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Ambulance crews have been warned not to rely on satellite navigation systems after a spate of incidents where they were directed onto slower routes causing delays in reaching patients.
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Source: HSJ, 28 August 2019
An NHS children’s mental health unit has been closed down by the Care Quality Commission after being rated “inadequate” last week.
A child and adolescent mental health ward run by Tees, Esk and Wear Valley’s Foundation Trust has been closed after the CQC took enforcement action to protect the safety of patients.
In a statement today, a CQC spokesman said: ”[We have] taken urgent enforcement action at Tees, Esk and Wear Valley’s Foundation Trust which will lead to the closure of the child and adolescent mental health service units at West Lane Hospital. The Holly unit at West Park Hospital and Baysdale Unit at Roseberry Park are unaffected. The action follows continued concerns identified at earlier inspections in June and August, and the recent inspection on 20 and 21 August 2019."
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Source: HSJ, 23 August 2019
A cardiologist has been struck off the UK medical register after he failed to check a patient’s medical notes before surgery, implanted the wrong type of pacemaker, and then destroyed the notes specifying the correct type.
Amer Chit, a locum consultant cardiologist at Royal Cornwall Hospitals NHS Trust, admitted to a trust investigation that, before implanting the pacemaker, he had looked at the operating list but not at the patient’s medical notes.
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Source: BMJ, 23 August 2019
The Healthcare Safety Investigation Branch (HSIB) has launched an investigation into the NHS’ use of so-called ‘smart pumps’ after three patients received an overdose of the powerful opioid fentanyl.
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Source: HSJ, 22 August 2019
Health leaders have written to Boris Johnson issuing new warnings on the impact of a no-deal Brexit. In a letter to the Prime Minister, the heads of 17 royal colleges and health charities across the UK say clinicians are "unable to reassure patients" their health and care will not be affected.
They go on to say they have "significant concerns about shortages of medical supplies". Government said it was working with the health sector on "robust preparations".
The letter, co-ordinated by the Royal College of Physicians, is signed by the heads of organisations including the British Dental Association, the Royal Pharmaceutical Society, Kidney Care UK and the Royal College of Emergency Medicine. It calls for the Health and Social Care Secretary Matt Hancock to be put on the EU exit strategy committee chaired by Michael Gove, who is in charge of no-deal planning.
The signatories argue that - given the scale of the NHS - without sufficient planning, even the smallest of problems could have "huge consequences on the lives of millions of people".
Source: BBC News, 21 August 2019
Two million pensioners are taking at least seven types of prescription drugs - putting them at risk of potentially lethal side-effects, a major report warns.
Age UK said the rise of “polypharmacy” was putting lives at risk, with three quarters likely to suffer adverse reactions to at least one of their drugs. The research found that the number of emergency hospital admissions linked to such side-effects has risen by 53 per cent in seven years, with some cases proving fatal.
Experts said GPs were doling out too many drugs because they were too busy to properly consider complex health problems, and the risk of side-effects, and interactions between different drugs.
Caroline Abrahams, Charity Director at Age UK, said: "We are incredibly fortunate to live at a time when there are so many effective drugs available to treat older people’s health conditions, but it’s a big potential problem if singly or in combination these drugs produce side effects that ultimately do an older person more harm than good.”
Source: The Telegraph, 22 August 2019
A mental health unit for young people where two girls died in two months is not safe. The Care Quality Commission (CQC) rated West Lane Hospital in Middlesbrough inadequate and said patients were at high risk of "avoidable harm". It found staff did not store medicines safely, out-of-date medicines were still in use, and staff used non-approved restraint techniques.
Tees, Esk and Wear Valleys NHS Trust said it was taking "urgent action".
The inspection in June uncovered a catalogue of failings, including "substantial and frequent staff shortages" and employees not always "adequately assessing, monitoring or managing risks to patients".
The report said staff did not feel supported or valued, with morale low, and some told inspectors not all incidents were reported.
Source: BBC News, 21 August 2019
Morale among community nurses is low and many are leaving the service due to stress and an increased workload, a report has claimed.
The report from a Welsh assembly committee said the changing nature of healthcare, in particular the move to provide more help in the home and the ageing population, made the role of community nurses increasingly important. But it said many community nurses feel they do not get the support they need and some see themselves as the “invisible service”.
One of the biggest issues raised by nurses in Wales during a committee inquiry was their inability to access to technology to enable them to do their job effectively.
Source: The Guardian, 21 August 2019
Action to help tens of thousands more people avoid lengthy spells in hospital is being rolled out nationwide as part of the NHS Long Term Plan.
NHS doctors, nurses and other staff are being encouraged to ask themselves ‘Why not home? Why not today?’ when planning care for patients recovering from an operation or illness, as part of a campaign – called ‘Where Best Next?’ – which aims to see around 140,000 people every year spared a hospital stay of three weeks or more.
The campaign will see posters and other information placed in hospitals aimed at different staff groups, encouraging them to take practical steps every day to help get patients closer to a safe discharge – whether to their own home or a more suitable alternative in the community.
Dr Taj Hassan, President of the Royal College of Emergency Medicine, said: “The ‘Why not home? Why not today?’ campaign is really important in helping staff to make sure patients are discharged promptly if it is medically appropriate... A greater length of stay increases the risk of hospital acquired infections and further illness. We know that extended stays in a hospital bed can lead to significant muscle loss, particularly in older people, so ensuring that patients do not stay any longer than they need really is vital."
Source: NHS England, 19 August 2019
Frontline staff are well placed to identify failings in care, but speaking up requires a supportive organisational culture to be effective, say Russell Mannion and Huw Davies in a recent analysis published in the BMJ.
Concerns about care are raised and ignored, staff are denigrated or bullied, the situation escalates into whistleblowing to outside authorities, and eventually, often years later, a formal inquiry is set up to get to the bottom of things. The long line of inquiries in the UK and elsewhere highlights the sentinel role of staff “speaking up” when they see unsafe or poor quality care. But exhortations to speak up (encapsulated by the statutory duty of candour introduced in the NHS after the Francis inquiries into failures at Mid Staffordshire NHS Trust) belie the complexity and ambiguity that it creates for staff.
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Source: BMJ, 19 August 2019
Counsellors without the required accreditation are providing NHS-funded therapy services, despite NHS England tightening the rules for providers reports the Health Service Journal.
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Source: HSJ, 19 August 2019
A new study published in the Canadian Medical Association Journal has found that patients who suffered harm after being admitted in an Ontario hospital took longer to recover, spent more time in hospital, and required more healthcare to undo or mitigate the harm.
Tessier et al. studied the records of 610,979 patients admitted to Ontario hospitals over a one-year period ending in March 2016. Overall, 36,004 or six per cent of the patients were harmed during their hospital stay. As part of the study, the researchers categorised the kinds of harms experienced by patients. Just over half suffered harm due improper treatment. This included failing to make the correct diagnosis or making an incorrect diagnosis that led to incorrect treatment and harm caused by medications.
The second biggest category (37%) was harm caused by an infection acquired during the hospital stay. The third leading cause (27.3%) was harm caused by a procedure, and the fourth (2.7%) was harm brought on by accidents such as falling off a hospital stretcher.
The current study is one of the first to use a new method that enables researchers to capture all of the care the patient received during their stay in hospital and following discharge from hospital, including home care.
In a commentary published alongside the study, Dr. Lauren Lapointe-Shaw and Dr. Chaim Bell wrote that reported rates of adverse events are widely considered to be the proverbial "tip of the iceberg."
Source: CBC Radio Canada. 12 August 2019
In a major nationwide push to tackle sepsis, including a one hour identification and treatment ambition, new ‘alert and action’ technology is being introduced which uses algorithms to read patients’ vital signs and alert medics to worsening conditions that are a warning sign of sepsis.
Three leading hospitals are using alerts to help identify sepsis and tell doctors when patients with the serious condition are getting worse, ahead of the measures being rolled out across England as part of the NHS Long Term Plan.
In Liverpool, the hospital’s digital system brings together lab results and patient observations into one place to help staff diagnose and treat suspected sepsis, saving up to 200 lives a year. In Cambridge, deaths from sepsis have fallen consistently over the last three years, with at least 64 lives saved in the past year thanks to the innovative alert and action feature. In Berkshire since introducing a digital system, the Trust has increased screening rates by 70% with nine in 10 patients now consistently screened for sepsis during admission as opposed to two in ten beforehand, allowing doctors to spot more cases sooner.
The schemes are part of a national effort to push best practice and new technology across the NHS, to help hospitals learn from the success of others and spread use of the best technology further, faster.
Dr Ron Daniels BEM, CEO of the UK Sepsis Trust, and the hub's topic leader, said: “Any kind of technology which assists clinicians in making prompt decisions when the warning signs of sepsis are detected should be embraced; with every hour that passes before the right antibiotics are administered the risk of death increases".
Source: NHS England, 18 August 2019
A review of NHS health checks, which will look at tailoring checks based on risk and increasing the range of checks offered, must involve a “rigorous evaluation” to ensure they are safe, accurate and of benefit to patients, GPs have warned. The Department of Health and Social Care announced the review in the prevention green paper last month and has now fleshed out its scope.
It says it will consider including additional checks to prevent musculoskeletal problems and hearing loss, as well as how the checks can be digitised and tailored so people are offered “personalised interventions” based on risk, location, predisposition to diseases and their DNA.
While some experts welcomed the more targeted approach, others said the current scheme still needs to be evaluated for cost effectiveness and questioned how GPs will take on the extra work.
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Source: BMJ, 16 August 2019
Private hospitals may have made more than £3 million from the actions of the disgraced breast surgeon Ian Paterson, a think tank has claimed.
Paterson was jailed in 2017 for carrying out unnecessary surgery on ten patients in private hospitals. However, it is believed he harmed about 750 patients, many of whom he wrongly led to believe they had cancer. He was paid each time he operated but the private hospitals would have received a separate payment for each operation, the Centre for Health and the Public Interest (CHPI) said.
CHPI wants the inquiry set up by the government into Paterson’s actions to examine the financial incentives that could affect how private hospitals treat patients. David Rowland, director of CHPI, said: “The current financial incentives to over-treat patients weigh heavily against the weak measures which are in place to protect patients.”
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Source: The Times, 19 August 2019
Twenty UK women are taking legal action after developing a rare form of cancer linked to their breast implants. More than 50 women have been diagnosed with the same condition in the UK, and hundreds more worldwide. A top surgeon said there were gaps in implant information and people were almost being "used as guinea pigs".
One manufacturer has issued a worldwide recall of some textured implants, which have been linked to most cases of breast implant-associated lymphoma. The Medicines and Healthcare products Regulatory Agency (MHRA), which regulates medical devices in the UK, is currently collecting data on women affected by breast implant associated-anaplastic large cell lymphoma (BIA-ALCL).
Tens of thousands of breast implant surgeries are thought to take place each year in the UK, mostly in private clinics.
Source: BBC News, 16 August 2019
Patients waiting for hip replacements are suffering pain "worse than death", a study by Edinburgh University suggests. The research recorded the health states of more than 2,000 people on waiting lists and found 19% were in extreme pain or discomfort.
The level is so poor it is defined by experts as "worse than death" - more painful than chronic health conditions such as diabetes, heart failure or lung diseases. Scientists who used the internationally approved EQ-5D measurement said the findings disprove perceptions that hip and knee arthritis only causes mild discomfort. Earlier this year research found that four in 10 clinical commissioning groups in England are rationing hip and knee operations.
The Royal College of Surgeons has described the restrictions are “alarming” and “arbitrary”.
Source: The Telegraph, 15 August 2019
After two decades of keeping the public in the dark about millions of medical device malfunctions and injuries, the US Food and Drug Administration (FDA) has published the once hidden database online, revealing 5.7 million incidents publicly for the first time.
The newfound transparency follows a Kaiser Health News investigation that revealed device manufacturers, for the past two decades, had been sending reports of injuries or malfunctions to the little-known database, bypassing the public FDA database that’s pored over by doctors, researchers and patients. Millions of reports, related to everything from breast implants to surgical staplers, were sent to the agency as “alternative summary” reports instead.
Source: Kaiser Health News, June 27 2019
NHS England has declared a national emergency over shortage of feed for babies and disabled patients, with some patients being told to go to Accident & Emergency (A&E) departments. Hundreds of NHS patients, including children, who depend on intravenous (IV) nutrition, have been experiencing delays in deliveries.
It follows an inspection by watchdogs which found manufacturers were failing to meet safety standards, and the presence of potentially fatal bacteria. The NHS National Patient Safety Director, Aiden Fowler, has written to all NHS hospital trusts, and affected patients, warning that the incident has been designated as an emergency incident, under the Civil Contingencies Act, at the highest level.
British manufacturer Calea had already said the shortages could last up to four weeks. But the letter warns that the crisis could last far longer, outlining plans to ration the product to those most in need.
Parents said the situation was “terrifying” with some told to go to A&E if vulnerable children were left too long without being fed.
Hospitals have now been asked to review all patients receiving such IV feed to ensure only those deemed at high-risk are allocated the supplies, which are tailored to meet specific individual needs. Others will be allocated standard bags of nutrition, with extra supplements.
In the letters from Dr Fowler, disclosed by the Health Service Journal, he warns that the NHS is facing a “difficult balance” between the risks caused by the shortages, and the dangers of allowing production to continue, without safety improvements.
Source: The Telegraph, 13 August 2019
Registrars at an Australian hospital have launched legal action against its management amid claims that they are being worked beyond exhaustion while being denied their mandatory clinical training.
The alleged plight of the doctors at Melbourne’s Sunshine Hospital has become the latest instalment in a growing list of complaints among doctors in training over excessive workload pressures, exploitation, harassment, and bullying across the country’s public hospital system.
Source: BMJ, 12 August 2019
Medical leaders need to prevent and tackle “problematic subcultures”, which can include groups of “divas” who are viewed as “untouchable”, new General Medical Council research has concluded.
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Source: HSJ, 14 August 2019
Nearly 2 million NHS patients are to be given access to video consultations with doctors employed by a digital healthcare supplier as a result of a series of deals signed with NHS commissioners.Nearly 2 million NHS patients are to be given access to video consultations with doctors employed by a digital healthcare supplier as a result of a series of deals signed with NHS commissioners.
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Source: HSJ, 12 August 2019
Whitehall investigators have launched an inquiry into allegations of serious misconduct during the official review of the Gosport hospital scandal. They are examining claims that civil servants working on the £13m inquiry bullied staff, buried evidence and went on taxpayer-funded “working retreats” to Spain.
An independent panel last year linked Dr Jane Barton to the premature deaths of up to 656 elderly people given opiate overdoses at Gosport War Memorial Hospital between 1989 and 2000.
Whistleblowers have alleged that the panel ignored concerns about the hospital’s culture and use of faulty medical equipment to deliver a “clean hit” and “draw a line under it all”.
The Department of Health said last night: “We take all and any allegations of wrongdoing very seriously. An investigation is being undertaken and it would be inappropriate to comment further until it is concluded.”
Source: The Sunday Times, 11 August 2019
Documents released in an Ohio court case last month, in a landmark, multi-district opioid lawsuit, gave new insight into an unparalleled opioid epidemic in the United States. It revealed that between 2006 and 2012, some 76 billion opioid pills were distributed in the United States — more than 200 pills for every man, woman and child.
It paints a damning picture of the tension between drug company profits and patient safety during the time opioid sales were climbing dramatically. In one 2009 exchange, a pharmaceutical company representative emailed a colleague at another company to alert him to a pill shipment. “Keep ’em comin’!” was the response. “Flyin’ out of there. It’s like people are addicted to these things or something. Oh, wait, people are.”
According to Charles L. Bennett et al. in an editorial published in the Los Angeles Times, the failings are at every point in the system, starting with drug approvals. But the authors believe there is a particularly serious problem with the mechanisms for identifying, monitoring and disseminating information about issues with a drug after its release.
They suggest a good starting point for reforming the system would be increased transparency about drugs already recognised as particularly dangerous. These drugs, currently numbering about 70 (including opioids), carry the FDA’s so-called 'black box warning,' intended to alert patients and their doctors to the high risks associated with the drugs. But that is not enough. The authors propose a 'black box' database or 'registry,' publicly available and simple to use, that would contain extensive information about where, by whom and for what purpose black box drugs are prescribed, as well as where and in what quantities such drugs are being distributed and sold. Information about adverse side effects, culled from the myriad of government databases that now collect them, would also be consolidated in an open form and format.
Source: Los Angeles Times, 8 August 2019
Appropriate methods and standards around artificial intelligence (AI) need to be created to protect patient safety, experts have said. Responding to the Government’s pledge of £250 million for a National Artificial Intelligence (AI) Lab, Matthew Honeyman, researcher at The Kings Fund, said the NHS workforce needs to be equipped with digital skills for the benefits of new technologies to be realised.
“AI applications are in development for many different use cases – from screening, to treatment, to admin work – there needs to be appropriate methods and standards developed for safe deployment and evaluation of these solutions as they enter the health system,” he told Digital Health.
Adam Steventon, Director of Data Analytics at the Health Foundation, said the commitment was a “positive step” but that technology needs to be driven by patient need and “not just for technology’s sake”. “Robust evaluation therefore needs to be at the heart of any drive towards greater use of technology in the NHS, so that technologies that are shown to be effective can be spread further, and patients protected from any potential harm,” he said.
Source: Digital Health, 9 August 2019