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USA: Antibody drug to protect the vulnerable from Covid goes unused

Sasha Mallett, Sue Taylor and Kimberly Cooley all have immune deficiencies that make them especially vulnerable to Covid-19, and all have tried to get the same thing: a new treatment that can prevent the disease in people who either cannot produce antibodies after receiving a coronavirus vaccine or cannot get vaccinated at all.

Ms. Cooley, a liver transplant recipient in Duck Hill, Mississippi, got the antibody drug, called Evusheld, from her transplant team at the University of Mississippi Medical Center with no trouble. But Ms. Taylor, of Cincinnati, was denied the treatment by two hospitals near her home. And Dr. Mallett, a physician in Portland, Ore., had to drive five hours to a hospital willing to give her a dose.

As much of the USA unmasks amid plummeting caseloads and fresh hope that the pandemic is fading, the Biden administration has insisted it will continue protecting the more than seven million Americans with weakened immune systems who remain vulnerable to Covid. Evusheld, which was developed by AstraZeneca with financial support from the federal government, is essential to its strategy.

But there is so much confusion about the drug among healthcare providers that roughly 80% of the available doses are sitting unused in warehouses and on pharmacy and hospital shelves.

Interviews with doctors, patients and government officials suggest the reasons the drug is going unused are varied. Some patients and doctors do not know Evusheld exists. Some do not know where to get it. Government guidelines on who should be prioritised for the drug are scant. In some hospitals and medical centres, supplies are being reserved for patients at the highest risk, such as recent transplant recipients and cancer patients, while doses in other areas of the country are being given out through a lottery or on a first-come, first-served basis.

Hesitance is also an issue. Some doctors and other providers do not know how to use Evusheld and are thus loath to prescribe it.

Read full story (paywalled)

Source: New York Times, 6 March 2022

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Delayed NHS patients will be able to choose private ops online

Patients whose operations have been delayed will be able to shop online for hospitals with the shortest waiting times in the public and private sector, under plans being announced by the health secretary this week reports The Times.

Sajid Javid will unveil a three-point plan to transform the NHS as part of efforts to tackle a record backlog of more than six million people.

Under the proposals, patients referred for hospital care will be able to go online to look up the waiting time at their local hospital, and compare it with times at any hospital in the country, including those in the private sector. The website will allow patients to book their treatment at any unit in the country and there are plans to make the service available on the NHS app.

The proposals will be set out in a speech on Tuesday. Javid said: “The NHS constitution says already that you as a patient have the right to ask for an alternative provider for your treatment."

However, is this just a distraction? writes Roy Lilley in his latest newsletter. Shopping on-line for treatment depends on getting a website organised that can collect real-time data from all Trusts, for every specialty, that can take into account staffing, rota-gaps and clinical priorities.

Software might be able to cope but has the potential to throw the NHS into chaos. People arriving from ‘out of area’ will need video-out-patient consultations, some way of doing blood, imaging and other tests. And post-op? The same again for out-patients and physio, OT, aids, adaptations, pharmacy and social care support... ... to say nothing of the stress on patients and their families.

None of this is impossible but the NHS is nowhere near geared up for it.

Sources:

The Times, 6 March 2022 (paywalled)

Roy Lilley's newsletter, 7 March 2022

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Release of vulnerable people from immigration detention is often medically unsafe and chaotic, says charity

Vulnerable people released from immigration detention in the UK are too often left without crucial continuity of care, leading to quickly deteriorating health, concludes a report.

The report comes from Medical Justice, a charity that sends independent volunteer clinicians into immigration removal centres across the UK to offer medical advice and assessments to immigration detainees.

The charity said that between 1 October 2020 and 30 September 2021 a total of 21 362 people were detained in UK immigration centres and 17 283 were released into the community, having been granted bail or leave to enter the UK or remain. Of these, 2239 were considered to be “adults at risk.”

One woman whose delay in treatment “could potentially have life or limb threatening consequences”, struggled to re-arrange an orthopaedic oncology appointment that she missed because she had been detained.  One released Medical Justice client described how he ended up a number of times in Accident & Emergency, having been unable to secure a recommended cardiology appointment.

The report found that release from detention is often unplanned, chaotic and medically unsafe.
 
Medical Justice sees repeated cases of vulnerable people released into the community without adequate care plans, with little or no information and support about entitlement and how to access a GP, and rarely with referrals to community support services such as local mental health teams. This has included people who had very recently attempted suicide in detention.

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Source: BMJ, 4 March 2022

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Midwife-supported home births scrapped in Guernsey

Midwife-supported homebirths will not be re-introduced in Guernsey after their suspension due to coronavirus. The committee for health and social care explained it is difficult for a small team to accommodate the births.

It said that if the service was reinstated, it may impact deliveries on Loveridge Ward in Princess Elizabeth Hospital.

A spokesperson said they were "very sorry" to parents who wanted to give birth at home.

The committee said homebirths rely on a demanding on-call commitment from community midwives on top of their contracted hours.

To facilitate a birth at home, two of the five midwives are required to be on-call for 24 hours a day, for up to five weeks at a time.

Deputy Tina Bury, vice president of the committee for health and social care, said: "The midwifery team is small and it was simply not sustainable or safe in the long-term to provide the kind of on-call cover needed to support homebirths.

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Source: BBC News, 5 March 2022

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Covid pandemic sparks steep rise in number of people in UK with long-term illness

More than a third of working-age people in the UK now suffer from a long-term illness, with new figures showing a dramatic rise since the pandemic began. Post-Covid conditions, including Long Covid, breathing difficulties and mental-health problems, are among the causes, according to disability charities and health campaigners.

An Observer analysis of the Office for National Statistics’ (ONS) labour market status of disabled people figures shows that nearly 14.2 million people in the UK aged 16 to 64 said they had a health condition lasting for at least 12 months in 2021 – a rise of 1.2 million during the two years of the pandemic.

Levels of long-term ill-health had been rising more slowly before the emergence of Covid, at an annual average of about 275,000 cases a year between 2014 and 2018, but the rapid increase over the last two years highlights the health problems facing the UK, says the disability charity Scope.

About 800,000 more people suffered from mental-health problems in 2020-21 than did so in 2018-19, Scope said, and the number of people with chest and breathing problems had grown by about 570,000 over the same period.

James Taylor, Scope’s director of strategy, said: “These figures show the ongoing shock waves of the past two years continue to affect lives today. We’re concerned things will continue to get worse as time goes on."

Long Covid is another factor. The latest ONS long Covid report estimates that 1.5 million have had Covid symptoms for more than four weeks, and 685,000 people had symptoms that had lasted more than a year.

Further analysis by Long Covid Kids shows that people with pre-existing conditions are more likely to suffer long Covid than those without. Those whose activity is limited are, on average, more than three times as likely to suffer long Covid as those with no pre-existing conditions.

Dr Susannah Thompson was infected in April 2020 while working as a GP in her local hospital’s urgent care centre in north-west England. She made a “slow, gradual recovery” over the next months and was involved in setting up the GP-led vaccination programme until she had a “massive relapse” in January 2021.

“It feels like we’re ignoring Long Covid,” Thompson said. “People in the middle of their lives are getting robbed of their livelihoods, at risk of losing their homes. I can’t fathom why we don’t try to prevent it. But we’re not.”

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Source: The Guardian, 5 March 2022

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NHS accused of racism as black nurses report being put in Covid areas

The NHS has been accused of “shocking and systemic” racism during the pandemic as black healthcare workers say they were given poor PPE and pushed into the Covid frontline first.

Hundreds of black and brown healthcare staff across the UK have spoken to academics at Sheffield Hallam University about their experiences of racism during the pandemic.

The accounts raised issues of racism within the health service which led to black and brown nurses and midwives being put at greater risk than their white colleagues, due to poorer PPE, training, workload and shift patterns.

Rosalie Sanni-Ajose, a senior theatre practitioner, who worked across multiple London NHS hospitals through an agency called Yourworld told The Independent: “During the pandemic, we found that most of us (black agency nurses) have been placed in ITU to look after Covid patients are on a Continuous positive airway pressure (CPAP) machine or the ventilator."

“Then when I work in A&E, they divided areas into sections - green area, red area, and the normal areas. So some of the ethnic minority staff were then put in the red areas all the time. Further some of us, we have comorbidities like asthma, or diabetes, or have an exemption that has been clearly stated they not allowed to work there.”

Through its research, which involved 350 black and brown nurses, midwives and healthcare staff across the UK, Sheffield Hallam University found 77% of respondents said they’d been treated unfairly when they challenged racism.

Just over 50% of the respondents said they’d experienced unfair treatment in the pandemic in relation to Covid deployment, PPE or risk assessment.

One third have left their job as a result of racism, while more than half have experienced poor mental health due to the racism they experienced.

The academic team, lead by Professor Anandi Ramamurthy said the healthcare professionals’ reports reveal “a story of systematic neglect and harassment which predates the pandemic.”

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Source: The Independent, 5 March 2022

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'Overworked staff' impacting patient safety at Torbay Hospital

The Care Quality Commission (CQC) has raised concerns about Torbay Hospital being understaffed and the impact that has had on patient safety.

It carried out an unannounced focused inspection of medical care services at Torbay Hospital in December, after receiving information of concern about the service. 

Cath Campbell, CQC’s head of hospital inspection, said: “When we inspected medical care services at Torbay Hospital, we were mindful of the pressures that the COVID-19 pandemic had had on the trust, and aware that staff were working extremely hard during this time. However, we were concerned to find some of the wards didn’t have enough staff to meet the needs of patients, especially those on a dedicated COVID-19 ward, and the trust wasn’t able to provide us with evidence that there were enough staff on the ward to monitor patients to keep them safe.!

“In addition, staff didn’t always complete risk assessments for each patient to remove or minimise risks to people’s safety. Staff also did not always identify patients at risk of deterioration and act quickly to keep them safe."

The Torbay and South Devon NHS Foundation Trust says it has taken the CQC’s findings very seriously and made immediate improvements, which the CQC have recognised. 

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Source: Torbay Weekly, 4 March 2022

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Cervical cancer: Scottish hospital is first in UK to pilot artificial intelligence in screening programme

A Scottish hospital has become the first in the UK and one of the first in the world to pilot using artificial intelligence (AI) in its cervical cancer screening programme.

University Hospital Monklands has increased capacity by around 25% and improved analysis turn-around times with the measure, which experts said could “revolutionise” the screening process.

The system, from medical technology company Hologic, creates digital images of cervical smear slides from samples that have tested positive for Human Papilloma Virus (HPV).

These are then reviewed using an advanced algorithm, which quickly assesses the cells in the sample and highlights the most relevant to medical experts, saving them time in identifying and analysing abnormalities.

“Preliminary results from the pilot are promising, as the team at University Hospital Monklands has increased capacity by around 25 per cent in the slide assessment and improved analysis turn-around times, as well as allowing screeners to dedicate more time to training on the latest technologies and dealing with difficult-to-diagnose cases,” says Allan Wilson, consultant biomedical scientist at NHS Lanarkshire who is leading the pilot.

"Through AI and digital diagnostics, we have the potential to improve outcomes for women not only in Scotland, but around the world.”

Samantha Dixon, chief executive of Jo’s Cervical Cancer Trust, welcomed the pilot.

“Catching cervical cell changes means they can be treated to prevent them from developing into cervical cancer,” she said.

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Source: The Scotsman, 4 March 2022

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Staffing crisis deepens in NHS England with 110,000 posts unfilled

The NHS is facing a deepening staffing crisis, with the number of unfilled posts across health services in England rising to 110,192, official figures show.

The shortages include 39,652 nurses and 8,158 doctors, according to the latest quarterly data for health service vacancies published by NHS Digital.

The disclosure prompted warnings that the shortage of frontline personnel would lead to longer delays, hit the campaign to cut the 6.1m treatment backlog and undermine quality of care.

Staff groups said they feared that low pay, burnout from heavy workloads and constant pressure during shifts, compounded by the Covid-19 pandemic, were leading demoralised workers to quit.

“The fact that nursing vacancies remain stubbornly high, at about 40,000 in the NHS in England, is deeply worrying. With every job that remains unfilled, safe patient care becomes even harder to maintain”, said Patricia Marquis, the Royal College of Nursing’s director for England.

Wes Streeting, the shadow health secretary, said: “The Conservatives’ scrapping of the nursing bursary and failure to fix staffing shortages has been disastrous for the NHS, and patients are paying the price. NHS staff do heroic work but there simply aren’t enough of them. Yet the government still has no plan to fill these positions, meaning patients will continue to wait unacceptable lengths of time for treatment.”

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Source: The Guardian, 3 March 2022

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RCN launches toolkit to help nursing staff raise concerns

The Royal College of Nursing (RCN) has designed a 'Raising Concerns toolkit', which includes information to help members navigate the process of escalation, from identifying a potential concern through to formally reporting it to senior colleagues.

It’s been designed to help members decide when to escalate a workplace issue and includes a flowchart to support them in deciding what, when and how to report concerns. 

The toolkit outlines the types of concerns that might be raised such as staffing and patient safety, a lack of support or training, as well as cultural or criminal issues. 

It supports nursing staff to understand the importance of remaining factual, staying neutral and keeping records of events. 

RCN Deputy Director of Nursing Eileen Mckenna said: “We know that raising a concern at work isn’t easy, but it safeguards nursing staff and can provide learning opportunities. Our Raising Concerns toolkit can be used by nurses, nursing associates, students and health care support workers in the NHS and independent sector to help them through the process of escalating an issue.

“All workplaces that employ nursing staff should have a culture of safety and focus on system learning, not individual blame in the event of a mistake being made. We will always support members who challenge unsafe practices, processes or conditions at work in the interests of their own safety and that of patients. It’s an important skill that promotes psychological safety, a positive learning environment and wellbeing.”

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Source: RCN, 2 March 2022

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GP surgeries are told to open late and at weekends

GP surgeries must open for routine appointments between 9am and 5pm on Saturdays and during weekday evenings, NHS bosses have said.

From October, patients will be able to book weekend and evening slots with “the full multi-disciplinary team” in a local practice, including for services such as screening, vaccinations and health checks.

The British Medical Association said it was “bitterly disappointed” by the changes, which had been imposed without its agreement. 

A letter tells GPs the appointments must be made available at least two weeks in advance. Same-day online booking should be possible “up until as close to the time slot as possible”. Any unused slots should be available for NHS111 to allocate to callers.

Some may be remote appointments, but networks are told to “ensure a reasonable number” of appointments are face-to-face consultations. 

Rachel Power, chief executive of the Patients Association, said: “There’s a great deal in this letter that patients will welcome, given the struggles they have had since the start of the pandemic to see their GPs face-to-face or even get through to their surgeries.”

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Source: The Times, 2 March 2022

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Failure to act on sepsis led to man’s death

A man died after an NHS trust failed to diagnose and treat sepsis quickly enough, a Parliamentary and Health Service Ombudsman investigation has found.

Stephen Durkin died after suffering organ failure from sepsis. Stephen’s wife Michelle made a complaint to the Ombudsman after she was left floored by his sudden death which she believed was avoidable.

Stephen was an otherwise healthy 56-year-old when he attended Wye Valley Trust A&E in July 2017 with chest pain. Hospital staff suspected he had a major blood vessel blockage and admitted him to a ward overnight. The next morning his overall condition had worsened but staff did not monitor him more closely, as national guidance advises, and he continued to deteriorate throughout the day.

The next day Stephen was admitted to intensive care and treated for sepsis but tragically died later that evening. In the space of 48-hours his condition deteriorated rapidly but staff did not act quickly enough and the critical care team attended Stephen ten hours too late.

His wife Michelle arrived at the hospital to visit Stephen, only to find that he was critically ill and unresponsive. She was left devastated by his death and turned to the Ombudsman to look into what had happened with his care.

Ombudsman Rob Behrens said: "Stephen’s tragic death could so easily have been avoided. His case shows why early detection of sepsis, as set out in national guidelines, is crucial."

"Sadly, this is not the first time we have had to highlight this issue. There is clearly more the NHS needs to do. It is vital that NHS trusts ensure their staff are sepsis-aware to reduce the number of avoidable deaths from this life-threatening condition."

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Source: PHSO, 3 March 2022

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More support needed for GPs to treat eating disorders

Two leading medical organisations have told the BBC that GPs are not getting the right support to treat eating disorders.

The Royal College of General Practitioners (RCGP) and the British Medical Association (BMA) say doctors need more time with patients and more specialist units.

Beat Eating Disorders asked nearly 1,700 people about their experience of trying to get a diagnosis from their GP. Over 92% asked thought their GP needed more training with eating disorders. Out of those questioned, 69% also said they felt their GP didn't know how to help them.

The survey has been released to coincide with Eating Disorder Awareness Week.

Jess Griffiths had an eating disorder between the ages of 11 and 21 and, now in full recovery, she works as a consultant to NHS England and with her local eating disorder service in Dorset.

She tells the BBC that when she first went to her GP to try to get help, she wasn't entirely transparent about what she was struggling with.

"I was presenting at a low weight and not having periods, so the GP put me on the pill, but I went there hoping he would ask me the questions [about a potential eating disorder]" she says.

"But it's really hard for people with eating disorders to - in a really pressurised situation with a doctor - say how they really feel."

Dr Richard Van Mellaerts is part of the BMA's GP committee and has told the BBC the results of the survey are "deeply saddening".

"People with eating disorders should never feel that GPs are a barrier to accessing care, so it is vital that medical education and training supports doctors to identify eating disorders and support their treatment," he says.

But he adds that there is "poor provision of specialist care", which has left GPs "frustrated up and down the country".

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Source: BBC News, 3 March 2022

Read hub blog from Dr Joanna Silver on the challenges the pandemic has brought to patients with eating disorders

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Patient at Broadmoor Hospital died after suffocating, inquest hears

A patient at Broadmoor Hospital has died after suffocating while staff were chatting outside of his room, an inquest has heard.

Aaron Clamp, a patient at the notorious high security mental health hospital Broadmoor, died on 4 January 2021 after asphyxiating whilst in his room.

The Independent understands Mr Clamp’s death may have been the first “non-natural” death since the new Broadmoor Hospital, run by West London Trust, opened in December 2019.

According to evidence heard at the inquest, staff who were meant to be carrying out continuous “eyesight” observations on Mr Clamp, were having a conversation without direct sight into his room.

Mr Clamp’s father told The Independent he was “tormented” by the criminal justice and mental health system which resulted in his “indefinite incarceration.”

“Diagnosed with a mental illness, schizoaffective disorder, the purpose of treatment was rehabilitation.  Psychiatric treatment is conventionally centred on medication to manage symptoms and risk," his father said.

He acknowledged there is a balance to be struck between managing risks and restricting patients, but closer attention of holistic compassionate care should be given.

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Source: The Independent, 3 March 2022

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NHS ‘woefully unprepared’ for care of an ageing England

The NHS is “flying blind” and “woefully unprepared” to cope with England’s rapidly ageing population, senior doctors have warned as stark new figures reveal the country has only one full-time geriatrician to care for every 8,000 older people.

The Royal College of Physicians (RCP) said the drastic shortage of specially trained physicians to look after the rising number of elderly people and a lack of NHS workforce planning meant England was “sleepwalking into an avoidable crisis of care for older people”.

Its analysis of NHS and Office for National Statistics data shows there is just one full-time geriatrician for every 8,031 people over the age of 65 in England. There are also regional disparities, with one geriatrician caring for more than 12,500 over-65s in the east Midlands, while the figure in north-east and central London is one per 3,254.

Estimates suggest that by 2040 there could be as many as 17 million over-65s. But the college warns that many doctors will soon be requiring geriatric care themselves as 48% of consultant geriatricians are due to retire within the next decade.

The RCP said the health service was short of staff across all specialities and the shortage of geriatricians was one example of why the health service needed more workforce planning. It said there was no publicly available data on the number of staff the NHS needed to train now to meet future demand for care.

Dr Jennifer Burns, the president of the British Geriatrics Society, said the crisis would only worsen with the “predictable rise” in the numbers of older people across the country. “It is absolutely vital that these fundamental issues around the recruitment, retention, development and support of the workforce are addressed, and that there is a properly resourced strategy for future needs,” she said.

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Source: The Guardian, 3 March 2022

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Parents sue over failures in child hearing service at NHS Lothian

More than a dozen families are seeking compensation following "significant failures" at NHS Lothian's hearing service for children.

The health board apologised to more than 155 families after an independent investigation found serious problems diagnosing and treating hearing loss.

Sophie was born partly deaf and failed repeated hearing tests for years. Her family say no help was offered by the paediatric audiology department at NHS Lothian who kept saying she would be fine. But her parents say she is not.

Sophie is now seven. Her speech and language has not developed fully and is sometimes hard to understand. Her confidence has been affected.

Her mum Sarah said: "They failed Sophie. You kind of trust what they were doing, you thought maybe she doesn't need hearing aids, maybe she will just catch up and now she's almost eight years old and she's still not caught up and you think 'OK, maybe there were mistakes made then'."

An independent investigation by the British Academy of Audiology (BAA), published in December last year, found "significant failures" involving 155 children over nine years at NHS Lothian.

Several profoundly deaf children were diagnosed too late for vital implant surgery. The health board has "apologised sincerely" to those affected.

The BAA looked at more than 1,000 patient records finding "significant failures" in almost 14% of them.

The BAA said it found "no evidence" that national guidelines and protocols on hearing tests for children had been followed or consistently applied "at any point since 2009".

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Source: BBC News, 2 March 2022

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Eating disorders: Worth more than 2 hours of teaching

On average, UK medical students receive less than two hours of teaching on eating disorders throughout their entire medical degree. Even more concerningly, a fifth of medical schools do not include eating disorders at all in their teaching.

Given that 1 in 50 people in the UK suffer from an eating disorder, and around 5% of the population will be affected at some point in their lifetime, this is something that needs to change. 

This week is Eating Disorders Awareness Week and Beat Eating Disorders are campaigning for UK medical schools to introduce comprehensive training on eating disorders to their programmes. 

Eating disorders are highly complex mental illnesses, but they are treatable. Just two hours of training is not enough time to equip medical students with the knowledge to identify the signs and symptoms and provide the necessary support to help sufferers access the most appropriate treatment at the earliest opportunity.

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Source: Beat Eating Disorders

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Private healthcare boom adds to fears of two-tier system in UK

Growing numbers of Britons are paying for private medical treatment in a shift that could undermine the NHS and create a “two-tier” health system, a report has warned.

Declining access to and quality of NHS care, both worsened by the Covid-19 pandemic, have begun to “supercharge” the trend, with one in six people prepared to go private instead of waiting.

That is among the findings of a report by the left-leaning IPPR thinktank, which warns that in future getting fast, high-quality care on the NHS could become as difficult as the situation that already exists in regards to state-funded dental treatment, which has become a postcode lottery.

“People are not opting out of the NHS because they have stopped believing in it as the best and fairest model of healthcare,” said Chris Thomas, the IPPR’s principal research fellow and co-author of the report.

“Rather, those who can afford it are being forced to go private by the consequences of austerity and the pandemic on NHS access and quality, and those without the funds are left to ‘put up or shut up’.”

The report says that unless the NHS starts performing better “people who can and are willing to do so will supplement their entitlement to NHS care with private healthcare products”.

“With NHS waiting lists now at record levels, it is not surprising that more patients across the country are looking at private healthcare,” said David Hare, chief executive of the Independent Healthcare Providers Network, a trade body that represents about 100 private providers across the UK.

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Source: The Guardian, 2 March 2022

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Study reveals stark disparities in cancer rates between ethnic groups

Stark disparities in cancer rates between different ethnic groups have been laid bare in new research showing black people are twice as likely to get prostate cancer while white people have double the chance of getting skin and lung cancers.

The analysis of NHS Digital cancer registration data by Cancer Research UK provides the most complete recording ever of cancer rates by ethnicity in England, offering crucial data on how some rates vary. The results are published in the British Journal of Cancer.

White people in England are more than twice as likely to get some types of cancer, including melanoma skin cancer, oesophageal, bladder and lung cancers compared with people from black, Asian or mixed ethnic backgrounds, according to the research.

Black people are almost three times more likely to get myeloma and almost twice as likely to get prostate cancer compared with white people. The study also found that black people are more likely to get stomach and liver cancers, and Asian people are more likely to get liver cancers. 

Genetics are thought to play a part in some of the findings, Cancer Research UK said. For example, white people are more likely to get skin cancer because they tend to burn more easily in the sun.

Preventable risk factors also appear to be involved, the charity added, as white people are more likely than most minority ethnic groups to smoke or be overweight or obese. These are the two largest risk factors in developing cancer and help explain why white people are more likely to get some types of cancer than other ethnic groups.

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Source: The Guardian, 2 March 2022

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Vaccines could mean only one smear test a lifetime

Women who have the HPV vaccine may need only one smear test to prevent cervical cancer in their lifetime, according to a leading scientist.

Women are currently invited for screening every three to five years in the UK. But Prof Peter Sasieni said the vaccine was leading to such dramatic reductions in cancer that the screening programme would need to change soon.

The NHS invites women, and people with a cervix, for regular screening. Swabs of the cervix are used to check for signs of abnormalities using a microscope (the traditional smear test) or more recently to test for the virus itself.

 However, a seismic shift in preventing cervical cancer started in the UK in 2008 with the introduction of the HPV vaccine. It is offered to girls (and boys since 2019) aged between 11 and 13.

Research published in December shows the vaccine is cutting cervical cancer by nearly 90% in those who choose to have the jab.

"This is really exciting," Prof Sasieni, the director of the clinical trials unit at King's College London, told Inside Health on BBC Radio 4.

His modelling suggests between one and three checks a lifetime would be appropriate for people who have been immunised.

"There's a new vaccine which will be used in the UK from the next school year, which protects against even more types of the virus, and I think with that probably one screen would be enough, maybe two, over a lifetime."

However, the Department of Health and Social Care said one in three people do not come for screening when invited, and a spokesperson added: "The NHS Cervical Screening programme remains an important way of protecting the population - including those who have not been vaccinated - from developing cervical cancer."

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Source: BBC News, 2 March 2022

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‘Advice to GPs’ will count towards elective care target

Avoiding GP referrals by providing ‘advice and guidance’ will contribute significantly towards NHS performance on the government’s elective care targets, according to draft NHS plans seen by HSJ.

Under the elective recovery plan, hospital specialists are being asked to offer more advice when GPs are deciding whether to refer a patient for an outpatient appointment, which would avoid some patients being added to waiting lists.

This is aimed at reducing instances where GPs may want to be risk averse and refer a patient when they might be unsure whether a secondary referral is needed.

New documents seen by HSJ, shared in draft by NHSE last week, reveal this avoided activity will be counted in assessing if the service or individual trusts have hit key government targets to increase activity.

NHS England has agreed with government to carry out 10% more ‘clock-stop’ activity in 2022-23 than was taking place pre-covid, but this is “after accounting for the impact of an improved care offer through system transformation, and advice and guidance”.

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Source: HSJ, 28 February 2022

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Biden vows to crack down on poorest-performing nursing homes in the US

The White House has announced plans to boost nursing home staffing and oversight, blaming some of the 200,000-plus covid deaths of nursing home residents and staff during the pandemic on inadequate conditions.

Officials said the plan would set minimum staffing levels, reduce the use of shared rooms and crack down on the poorest-performing nursing homes to reduce the risk of residents contracting infectious diseases. The White House also said it planned to scrutinise the role of private equity firms, citing data that their ownership was linked with worse outcomes and higher costs.

Nursing homes have been an epicenter of covid spread during the pandemic, as the virus initially tore through facilities before vaccines were available in 2020, and then continued to sicken and kill residents at an elevated rate last year. Advocates have demanded better policies to ensure the facilities are prepared for emergencies and follow practices to curb the spread of infections.

Under Biden’s plan, officials at the Centers for Medicare and Medicaid Services will propose minimum staffing levels within the next year, which the White House said would improve safety by ensuring residents receive sufficient care and attention. The administration also cited a study that found increased staffing levels were linked with fewer covid cases and deaths.

The nursing home industry has warned that the pandemic has exacerbated long-running staffing shortages, noting that roughly 420,000 employees in nursing homes and long-term care facilities, many of whom complained about low pay, have departed over the last two years.

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Source: The Washington Post, 28 February 2022

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NHSE wants ‘witch hunt’ lessons shared widely, says trust’s CEO

NHS England wants lessons learned by a trust overhauling its culture after a high-profile bullying scandal to be shared systemwide because similar problems have been evident at other trusts, the hospital’s boss has said.

West Suffolk Foundation Trust interim chief executive Craig Black said the trust was getting national level “support” to help with a cultural overhaul after a scathing independent review published in December concluded the trust’s hunt for a whistleblower had been “intimidating… flawed, and not fit for purpose”.

Mr Black said he thought NHSE would be “looking to learn from what we are doing” because senior managers viewed concerns raised in the West Suffolk review as having ”resonance with a number of organisations in the NHS at the moment”.

As well as the specific “witch hunt” case, the review raises wider issues about how trusts respond to whistleblowing and other concerns about care and patient safety.

West Suffolk’s executive director of workforce and communications Jeremy Over told the meeting the cultural change required was “organisational development which will take time, significant time”.

The report, West Suffolk Review – organisational development plan, sets out nine broad themes of work, linked to the trust’s core functions, “that capture the priority areas for organisational and cultural development at WSFT in light of the learnings from the report”. 

The document sets out how the trust’s governance, freedom to speak up, HR, staff voice, patient safety and other parts of its corporate infrastructure failed and contributed to a scandal.

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Source: HSJ, 1 March 2022

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Record demand for mental health services as new mothers are left ‘isolated’ in pandemic

Tens of thousands of new mothers have been left feeling “hopeless” and “isolated” during the pandemic, with the NHS seeing record numbers of referrals to mental health services.

Requests for help from new, expectant and bereaved mothers jumped by 40% in 2021 compared with 2019, analysis by The Independent has revealed.

NHS data shows mental health referrals hit an all-time high of 23,673 in November last year, with average monthly referrals for the whole of 2021 running 21% higher than the year before, jumping from 17,226 to 21,990.

Among those affected when support systems were “suddenly” removed in March 2020 was Leanne, a woman who had her second child just before the pandemic and experienced a mental health crisis. She told The Independent how she had struggled following the first lockdown.

“I just thought, Oh God, my recovery is going to stop, how am I going to get better now because I’ve got no support – I’m on my own with it,” she said.

“I was [also] anticipating the lockdown … in addition to the nursery closing, and I was getting quite anxious about that, and feeling quite hopeless. The pressure piled on me was enormous, and I had no one who could see me or support me."

Dr Rosena Allin-Khan MP, the shadow minister for mental health, said the figures uncovered by The Independent were “extremely concerning” and that pregnant women had been “forgotten about through the pandemic”.

The Royal College of Psychiatrists’ lead for perinatal mental health services, Dr Joanne Black, said the NHS pandemic recovery plan had lost sight of women in pregnancy and children under two years old, who have been “disproportionately affected”.

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Source: The Independent, 28 February 2022

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Sussex woman forced to sleep in wheelchair due to lack of care staff

A woman has been left to sleep in her wheelchair several nights a week and remain in bed for the rest of it due to a lack of social care in her local area.

Mandy Page, 53, who lives alone in Hove, has difficulty getting into and out of bed on her own and previously had carers to provide support in the morning and evenings.

However, since before Christmas she has had no care support in the evenings after the MyLife East Sussex agency told her it was no longer covering her care, and that the agency believed her care was now being provided by her local authority.

Page receives dialysis three times a week at Royal Sussex county hospital, and on those days arrives home, by hospital transport, after 6pm. This means that without help getting out of her wheelchair and into bed she must sleep in the wheelchair.

“It’s very stressful, because at the moment I’m in bed every day. I can’t get up without help, and I can’t get back to bed on a dialysis day,” Page said. “On a dialysis day, I go to dialysis and I’m in my wheelchair. Every other day, I’m in bed all day and all night. That’s no life.

Page’s situation exemplifies the crisis in social care. England has faced chronic shortages of care workers, with a survey by Care England finding that 95% of care providers struggle to recruit and retain staff. In 2020/21, there were around 105,000 vacancies at any one time in the social care sector, and more than a third of the sector’s staff left their jobs during the year.

Page says the lack of adequate social care has taken a negative toll on her quality of life, and has meant she hasn’t been able to undertake everyday tasks.

Rob Persey, the executive director for health and adult social care at Brighton and Hove council, said the council had not been able to source a new provider for Page since her earlier care was withdrawn.

“This is a national as well as a local problem as there are insufficient home care staff to meet demands. Various local initiatives, including additional funding, have been taken to increase the home care workforce, but so far they have only had a limited impact."

“We recognise Mandy does not want respite care, and acknowledge this is a completely unacceptable situation for her,” he said.

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Source: The Guardian, 28 February 2022

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