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Occupational health staff told not to get involved in decisions on mandatory covid vaccination

Occupational health professionals should avoid employment and management matters related to unvaccinated NHS staff, new guidance has warned.

The Faculty of Occupational Medicine guidance comes as trusts are considering their options of how to approach patient-facing staff who remain unvaccinated, including their potential redeployment or dismissal.

However, HSJ understands some occupational health practitioners are concerned they may become entangled in difficult ethical issues, such as the vaccination status of individual employees, or disciplinary processes.

Today’s FOM guidance said: “There is no scope for occupational health practitioners to provide an opinion on medical exemptions, whether to confirm or refute them…

“Redeployment, dismissal and other employment consequences of vaccine refusal by a worker, within the scope of the proposed regulations, are entirely employment and management matters, and not an area in which occupational health should be involved.”

FOM president Steve Nimmo said: “When the programme is implemented, occupational health professionals should be mindful of ethical and consent issues, and be careful not to be associated with any disciplinary process.”

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Source: HSJ, 7 January 2022

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Trust tells clinicians ‘we’ll support you’ over safety risks caused by covid pressures

A trust has written to its registered workforce to reassure them of management support when delivering care in ‘extremely challenging circumstances’.

Derbyshire Community Health Services Trust sent out a “statement of support for professionally registered colleagues”, in which it thanked them for their “continued efforts”, and explained how they would support staff from a “professional and regulatory perspective”, when delivering services that require “a high level of clinical knowledge and autonomous decision-making”.

This week has seen NHS staff absences hit new highs – over 100,000 – and the military brought in to support care in London hospitals, in combination with very high community covid transmission rates and very busy acute trusts. 

The DCHST email, signed by executive director of nursing Michelle Bateman, executive medical director Ben Pearson and interim director of Allied Health Professionals Trish Bailey, said: “When services are at this high level of escalation it can mean that we are not always able to deliver care in the way we would like and that can challenge our professional values.”

Helen Hughes, chief executive of charity Patient Safety Learning, said Derbyshire Community Healthcare’s message needed to be echoed by every trust in the country.

“Without sufficient staffing resources, difficult decisions are required to prioritise care,” Ms Hughes said. “In some cases, delays in treatment as a result of these decisions could lead to avoidable harm.”

She stressed it was “imperative” that future investigations into safety incidents “properly reflect the systemic nature of reasons for error or harm, not simply blaming staff for failures to provide safe care”.

“Health professionals’ codes mean that they are not allowed to work outside their sphere of competence. But what if staff are being tacitly encouraged or required to work in an unsafe system? Staff need to be able to feel secure in raising any concerns they have, being listened to and being supported,” Ms Hughes added.

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Source: HSJ, 10 January 2022

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Tory pledge to bolster GP surgery staff set to be broken, say health leaders

A manifesto pledge to hire 26,000 extra health professionals to work in GP surgeries is set to be broken by the government, health leaders have warned, leaving family doctors straining under a heavier workload.

About 9,500 of the promised physiotherapists, pharmacists, mental health therapists and other clinical staff so far have been recruited to help GPs and practice nurses.

Senior doctors have warned that patients will pay the price for the slow delivery of extra personnel by facing persistently long waits for an appointment.

The plan was to free up family doctors’ time by having physiotherapists see patients with sore backs, pharmacists undertaking medication reviews, counsellors supporting people with mental health problems and dieticians advising those with food-related problems.

Those 26,000 staff, alongside the arrival of “6,000 more doctors in general practice” in a separate pledge, would help GPs and their teams offer 50m more consultations, the Conservatives said. But in November the health secretary, Sajid Javid, admitted that Johnson’s often-repeated 6,000 extra GPs pledge would be missed.

“Whilst progress in meeting this target is better than the GP [recruitment] target, it’s still slow and very concerning that this could be another promise that won’t be met,” said Prof Matin Marshall, the chair of the RCGP.

“The impact of not having enough staff in general practice is being felt acutely both by GPs and our team members who are working to their limits, and our patients, who are facing longer waits for the care they need. Meeting this [extra staff] target – and the GP target – will be vital to addressing this.”

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Source: The Guardian, 9 January 2022

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Pregnant women urged not to delay getting jab

Pregnant women are being urged not to delay getting their Covid jab or booster in a government campaign.

More than 96% of pregnant women admitted to hospital with Covid symptoms between May and October last year were unvaccinated, according to the UK Obstetric Surveillance System.

The campaign will share testimonies of pregnant women who have had the jab on radio and social media.

The government said the vaccine was safe and had no impact on fertility.

In December, the Joint Committee on Vaccination and Immunisation added pregnant women to the priority list for the vaccine, saying they were at heightened risk from Covid.

Around one in five pregnant women admitted to hospital with the virus needed to be delivered pre-term to help them recover, and one in five of their babies needed care in the neonatal unit, the Department of Health and Social Care (DHSC) said.

Prof Lucy Chappell, chief scientific adviser to the DHSC, told BBC Radio 4's Today programme that a third of unvaccinated pregnant women with COVID-19 needed help with breathing and one in six were admitted to intensive care.

"We've also seen stillbirths and neonatal deaths in the latest wave," she said.

Prof Chappell said the vaccine causes pregnant women to produce antibodies against the virus, which cross over to their babies and give them protection too.

Dr Jen Jardine, from the Royal College of Obstetricians and Gynaecologists, who is seven months pregnant and has had her booster jab, said: "Both as a doctor and pregnant mother myself, we can now be very confident that the Covid-19 vaccinations provide the best possible protection for you and your unborn child against this virus."

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Source: BBC News, 10 January 2022

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A WHO official weighs in on Covid, vaccines, and mistakes that were made

The Covid-19 pandemic has entered its third year, with no end in sight, and the world is fed up to the gills. A new and even more highly transmissible variant, Omicron, has been scorching through holiday gatherings over the past couple of weeks. People who are thrice vaccinated are among the infected.

STAT asks Mike Ryan, head of the health emergencies programme at the World Health Organization, if he expected the pandemic to last as long as it has, who should make the call on whether to update Covid vaccines, and what he thinks are the main mistakes the world has made.

“What’s shocked me most in this pandemic has been that absence or loss of trust,” he said of people’s unwillingness to follow the advice of public health leaders and the containment policies set out by governments," says Ryan.

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Source: STAT, 3 January 2022

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Trust fined following patient’s death linked to ‘outdated’ IT system

A Norfolk hospital trust has been fined £60,000 after pleading guilty to criminal charges of exposing a 28-year-old patient who died to significant risk of avoidable harm.

Queen Elizabeth Hospital King’s Lynn Foundation Trust was sentenced on Thursday 8 December at Chelmsford Magistrates’ Court, as a result of a prosecution brought by the Care Quality Commission.

The dilapidated hospital’s “outdated” computer system, which is long overdue a major upgrade, was cited as a factor in the young patient’s death, which followed a mix-up over scans.

Lucas Allard, who was awaiting heart surgery, had attended the hospital’s emergency department on 12 March 2019 with chest pain.

He was sent home after staff determined his computerised tomography scan results meant he was fit for discharge. But two days later, a consultant discovered staff had been looking at the wrong scan, and the correct report showed significant abnormality.

Mr Allard was urgently called back to the hospital but suffered a cardiac arrest shortly after arriving, and died despite attempted resuscitation.

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Source: HSJ, 9 December 2022

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Absences hit 120,000 as military sends 200 staff to help hospitals

The government has announced 200 military personnel are being deployed to “support the NHS in London amid staff shortages due to COVID-19”. The 200 figure is equivalent to about 1.8% of the covid-related absences in acute trusts in the capital on Wednesday, and 0.2% of the national all-trust total of 120,000.

The Ministry of Defence will provide 40 defence medics and 160 general duty personnel, it said. The first were deployed this week, including in Whipps Cross in east London.

According to the minutes of an internal meeting held by senior leadership at the hospital, 10 general duty military personnel have been deployed. They do not have clinical training so cannot take blood, but will undertake general duties, such as feeding patients and communication with teams and relatives. 

Staff absences from NHS trusts hit nearly 120,000 on Wednesday after another increase, HSJ has learned.

Figures due to be published by NHS England are expected to show there were total absences across acute trusts of just over 80,000 on 2 January, down from more than 85,000 on 30 December. 

However, figures seen by HSJ show that, after the end of the new year bank holiday period, this acute trusts figure leapt to more than 92,000 by Wednesday (5 January).

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Source: HSJ, 7 January 2022

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Trusts fall far short of NHSE discharge target

NHS trusts have been unable to get anywhere close to the target for reducing delayed discharges set by NHS England last month ahead of the omicron wave.

The latest NHSE data shows that, in the week beginning 27 December, there were on average 9,857 medically fit for discharge adult patients occupying hospital beds.

This is just 836 fewer than the average of 10,693 in the week of 13 December. This was when NHSE told trusts to discharge at least half of their medically fit patients to free up beds ahead of a surge in Covid patients.

The news follows ministers announcing £300m would be invested into the adult social care workforce to fund community placements to aid discharges. However, in the letter on 13 December, NHSE said “a significant proportion of discharge delays are within the gift of hospitals to solve”.

Meanwhile, ambulance handover delays remained a near record high levels last week as the urgent and emergency care system showed clear signs of pressure, including massive demand on NHS 111.

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Source: HSJ, 7 January 2022

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NHS to begin move to dismiss staff who refuse covid vaccine or redeployment

Trusts will be told next week how they should go about dismissing potentially thousands of NHS staff who have decided not to be vaccinated against covid, HSJ has learned.

Last year, the government decided all patient-facing NHS staff would need to have received their first dose of the covid vaccine by 3 February, and two doses by April 2022. The stipulation covers non-clinical staff who may have face-to-face contact with patients, such as receptionists, porters and cleaners.

NHS England published the first part of its guidance for employers in December last year, which warned staff who have to be redeployed because of a refusal to have the covid vaccination could be forced to compete for their job and also have their pay and pension affected.

HSJ understands NHSE will issue its ‘phase two’ guidance’ next week.

To date, government and NHSE announcements or guidance have not mentioned what will happen to patient-facing staff who refuse to be redeployed or are exempt from the requirement.

However, HSJ understands the new guidance will make it clear that — while redeployment remains the preferred outcome — some staff are likely to be dismissed and trusts should be prepared for taking that action next month.

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Source: HSJ, 6 January 2022

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Patients at risk’ from ‘hastily rolled out virtual wards’

NHS England’s plans to rapidly expand virtual wards are being ‘hastily rolled out’ and could put patients at risk while taking up significant staffing capacity, leading clinicians have warned.

The Society for Acute Medicine and the Royal College of Physicians are among those who have raised concerns to HSJ about the huge increase in the use of the virtual wards model, under which patients are discharged home and given oximeters that fit on their finger so they can be remotely monitored by clinical staff.

The concerns follow NHSE ordering trusts to ensure a minimum of 15% of hospital covid patients were being treated in virtual wards, in plans to help ease pressures on hospital wards announced just before Christmas.

At the time NHSE announced the plans there were around 7,000 covid inpatients in English NHS hospitals, meaning around 1,000 patients should be in virtual wards. But the covid inpatient figure had more than doubled to nearly 16,000 by 5 January.

The project is hugely significant because NHSE and trust chiefs want to use virtual wards much more widely – including for non-covid patients – and believe they represent a potentially game-changing option when it comes to alleviating pressure on hospitals and speeding up discharges.

Many of the clinicians who spoke to HSJ were supportive of the principle of virtual wards but had serious concerns about the speed and timing of the rollout. They said there was a lack of evidence the approach was safe.

Society for Acute Medicine president Tim Cooksley said virtual wards had potential for the future but that they “simply cannot be seen as a short-term mitigation measure which can be hastily rolled out mid-pandemic”.

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Source: HSJ, 7 January 2022

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Nurse ‘bullied’ for wearing cross wins unfair dismissal case

A Christian nurse who claimed she was discriminated against for wearing a cross at work has won her case for unfair dismissal.

Mary Onuoha, a theatre practitioner at Croydon University Hospital in London, said she was bullied and harassed for refusing to remove her necklace in 2018.

But an employment tribunal has ruled Croydon Health Services NHS Trust discriminated against and harassed Ms Onuoha over her refusal to remove the jewellery. The trust told her the necklace was a safety risk and must not be outwardly visible.

Ms Onuoha, supported by Christian Legal Centre, said she had worked at the hospital for 13 years before being asked to remove the symbol.

The tribunal found the employer’s uniform policy arbitrary, with many staff allowed to wear necklaces and other religious symbols were permitted.

Following the ruling, Christian Legal Centre chief executive Andrea Williams said the trust’s interpretation of uniform guidance had led to a campaign of harassment against a devoted, experienced, and highly professional nurse, who was in effect hounded out of the NHS.

Ms Onuoha said she was investigated and suspended from clinical duties when she refused to remove the item and she was demoted to receptionist duties. In June 2020, she went off work with stress and said she felt she had no alternative but to resign.

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Source: Nursing Standard, 6 January 2022

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UK survey suggests 1.3 million have Long Covid

About 1.3 million people in the UK have Long Covid symptoms lasting more than four weeks after an initial infection, an Office for National Statistics survey suggests. Of those, 892,000 (70%) first caught the virus at least 12 weeks ago and 506,000 (40%) at least a year ago.

The survey asked nearly 352,000 people to record their own symptoms. There is no universally agreed definition of long Covid and different studies use varying definitions.

The ONS survey, over four weeks in November and December 2021, suggests, of those with Long Covid:

  • 51% have fatigue
  • 37% have loss of smell
  • 36% have shortness of breath
  • 28% have difficulty concentrating.

University of Exeter senior clinical lecturer Dr David Strain said: "The stark warning here is that, based on this, in the previous waves, over 800,000 people have their day-to-day activities significantly affected over three months after catching Covid and nearly a quarter of a million report this has a dramatic impact on their quality of life.

"As we continue to see case numbers of Omicron rise, we must be wary that our reliance purely on hospitalisations and death as a measure of the risk from Covid could grossly underestimate the public-health impact of our current Covid strategy."

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Source: BBC News, 6 January 2022

 

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Number of adults with dementia to exceed 150m by 2050, study finds

The number of adults living with dementia worldwide is on course to nearly triple to 153 million by 2050, according to the first study of its kind.

Experts described the data as shocking and said it was clear that dementia presented “a major and rapidly growing threat to future health and social care systems” in every community, country and continent.

US researchers said the dramatic rise from an estimated 57 million cases in 2019 would be primarily due to population growth and ageing. However, several risk factors for dementia – including obesity, smoking and high blood sugar – would also fuel the increase, they said.

Improvements in global education access are projected to reduce global dementia prevalence by 6.2 million cases by 2050. But this will be countered by anticipated trends in obesity, high blood sugar and smoking, which are expected to result in an extra 6.8 million dementia cases.

Hilary Evans, the chief executive of Alzheimer’s Research UK, who was not involved in the study, said the figures “lay bare the shocking scale of dementia across the world”.

She said: “We need to see concerted global action to avoid this number tripling. Dementia doesn’t just affect individuals, it can devastate whole families and networks of friends and loved ones. The heartbreaking personal cost of dementia goes hand in hand with huge economic and societal impacts, strengthening the case to governments across the world to do more to protect lives now and in the future.”

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Source: The Guardian, 6 January 2022

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Deadly Omicron should not be called mild, warns WHO

The World Health Organization (WHO) has warned against describing the Omicron variant as mild, saying it is killing people across the world.

Recent studies suggest that Omicron is less likely to make people seriously ill than previous Covid variants.

But the record number of people catching it has left health systems under severe pressure, said WHO chief Dr Tedros Adhanom Ghebreyesus.

On Monday, the US recorded more than one million Covid cases in 24 hours.

The WHO - the UN's health agency - said the number of global cases has increased by 71% in the last week, and in the Americas by 100%. It said that among severe cases worldwide, 90% were unvaccinated.

"While Omicron does appear to be less severe compared to Delta, especially in those vaccinated, it does not mean it should be categorised as mild," Dr Tedros told a press conference on Thursday.

"Just like previous variants, Omicron is hospitalising people and it is killing people.

"In fact, the tsunami of cases is so huge and quick, that it is overwhelming health systems around the world."

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Source: BBC News, 6 January 2022

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Omicron blocks thousands of overseas doctors joining NHS

Thousands of overseas-qualified doctors wanting to work in the UK will be delayed after the General Medical Council cancelled exams due to the surge in Covid cases.

The regulator said its decision to pause professional and linguistic assessment board tests, scheduled for January and February, was made “in direct response” to the current omicron wave. Up to 54 doctors would have been needed each per day as examiners, it said, alongside a “large number of role players and staff”.

It comes as overseas recruitment is seen by government and national officials as a crucial way to boost NHS staffing, including GPs.

Director of registration Una Lane said: “We are deeply disappointed to have to cancel exams at this time, but given the pressures on the NHS and the impact on examiner availability, it was the only viable option.”

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Source: HSJ, 6 January 2022

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A quarter of inpatients at mental health trust have Covid

More than one in four inpatients at one of England’s largest mental health trusts were reported as covid-positive this week, according to data seen by HSJ.

Around 160 inpatients across South London and Maudsley (SLAM) Foundation Trust’s sites, or 28% of its total open beds, were reported as positive at the beginning of the week. 

Several other London mental health trusts have seen high rates of covid cases in recent weeks, as there has been enormous spread of the omicron variant in the capital, although rates have not been as high as at SLAM.

SLAM told HSJ that infection rates rose and fell in a reflection of community transmission, with covid-positive people being admitted, and there being spread within inpatient units.

While no wards have been closed and all of the trust’s services are open, visiting was suspended in mid-December due to what the organisation described on its website as a “high number of [covid] outbreaks”.

Several sources in the sector told HSJ there had been widespread omicron outbreaks in mental health units across England. They said the nature of psychiatric wards and use of restraints meant adhering to stringent social distancing measures, in the face of a highly infectious variant, was more difficult than in other settings.

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Source: HSJ, 6 January 2022

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Hundreds of babies born addicted to drugs and alcohol

Scottish Liberal Democrat leader Alex Cole-Hamilton is calling for more cash to be invested in drug and alcohol services after “utterly heart-breaking” figures showed at least 852 babies have been born addicted since April 2017.

A total of 173 such births were recorded in both 2019-20 and 2020-21, down from 205 in 2018-19 and 249 in 2017-18.

In addition to this, a further 52 babies were born addicted in the first part of 2021-22, according to the figures, which were compiled by the Scottish Lib Dems using data obtained under Freedom of Information.

Mr Cole-Hamilton described the figures as being “utterly heart-breaking”, adding: “It is hard to think of a worse possible start in life for a newborn baby to have to endure.”

He criticised SNP ministers, saying: “In 2016, the Scottish Government slashed funding to drug and alcohol partnerships by more than 20 per cent. Valuable local facilities shut their doors and expertise was lost which has proved hard to replace."

“Scotland now has its highest-ever number of drug-related deaths. The Scottish Government has belatedly begun to repair that damage but there is so much more to do."

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Source: The Independent, 6 January 2022

 

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Fix NHS staffing crisis to tackle waiting lists backlog, warn MPs

A long-term plan to fix the staffing crisis in the NHS is needed to cut record waiting lists for treatment, the government is being warned.

Currently, nearly six million people in England are waiting for routine operations and procedures - many of whom are in pain.

A report from MPs says the government needs to address staff shortages - or NHS workers will quit. 

There have been repeated warnings over the length of hospital waiting lists in England. As of September 2021, a record 5.8 million patients were waiting for surgery - such as hip or knee replacements - with 300,000 waiting more than a year compared with just 1,600 before the pandemic.

In the autumn Budget, the government announced an extra £5.9bn for the NHS in England to help clear the backlog. This was on top of another funding package in September to create an extra nine million checks, scans and operations.

But in its report published today, the Commons health and social care select committee said the health service was hugely understaffed and was facing an "unquantifiable challenge" in tackling the backlog.

Jeremy Hunt, the former health secretary who now chairs the committee, said the NHS was short of 93,000 workers and there was "no sign of any plan to address this".

He described the staffing crisis as "entirely predictable", adding: "The current wave of Omicron is exacerbating the problem, but we already had a serious staffing crisis, with a burnt-out workforce."

"Far from tackling the backlog, the NHS will be able to deliver little more than day-to-day firefighting unless the government wakes up to the scale of the staffing crisis facing the NHS."

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Source: BBC News, 6 January 2022

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Ministers order review into Covid-hit ambulance chiefs telling people to get a lift to A&E

A health minister has asked NHS England to look into a stricken ambulance trust that is asking patients to get a lift to A&E.

The North East Ambulance Service (NEAS) said staff should “consider asking the patient to be transported by friends or family.” See previous news story.

NEAS medical director Dr Mathew Beattie said the service had “no option than to try to work differently” amid Covid staff shortages.

However, Health Minister Gillian Keegan said she would ask NHS England to look into the situation.

She told Sky News: "That is not what we have put in place at all. We have more ambulance crews in operation than we have ever had."

“We also gave £55 million extra just for this period to cover staff and make sure we had increases in staff and staffing levels.

"I've actually asked NHS England to look at that particular case because that doesn't sound to me like that's an acceptable approach.

“People should be able to get an ambulance if they have a heart attack and that's why we've put that extra funding in place, and why we've been building up our ambulance service over the last couple of years."

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Source: Mirror, 5 January 2022

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Government to review number of healthcare regulators

The government has ordered an external review of whether the number of professional healthcare regulators should be reduced to ‘simplify’ the system.

Newly published procurement documents reveal the Department of Health and Social Care has hired KPMG to make recommendations on whether the number of regulators “should be reduced and how this might be achieved”.

The scope of the review covers the eight independent healthcare regulators – which include the General Medical Council, the Nursing and Midwifery Council and the Professional Standards Authority for Health and Social Care. It does not cover other healthcare regulators such as the Care Quality Commission, NHS England/Improvement, or the Medicines and Healthcare Products Regulatory Agency. 

According to DHSC there is ongoing work to “reform the healthcare regulators’ legislation” which has created an “opportunity to consider” if the regulatory landscape could be “simplified to provide better public protection in a more efficient way”.

A spokeswoman for the DHSC told HSJ that “stakeholders” accepted that having nine separate professional regulatory bodies “can be confusing for the public”.

She said: “We know health regulators play an integral role in our commitment to making sure everyone has access to safe and effective healthcare, and we will continue to identify opportunities to improve the professional regulation system.” 

In 2014, Sir Robert Francis, who chaired the inquiry into failings at Mid Staffordshire Foundation Trust, said there were too many healthcare regulators in the NHS.

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Source: HSJ, 5 January 2022

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Pilot scheme has 'changed critical care forever'

A specialist service to transport critically ill and injured patients is being copied around England after the success of a trial in the South West.

More than 700 patients have been transported since the pilot scheme began a year ago.

Retrieve was set-up to transport the most seriously ill patients between intensive care units to take pressure off ambulance and hospital staff.

Six other regions around England are now developing a similar service.

"Everyone will have a service that looks similar to Retrieve by the end of next year which is amazing in the short period of time that we've been talking about it," said Dr Scott Grier, lead consultant for Retrieve.

Dr Grier said critically unwell patients need to be transported between hospitals for various reasons, though frequently to be treated in a hospital specialising in the care they require.

The service, which operates in Bristol, Gloucestershire, Wiltshire, Somerset, Devon and Cornwall, is funded by NHS England and Improvement South West and costs £3.2m a year.

"It sounds expensive but it's an efficient service and every time we make a transfer we save the hospital and staff time and those hospitals can care for other people while we care for their patients on the move.

"It's incredibly exciting because we have changed this area of critical care forever," added Dr Grier.

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Source: BBC News, 5 January 2021

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More than 90 care home operators in England declare red alert over staffing

Care operators are facing acute staffing shortages caused by Omicron with more than 90 declaring a “red” alert, which means staffing ratios have been breached.

Over 11,000 care home workers are off for Covid reasons, according to internal health system staffing data seen by the Guardian. One of the UK’s largest private operators, Barchester, is dealing with outbreaks in 105 of its 250 homes. It said that rules meaning homes with Covid cannot accept hospital discharges will cause backlogs in the already struggling NHS.

Across England, 9.4% of care home staff are off work, according to government live data, with close to 3% absent because of Covid. The figures, which may be an underestimate because of the festive break, are drawn from submissions by thousands of care providers.

“The spread of Omicron across the country will bring more care homes into outbreak, put huge pressure on the already compromised staff group and mean those who need care do not get it,” said Vic Rayner, chief executive of the National Care Forum. Many care operators said delays in getting PCR test results back were a key frustration, meaning workers who may not be infected were isolating longer than necessary."

Stephen Chandler, president of the Association of Directors of Social Services, said councils were braced for calls for help from care operators and said “the care that people experience will be affected”.

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Source: The Guardian, 5 January 2022

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‘Get a lift to hospital,’ ambulance trust tells patients with suspected heart attacks

Ambulance trusts have begun asking patients with heart attacks and strokes to get a lift to hospital with family or friends instead of waiting for an ambulance, because of high covid absences and ‘unprecedented’ surges in demand, HSJ has learned.

An internal note at North East Ambulance Service Foundation Trust said that where there was likely to be a risk from the delay in an ambulance reaching a patient, call handlers should “consider asking the patient to be transported by friends or family”.

This applies to calls including category two, which covers suspected strokes and heart attacks, according to the note seen by HSJ.

It said call handlers should “consider all forms of alternative transport” for patients. 

The note from medical director Mathew Beattie gives the example of a person with chest pain who would normally get a category 2 response – with a target of reaching them within 18 minutes – but where the ambulance response time would be two hours.

In the message to staff, Dr Mathew Beattie said: “To manage [current] unprecedented demand, we have no other option than to try and work differently which I am aware will not sit comfortably but is absolutely essential if we are to sustain a service to those who need it most."

“We need to weigh up the risk of delays for ambulances against alternative disposition or transport options. Where such risks are considered, I want you to be aware that the trust will fully support you in your decision-making under these circumstances.”

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Source: HSJ, 4 January 2022

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Women 32% more likely to die after operation by male surgeon, study reveals

Women who are operated on by a male surgeon are much more likely to die, experience complications and be readmitted to hospital than when a woman performs the procedure, research reveals.

Women are 15% more liable to suffer a bad outcome, and 32% more likely to die, when a man rather than a woman carries out the surgery, according to a study of 1.3 million patients.

The findings have sparked a debate about the fact that surgery in the UK remains a hugely male-dominated area of medicine and claims that “implicit sex biases” among male surgeons may help explain why women are at such greater risk when they have an operation.

“In our 1.3 million patient sample involving nearly 3,000 surgeons we found that female patients treated by male surgeons had 15% greater odds of worse outcomes than female patients treated by female surgeons,” said Dr Angela Jerath, an associate professor and clinical epidemiologist at the University of Toronto in Canada and a co-author of the findings.

“This result has real-world medical consequences for female patients and manifests itself in more complications, readmissions to hospital and death for females compared with males.

“We have demonstrated in our paper that we are failing some female patients and that some are unnecessarily falling through the cracks with adverse, and sometimes fatal, consequences.”

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Source: The Guardian, 4 January 2022

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Leak shows surge in staff absence as trusts consider letting covid positive clinicians return to wards

NHS staff absences due to covid have risen by a further 11,000 staff in a week in England, figures seen by HSJ reveal. 

At a national level, the number of absences for covid-related reasons - including isolation - rose to about 44,200 on 29 December, up from 32,800 on 22 December.

The 29 December figure has pushed up overall absence for all reasons to 103,727 - 7.8% of the total reported workforce - the leaked data shows.

Numerous senior NHS managers have said their main concern at present is about the level of staff absences, which in some cases is undermining services, with staff having to be redeployed to support others. There is concern about it rising further in the new year.

One trust is looking at whether staff who test positive could opt to work on wards dedicated to covid patients. Louise Ashley, the chief executive of Dartford and Gravesham Trust in Kent, tweeted yesterday that some nurses had asked if they could come into work while positive but asymptomatic.

Ms Ashley later confirmed to HSJ that the trust had assessed the request and “unfortunately” had to refuse it.

The two main reasons for the decision were that staff may have the more dangerous Delta strain and that it be too difficult to keep them isolated from other staff.

She added: ”I am amazed at their commitment to their patients and colleagues – very humbling after the two years they have been through. We are seeing high levels of staff absenteeism but we are hurrying through PCR tests to get staff back to work and are managing safe staffing levels currently.”

 There is also growing concern over NHS staff access to testing, which is required to enable contacts to come to work if they are negative.

Read full story (paywalled)

Source: HSJ, 31 December 2021

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