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‘Difficult discussions’ as NHS faces shortage of childbirth pain relief

The NHS has been hit by a shortage of epidural kits to give mothers-to-be, a key form of pain relief during childbirth, as well as the drug that women are offered as an alternative.

Supplies of epidural kits and the painkiller Remifentanil are now under such pressure that some hospitals cannot offer pregnant women their usual right to choose which one they want to reduce labour pains.

Anaesthetists have told the Guardian that the simultaneous shortage of both forms of pain management has led to “difficult discussions” with women who had been told during their antenatal care that they would have that choice but were upset to learn that it was not available.

The disruption to supplies of epidural kits is so acute that NHS Supply Chain (NHSSC), the health service body that ensures hospitals in England and Wales receive regular supplies of drugs and equipment, to ration deliveries to just one week’s worth of stock.

Childbirth organisations voiced their concern and warned that the disruption to supplies meant some women in labour were already facing long delays before they received pain relief.

“Offering a choice of options during birth is an integral element of good maternity care, and this includes pain relief. It is concerning that the shortage of epidural kits and Remifentanil could be denying many that right”, said Jo Corfield, the NCT’s head of communications and campaigns.

“We don’t yet fully understand the impact this shortage is having but we have heard of long waiting times to receive pain relief and epidurals.”

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Source: The Guardian, 7 August 2022

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‘Devastating, tragic, and deadly’: VA leaders in Arkansas allowed impaired pathologist to harm hundreds of veterans, watchdog finds

Oversight failures, a fearful workplace culture and lax quality standards for years at a Veterans Affairs hospital in Arkansas, USA, allowed a pathologist who was routinely drunk on the job to misdiagnose thousands of veterans — sometimes with dire or deadly consequences, a new investigation has found.

Hospital leaders “failed to promote a culture of accountability” that would have led more of the doctor’s colleagues to come forward with accounts that his behavior was putting patients at risk, according to the report released Wednesday by VA’s Office of Inspector General. But the staff members at the Veterans Health Care System of the Ozarks in Fayetteville feared that reporting their concerns would lead to retaliation from their bosses.

“Any one of these breakdowns could cause harmful results,” Inspector General Michael Missal’s staff wrote in an 86-page report about the failures to stop the pathologist, Robert Morris Levy. “Together and over an extended period of time, the consequences were devastating, tragic, and deadly.”

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Source: The Washington Post, 2 June 2021

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‘Devastated’ doctors warn trust CEO of ‘extremely unsafe situation’

Consultants at a major tertiary centre have written to their chief executive, warning services are in ‘an extremely unsafe situation’ and calling for elective work to be diverted elsewhere.

Surgeons and anaesthetists at the former Brighton and Sussex University Hospitals Trust — now part of University Hospitals Sussex Foundation Trust — said: “We are devastated to report that the care we aspire to is not being provided at UHS… we are forced to contemplate that it is not safe to be open as a trauma tertiary centre and we feel elective activity must be proactively diverted elsewhere.”

The letter from BSUH’s anaesthetist and surgical consultant body is dated yesterday and was sent to UHSussex chief executive Dame Marianne Griffiths. The Royal Sussex County Hospital in Brighton — part of the trust — is the major trauma centre for the South East coast, from Chichester to parts of Kent.

In the letter, seen by HSJ, the consultants claimed a shortage of theatre staff is leading to “clinical safety issues, gross operational inefficiencies and burnout within our remaining depleted staff groups”. 

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Source: HSJ, 21 September 2021

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‘Devastated’ director quits after ‘bullying’ row with consultants

A trust director has stepped down after a row with consultants about the leadership culture within her department, HSJ  has learned.

Pratima Gupta quit as director of women’s services at University Hospitals Birmingham Foundation Trust last week after a group of consultants expressed “no confidence” in her leadership. They claimed there was “intimidating and bullying behaviour” by individual managers.

However, Ms Gupta said the allegations are untrue, and said she has faced “obstruction at almost every step” from some consultants when trying to improve training and culture within the department.

Trainee doctors in obstetrics and gynaecology have previously expressed concerns around a lack of support from consultants, with the trust recently receiving a further warning around this from the General Medical Council and Health Education England.

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Source: HSJ, 1 June 2023

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‘Demoralised’ nurses ‘driven out’ of profession, survey finds

Most nurses warn that staffing levels on their last shift were not sufficient to meet the needs of patients, with some now quitting their jobs, new research reveals.

A survey of more than 20,000 frontline staff by the Royal College of Nursing (RCN) suggested that only a quarter of shifts had the planned number of registered nurses on duty.

The RCN said the findings shone a light on the impact of the UK’s nursing staff shortage, warning that nurses were being “driven out” of their profession.

In her keynote address to the RCN’s annual congress in Glasgow, general secretary Pat Cullen will warn of nurses’ growing concerns over patient safety.

Four out of five respondents said staffing levels on their last shift were not enough to meet all the needs and dependency of their patients.

The findings also indicated that only a quarter of shifts had the planned number of registered nurses, a sharp fall from 42% in 2020 and 45% five years ago, said the RCN.

Ms Cullen will say: “Our new report lays bare the state of health and care services across the UK.

“It shows the shortages that force you to go even more than the extra mile and that, when the shortages are greatest, you are forced to leave patient care undone.

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Source: The Independent, 6 June 2022

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‘Deliberate attempts’ to conceal racism at NHS agency, says leaked report

Deliberate attempts were made to “conceal the extent of racial discrimination” at a national NHS agency, according to a report leaked to HSJ.

A highly critical internal report at NHS Blood and Transplant (NHSBT) also said fewer than half the recommendations made in 2020 by external mediation experts, around issues of racism, had so far been actioned.

A review conducted by Globis Mediation Group in 2020 found “systemic racism” among management at the agency’s large Colindale site in north London, with ethnic minority staff being “ignored, being viewed as ineligible for promotion and enduring low levels of empathy”.

It made nine recommendations, including exploring whether similar issues existed at the other 15 NHSBT sites.

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Source: HSJ, 16 March 2023

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‘Deep-rooted cultural problems’ found within trust’s ‘inadequate’ maternity services

The Care Quality Commission (CQC) has raised serious concerns about a major teaching trust’s maternity services and taken action to prevent patients coming to harm.

The watchdog has imposed conditions on the registration of Nottingham University Hospitals Trust’s maternity and midwifery services at Nottingham City Hospital and Queen’s Medical Centre and rated them “inadequate”. 

Following an inspection in October, the CQC identified several serious concerns, including leaders lacking the skills to effectively head up the service, a lack of an open culture where staff could raise concerns, and staff failing to complete patient risk assessments or identify women at risk of deterioration. 

In its findings, the CQC reported how “fragile” staff wanted to escalate their concerns directly to the regulator, particularly around the leadership’s response to the “verbal outcome of the inspection”. The regulator called this “further evidence of the deep-rooted cultural problems” and escalated these concerns directly to trust CEO Tracy Taylor, who would be “personally overseeing the improvement process required”.

Inspectors also found the service did not have enough staff with the right skills, qualifications and experience to “keep women safe from avoidable harm”.

The CQC also issued the trust a warning notice over concerns around documenting risk assessments and IT systems. The trust has three months to make improvements. 

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Source: HSJ, 2 December 2020

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‘Deadly cancer timebomb’ as thousands more than expected killed by the illness since pandemic

Nearly 8,900 more people have died of cancer than expected in Britain since the start of the pandemic, amid calls for the Government to appoint a minister to deal with the growing crisis. 

In an essay in The Lancet Oncology, campaigners and medics said the upward trend of cancer deaths is likely to continue, with 3,327 in the last six months alone. 

They urged the Government to tackle the crisis with the same focus and urgency given to the Covid vaccine rollout, and called for a cancer minister to get on top of the backlog.

NHS data from November showed that in the last 12 months, 69,000 patients in the UK have waited longer than the recommended 62-day wait from suspected cancer referral to start of treatment.

Professor Gordon Wishart, a former cancer surgeon and chief medical officer of Check4Cancer, said: “The Covid-induced cancer backlog is one of the deadliest backlogs and has served to widen the cracks in our cancer services". 

“Now we face a deadly cancer timebomb of treatment delays that get worse every month because we don’t have a sufficiently ambitious plan from policymakers. I urge the Government to work with us.”

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Source: The Telegraph, 15 December 2022

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‘Cuts will result in patient deaths’: hospitals shed medical staff after being told to balance the books

Hospitals are being forced to cut medical staff, threatening their ability to care for patients, senior health leaders have warned.

NHS trusts are reporting budget deficits after the chancellor Jeremy Hunt gave England’s health service £2.5bn extra funding, which only covers inflation and pay increases.

The UK’s ageing population and the impact of having more than 6 million patients waiting for more than 7.5m treatments means that demand on the health service has increased substantially.

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Source: Guardian, 5 May 2024

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‘Culture of fear’ at Sussex hospitals trust, Royal College of Surgeons reports

Bosses at hospitals where police are investigating dozens of deaths have been criticised for “bullying” and fostering a “culture of fear” among staff in a damning review by the Royal College of Surgeons in England.

The review focused on concerns about patient safety and dysfunctional working practices in the general surgery departments at the Royal Sussex County hospital in Brighton and the Princess Royal hospital in nearby Haywards Heath.

But the reviewers were so alarmed by reports of harassment, intimidation and mistreatment of whistleblowers that they suggested executives at the University Hospitals Sussex trust may have to be replaced.

They concluded: “Consideration should be given to the suitability, professionalism and effectiveness of the current executive leadership team, given the concerning reports of bullying.”

The report comes as Sussex police continue to investigate allegations of medical negligence and cover-up in the general surgery department and neurosurgery department, involving more than 100 patients, including at least 40 deaths, from 2015 to 2021.

The investigation was prompted by concerns from a general surgeon, Krishna Singh, and a neurosurgeon, Mansoor Foroughi, who lost their jobs at the trust after blowing the whistle over patient safety.

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Source: The Guardian, 6 February 2024

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‘Culture of blame’ found at troubled health trust

The former police chief who investigated mental health services in a crisis-hit health board was “shocked” by the poor working relationships and “blame shifting” he uncovered.

David Strang, who led the independent inquiry into the issues in NHS Tayside, said staff felt isolated and unsupported and people complained about each other’s practices without coming together to sort the issues out.

He described asking staff questions based on information he had received and being met with the response: “Who told you?” He added: “A lot of staff felt there was a real blame culture and that risk and blame fell to the front line.”

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Source: 6 February 2020, The Times

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‘Culture battle’ over NHS England’s emergency recovery plans

Senior sources have described a ‘culture battle’ in NHS England’s approach to urgent care recovery after systems were told to carry out “maturity” self-assessments, and appoint “champions” to drive improvements.

Systems were last week told by NHSE to ”self assess” their compliance against key asks in the UEC recovery plan, and asked to nominate urgent care “recovery champions” to “create a community, close to the front line, who can help drive improvement” in emergency care.

The “champions” and self-assessments are part of a new “universal offer” of support being drawn up by NHSE under its scheme for urgent care recovery, in which Integrated Care Boards are also being placed in “tiers” of intervention.

It is the first project carried out under NHSE’s new service improvement banner, called “NHS Impact” or “improving patient care together”, which was established after an internal review recommended it should focus on a “small number of shared national priorities”.

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Source: HSJ, 18 July 2023

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‘Critical decision-making’ at major cancer centre left to trainees

Trainee oncologists at a major cancer centre covered clinics and made “critical” decisions without senior supervision, including for cancers they were not trained for, HSJ has revealed.

A Health Education England (HEE) reviews aid: “The review team was concerned to hear that trainees were still expected to cover clinics where no consultant was present, including clinics relating to tumour sites that they were unfamiliar with.”

Guy’s and St Thomas’ Foundation Trust’s trainee clinical oncologists felt “they could only approach 50–75% of the consultants for critical decision-making”, the document said.

The HEE “urgent concern review” report said: “The trainees also reported that there was a continued lack of clear consultant supervision for inpatient areas in clinical oncology, which meant that they were not able to access senior support for decision-making.”

A trust spokesman said: “We recognise that senior support to the clinical team is a vital part of keeping our patients safe.”

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Source: HSJ, 16 January 2020

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‘Cowboy’ Rishi Sunak hit by new concrete crisis as it threatens pledge to cut NHS backlog

Rishi Sunak’s pledge to cut the NHS waiting list backlog is being threatened by the crumbling concrete crisis as affected hospitals warn they will be forced to shut wards and theatres.

Hospitals were told they had buildings prone to collapse in 2019 but four years later they are still dealing with the issue.

In a report last year, West Suffolk NHS Foundation Trust leaders said that work to replace reinforced autoclaved aerated concrete (Raac) in its hospitals would hit general surgery, urology, gynaecology and orthopaedic care.

Wards have had to close, piling pressure on a crowded A&E as patients can’t be offloaded due to lack of beds, and threatening its ability to hit government targets to reduce waiting lists, it added.

The warning comes as Sir Keir Starmer used Prime Minister’s Questions to attack Mr Sunak over the crisis. He argued that “the cowboys are running the country” and asked the PM if he was “ashamed” of the scandal caused by 13 years of “botched jobs”.

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Source: The Independent, 6 September 2023

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‘Covert filming could get you prosecuted’, trust warns staff after undercover exposé

An ambulance trust that was the subject of a documentary involving covert filming by an employee has warned staff they could be subject to ‘disciplinary action and even prosecution’ if they take this type of action.

East of England Ambulance Service Trust sent an all staff email yesterday outlining the potential consequences of filming covertly and reminding staff they must adhere to the trust’s social media and digital guidelines.

The email, seen by HSJ, followed Channel 4 broadcasting a documentary called Undercover ambulance: NHS Chaos – Dispatches which featured footage filmed covertly by one of the trust’s apprentice emergency technicians, and laid bare the extreme pressures on hospital and ambulance staff.

The message sent on Thursday by the trust’s interim officer Melissa Dowdeswell, said the apprentice who carried out the filming had since resigned and then set out what support staff could access from the trust if they had been affected by “an incredibly difficult couple of weeks”.

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Source: HSJ, 17 March 2023

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‘Cover-up’ fears over trust’s toxic culture

An independent group overseeing the reviews into a toxic culture at University Hospitals Birmingham have raised concerns over a possible ‘cover up’ of key reports.

The cross-party reference group, which includes MPs, council and Healthwatch officials, has demanded transparency over key decisions, and says there are continuing concerns over the trust’s leadership. It has been scrutinising a review into patient safety concerns at UHB, which found the trust’s executive had become “overzealous and coercive”.

On the day this review was released, it was revealed that UHB’s former CEO David Rosser had decided to retire.

The group, chaired by MP Preet Gill, said in a statement: “The allegations made by whistleblowers were not isolated incidents, but the result of a deep-seated and toxic culture. While Dr Rosser has recently announced his retirement, one member of staff, albeit a chief executive, cannot be responsible for this alone. Feedback from staff has made it clear that there must be collective accountability by the senior leadership for the distressing culture afflicting the trust."

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Source: HSJ, 5 April 2023

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‘Cost of living crisis’ contributing to stillbirths, research finds

The cost of living squeeze is a significant factor in some stillbirths, according to case reviews carried out in one of England’s most deprived areas.

The review was undertaken in Bradford last year, and concluded: ”the current financial crisis is impacting on the ability of some women to attend essential antenatal appointments”. Missing these appointments was a factor in a range of maternity safety events, including stillbirths, it said. 

The researchers are now calling for new national funding to help ensure expectant parents do not miss important appointments because they cannot afford to attend.

The research findings include:

  • ‘Did not attend’ rates increased due to lack of funds for transport to antenatal appointments;
  • “Lack of credit on phones prevented communication between women and maternity services, for example, making [them] unable to rearrange scans or appointments”;
  • Wide spread incidence of “digital poverty, [for example] a lady with type 1 [diabetes] was unable to monitor her glycaemic control over night due to only having one phone charger in the house”; and
  • “Families with babies on a neonatal unit going without food in order to finance transport to and from the unit.”

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Source: HSJ, 25 August 2023

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‘Controversial’ A&E policy 'showed we're all shouldering the pain', says CEO

A high-profile shift to admitting patients from A&E to wards irrespective of bed capacity has ‘turned the dial’ for an acute trust’s emergency care, its chief executive has told HSJ.

Since introducing the model in July last year North Bristol Trust has seen a significant improvement in its performance against the national target, with the number of patients seen within four hours rising from 51% to 72% in August 2023 – with a peak of 80% in April 2023.

The model attracted interest from NHS England last year, as well as some concern from the Nuffield Trust over patient safety – but NBT CEO Maria Kane said the trust was “happy, on balance” with the system.

She said the model “won’t be for everyone and we never claimed it would be” but she added: “Engendering whole hospital conversations about the principles of flow and understanding of [the emergency department] is something we could all do.”

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Source: HSJ, 8 November 2023

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‘Continuity risk’ to abortion services triggers national intervention

NHS England has told integrated care board (ICBs) leaders they must intervene over failures in abortion services in their patches amid “unprecedented demand” for such provision, HSJ has learned.

NICE guidance states people should be assessed within a week of requesting an abortion, while procedures should take place within a week of assessment.

However, NHSE said in a letter to ICBs today that “significant service pressures” have driven up waiting times for surgical abortions – approximately 13% of procedures – to three weeks or longer.

NHSE has told ICBs to work with providers to, by July 2024:

  • Respond to cases of “acute service disruption” and instances where rising waiting times risk limiting access to services;
  • Establish referral pathways and procedures to ensure smooth transfers of care between independent and NHS providers when required;
  • Ensure contracts for 2024-25 are sustainable and follow guidance in the NHS payment scheme; and
  • Commission services in a more managed and collaborative way, including coordination of provision locally to bring waiting times in line with NICE standards.

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Source: HSJ, 12 March 2024

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‘Contentious’ US tech firm to harvest patient data in NHSE waiting list push

NHS England has ordered the collection of identifiable patient data from hospitals by US data firm Palantir, for a pilot scheme aimed at accelerating recovery of elective waiting lists.

The regulator has instructed NHS Digital, with which it will merge in January, to use Palantir’s Foundry platform to collect data about patients’ admission, inpatient, discharge and outpatient activity at acute hospitals.

Identifiable data such as patients’ NHS numbers, date of birth, and postcode will be collected through Palantir’s software. Patients cannot opt out of having their data collected.

But NHS Digital’s Caldicott Guardian – who is meant to safeguard use of data – has identified “risks” in the pilot and said it needs additional work before it can meet confidentiality requirements.

The data collected will be “anonymised in accordance with the ICO’s (Information Commissioner’s) Anonymisation Code of Practice”. However, privacy campaigners Medconfidential claimed this code is not fit for purpose and warned that NHS chiefs were making the same mistakes as previous failed efforts to use patient data appropriately.

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Source: HSJ, 1 November 2022

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‘Constructive’ first ambulance strike agreement revealed

Elderly people who fall may only be sent an ambulance after they have spent four hours on the floor, and some category 2 calls may not be responded to under one of the first agreements with ambulance unions about next week’s strikes.

But the deal between South East Coast Ambulance Service and the GMB union will see many union staff continue to work on ambulances and in control rooms – and others may be asked to come off the picket line if operational pressures escalate.

HSJ has seen the details of the deal – thought to be one of the first agreed before next Wednesday’s strike. Some other trusts are hoping to conclude negotiations shortly, but for several — such as in the North West and London — it is thought no strike “derogations” (exceptions) have so far been agreed, and managers are concerned that unions are resistant. Trusts have been pushing for more cover on strike days – especially around category 2 calls.

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Source: HSJ, 15 December 2022

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‘Confused messaging’ around Oxford vaccine helping fuel Covid spread, says scientist behind jab

Experts have warned misinformation around the Covid vaccine may be helping fuel the spread of the virus. Director of the Oxford Vaccine Group has warned "confused messaging" around the effectiveness to protect the population could threaten confidence in the jab. 

Sir Andrew, together with Professor of vaccinology Shabir Madhi at the University of Witwatersrand in South Africa, have suggested lessons can be learned from South Africa. Writing for The Independent, they said “South Africa was one of the first African countries to procure the Oxford-AstraZeneca vaccine from Serum Institute of India. Unfortunately, these doses were never deployed because of misguided fears over efficacy, allowing the present third wave to occur in a largely unvaccinated population.” 

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Source: The Independent, 26 July 2021

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‘Confidential’ document warns second covid peak could hit NHS five times harder

Modelling being used by NHS officials forecasts that hospital admissions could peak at five times the level seen in April without additional measures to control the virus, HSJ can reveal.

In all scenarios presented, covid hospital admissions would remain high for an extended period of many months, even if new lockdown actions were taken. However, putting multiple measures in place could contain them to a peak of less than that seen in the spring, according to the work.

They were included in a document marked “confidential” and included, apparently by accident, in public papers for Thursday’s meeting of Medway Foundation Trust board. Within hours of HSJ asking for more information, they were removed.

They were badged with Kent and Medway Clinical Commissioning Group, the NHS body which oversees services for that area. The forecasts were marked as being “Kent and Medway level”, but were referred to as “regional scenarios”, indicating they may have been produced by regional teams of NHS England and Improvement. The trust’s board papers said its own planning for the coming months would make use of the three scenarios presented in the document.

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Source: HSJ, 7 September 2020

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‘Computer error’ removed 1,800 patients from trust’s elective waiting list

A trust has discovered 1,800 patients who were removed by mistake from its elective waiting list.

Barking, Havering and Redbridge University Hospitals Trust chief executive Matthew Trainer wrote to colleagues in the east London health system today to “apologise for the stress this will have caused those experiencing a delay”.

Of the 1,800 patients involved, 600 have been waiting more than a year and roughly 200 have been waiting for more than two years.

Mr Trainer’s note explained: “The patients have been waiting to see our specialists in routine clinics in gynaecology, neurology, neurosurgery and ophthalmology.”

It continued: “As we have been working through our waiting lists, we have discovered a problem with one of them that was used to deal with the backlog created by the pandemic.

“It contained routine referrals that were submitted by GPs who wanted their patients to be seen by a specialist, but for whom there were no appointments available due to covid-19. Unfortunately, these patients were removed automatically from this list before they had been seen.”

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Source: HSJ, 26 April 2022

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‘Climate of fear’ faces staff who voice bullying concerns at major trust

A major trust’s Freedom To Speak Up Guardian has warned that a failure to address staff concerns about alleged bullying and long-standing ‘dysfunctional behaviours’ is damaging confidence and resulting in the loss of high-quality staff.

Professor Julian Bion, presenting a half-yearly report to University Hospitals Birmingham Foundation Trust’s board, revealed that the majority of the 41 reports to the FTSU service between April and October this year had expressed a “fear of detriment” when raising concerns.

Just under half (44%) of 34 concerns raised by the contacts related to “problematic attitudes and behaviours”, ranging from reports of micro-aggressions to overt bullying.

Professor Bion, UHB’s FTSU guardian since 2019, told HSJ such concerns are always “complex and sensitive issues” and recognised that the trust is handling them during “difficult circumstances” for the NHS. UHB has seen very large numbers of covid patients throughout much of the pandemic.

But he warned the board that several “common themes” were emerging in UHB’s complaints process – including a fear of detriment, “problematic” delays to cases being resolved, and a lack of response from divisional departments.

Suggesting there is a “disinclination” within the trust to address concerns, he said: “Very often, these dysfunctional behaviours are known about for a long time but they haven’t been addressed.”

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Source: HSJ, 2 November 2021

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