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Pandemic changes affected maternity care for women who had stillbirths

Changes to maternity services during the pandemic, including the mandatory redeployment of midwives and doctors to care for infected patients, may have affected the care given to women who had stillborn babies, a Healthcare Safety Investigation Branch (HSIB) investigation has found.

The safety watchdog launched an investigation after the number of stillbirths after the onset of labour increased between April and June 2020. During the three months there were 45 stillbirths compared to 24 in the same period in 2019.

The HSIB launched a probe examining the care of 37 cases. Among its findings the watchdog said staffing levels were affected because of the NHS response to the pandemic.

In its report it said this “influenced normal work patterns and the consistency and availability of clinicians.”

As an example, in one maternity unit the staffing numbers were short by three midwives due to sickness and redeployment. In another consultant presence was reduced overnight.

During the pandemic both the Royal College of Midwives and the Royal College of Obstetricians criticised NHS trusts for redeploying maternity staff when mothers continued to need services regardless of the pandemic.

HSIB said none of the women in its report were recorded as having the virus, but it found the pressures and changes as a result of the pandemic may have affected the care they received.

The study stressed that the proportion of consultations undertaken remotely was not known and "the impact of remote consultations is not clear from this review".

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Source: The Independent, 16 September 2021

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Patient groups, Royal Colleges, medical charities and industry launch new Patient Coalition for AI, Data and Digital Tech in Health

A new coalition with members from Royal Colleges, health charities (including Patient Safety Learning) and patient groups has come together to ensure the interests of patients are at the heart of the development of policy in digital health technology.

The Patient Coalition for AI, Data and Digital Tech in Health is the first coalition to unite such a diverse range of stakeholders from across the health policy landscape in order to champion the patient perspective in this field.

Currently, not enough is being done to ensure that patients are included in the evolving policy discussions surrounding the development, implementation or evaluation of digital health technologies in the UK. In fact, there is limited understanding of what patients actually want from digital health. The danger is that these technologies end up as something done ‘to’ patients rather than ‘with’ and ‘for’ them. 

In addition to providing a forum for discussion, this Coalition will act as an independent campaigning coalition, taking forward joint pieces of work and engaging actively to help influence Government and NHS policy on the use of digital technology in healthcare. The goal will be to ensure patient interests are at the forefront of ongoing media and policy discussions surrounding digital health tech, and being incorporated into the policymaking process. The goal is to cultivate the necessary policy conditions to enable the UK to capitalise on new digital health technologies to the benefit of patients and the NHS.

Issues Coalition members have committed to tackling include:

  • Examining health inequalities and calling for the prioritisation of access to digital health.
  • Sharing best patient-centric practice in digital health.
  • Ensuring the patient perspective is embedded in policy and government strategies.  

 The Coalition’s objectives for the next year are to:

  • Promote understanding of the patient experience of digital health
  • Ensure patients receive the support needed to access digital health tech
  • Inform policymakers on what good practice looks like.

The Coalition will continue to engage proactively with policymakers, health agencies and others to help inform digital health policy. It will campaign for policies such as:

  • Ensuring all patients have access to digital health technology, regardless of where they are in the country
  • Providing patients with the choice of how they receive care, and empowering them to make that decision for themselves
  • Prioritising digital assurance so that patients feel confident when engaging with digital health technologies that they are using products that have been approved by the NHS
  • Ensuring there are clear regulations for the collection, sharing and use of patient data.

Read the full press release on the Patients Association website. GetImage.jpg.097f6e75656e267785ada65326586c95.jpg

Read the Coalition's first report: Digital Health during the Covid-19 Pandemic: Learning Lessons to Maintain Momentum.

Source: Patients Association, 15 September 2021 

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Children harmed by mental health service failings

Young people cared for by an NHS mental health service "came to harm" because of its failings, inspectors said.

The care provided by Essex Partnership University NHS Foundation Trust (EPUT) has been rated "inadequate" by the Care Quality Commission (CQC). It has now been stopped from admitting new patients after inspectors found "serious concerns" in the children and adolescent mental health services.

EPUT said it had increased staffing levels and had been coaching staff.

The inspection was prompted by a serious incident and concerning information received about safety and quality, the CQC said.

Inspectors visited, unannounced, in May and June and looked at the Larkwood and Longview wards at the St Aubyn Centre in Colchester and the Poplar Adolescent Unit at Rochford Hospital.

The CQC found observations were not always carried out safely and patients "had been harmed as a result of the poor practices", which included patients self-harming.

It said these incidents were not always reported or dealt with appropriately.

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Source: BBC News, 15 September 2021

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Being visible on wards and understanding frontline staff is “critical” for hospital leaders

A retiring chief executive was “astonished” how many junior doctors had never met the senior directors of their hospitals — and stressed how being visible on the wards is “critical” to good leadership.

Karen Partington, who has this month stepped down after 10 years leading Lancashire Teaching Hospitals Foundation Trust, said she had made it her mission to understand the feelings and motivations of frontline staff.

In an interview with HSJ, she was asked if being visible and spending significant time talking to frontline staff is the most important bit of advice she would give a first-time chief executive.

She said: “In my personal opinion, it’s critical. How can CEOs be compassionate leaders without understanding the daily pressures faced by the whole team?"

“My executive team and I [would] meet regularly with our junior doctors and do a ‘you said, we did’ session, which really helped us to change their experiences for the better. But it was also an opportunity to ensure our frontline colleagues understood the environment they were working in as well. I have always found that when people understand ‘why’, [then] they will come up with the solutions."

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Source: HSJ, 14 September 2021

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Opioid pain relief 'soared during pandemic' for some patients

The use of opioids for pain relief soared during the pandemic as some patients waited longer for surgery, according to new research.

The University of Aberdeen team focused on more than 450 patients due to have hip or knee replacement surgery.

They said waiting times for these procedures increased by an average of 90 days and that the numbers of patients using opioids while waiting for surgery increased by 40% compared to pre-pandemic levels.

The research, published in the BMJ Quality and Safety, looked at data collected from 452 NHS patients from the north east of Scotland.

The university's Luke Farrow, who led the research, said alternative ways of managing severe arthritis pain needed to be found "urgently" for those waiting for this kind of surgery.

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Source: BBC News, 15 November 2021

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Staff frightened to speak about NHS trust bullying

A culture of bullying and racial discrimination has been found at a hospital trust, according to an inspection report.

The Care Quality Commission (CQC) said there was a bullying culture across Nottingham University Hospitals (NUH) Trust, with many staff too frightened to speak up. The trust has been told it requires improvement as a result of the report.

NUH said it was working to address the concerns.

The report said a number of the bullying cases were directly attributable to racial discrimination.

It said the trust's latest staff survey showed the organisation was above average for black, Asian and minority ethnic staff experiencing bullying.

Sarah Dunnett, the CQC's head of hospital inspection, said they were told of bullying incidents that had not been addressed.

"We were concerned about the culture of bullying across the trust with many staff being too frightened to speak up," she said.

She said the CQC would "monitor the service closely" to ensure changes were made.

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Source: BBC News, 15 September 2021

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Innovation and new technology to help reduce NHS waiting lists

Surgical hubs, new technology and innovative ways of working will help tackle waiting lists and treat around 30% more elective care patients by 2023 to 2024.

Backed by a new £36 billion investment in health and social care over the next 3 years, ‘doing things differently’ and embracing innovation will be the driving force to get the NHS back on track.

The funding will see the NHS deliver an extra 9 million checks, scans and operations for patients across the country, but it’s not enough to simply plug the elective gaps. The NHS will push forward with faster and more streamlined methods of treatments.

Surgical hubs already being piloted in a number of locations, including London, are helping fast-track the number of planned operations, including cataract removal, hysterectomies and hip and knee replacements, and will be expanded across the country. Located on existing hospital sites, surgical hubs bring together the skills and resource under one roof while limiting infection risk and providing a COVID-secure environment, with more planned to open in the coming year.

The NHS has been trialling a range of new ways of working in 12 areas, backed by £160 million, to accelerate the recovery of services. This includes setting up pop-up clinics so patients can be treated quickly, in person, and discharged closer to home, as well as virtual wards and home assessments to allow patients to receive medical support from the comfort of their home, freeing up beds in hospitals.

GP surgeries are using artificial intelligence to help prioritise patients most in need and identify the right level of care and support needed for patients on waiting lists.

The latest cancer tests being deployed across the NHS are also helping speed up diagnosis and spot cancer early on. Thanks to the hard work of staff, a quarter of a million people were checked for cancer in June – the second highest number on record – and more than 27,000 people started treatment for cancer in the same period.

Professor Steve Powis, NHS England medical director, said:

"Although the pandemic is still with us and we will have to live with the impact of COVID for some time, the NHS has already made effective use of additional resources to recover services. From adopting the latest technologies to more evening and weekend working, NHS staff are going to great lengths to increase the number of operations carried out.

The further funding announced this week will support staff to deliver millions more vital checks, tests and operations, so if you have a health concern, please do come forward to receive the care and treatment you may need."

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Source: 8 September, Department of Health and Social Care

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New volunteer programme to help older patients reduce risk of fall

A new volunteering programme is aiming to bring trained volunteers into the homes of older patients to provide one-to-one support.

The Falls Prevention Community Exercise Volunteers programme is being run by the volunteering service at Kingston Hospital NHS FT, which is funded by the volunteering organisation Helpforce and the Kingston Hospital Charity.

It hopes that this will improve the strength, balance, and mobility of elderly patients, as well as improve their overall health and well-being. This is then expected to reduce the strain on the NHS caused by falls among older patients.

Research from NICE in 2018 showed that the risk of falls in elderly patients can be reduced by as much as 54%, when they take part in exercises focused on improving strength and balance.

Bianca Larch, Community Outreach Manager at the trust, said: “We are delighted to launch this much needed volunteering service to support our patients at home.

“With volunteers supporting patients to undertake a physiotherapy prescribed exercise programme, we hope to see improved strength, mobility and balance in our patients and in turn reduce their risk of falls significantly.

“This programme can really improve the quality of life of our patients by restoring well-being and independence, especially for those waiting to access various community interventions.”

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Source: National Health Executive, 9 September 2021

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Shortfall of 50,000 doctors may overwhelm NHS in winter, BMA warns

The NHS may be unable to cope this winter because of a “frightening” shortfall of more than 50,000 doctors, the head of the British Medical Association has warned.

The number of medics in England has fallen further behind comparable European countries over the summer, ahead of what is predicted to be one of the worst winters in the 73-year history of the health service, Dr Chaand Nagpaul said.

“Winter is an incredibly difficult time for the health service,” he said. “With flu season on the horizon and even fewer staff this time round, it’s a total unknown as to how well our services will cope – if they even cope at all.”

With more GPs and hospital doctors quitting over the summer, the shortage has risen to 50,191, according to the BMA. This reflects a loss of 919 doctors in primary care and 110 in secondary care over the last two months.

Yet more doctors are actively considering quitting in the coming months due to burnout and excessive workloads. “Alarm bells” should be ringing, Dr Nagpaul said.

The workforce crisis means staff are working longer hours to keep up with patient demand. Some feel they have no choice but to hand in their notice to get the respite they need. This piles pressure on those that remain, Dr Nagpaul said.

Last week, Prof Martin Marshall, the chair of the Royal College of General Practitioners, told the Guardian that GPs in England are “finding it increasingly hard to guarantee safe care” for millions of patients, because the shortage of medics means they are unable to cope with soaring demand."

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Source: The Guardian, 13 September 2021

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Post-illness symptoms like long Covid are probably more common than we think

In recent months, long Covid has received a great deal of media and public attention. Research has found that as many as one in four of those infected with Covid suffer from chronic long-term symptoms, including headaches, dizziness, abdominal pain, heart problems, fatigue, anxiety, depression, cognitive impairment and other conditions.

It is a difficult and complex illness, and we must do much more to help those who are struggling with it. At the same time, it is important to realise that rather than being a strange special case, long Covid is probably part of a broader phenomenon that affects many more people. In recent years, doctors and researchers have increasingly realised that many of those who survive an illness of any kind, or who go through serious physical trauma, are at high risk for a range of debilitating and chronic physical, cognitive and mental health symptoms – problems that closely resemble long Covid.

As medicine has advanced, clinicians have learned how to save hundreds of thousands of severely ill or injured patients who would have previously died. Although this is a remarkable accomplishment, however, in many cases, survival does not mean complete recovery: some patients find that their bodies, brains and psyches continue to bear the scars of what they have gone through.

One non-Covid study found that a year after hospitalisation, a third of patients with severe respiratory failure or shock had significant cognitive impairment. Another found that between a quarter and a third of patients who were treated in the ICU had significant and long-lasting symptoms of anxiety, depression or PTSD. Researchers have found similar results for survivors of other medical conditions, including cancer, multiple sclerosis and ALS.

Unfortunately, people with long Covid, as well as other chronic post-illness symptoms, often find that the medical establishment doesn’t understand their experience, and so minimises or questions it. This is not surprising: clinicians tend to pay less attention to how patients with severe illness do once they are out of mortal danger, or once symptoms extend beyond an arbitrary time frame.

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Source: The Guardian, 12 September 2021

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Covid deaths rare among fully vaccinated

Fully vaccinated people are much less likely to die with COVID-19 than those who aren't, or have had only one dose, figures from the Office for National Statistics (ONS) show.

Out of more than 51,000 Covid deaths in England between January and July 2021, only 256 occurred after two doses.

They were mostly people at very high risk from illness from COVID-19.

The figures show the high degree of protection from the vaccines against illness and death, the ONS said.

Some deaths after vaccination were always expected because vaccines are not 100% effective, and it takes a couple of weeks after your second dose to build the fullest protection.

Breakthrough" deaths - occurring at least two weeks after the second jab along with a first positive PCR Covid test - tend to happen in the most vulnerable, men and those with weakened immune systems, with the average age being 84.

But overall numbers were very small - they accounted for only 0.5% of all deaths from COVID-19 over the first six months of the year.

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Source: BBC News, 14 September 2021

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Hospital admits patient care is being compromised as cancer operations delayed

Cancer operations at one of England’s largest hospital trusts are being delayed as bosses admit patient care on wards is being compromised.

Nottingham University Hospitals Trust has been forced to convert one of its few remaining wards for cancer surgery patients into an emergency medical ward to cope with an influx of patients.

The Independent understands the trust’s A&E department is regularly overcrowded with 40 or more patients waiting for a bed at the start of most days.

In a leaked message to staff sent on Friday and shared with The Independent, bosses at the hospital said the trust was facing an “exceptionally difficult time” which was “probably the most challenging position we have been in since the pandemic began”.

It added: “There is no doubt that we are having to compromise the quality of care we are providing to some patients to ensure that we are able to maintain a service for the whole population.”

“Our emergency department is over capacity continuously, which means that patients are waiting for extended periods on trolleys with little privacy and dignity because they do not have a bed to go to. We are having to make difficult decisions every day as to whether we can proceed with cancer and urgent operations and we are not able to tell some patients when they will get their operation."

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Source: The Independent, 13 September 2021

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Early CT scans deliver huge fall in lung cancer deaths, study shows

Screening smokers and ex-smokers could dramatically reduce deaths from lung cancer – Britain’s biggest cancer killer – a major new study has found.

Low-dose computerised tomography (CT) scans can detect tumours in people’s lungs early and cut deaths by 16%, according to the UK Lung Cancer Screening Trial (UKLS).

The findings have prompted renewed calls from lung cancer experts for the government to bring in routine screening across the UK of all those who are at risk because of their smoking history. They say that early detection means patients can have potentially curative surgery or radiotherapy.

“Lung cancer early detection and surgical intervention saves lives,” said Professor John Field of Liverpool University, an author of the trial. 

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Source: The Guardian, 12 September 2021

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Attitudes to long Covid are straight out of the ME playbook

Dr Kelly Fearnley caught COVID-19 in November 2020, after being redeployed to work on a coronavirus ward. Ten months on, she’s still living with debilitating symptoms of the condition known as long Covid.

The latest estimates, published in June, suggest more than two million people in the UK have had long Covid since the pandemic began, while figures released by the Office for National Statistics in April show that more than 120,000 of those are NHS staff.

Dr Fearnley discusses with iNews her experience of being taken to hospital after becoming seriously unwell. Dr Fearnley had a high resting heart rate and wasn’t able to get out of bed. She had pins and needles and was experiencing attacks of breathlessness, as well as violent shaking of her entire body. Yet, after running tests, she says the senior doctor she saw made it clear they believed Dr Fearnley was suffering from anxiety.

“I was [treated as] an anxious little girl. My concerns weren’t taken seriously. Despite being a doctor myself, I felt let down by my colleagues at a time when I needed help but help wasn’t there,” Dr Fearnley said. “Sadly, I know my experience isn’t uncommon. I know a lot of long haulers have had their symptoms dismissed as anxiety.”

But Dr Fearnley’s experience is also not unique to long Covid patients. “There’s a long history in medicine of dismissing hard-to-diagnose and hard-to-treat patients as having psychological or behavioural problems,” says Brian Hughes, Professor of Psychology at the National University of Ireland, Galway.

“Historically, these problems have also been far more likely to emerge where illnesses primarily affect women,” he added.

There are countless examples of this, but the condition that’s been most closely linked to long Covid is myalgic encephalomyelitis (ME) – also known as chronic fatigue syndrome or ME/CFS. 2020 research into GPs’ knowledge and understanding of the condition found that between a third and half of GPs did not accept ME as a “genuine clinical entity“. As a result, patients have continued to have their symptoms disbelieved or dismissed as psychological for decades. 

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Source: iNews, 9 September 2021

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GPs say shortage of doctors puts safe care at risk

GPs in England are finding it "increasingly hard to guarantee safe care" as the number of doctors falls and demand surges, a senior medic said.

Prof Martin Marshall, chair of the Royal College of GPs, told the Guardian GP numbers had fallen by 4.5% despite an ageing population with an increased need for care. GPs feared making serious mistakes due to excessive workloads, he said.

Prof Marshall also defended the continued use of remote consultations.

Prof Marshall said the demand for services from GPs, including more complex consultations and the vaccination programme, on top of this decline in numbers was putting family doctors under strain.

"The fact that general practice is under such enormous pressure means it can't deliver the patient-centred services that it wants to. Many GPs are even finding it challenging to maintain a safe service," he said.

He said family doctors were more likely to make a mistake if they were working 11- or 12-hour days, seeing 50 or 60 patients.

"GPs are finding it increasingly hard to guarantee safe care to their patients," he said. "The chances of making a mistake in a diagnosis or a mistake in a referral decision or a mistake in prescribing are all greater when you're under stress."

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Source: BBC News, 11 September 2021

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Sharp rise in acute medical beds occupied by children with nowhere else to go

A third of all children’s acute hospital beds in parts of England are being occupied by vulnerable children who do not need acute medical care but have nowhere else to go, safeguarding experts have warned.

Doctors say they feel like very expensive “babysitters” for vulnerable children, many of whom are in care but whose placements have broken down because of their violent and self-harming behaviour. Others have severe neurodevelopmental or eating disorders and need specialist treatment not available on ordinary children’s wards, where they get “stuck”, sometimes for months at a time.

Paediatricians told the Guardian they have had to deal with vulnerable children who were not physically ill but displayed such challenging behaviour that they could not be looked after in children’s homes.

“It is estimated that roughly a third of acute hospital beds at the moment are full of these vulnerable young people, many who are subject to child protection plans, or they are already children in care, living in a residential placement that’s falling apart,” said Dr Emilia Wawrzkowicz, a paediatric consultant who is the assistant officer for child protection at the Royal College of Paediatrics and Child Health (RCPCH).

Though many of these children are in extreme distress, they often have no diagnosable mental illness and do not qualify for a psychiatric “tier four” bed. 

“Some children have such extreme emotional and behavioural issues or are at risk of exploitation that they can’t get back to their residential placements or their foster parents. They can’t obviously go back to their homes, and we’ve got to keep them safe. So they sit in the hospital because there’s nowhere else to go. There are children sitting on our wards for months,” said Wawrzkowicz.

Charlotte Ramsden, president of the Association of Director of Children’s Services, warned that a failure to increase the suitable provision for traumatised children would lead to more child suicides and more children ending up in custody after harming others.

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Source: The Guardian, 13 September 2021

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Prostate cancer: Apology over failure to monitor patients

Failures by a health board led to eight cancer patients not being appropriately monitored or included in treatment targets after being referred to England, the ombudsman has found.

Of the 16 patients on Wale's Betsi Cadwaladr health board's prostatectomy waiting list in August 2019, eight were referred to England for treatment. None of those treated in England met the health board's targets.

The health board, which covers north Wales, has apologised to the patients. It said it had accepted the findings of the report and agreed to implement its recommendations.

The investigation was launched after a report into the case of a prostate cancer patient raised suspicion there were further incidents.

Public Services Ombudsman for Wales Nick Bennett said: "Clearly there's consequences for any type of cancer treatment, where people who are treated in England do not receive the same monitoring, do not receive the same harm reviews...

"Going forward, this must never happen again."

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Source: BBC News, 9 September 2021

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Third of BAME staff in NHS mental health services face racist abuse at work

NHS leaders are being urged to tackle racist abuse of staff as new figures reveal that a third of black, Asian or minority ethnic workers in mental health trusts in England have experienced harassment, bullying or attacks by patients, relatives or members of the public.

One in three (32.7%) BAME staff in mental health settings have experienced abuse, according to analysis by the Royal College of Psychiatrists. For BAME workers across the NHS, the rate is more than one in four (28.9%).

One medical director told the Guardian that hot tea had been thrown at them “because of the colour of my skin”. A psychiatrist told how they were left traumatised after they were racially abused – then threatened with a knife.

The college is calling on health leaders to take a stand against discrimination by setting up better processes in NHS trusts to record and understand data about bullying and harassment.

Dr Adrian James, president of the Royal College of Psychiatrists, said the findings were deeply concerning. He said: “NHS leaders and local health bosses must tackle this head-on.”

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Source: The Guardian, 9 September 2021

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Mental health unit 'failed' man who took own life

The father of a man who took his own life said the mental health unit where he was staying "failed him completely".

Joshua Sahota, 25, died as a result of asphyxia and psychosis at the Wedgewood Unit in Bury St Edmunds, Suffolk, on 9 September 2019.

Insufficient staffing levels at the unit contributed to his death, an inquest jury found.

Mr Sahota, from Kennett in Cambridgeshire, was taken to the unit three weeks before his death as his mental health had declined.

There was no psychologist in post and the jury at Suffolk Coroner's Court recorded this as having contributed to his death.

It also found that a plastic bag which contributed to his death was on a restricted items list, but this was "unclear" and there were "inconsistencies of understanding this" by staff and visitors.

Other factors that the jury said contributed to his death included insufficient observations and one-to-one processes, no clear and concise risk assessments, being slow to develop a care plan and the absence of a documented crisis plan.

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Source: BBC News, 10 September 2021

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‘Heavy-handed, expensive’ inspections wrong way to regulate hospitals, says ex-CQC chair

‘Very heavy-handed, laborious and expensive’ inspections ‘have not been the right way’ of regulating hospitals, according to the Care Quality Commission’s (CQC) former chair.

Speaking at a Royal Society of Medicine event on Wednesday, Lord David Prior, who is now the chair of NHS England, said “very few” physicians will have improved their work after reading a report from the regulator.

He added that there is a role for the CQC to move in when “things are going wrong” although he is “sceptical” the regulator can actually drive improvement in hospitals.

Lord Prior said: “I am highly sceptical as to whether or not CQC or any regulator can really drive improvement and drive the top hospitals to make them better.

“And certainly I think there’ll be very few physicians who will say that their clinical work has improved as a result of reading a CQC report.

“I think the sadness I have about CQC is that we have not been able, or it has not been able, to develop a series of predictive metrics that could replace these very heavy handed, very laborious and very expensive visits that we used to do.”

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Source: HSJ, 9 September 2021

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Vulnerable patient deaths prompt hospitals warning

The deaths of three adults with learning disabilities at a failed hospital should prompt a review to prevent further "lethal outcomes" at similar facilities, a report said.

The report looked at the deaths of Joanna Bailey, 36, and Nicholas Briant, 33, and Ben King, 32, between April 2018 and July 2020. It found here were significant failures in the care of the patients at Jeesal Cawston Park, Norfolk.

Ms Bailey, who had a learning disability, autism, epilepsy and sleep apnoea, was found unresponsive in her bed and staff did not attempt resuscitation, while the mother of Mr King said he was "gasping and couldn't talk" when she last saw him. Mr Briant's inquest heard he died following cardiac arrest and obstruction of his airway after swallowing a piece of plastic cup.

The report found:

  • "Excessive" use of restraint and seclusion by unqualified staff.
  • Concerns over "unsafe grouping" of patients.
  • Overmedication of patients.
  • High levels of inactivity and days of "abject boredom".

Relatives described "indifferent and harmful hospital practices" and said their questions and "distress" were ignored

Joan Maughan, who commissioned the report as chairwoman of the Norfolk Safeguarding Adults Board, said: "This is not the first tragedy of its kind and, unless things change dramatically, it will not be the last."

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Source: BBC News, 9 September 2021

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Scandal-hit trust sees surge of staff voicing concerns

A trust facing serious questions about its working culture has had a dramatic rise in the number of concerns raised about issues such as harassment and bullying. 

In the first quarter of 2021-22, staff raised 84 incidents to East of England Ambulance Service Trust’s Freedom to Speak Up guardian, compared with only eight in the first quarter of 2020-21. 

Half of the cases raised to the guardian this year involved issues of harassment, bullying or concerns about behaviours or relationships, according to a report to the trust board.

However, the biggest single area of concern — with 35 cases — was “the inconsistent applications of processes in policies” and only one out of 84 cases involved patient safety or quality.

The report said: “Staff across the organisation are exhausted and express concern at continuing under this pressure… staff continue to report that the slow pace of change leaves them with little confidence of lasting change.”

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Source: HSJ, 8 September 2021

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Concern raised over death of five patients seen remotely by GPs

Patients being assessed remotely in general practice, rather than face-to-face, has been raised as a risk in reports on five deaths by a single coroner since the pandemic hit.

Senior coroner for Greater Manchester Alison Mutch has written five prevention of future deaths reports highlighting concerns that doctors were missing details in telephone appointments which may have been spotted, had the patient been seen in person. The reports cover a variety of conditions, including covid, a broken femur, and anxiety and depression.

In March 2020, NHS England guidance instructed GPs to adopt a “total triage” approach, where face-to-face appointments should generally only follow a phone, video or digital consultation. But, in May, NHSE wrote to GPs to ask them to “ensure they are offering face to face appointments”, adding remote appointments “should be done alongside a clear offer of appointments in person”.

There have been growing calls in the media for increased face-to-face appointments, while, in March 2021, a report by Healthwatch concluded: “While telephone appointments are convenient for some, others are worried that their health issues will not be accurately diagnosed.”

Maureen Baker, former chair of the Royal College of GPs and Patient Safety Learning trustee told HSJ she was “not aware pre-pandemic of any major concerns with remote consulting”, adding: “It’s not that things don’t go wrong. They do, but things can and do go wrong in face-to-face consultations as well.”

“Many practices have been using remote consulting very successfully for many years [but for GPs introducing remote consultations during the pandemic] the concern is that practices will have had to change and implement it very quickly.”

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Source: HSJ, 9 September 2021

You may also be interested in a recent blog from Trish Greenhalgh: 'Why remote consultation with a doctor is difficult – and how it can be improved'

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Unvaccinated health and care workers in England could be redeployed

Health and care sector workers in England who decline to be fully vaccinated could be moved to back-office roles, a UK government minister has suggested, as a consultation on plans to mandate COVID-19 and flu vaccinations was launched.

The six-week consultation process will take views on whether vaccine requirements should apply for health and wider social care workers – those in contact with patients and people receiving care.

It would mean only those who are fully vaccinated, unless medically exempt, could be deployed to deliver health and care services.

Speaking on Times Radio, Helen Whately, the minister for care, said the government was working with care homes and other settings to see if workers who refused the vaccine could be redeployed.

She said: “You can look at whether there are alternative ways somebody could be deployed, for instance, in a role that doesn’t involve frontline work, or doesn’t involve being physically in the same setting as the patient – whether it’s, for instance, working on 111, something like that."

But she suggested that people who refused to get vaccinated against coronavirus should not work in social care.

Speaking on Sky News, Whately said care homes had been hit particularly hard by Covid, and added: “The reality is that one of the best ways we can protect people living in care homes is through making sure that staff are vaccinated.”

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Source: The Guardian, 9 September 2021

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Covid-positive care home staff work amid shortage

A care home owner has said she was "forced" to ask two staff with Covid-19 to work because of a staff shortage.

The Caledonia home in Holyhead, Anglesey, said 11 of its 12 residents had Covid and the two staff only cared for residents who were also positive.

Ann Bedford said Anglesey council and an agency had both been unable to provide emergency cover for staff who were sick or isolating. After speaking to social services, it was agreed the staff could work.

"I have never known a situation as bad as we faced over the last weekend. As a matter of course we have contingency plans in place to cope in emergencies but even these buckled under the strain," she said.

"My heart sinks when I think about the weeks and months ahead. We felt abandoned and alone. I called on social services for help but they were facing their own emergencies."

"The shortage of carers on Anglesey is at dangerous levels and is being intensified by the pandemic."

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Source: BBC News, 8 September 2021

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