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Trusts with the biggest falls in staff confidence in care provided

Several large teaching hospitals are among those which saw the steepest declines in the proportion of staff who would recommend the care of their organisation, according to the NHS staff survey results.

Norfolk and Norwich University Hospitals Foundation Trust, University Hospitals Birmingham, Liverpool University Hospitals FT and Nottingham University Hospitals Trust saw declines of 12 percentage points or more in 2021 — for the proportion of staff saying they would be happy for a friend or relative to be treated at their organisation. This was double the average drop in the acute sector.

In a message to staff, Sue Musson, chair of Liverpool University Hospitals Trust, said about her trust’s overall results: “On behalf of the trust board, I want to apologise to everyone that the experience of working at the trust is so deeply unsatisfactory for so many colleagues.

“It would be wrong to suggest that there are quick fixes to these issues. The promise I can give you today is a genuine commitment to listen and learn; we particularly need to understand what would make the difference for colleagues across the trust, recognising that there may well be different answers in different parts of the organisation.

“We will seek to learn from the trusts that have demonstrated the best staff experience scores and to implement best practices at pace. We will also be seeking support and input from national and staff side colleagues.”

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Source: HSJ, 11 April 2022

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The US is trying to fix medical devices’ big cybersecurity problem

Medical devices are one major weak point in health care cybersecurity, and both the US Congress and the Food and Drug Administration took steps towards closing that gap this week —Congress with a proposed bill and the FDA with new draft guidelines for device makers on how they should build devices that are less likely to be hacked.

Devices like infusion pumps or imaging machines that are connected to the internet can be targets for hacks. Those attacks can siphon off patient data or put their safety directly at risk. Experts consistently find that devices in use today have vulnerabilities that could be exploited by hackers.

The new document is still just a draft, and device makers won’t start using it until it’s finalised after another round of feedback. But it includes a few significant changes from the last go-around — including an emphasis on the whole lifecycle of a device and a recommendation that manufacturers include a Software Bill of Materials (SBOM) with all new products that gives users information on the various elements that make up a device. An SBOM makes it easier for users to keep tabs on their devices. If there’s a bug or vulnerability found in a bit of software, for example, a hospital could easily check if their infusion pumps use that specific software.

The FDA also put out legislative proposals around medical device cybersecurity, asking asking Congress for more explicit power to make requirements. “The intent is to enable devices to be that much more resilient to withstand the potential for cyber exploits or intrusion,” Schwartz says. Manufacturers should be able to update or patch software problems without hurting the devices’ function, she says.

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Source: The Verge, 8 April 2022

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Washington State Nurses Association: Joint statement on the conviction of RaDonda Vaught

On 25 March2022, a Tennessee jury convicted RaDonda Vaught, a nurse at Vanderbilt University Medical Center, of criminally negligent homicide and impaired adult abuse in a 2017 medication administration error that tragically resulted in a patient death. The Washington State Nurses Association have issued a joint statement adamantly opposed to criminalization of patient care errors. 

"Focusing on blame and punishment solves nothing. It can only discourage reporting and drive errors underground. It not only undermines patient safety; it fosters an environment of fear and lack of respect for health care workers."

"The Vaught case has drawn intense national attention and concern. We join with health care workers and patient safety experts around the country and the world in rejecting the criminalization of medical errors. Further, we are committed to redoubling our efforts to achieve health care environments that are safe for patients and health care workers alike. This includes the ongoing, critical fight to achieve safe staffing standards in Washington state."

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Source: Washington State Nurses Association, 8 April 2022

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GP numbers in England down every year since 2015 pledge to raise them

The number of GPs in England has fallen every year since the government first pledged to increase the family doctor workforce by 5,000, a minister has admitted.

There were 29,364 full-time-equivalent GPs in post in September 2015, when the then health secretary, Jeremy Hunt, first promised to increase the total by 5,000 by 2020.

However, by September 2020 the number of family doctors had dropped to 27,939, a fall of 1,425, the health minister Maria Caulfield disclosed in a parliamentary answer. And it has fallen even further since then, to 27,920, she confirmed, citing NHS workforce data.

In the 2019 general election campaign, Boris Johnson replaced Hunt’s pledge with a new commitment to increase the number of GPs in England by 6,000 by 2024. However, Sajid Javid, the health secretary, admitted last November that this pledge was unlikely to be met because so many family doctors were retiring early.

Organisations representing GPs say their heavy workloads, rising expectations among patients, excess bureaucracy, a lack of other health professionals working alongside them in surgeries, and concern that overwork may lead to them making mistakes are prompting experienced family doctors to quit in order to improve their mental health and work-life balance.

The British Medical Association (BMA) said the figures Caulfield cited showed that the lack of doctors in general practice was “going from bad to worse for both GPs and patients”, and it warned that patients were paying the price in the form of long waits for an appointment.

“Despite repeated pledges from government to boost the workforce by thousands, it’s going completely the wrong way,” said Dr Kieran Sharrock, the deputy chair of the BMA’s GP committee. “As numbers fall, remaining GPs are forced to stretch themselves even more thinly, and this of course impacts access for patients and the safety of care provided.”

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Source: The Guardian, 11 April 2022

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Ambulance chief calls out acute trust over ‘lack of action’ on handover delays

An ambulance service has raised concerns over the record number of ‘hours lost’ to handover delays at an acute hospital on its patch, which it says is happening despite the number of arrivals being at its lowest level in seven years.

West Midlands Ambulance Service University Foundation Trust has said the situation at Royal Stoke Hospital presents a “significant risk to patient safety”, but “we don’t currently see actions being taken that are reducing this risk”.

It comes amid rising frustrations from ambulance chiefs around the country at a perceived lack of support from acute hospitals around handover delays. Ambulance response times for some of the most serious 999 calls have ballooned in recent months, in part due to lengthy handover delays at emergency departments.

In a letter sent to a member of the public on 31 March, Mark Docherty, director of nursing at WMAS, said: “WMAS [is] experiencing difficulties as a direct result of delays in patient handovers at acute hospitals. We have been highlighting our concerns for over six years as the situation has become progressively worse every year."

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Source: HSJ, 10 April 2022

 

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“Implementation gap” renders reviews of patient safety incidents ineffective, finds charity

Patients continue to experience avoidable harms from unsafe care because the NHS fails to learn from its mistakes, a report that tracked what actions the NHS took following safety reviews over several decades has found.

Patient Safety Learning looked at the findings of a variety of investigations, including widespread public inquiries, Healthcare Safety Investigation Branch (HSIB) reports, Prevention of Future Deaths reports, incident reports, and complaints and legal action by patients and their families.

It found an “implementation gap” in learning lessons and taking action to prevent future harms. It highlighted an absence of a systemic and joined up approach to safety; poor systems for sharing learning and acting on that learning; lack of system oversight, monitoring, and evaluation; and unclear patient safety leadership.

Helen Hughes, chief executive of Patient Safety Learning, said, “Time and time again there is a lack of action and coordination in responding to recommendations, an absence of systems to share learning, and a lack of commitment to evaluate and monitor the effectiveness of safety recommendations.

“This is a shocking conclusion that is an affront to all those patients and families who have been assured that ‘lessons have been learnt’ and ‘action will be taken to prevent future avoidable harm to others.’ The healthcare system needs to understand and tackle the barriers for implementing recommendations, not just continually repeat them.”

The report calls for “systemwide commitment and resources, with effective and transparent performance monitoring” for patient safety inquiries and reviews and HSIB reports to ensure that the accepted recommendations translate into action and improvement.

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Source: BMJ, 8 April 2022

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Thousands of ventilators pulled as electrical faults put UK patients’ lives at risk

Two thousand ventilators being used in UK hospitals are at risk of suddenly shutting down due to electrical faults that have led to a global safety alert.

Hospitals have been ordered to source replacement ventilators after Philips Respironics said its breathing support devices could suddenly stop working, in some cases without activating a warning alarm.

The Medicines and Healthcare products Regulatory Agency (MHRA) said the problem related to “a number of electrical faults in the devices, which can result in an unexpected shutdown, leading to loss of ventilation”.

It said there had been five reported cases of shutdowns in the UK so far, none of which involved patient harm. Globally, there have been 389 reports of failures, including one where the patient died and four where they were seriously injured. In six of the total cases, the warning alarm didn’t sound.

Philips Respironics is one of several manufacturers that increased production of ventilators during the pandemic. The MHRA brought in a fast approval process for ventilators and other medical devices in response to Covid-19.

The MHRA said the root cause of the problem was not yet known and remained under investigation, but that Philips Respironics currently had “no permanent solution” to correct it.

Helen Hughes, chief executive of Patient Safety Learning, said there was a “significant patient safety concern” that some Philips devices could remain in use until replacements were sourced.

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Source: The Guardian, 9 April 2022

National Patient Safety Alert: Philips Health SystemsV60, V60 Plus and V680 ventilators – potential unexpected shutdown leading to complete loss of ventilation

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This Easter will be worse than any winter for the NHS

Two years ago the first wave of the covid pandemic reached its peak. The NHS had reacted with impressive speed to prepare for an influx of patients with an infectious disease that few knew much about, had no cure for, and for which there was no known vaccine.

However, now the NHS goes into the Easter break in a more fragile state than in any previous winter since, at least, the 1990s.

This is not just the direct result of covid hospitalisation, of course – although the distracting narrative of ‘with rather than because of covid’ has obscured how hugely damaging any kind of infectious disease that is as widespread in the community as covid is now can be to effective hospital care.

For someone who has just undergone an operation, for example, the greatest threat is not from catching covid itself, but from the impact the virus may have on how quickly their wound may heal.

Perhaps covid’s greatest continuing impact is on growing staff absences and the pernicious impact it is having on the long-term health of those who had the disease – even in some cases where it has been relatively mild. For the tens of thousands who have been hospitalised with covid, the consequences for their long-term health look more serious every day.

Much of this new workload is ending up at the doors of primary and community care – and displacing other needs and services just when they are most required after two years of coping with the pandemic.

There is usually one thing you can confidently say about the NHS, which is that in any crisis it will make sure the life-saving decisions are made on time.

However, in the South West, and probably other regions too, that is not happening. People are dying because the NHS cannot – despite its best efforts – save them.

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Source: HSJ, 8 April 2022

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I was brainwashed by the NCT — and nearly died

Exhausted after three sleepless days in labour, Jane O’Hara, then 34, screamed and burst into tears when the midwives and doctors at Harrogate District Hospital told her the natural birth she wanted was not going to happen.

She ended up needing life-saving surgery and 11 pints of blood after a severe haemorrhage. Mercifully, Ivy was fine and is now a healthy 12-year-old. 

In recent weeks, the NHS has been rocked by the conclusions of an inquiry into the worst maternity disaster in its history: 201 babies and nine mothers died and another 94 babies suffered brain damage as a result of avoidable poor care at Shrewsbury and Telford Hospital NHS Trust. This has been linked to a culture of promoting natural — that is, vaginal — birth and avoiding caesarean sections. 

Blame thus far has been aimed largely at the NHS — but parents have started speaking out online about what they believe has been the role of the National Childbirth Trust (NCT), a leading provider of antenatal classes in Britain, in promoting vaginal births.

“I can absolutely point to key decisions that I made that were influenced by the NCT’s mantra. I was led into a position where I believed I had more control over my birth than I actually did,” says O’Hara, who is now a professor of healthcare quality and safety at the University of Leeds. She believes she was a victim of a “normal birth” ideology that was heavily promoted at the NCT classes she attended.

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Source: The Times, 10 April 2022

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Care home resident died after unqualified nurse administered wrong medication

A nurse with no qualifications gave a care home resident a fatal dose of the wrong drug, leading to her death before she then tried to cover up her mistake.

Katherine Hutchinson gave Fiona Jayne Thorne a fatal overdose of a powerful anti-psychotic drug, which was meant for another patient, an inquest heard.

She then tried to cover up her errors which contributed to the death of the 36-year-old with learning difficulties, Derbyshire Live reported .

Ms Hutchinson had, at the time, been the nurse in charge at Whitwell Park Care Home, in Whitwell, Derbyshire despite not having any qualifications.

She gave Miss Thorne clozapine, which had been intended for another resident, on October 6, 2010.

Instead of owning up to what she did, Ms Hutchinson then tried to cover up her mistake by taking Miss Thorne to bed and leaving her there until she was discovered, Senior Coroner Dr Robert Hunter said.

Miss Thorne was "found by the care support worker around midnight, when undertaking routine checks on residents”, the inquest heard.

And then Ms Hutchinson’s mistake was only discovered after an audit was carried out of the medication trolley and a dosage of clozapine was found.

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Source: Mirror, 8 April 2022

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Why nurses are raging and quitting after the RaDonda Vaught verdict

Emma Moore felt cornered. At a community health clinic in Portland, Oregon, USA, the 29-year-old nurse practitioner said she felt overwhelmed and undertrained. Coronavirus patients flooded the clinic for two years, and Moore struggled to keep up.

Then the stakes became clear. On 25 March, about 2,400 miles away in a Tennessee courtroom, former nurse RaDonda Vaught was convicted of two felonies and facing eight years in prison for a fatal medication mistake.

Like many nurses, Moore wondered if that could be her. She'd made medication errors before, although none so grievous. But what about the next one? In the pressure cooker of pandemic-era health care, another mistake felt inevitable.

Four days after Vaught's verdict, Moore quit. She said Vaught's verdict contributed to her decision.

"It's not worth the possibility or the likelihood that this will happen," Moore said, "if I'm in a situation where I'm set up to fail."

In the wake of Vaught's trial ― an extremely rare case of a health care worker being criminally prosecuted for a medical error ― nurses and nursing organizations have condemned the verdict through tens of thousands of social media posts, shares, comments, and videos. They warn that the fallout will ripple through their profession, demoralizing and depleting the ranks of nurses already stretched thin by the pandemic. Ultimately, they say, it will worsen health care for all.

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Source: Kaiser Health News, 5 April 2022

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NHS regulator ‘not fit for purpose’ for dismissing baby deaths scandal warnings

The healthcare regulator has been branded “not fit for purpose” after dismissing warnings of the biggest maternity scandal in NHS history, The Telegraph can reveal.

Letters seen by this newspaper show that the Care Quality Commission (CQC) told grieving parents it would not support an independent inquiry into baby deaths, just months before such an investigation was ordered.

Rhiannon Davies wrote to the watchdog in Dec 2016, alerting the regulator to 19 avoidable deaths of mothers and babies at the Shrewsbury and Telford Hospital NHS Trust, as well as a string of cases where lives were put at risk.

However, the head of the CQC at the time assured Ms Davies that the culture was “changing for the positive”, rebuffing her calls for an independent inquiry.

Ms Davies had provided the watchdog with details of a string of deaths, which she and fellow bereaved parents had found from publicly available information.

The information was contained in a letter to Jeremy Hunt, the health secretary at the time, and shared with the regulator, setting out why families believed an inquiry was required.

On Tuesday night, Ms Davies said that the refusal of the CQC to back an investigation, and the false assurances given by its most senior figure, showed how it “never scratched beneath the surface” despite death after death.

Ms Davies said that she had “absolutely no faith” in its current ability to regulate and spot future scandals, saying it had “pushed back” every effort made by families to expose the failings at Shrewsbury.

“They are not fit for purpose because we cannot trust them to be doing their job properly,” she told The Telegraph.

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Source: The Telegraph, 5 April 2022

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Families in Nottingham maternity inquiry hit out at review

Dozens of families have written to the government expressing concern over a review into failing maternity units in Nottingham.

A probe into Nottingham University Hospitals Trust is under way after dozens of babies died or were injured.

But families say the review is "moving with the viscosity of treacle".

They have called for Donna Ockenden, who led the inquiry into the UK's biggest maternity scandal, to take charge of a review.

In a letter to Health Secretary Sajid Javid, a group of 100 people raised concerns with the current thematic review, which has been commissioned by the local clinical commissioning group (CCG) and NHS England, and NHS Improvement.

According to the CCG, the review will look at themes and trends and put in "place detailed and measurable actions so improvements can be made fast".

But families have questioned the independence of the review and the experience of the team to handle a probe of this magnitude.

It is chaired by Cathy Purt, a long-time NHS manager who the families believe has no experience of running complex inquiries or maternity services.

The letter states: "If families are to be safeguarded, real intervention is required."

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Source: BBC News, 7 April 2022

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Thousands have PTSD symptoms after miscarriage

Tens of thousands of women in the UK may be experiencing symptoms of post-traumatic stress disorder (PTSD) after miscarriages each year, a leading researcher warns.

Prof Tom Bourne estimates the number affected could run to 45,000 annually.

But he says most are not given prompt psychological support that could help prevent PTSD developing.

The Miscarriage Association says there is an urgent need for better access to talking and other psychological therapies for those affected. At present, most women have to ask for help themselves rather than support being in place.

Prof Bourne believes there needs to be more research into other ways of helping people experiencing loss. His team is trying out a variety of new approaches - including virtual reality - to help address the issue.

One idea his team is experimenting with is offering women virtual reality headsets during miscarriage procedures.

It builds on previous work that shows VR headsets can help reduce pain during some medical procedures.

Researcher Dr Nina Parker says the aim is "to transport them to sort of a more calm, virtual reality world for distraction from the pain and anxiety during the procedure".

She adds: "There is nothing that we are ever going to be able to do that takes away from the loss and the trauma of losing pregnancy and having a miscarriage.

"But if we can do everything that we can to minimise any additional trauma we might be adding to in the interactions that are had within the hospital, then we are obligated to do that."

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Source: BBC News, 8 April 2022

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Leaders ‘pay lip service’ to public engagement, NHSE director says

Health leaders ‘pay lip service’ to engaging with patients and "do not look like or live the lives of the people they are making decisions about", an NHS England director has said.

Olivia Butterworth, NHSE’s deputy director of people and communities, told a public event hosted by the New Local think tank there is a “whole load of work” going on around reforming patient-reported outcome measures.

But she said that “none” of this work “starts with conversations with people about what do they value and what they want to measure.”

Asked whether NHS England’s top leadership is “paying lip service” to patient engagement, Ms Butterworth said: “I think often everybody pays lip service to it. We all use the right words. But whether it’s local government, whether it’s the NHS we know the words to use, but do we really live that in our actions in the way that we really like to change things?

“Or do we just blame the system for being too complex and it is the system that won’t let us, without recognising that we are the system, we make the system, we run the system, the system is people.”

Elsewhere in the session, Ms Butterworth said that “our decision makers do not look like or live the lives of the people they are making decisions about.”

She added that health services need to “join up around people” and that integrated care systems and partnerships offer the opportunity to “cut the crap of the organisational boundaries that stopped us doing things”.

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Source: HSJ, 8 April 2022

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Nurse suspended after forcing medication into patient’s mouth

A nurse has been suspended for three months by the Nursing and Midwifery Council (NMC) after forcing medication into a person with dementia's mouth.

An NMC Fitness to Practise (FtP) panel found Reni Kirilova had forced medicine into the patient’s mouth, held her mouth closed and shouted ‘take your tablets’ while working at the Chocolate Quarter Care Home in Bristol, run by the St Monica Trust.

Patient was reportedly distressed, waving her hands and shouting

The incident occurred on 30 May 2019, seven days after Ms Kirilova began working at the care home on 23 May. She was suspended on 7 June pending a police investigation and she resigned the same day.

One witness told the NMC hearing that they saw the nurse’s fingers go over the patient’s mouth for around 30 seconds while the patient was ‘flapping her hands’ and ‘trying to spit them out’.

They added the patient was distressed and was ‘waving her hands everywhere’ and shouting ‘no, no, no’.

Ms Kirilova denied the allegations and said that she had given the patient some water and then tilted the patient’s chin to help her swallow.

The panel found that the allegation she held her hand over the patient’s mouth was not true but that she had held it closed in some way, after three witnesses corroborated this.

The panel said they were not satisfied that she had considered how she would cope with stressful situations in the future and there was a risk it could happen again.

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Source: Nursing Standard, 7 April 2022

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Patients asked to travel 200 miles in push to cut elective waits

Long waiting times at Devon’s acute hospitals have forced commissioners to offer patients treatment 200 miles away in London in a bid to reduce the elective backlog.

Devon Clinical Commissioning Group has secured extra capacity for patients requiring complex orthopaedic surgery under a new deal with the South West London Elective Orthopaedic Centre, located at Epsom General Hospital.

The NHS-run orthopaedic centre is around 170 miles from Exeter in east Devon and 210 miles from Plymouth in west Devon. Many patients have declined to go, despite the CCG offering to cover their travel costs.

It is the longest publicly reported distance patients are being sent for elective treatment in the NHS, with patients usually referred to neighbouring hospitals or integrated care systems if there is no capacity at their local provider.

Nearly 1,500 patients in the Devon ICS have waited longer than two years for treatment. The latest national data for England showed nearly 23,000 patients had been waiting longer than two years in January.

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Source: HSJ, 8 April 2022

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Leading clinicians ‘horrified’ as NHSE slashes community funding without warning

Senior medics have reacted in horror to NHS England’s decision to ‘dramatically’ cut the funding of a key long-term plan commitment designed to improve older people’s community services and deliver more care at home.

British Geriatrics Society president Jennifer Burns told HSJ the professional body was “horrified” that the budget for the Ageing Well programme for 2022-23 would be £70m instead of the £204m originally promised in the long-term plan for the NHS.

“We are dismayed that the promised funding for the Ageing Well programme as set out in the NHS long-term plan is being so dramatically cut at this time,” Dr Burns said.

NHSE said: “The NHS is also investing an additional £200m in funding for virtual wards across the country by March 2023, delivering more care to patients safely in the comfort of their own home which will directly benefit older patients.”

But Dr Burns said that although virtual wards would go “some way to helping with hospital admissions”, they were “no substitute” for the original commitments.

“Older people suffered a devastating toll during the pandemic. Now is the time for systems to ensure the right services are in place and there is sustainable planning for the healthcare needs of an ageing population.”

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Source: HSJ, 7 April 2022

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My body caught on fire halfway through surgery – my insides were scorched and it took a year to recover

A patient was left traumatised when his body caught on fire halfway through surgery - leaving his insides scorched.

Mark, 52, went to hospital for a routine abscess removal - but woke up to the news that a freak accident in theatre had sparked an horrific blaze.

A diathermy machine, used to stop bleeding, caused a swab to catch fire - before flames burnt their way through his exposed flesh, Mark explained.

It took over a year for Mark - not his real name - to recover from his dreadful injuries - and the emotional scarring it caused.

Between 2008 and 2018, 37 cases were acknowledged by NHS trusts across Britain. But from 2009 to 2019, it has paid out nearly £14 million in compensation settlements and legal fees.

Fires such as these are often fuelled by leaking oxygen - and are caused by faulty machinery or sparking equipment.

Campaigners are concerned that UK hospitals are lagging behind other countries in recording surgical fires and introducing protocols to reduce both their frequency and severity.

Theatre scrub nurse Kathy Nabbie has spent the past five years trying to make colleagues more aware of the threat of surgical fires.

In 2017 - after hearing how a woman in Oregon, USA, had suffered severe burns when her face was set alight in surgery - she made a  simple safety checklist. 

Her Fire Risk Assessment tool allowed colleagues to check for the presence of elements that together might cause a fire to break out.

But senior staff failed to implement the initiative and - when a surgical fire actually took place three months later - Kathy learned that her laminated checklist had simply been put in a drawer.

 “I couldn’t believe it,” she said. “After that they did start using it, but why on earth should it have taken an actual fire to persuade them?”

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Source: The Sun, 7 April 2022

Further reading

What can we do to improve safety in the theatre? Reflections from theatre nurse Kathy Nabbie

How I raised awareness of fires in the operating theatre - Kathy Nabbie

 

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Families asked to take in Covid-positive loved ones as NHS faces ‘perfect storm’

NHS chiefs have issued an extraordinary plea for families to help them discharge loved ones even if they are Covid-19 positive as the health service faces a “perfect storm” fuelled by heavy demand, severe staff shortages and soaring Covid cases.

Hospitals and ambulance services across England are under “enormous strain”, health leaders have warned, after NHS trusts covering millions of patients declared critical incidents or issued stark warnings to residents.

Dr Layla McCay, director of policy at the NHS Confederation, which represents the whole healthcare system, said the situation had become so serious that “all parts” of the health service were now becoming “weighed down”. This will have a “direct knock-on effect” on the ability of staff to tackle the care backlog, she added, as well as the current provision of urgent and emergency care.

On Wednesday evening, the crisis became so acute in Hampshire and the Isle of Wight that its chief medical officer urged relatives of patients well enough to be discharged to collect them immediately – even if they were still testing positive for coronavirus.

Dr Derek Sandeman, of the Hampshire and Isle of Wight Integrated Care System, revealed that almost every hospital in the two counties was full, and said the number of people with Covid-19 being cared for in hospitals across the area was 650 – more than 2.5 times higher than in early January. He added that 2,800 staff working for local NHS organisations were off sick, half of which absences were due to Covid-19.

“With staff sickness rates well above average, rising cases of Covid-19 and very high numbers of people needing treatment, we face a perfect storm – but there are some very specific ways in which people can help the frontline NHS and care teams,” said Sandeman.

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Source: The Guardian, 6 April 2022

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‘Big personalities’ accused of bullying thought to be ‘bullet proof’, finds review

Doctors at an acute trust believe their clinical leaders have failed to tackle the ‘big personalities’ accused of being aggressive bullies, a review has found.

The probe at University Hospitals of North Midlands Trust was prompted by a survey carried out last year by the British Associations of Physicians of Indian Origin, after concerns were raised by its members.

The review was undertaken by Birmingham-based equalities charity Brap, and Roger Kline, a research fellow at Middlesex University Business School. It found the trust was not an outlier in statistical measures of bullying and harassment, but suggested the situation was still worse than leaders would wish.

They said: “The most common reason people cited for bullying/harassment they experienced was the personality, attitude, and disposition of their managers and colleagues… it is felt senior clinical leaders have, in the past, failed to tackle these ‘big personalities’.

“It is worth noting feedback from interviews suggesting many doctors feel they have endured poor behaviour – talking over people during meetings, criticising work in public, aggressive questioning – for years, and have simply become inured to it.

The reviewers found that as a consequence, certain people within the organisation were perceived to be “bullet proof”, and added: “We would suggest the trust needs a big, long-term plan to ‘rehumanise’ the organisation.

“The trust’s existing culture has permitted, and continues to permit infringements in behaviour… While this is not condoned by senior leaders in the trust, the lack of a plan to proactively tackle a legacy of overlooking poor behaviours has allowed them to persist.”

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Source: HSJ, 6 April 2022

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Patients continue to die and be harmed by the failure to learn from unsafe care

Press release: 7 April 2022

Today the charity Patient Safety Learning has published a new report, ‘Mind the implementation gap: The persistence of avoidable harm in the NHS'.

The report is an evidence-based summary of the failures over decades to translate learning into action and safety improvement.  It highlights that avoidable unsafe care kills and harms thousands of people each year in the UK and costs the NHS billions of pounds for additional treatment, support, and compensatory costs.  The report highlights how we fail to learn lessons from incidents of unsafe care and are not taking the action needed to prevent harm recurring.

The report focuses on six sources of patient safety insights and recommendations, ranging from inquiry reports into patient safety scandals, such as the recent Ockenden report into maternal and neonatal harm at Shrewsbury and Telford Hospital, to the findings of Coroner’s Prevention of Future Deaths reports. It calls on the Government, parliamentarians, and NHS leaders to take action to address the underlying causes of avoidable harm in healthcare and proposes recommendations in each policy area. Patient Safety Learning is calling for system-wide action in healthcare to transform our approach to learning and safety improvement.

Helen Hughes, Chief Executive of Patient Safety Learning, said:

“Today’s report highlights the all too frequent examples of where healthcare organisations fail to learn lessons from incidents of unsafe care and not taking the action needed to prevent future harm. Time and time again there is a lack of action and coordination in responding to recommendations, an absence of systems to share learning and a lack of commitment to evaluate and monitor the effectiveness of safety recommendations.”

“This is a shocking conclusion that is an affront to all those patients and families who have been assured that ‘lessons have been learned’ and ‘action will be taken to prevent future avoidable harm to others’. The healthcare system needs to understand and address the barriers for implementing recommendations, not just continually repeat them. Hope is not a strategy.”

This report has been published as part of the Safety for All Campaign, which calls for improvements in, and between, patient and healthcare worker safety to prevent safety incidents and deliver better outcomes for all. The campaign is supported by Patient Safety Learning and the Safer Healthcare and Biosafety Network.

Notes to editors:

  1. Patient Safety Learning is a charity and independent voice for improving patient safety. We harness the knowledge, insights, enthusiasm and commitment of health and social care organisations, professionals and patients for system-wide change and the reduction of avoidable harm.

  2. Safer Healthcare and Biosafety Network an independent forum focused on improving healthcare worker and patient safety and has been in existence more than 20 years. It is made up of clinicians, professional associations, trades unions and employers, manufacturers and government agencies with the shared objective to improve occupational health and safety and patient safety in healthcare. COVID-19 pandemic has provided a stark reminder of the vital role healthcare professionals play in providing care to those in our society who need it most and this was recognized in the WHO Patient Safety Day in September 2020: only when healthcare workers are safe can patients be safe. In 2020, the Network launched a campaign called ‘Safety for All’ to improve practice in, and between, patient and healthcare worker safety to prevent safety incidents and deliver better outcomes for all.

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Increase in hepatitis (liver inflammation) cases in children under investigation

The UK Health Security Agency (UKHSA) has recently detected higher than usual rates of liver inflammation (hepatitis) in children. Similar cases are being assessed in Scotland.

Hepatitis is a condition that affects the liver and may occur for a number of reasons, including several viral infections common in children. However, in the cases under investigation the common viruses that cause hepatitis have not been detected.

UKHSA is working swiftly with the NHS and public health colleagues across the UK to investigate the potential cause. In England, there are approximately 60 cases under investigation in children under 10.

Dr Meera Chand, Director of Clinical and Emerging Infections, said:

"Investigations for a wide range of potential causes are underway, including any possible links to infectious diseases. We are working with partners to raise awareness among healthcare professionals, so that any further children who may be affected can be identified early and the appropriate tests carried out. This will also help us to build a better picture of what may be causing the cases."

"We are also reminding parents to be aware of the symptoms of jaundice – including skin with a yellow tinge which is most easily seen in the whites of the eyes – and to contact a healthcare professional if they have concerns."

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Source: UK Health Security Agency, 6 April 2022

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NI Health: Quarter of cancer patients diagnosed in A&E

More than a quarter of cancers in Northern Ireland are being diagnosed in hospital emergency departments, according to Cancer Research UK.

The study, published in The Lancet Oncology, was supported by NI Cancer Registry at Queen's University Belfast.

It looked at 857,068 cases diagnosed between 2012 and 2017 in six countries including Australia, Denmark and the UK.

Clare Crossey, 35, from Lurgan was diagnosed with acute myeloid leukaemia in February 2018 after being admitted to hospital as an emergency.

The 35-year-old mother-of-two, who is a domiciliary care assistant, suddenly became very unwell with symptoms including tiredness and bruising.

She told BBC News NI she had contacted her local health centre, where a GP told her she was being overly anxious.

Ms Crossey said she had panicked, fearing she may have leukaemia after looking up her symptoms on the internet.

"I had a feeling that things weren't right," she said.

"The doctor did not agree with my suspicions as they passed me the number of the Samaritans helpline, a prescription for beta blockers and told me to wait a week for blood tests."

She said: "I went to Craigavon's A&E, they did blood tests and within hours a consultant broke the news to me that I might have leukaemia."

The medical team told her that had she waited any longer to come to the emergency department, she could have died, said Ms Crossley.

Barbara Roulston, from Cancer Research UK, said the study confirmed too many people were only being diagnosed with cancer once their health had deteriorated to a point when they needed to go to their emergency department.

"We need to reduce the number of cancer diagnoses that are happening in this way," she said.

"That means renewed focus on early diagnosis and prevention through things like better awareness of symptoms, better uptake of screening programs and the way to do that is to get funding for the cancer strategy which was published recently.

"If we don't, the risk is that we will start to see cancer survival going backwards."

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Source: BBC News, 7 April 222

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Covid had devastating toll on poor and low-income communities in US

The devastating impact of the Covid-19 pandemic on poor and low-income communities across America is laid bare in a new report that concludes that while the virus did not discriminate between rich and poor, society and government did.

As the US draws close to the terrible landmark of 1 million deaths from coronavirus, the glaringly disproportionate human toll that has been exacted is exposed by the Poor People’s Pandemic Report. Based on a data analysis of more than 3,000 counties across the US, it finds that people in poorer counties have died overall at almost twice the rate of those in richer counties.

Looking at the most deadly surges of the virus, the disparity in death rates grows even more pronounced. During the third pandemic wave in the US, over the winter of 2020 and 2021, death rates were four and a half times higher in the poorest counties than those with the highest median incomes.

During the recent Omicron wave, that divergence in death rates stood at almost three times.

Such a staggering gulf in outcomes cannot be explained by differences in vaccination rates, the authors find, with more than half of the population of the poorest counties having received two vaccine shots. A more relevant factor is likely to be that the poorest communities had twice the proportion of people who lack health insurance compared with the richer counties.

“The findings of this report reveal neglect and sometimes intentional decisions to not focus on the poor,” said Bishop William Barber, co-chair of the Poor People’s Campaign which jointly prepared the research. “The neglect of poor and low-wealth people in this country during a pandemic is immoral, shocking and unjust.”

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Source: The Guardian, 4 April 2022

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