, the pre-existing crisis of patient safety, and second, healthcare overall is now at a breaking point after three years of COVID-19, according to healthcare workers.

Edmonton physician Dr. Darren Markland, for example, recently closed his kidney specialist practice after making a few "profound mistakes." In an interview with Global News, he explains he could no longer work at the current pace.

He is not alone in this decision. Across the country, there have been waves of resignations in health care, leaving some areas struggling with a system that is "degrading, increasingly unsafe, and often without dignity."

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Source: MedicalXpress, 17 June 2022

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Violence against ambulance staff in England at record high

Violence against ambulance staff in England has reached a record high, as the NHS crisis in emergency care continues to deepen.

An estimated 12,626 incidents were reported in the 12 months to April 2022, according to nationwide data shared with The Independent – a 7% rise on the previous year.

However, since 2016, the number of paramedics who have been verbally or physically assaulted, or threatened with assault, has nearly doubled, rising from 7,689.

Adam Hopper, the national ambulance violence prevention and reduction lead for the Association of Ambulance Chief Executives (AACE), which provided the data, said the findings “confirm the worrying trend of increasing violence against ambulance staff”.

One paramedic told The Independent a bone was broken in his neck after he was strangled by a drunken patient he was attempting to treat.

Matthew Taylor, chief executive of the NHS Confederation, a membership body for trusts in England, said that alcohol is the most prominent factor in such assaults, followed by drugs and people being in mental health crisis. “Race and sexuality have also increased as exacerbating factors in these assaults, as have delays to treatment and arrival times,” he added.

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Source: The Independent, 19 June 2022

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Newborn infection trial ‘will fail’ unless Government intervenes, experts warn

A clinical trial to test pregnant women for Group B Strep (GBS) – the most common cause of life-threatening infection in newborn babies – will fail unless the Government intervenes, experts have warned.

Some 80 hospitals are needed for the trial to go ahead but only 32 have committed to it, with a deadline for registering of September.

The trial is being funded by the National Institute for Health Research (NIHR) and will look at whether testing women for Group B Strep reduces the risk of babies dying or suffering harm.

Now Dr Jane Plumb, chief executive of Group B Strep Support, who lost her son Theo to the infection, is calling on the Government and NHS England to intervene to make sure the trial goes ahead.

She said: “The reality is that unless a further 48 hospitals sign up for this trial, then it will fail.

“The Government is waiting for the results from this trial to determine whether to test pregnant women for Group B Strep.

“Yet there seems to be little acknowledgement that this trial is heading towards failure.

“We need more hospitals on board and we need to make sure that the investment in this trial is not wasted.

“This is about saving the lives of babies, and it really is now or never.”

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Source: The Independent, 20 June 2022

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Thousands of women given ‘dangerous’ electric shocks as mental health treatment in England

Thousands of women in England with mental health problems are being given electric shock treatment despite concerns the therapy can cause irreparable brain damage.

NHS data seen by The Independent reveals the scale of electroconvulsive therapy (ECT) prescribed disproportionately to women, who make up two-thirds of patients receiving the treatment.

Health professionals have warned the therapy can cause brain damage so severe recipients are unable to recognise family and friends or do basic maths.

While some patients say the therapy profoundly helped them, leading mental charities have branded it “damaging” and “outdated” and called for its use to be halted pending an urgent review or banned entirely.

Statistics obtained through Freedom of Information requests by Dr John Read, a professor at the University of East London and leading expert on ECT, showed 67% of 1,964 patients who received the treatment in 2019 were female.

ECT was given to women twice as often as men across 20 NHS trusts in the UK, his research found. The trusts also said some 36% of their patients in 2019 underwent ECT without providing consent.

A spokesperson added patients should be fully informed of the risks associated with ECT and the decision to deploy the treatment “should be made jointly with the person with depression as far as possible”.

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Source: The Independent, 19 June 2022

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Epilepsy drug that harms babies may damage their children too

An epilepsy drug that caused disabilities in thousands of babies after being prescribed to pregnant women could be more dangerous than previously thought.

Sodium valproate could be triggering genetic changes that mean disabilities are being passed on to second and even third generations, according to the UK’s medicines regulator.

The Medicines and Healthcare Products Regulatory Agency (MHRA) has also raised concerns that the drug can affect male sperm and fertility, and may be linked to miscarriages and stillbirths.

Ministers are already under pressure after it emerged in April that valproate was still being prescribed to women without the legally required warnings. Six babies a month are being born after having been exposed to the drug, the MHRA has said. It can cause deformities, autism and learning disabilities.

Cat Smith, the Labour chairwoman of the all-party parliamentary group on sodium valproate, said: “This transgenerational risk is very concerning. There have been rumours that this was a possibility, but I had never heard it was accepted until last week by the MHRA."

“The harm from sodium valproate was caused by successive failures of regulators and governments, and this news means it could be an order of magnitude worse than we first thought. It underlines the need for the Treasury to step up to their responsibilities around financial redress to those families.”

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Source: Sunday Times, 19 June 2022

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MHRA joins international partnerships to set global standards for medicines and medical devices regulation

The UK is set to play a greater international role in making sure medicines and medical devices are regulated safely and efficiently worldwide, the Medicines and Healthcare products Regulatory Agency (MHRA) announced after being accepted as a full member of three international work-sharing partnerships.

Two of these, the International Medical Device Regulatory Forum (IMDRF) and the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) are focused on improving the harmonisation and convergence of medicines and medical devices regulation globally.

Through these partnerships, the MHRA will share expertise with other leading organisations, support the development of regulatory guidelines and drive greater harmonisation of regulation around the world. This will help deliver timely access to innovative medical products not just in the UK but globally.

The MHRA has also been accepted as a member of the US-based Medical Devices Innovation Consortium (MDIC). This public-private partnership brings together representatives of regulatory bodies, industry, non-profits, and patient organisations from different countries to improve the processes for development, assessment, and review of new medical technologies. This enables transformational medical technology to get to the people who need it sooner, by shortening the path from innovation to safety to access.

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Source: Gov.uk, 16 June 2022

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Man paralysed from neck down ‘not eligible’ for night-time care

A quadriplegic man was told his care funding would be revoked, after NHS officials deemed him not disabled enough to qualify for support.

Simon Shaw, 54, has received 24-hour care since he was left paralysed from the neck down after a car accident in 1984.

He relies on carers at night to help him with everything from turning in bed to having a drink of water. They also intervene with medical aid if he develops life-threatening complications related to his paralysis, which could happen at any time, without warning.

But a recent NHS assessment controversially ruled Shaw’s health needs were not severe enough to warrant full-time medical care. Local health authority officials told him he did not meet eligibility criteria and his NHS funding would be stopped from 20 June.

Shaw, from Clapham, south London, said that meant there was no money for his night-time care and he would be left unsupported from 8pm to 8am for the first time in nearly four decades.

“It’s frightening, to be honest,” Shaw said. “I don’t know what I’m going to do when they take my care away.

“I don’t cease to exist after 8pm. I still need to get into bed, have a drink of water and use the toilet – and I can’t do any of it on my own.

“There are a lot of things that can go wrong with my health and when they do, they usually need urgent attention. If there’s no one there, to be frank… it could mean death.”

Mandy Jamieson, a caseworker for the Spinal Injuries Association, said: “We have noticed an increase in patients with severe disabilities being turned down for funding in recent years, particularly since the introduction of assessments via video call since the pandemic.

“But I feel particularly in Simon’s case the decision that has been made is wrong. He has so many health needs that I find it incredible that they turned him down.”

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Source: The Guardian, 19 June 2022

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Coeliac patient died after being fed Weetabix in hospital, inquiry hears

An 80-year-old woman with coeliac disease died within days of being fed Weetabix in hospital, an inquest has heard.

Hazel Pearson, from Connah’s Quay in Flintshire, was being treated at Wrexham Maelor hospital and died four days later on 30 November from aspiration pneumonia. Although her condition was recorded on her admission documents, there was no sign beside her bed to alert healthcare assistants to her dietary requirements.

Coeliac disease is a condition where the immune system attacks the body’s own tissues after consuming gluten, a type of protein found in wheat, rye and barley, causing damage to the small intestine.

The hospital’s action plan to avoid similar fatal incidents lacked detail and had “narrow vision”, the coroner said.

The hospital’s matron, Jackie Evans, told the inquest that changes, including placing signs above the beds of patients with special dietary requirements, had been implemented since Pearson’s death. But Sutherland raised concerns that the hospital had yet to carry out a formal investigation into what went wrong.

She said: “The action plan lacks detail. What has happened locally is commendable, but it lacks detail and it has narrow vision.” She added that the plan that had been put in place was “amateurish with no strategic vision”.

The assistant coroner said she would be unable to make a decision on a prevention of future deaths report until the Betsi Cadwaladr University Health Board (BCUHB) provided a witness to answer further questions about changes.

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Source: The Guardian, 17 June 2022

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'Urgent' changes needed for child disability care

The mothers of two teenage boys who died after failures in their care have called on the government to make "urgent improvements" to how children with disabilities are assessed.

Sammy Alban-Stanley, 13, and 14-year-old Oskar Nash both died in 2020. Inquests for both boys recorded they had received inadequate care from local authorities and mental health services.

The calls were made in an open letter to the secretaries of state for health and social care, and education.

Patricia Alban and Natalia Nash asked Sajid Javid and Nadim Zahawi to make fundamental changes to several care areas to prevent future deaths.

The pair said they both experienced problems with support for disabled children and families.

Services lacked understanding of neurological conditions like autism, they said.

The pair also pointed to a lack of access to children and adolescent mental health services (CAMHS), and failure to assess or review the severity of a child's developing needs.

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Source: BBC News, 16 June 2022

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Almost 100,000 facing excessive wait for serious cardiac care in England

Almost 100,000 people with serious heart problems, including some “living on borrowed time”, are enduring long waits for potentially life-saving NHS care because hospitals are so busy.

Some of them are in such poor health they will have a heart attack and die as a consequence of facing such “dangerous” long delays, the British Heart Foundation has warned.

The number of patients in England being forced to wait more than the supposed maximum 18 weeks for cardiac treatment has trebled since Covid-19 struck, from 32,186 in February 2020 to an unprecedented 96,321, a BHF analysis of published NHS England data shows.

They are waiting for procedures such as having a stent or balloon inserted to reopen a blocked artery, a pacemaker or implantable defibrillator fitted, or open heart surgery, including bypasses or valve replacement operations. Others urgently need to have an echocardiogram, CT or MRI scan to help doctors decide on treatment.

Dr Sonya Babu-Narayan, a consultant cardiologist who is also the BHF’s associate medical director, said: “Cardiac care can’t wait. Without timely treatment, heart patients may be living on borrowed time.”

“Tens of thousands of people feel in limbo, waiting many months or even years for cardiac surgery, invasive heart procedures or important diagnostic tests. During this time they could quite quickly become much sicker, and tragically some could even die before they can receive the heart care they so desperately need,” she added.

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Source: The Guardian, 16 June 2022

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Sweden: surgeon convicted of bodily harm over synthetic trachea transplant

A Swedish court has found an Italian surgeon, once hailed for pioneering windpipe surgery, guilty of causing bodily harm to a patient, but cleared him of assault charges.

Paolo Macchiarini won praise in 2011 after claiming to have performed the world’s first synthetic trachea transplants using stem cells while he was a surgeon at Stockholm’s Karolinska University hospital. The experimental procedure was hailed as a breakthrough in regenerative medicine.

But allegations soon emerged that the procedure had been carried out on at least one person who had not been critically ill at the time of the surgery.

During the May trial, held in the Solna district court, prosecutors argued that the surgeries on three patients in Sweden constituted assault, or alternatively bodily harm due to negligence, as Macchiarini disregarded “science and proven experience”.

The district court agreed with the prosecutors, but cleared Macchiarini on two counts as the patients’ health was in such a dire state. “Given the patients’ condition, the district court finds that the procedures on the first two patients were justifiable,” it said in a statement.

However, in the third patient, the court found him guilty of "causing bodily harm". 

"At the time of the third procedure, the experience from the first procedures was such that the surgeon should have refrained from letting yet another patient go through the operation", the court said.

Macchiarini was handed a suspended sentence.

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Source: The Guardian, 16 June 2022

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England appoints ambassador to shake up women's health

England's first women's health ambassador is calling for "one-stop shops" where women can sort out their health needs.

Dame Lesley Regan, also a practising doctor, wants to make it easier for women and girls to access care such as contraception and smear tests in the community.

Her new role aims to close the "gender health gap". She will also support the upcoming government-led women's-health strategy.

"At the moment, we waste a lot of resource in telling girls and women that they cannot have things," she told BBC News.

"So you might go off to your doctor or gynaecologist or heart specialist and get told, well, you cannot have a smear here, even if it is due, or you need to go somewhere else for this, that and the other.

"We should make it very, very easy for people to access this out in the community - why do you need to go to a secondary or tertiary facility for things that are very easy to provide?"

Instead, she wants health hubs where women could "go for half a day and get all these things sorted out" and then get on with their lives.

"A one-stop shop is what I want for myself and what I want for my daughters and I'm sure it is what every other girl and woman wants and what every man and boy wants for the women in their lives, to be looked after that way," Dame Lesley said.

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Source: BBC News, 17 June 2022

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Over half of ethnic minority NHS leaders consider quitting due to racism

Just over half of senior ethnic minority leaders have considered leaving the NHS due to experiencing workplace racism a survey suggests.

The survey was carried out by the NHS Confederation’s BME Leadership Network and its 123 respondents included chief executives, directors and senior managers.

Responses were collected from network members online before three roundtables were held with senior ethnic minority leaders to understand their experiences and the challenges they have faced in relation to discrimination.

The survey found:

  • 51% of respondents said they had considered leaving the NHS in the past three years because of their experience of racist treatment while working.
  • More than 20% said they had experienced verbal abuse or abusive behaviour targeting racial, national or cultural heritage five times or more in the last three years.
  • 69% had experienced this behaviour from other leaders or managers within their organisation at least once in the same timeframe.
  • 57% had experienced it from leaders or managers in another organisation at least once over the same period.

Joan Saddler, NHS Confederation’s director of equality and partnerships, said the NHS was at risk of losing “committed, highly skilled and motivated talent to institutional racism and discrimination”.

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Source: HSJ, 17 June 2022

You may also be interested in reading: BMA: Racism in medicine

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Rail strikes ‘will kill people’, warns NHS leader

Next week’s rail strikes will ’probably end up killing people’ as they will prevent staff working for already struggling ambulance trusts from getting to work, a senior NHS leader has told HSJ.

Both London Ambulance Service Trust and South Central Ambulance Service Foundation Trust have moved to ”Reap 4”, This is the highest level of alert, meaning they are under extreme pressure. 

Ambulance trusts are already experiencing high demand amid soaring temperatures and continuing problems with lengthy handovers at the accident and emergency departments. Fears are now growing that next week’s rail strikes will push services to breaking point as many ambulance staff travel to work by public transport.

The three days of rail strikes – on Tuesday, Thursday and Saturday next week – will see many lines with very limited services. Tube services in London will also be hit by a strike on Tuesday and the London Overground and some tube lines will be affected on rail strike days. 

A senior leader closely involved in southern England’s emergency and urgent care services told HSJ: “Next week’s rail strikes will probably end up killing people because they’ll prevent ambulance trust staff getting to work.”

Other ambulance trusts are understood to be monitoring the situation closely. Trusts in REAP 4 (REAP stands for resource escalation action plan) normally take a series of measures including diverting more staff to frontline duties, asking some patients to make their own way to hospital and concentrating on reaching the most serious patients.

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Source: HSJ, 16 June 2022

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Doctors warn against over-medicalising menopause after UK criticism

Doctors have hit back at critics saying they are failing menopausal women, and said that treating menopause as a hormone deficiency that requires medical treatment could fuel negative expectations and make matters worse.

Writing in the British Medical Journal they said there was an urgent need for a more realistic and balanced narrative which actively challenges the idea that menopause is synonymous with an inevitable decline in women’s health and wellbeing, and called for continued efforts to improve awareness about the symptoms and how to deal with them.

“Menopause is a natural event for half of humankind. While media attention in the UK may give the impression that growing numbers of women are struggling to cope with menopausal symptoms and are seeking hormonal treatment, there is no universal experience and most women prefer not to take medication unless their symptoms are severe,” wrote Martha Hickey, a professor of obstetrics and gynaecology at the University of Melbourne, Australia, and colleagues.

They added that over-medicalisation of the menopause risked collapsing this wide range of experiences into a narrowly defined disease requiring treatment.

“It tends to emphasise the negative aspects of menopause and, while effective treatments are important for those with troublesome symptoms, medicalisation may increase women’s anxiety and apprehension about this natural life stage.”

Women’s experiences of menopause were strongly influenced by personal, family and social factors, they said. For instance, a recent review found that negative attitudes and expectations before menopause predicted the likelihood of women experiencing distressing symptoms.

“Changing the narrative by normalising menopause and emphasising positive or neutral aspects such as freedom from menstruation, pregnancy and contraception, together with information about managing troublesome symptoms might empower women to manage menopause with greater confidence,” Hickey said.

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Source: The Guardian, 15 June 2022

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Time for change: The College of Medicine launches its Beyond Pills campaign

On Thursday 16 June, The College of Medicine launched its Beyond Pills campaign – calling for Government intervention on over-prescribing – at the Integrated and Personalised Medicine Congress 2022.

Around 1.1 billion medicines are currently prescribed unnecessarily. Supported by eminent voices in both the Government and our healthcare system, the Beyond Pills campaign calls for the Government to immediately address the nation’s unsustainable prescription service through re-prescribing and social prescribing.

Speaking at the Integrative and Personalised Medicine Congress 2022, The College of Medicine Chair Dr Michael Dixon said: “Medicine, as we know it, is no longer affordable or sustainable. Nor is it able to curb the increase in obesity, mental health problems and most long-term diseases.

“A new medical mindset is needed, which goes to the heart of true health care. The advantages and possibilities of social prescription are limitless.

“An adjustment to the system now will provide a long-term, sustainable solution for the NHS to meet the ever-increasing demand for funding and healthcare professionals.”

The Campaign was established in the wake of the Chief Pharmaceutical Officer’s National Overprescribing Review published in September 2021.

The Beyond Pills Campaign aims to reduce drug prescription, expand the number of social prescribing link workers, save crucial funds, and provide support to individuals and local communities hampered by health inequalities. To achieve these goals, it has today launched a campaign that includes six specific actions that need to be taken:

  • Improving medical and healthcare training. Social prescribing and a psychosocial approach to treatment needs to be embedded throughout the curriculum
  • Addressing financial incentives within the NHS. Financial incentives in the system should centre around community health. For those patients already on a cocktail of pills, medication reviews and appropriate deprescribing need to be emphasised
  • Increasing the number of social prescribing link workers. Primary Care
  • Networks need to employ more link workers to enable access to social prescribing for everyone who could benefit
  • Increasing support for the voluntary sector. Government departments need to fund and support voluntary initiatives that encourage healthy communities
  • Empowering individuals and communities. Informing individuals about social prescribing and collaborating with volunteers involved in social prescription and local health creation and showcasing benefits
  • Further systematic research. Mobilising the research community to develop a fully-fledged programme review into topics including the therapeutic efficacy of social prescribing

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Source: College of Medicine, 16 June 2022

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