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Weaknesses that led to patients getting Covid in hospital remain

Almost as soon as the pandemic struck early last year, NHS England recognised that patients catching Covid-19 while they were in hospital for non-Covid care was a real risk and could lead to even more deaths than were already occurring. Unfortunately their fears have been borne out by events since – every acute hospital in England has been hit by this problem to some extent.

Over the last 15 months various NHS and medical bodies have looked into hospital-acquired Covid and published reports and detailed guidance to help hospitals stem its spread. They include the Healthcare Safety Investigation Branch (HSIB) and Public Health England (PHE). Last May, for example, PHE estimated that 20% of coronavirus infections in hospitalised patients and almost 90% of infections among healthcare staff may have been nosocomial, meaning they were caught in a hospital setting.

Before the pandemic the NHS was over-stretched and resources were limited. The crisis distorted it further out of shape and despite NHS staff making huge efforts to contain the virus in extremely challenging circumstances, too often they were overwhelmed.

There are many other reasons, including inadequate ventilation, the sharing of equipment, and nurses and doctors having to gather at nurses’ stations and in doctors’ messes. Some bereaved relatives also cite hospitals deciding – inexplicably – to put their Covid-free loved ones in a bay or ward with one or more people who had the disease, sometimes resulting in tragedy.

While some of these inherent weaknesses have been addressed, others remain, leaving further infections and even more deaths in this way a distinct possibility if the NHS is hit by another Covid surge.

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Source: The Guardian, 24 May 2021

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Serious safety concerns over third major specialty at struggling trust

Serious patient safety concerns have been raised about a third major specialty at a struggling acute trust, with inspectors also flagging wider leadership issues.

The Care Quality Commission (CQC) has issued an immediate warning notice in relation to the stroke service at University Hospitals of Morecambe Bay Foundation Trust, following an inspection earlier this month.

A full report will be published later this year, but the immediate issues have been outlined within various documents published ahead of the trust’s board meeting on 26 May.

According to a summary within the papers, the CQC warning notice has flagged “a range of incidents… identifying poor care that requires investigation”, governance concerns around the grading of incidents, poor levels of training and competencies, and worrying delays around administering thrombolysis.

The problems were predominantly found at Royal Lancaster Infirmary.

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Source: HSJ, 25 May 2021

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‘Unnecessary secrecy’: 42 NHS trusts criticised over Covid deaths data

Hospitals have been accused of “unnecessary secrecy” for refusing to disclose how many of their patients died after catching Covid on their wards.

The Patients Association, doctors’ leaders and the campaign group Transparency International have criticised the 42 NHS acute trusts in England that did not comply fully with freedom of information request for hospital-acquired Covid infections and deaths.

The Guardian revealed on Monday that up to 8,700 patients lost their lives after probably or definitely becoming infected during the pandemic while in hospital for surgery or other treatment. That was based on responses from 81 of the 126 trusts from which it sought figures.

The British Medical Association, the main doctors’ trade union, said the 42 trusts that did not reveal how many such deaths had occurred in their hospitals were denying the bereaved crucial information.

“No one should come into hospital with one condition, only to be made incredibly ill with, or even die from, a dangerous infectious disease,” Dr Rob Harwood, chair of the BMA’s hospital consultants committee, said.

“Families, including those of our own colleagues who died fighting this virus on the frontline, deserve answers. We will only get that if there is full transparency."

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Source: The Guardian, 25 May 2021

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Hancock: ICSs to be rated on safety, integration and leadership

Safety and quality, as well as integration and leadership, will be a “core focus” for the Care Quality Commission’s (CQC) ratings of integrated care systems (ICS), health secretary Matt Hancock has indicated.

In a letter to health and social care committee chair Jeremy Hunt, Mr Hancock said the Department of Health and Social Care is working with the CQC and NHS England to develop “detailed proposals” on how ICSs will be regulated. The CQC is due to be given “new powers” to rate ICSs under the government’s proposed health and social care bill.

The confirmation that the CQC’s ratings of ICSs will include a focus on safety and quality comes days after former health secretary Mr Hunt warned the NHS could take a “big step back” if ICSs are not rated on these domains.

In the letter published today, Mr Hancock said: “I see these new powers for the CQC as an excellent opportunity not only to inform the public about the quality of health and care in their area, but also as a way to review progress against our aspirations for delivering better, more joined up care across integrated care systems.

“I note your recommendation that quality and safety of care should be a core domain of the CQC reviews and would like to assure you that, alongside integration and leadership, quality and safety will be a core focus when rating integrated care systems."

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Source: HSJ, 25 May 2021

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Wrong leg amputation focuses attention on surgical errors and other medical mistakes

“Human error” resulted in a man having the wrong leg amputated at a major Austrian hospital.  The error occurred when a healthcare employee marked the wrong leg for amputation during pre-surgical procedures.

The mistake was not noticed anytime during the surgery, or even during the immediate postoperative period.  It was recognised during a routine wound dressing change, about 48 hours postoperatively.

“A disastrous combination of circumstances led to the patient’s right leg being amputated instead of his left,” the hospital’s statement said.  “We would also like to affirm that we will be doing everything to unravel the case, to investigate all internal processes and critically analyze them. Any necessary steps will immediately be taken.”

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Source: Lansing Injury Law News, 24 May 2021

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Detectives consider corporate manslaughter charge in NHS maternity scandal involving 200 families

Detectives are examining a series of baby deaths at a troubled NHS trust as the number of cases being investigated by an independent inquiry nears 200 – making it one of the worst maternity scandals in NHS history.

The Independent has learned officers in the serious crime directorate at Kent Police are looking at unsafe maternity care at the East Kent Hospitals University Trust and have held a series of high-level meetings, including with the Crown Prosecution Service.

The discussions are believed to centre on the possibility of opening a criminal investigation and bringing charges related to corporate manslaughter and/or gross negligence manslaughter.

If this goes ahead, it would be only the second time an NHS trust had faced a corporate manslaughter charge.

Today, former health secretary Jeremy Hunt said he was “deeply concerned” about the new revelations and added that this latest scandal showed “deep-seated cultural and systemic issues” in maternity care.

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Source: The Independent, 24 May 2021

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Ten-fold increase in children waiting too long for specialist care

The number of children and young people waiting longer than recommended for admission to a mental health bed has increased nearly ten-fold since last summer, according to figures from one NHS region seen by HSJ.

There has been major concern about worsening mental health of children and young people through the pandemic, but these are thought to be the first official figures to emerge indicating the extent of the growth in waiting times.

Board papers show that, across the NHS’ South East region, from mid-March to mid-April this year, about 50 young people each week were waiting more than the recommended time for admission or transfer into a child and adolescent inpatient mental health unit. Last June, the weekly average was less than six.

The papers show much of the rise was due to eating disorders referrals, which rose from five in June to nearly 30 in early March. However, other specialist services also saw rises.

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Source: HSJ, 25 May 2021

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Up to 8,700 patients died after catching Covid in English hospitals

Up to 8,700 patients died after catching Covid-19 while in hospital being treated for another medical problem, according to official NHS data obtained by the Guardian.

The figures, which were provided by the hospitals themselves, were described as “horrifying” by relatives of those who died.

Jeremy Hunt, the former health secretary, said that hospital-acquired Covid “remains one of the silent scandals of this pandemic, causing many thousands of avoidable deaths”.

NHS leaders and senior doctors have long claimed hospitals have struggled to stop Covid spreading because of shortages of single rooms, a lack of personal protective equipment and an inability to test staff and patients early in the pandemic.

Now, official figures supplied by NHS trusts in England show that 32,307 people have probably or definitely contracted the disease while in hospital since March 2020 – and 8,747 of them died.

That means that almost three in 10 (27.1%) of those infected that way lost their lives within 28 days.

“The NHS has done us all proud over the past year, but these new figures are devastating and pose challenging questions on whether the right hospital infection controls were in place”, said Hunt, who chairs the Commons health and social care select committee.

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Source: The Guardian, 24 May 2021

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UB researcher developing algorithm to cut hospital readmissions for COPD patients

To lower hospital readmission rates for patients with chronic obstructive pulmonary disease (COPD), UB pharmacy researcher David Jacobs has received a $962,000 award from the US National Heart, Lung, and Blood Institute to develop a real-time readmission risk-prediction algorithm.

Through a five-year Mentored Patient-Oriented Research Career Development Award, Jacobs will combine social information with rich clinical data to build predictive models that will be integrated into patient-centric interventions and tested in clinical practices.

If successful, the research will help clinicians provide individualized treatment at the transition from hospital to home for COPD patients, who experience high rates of early hospital readmission, says Jacobs.

“Each year, 7.8 million hospital-discharged patients are readmitted, costing the United States $17 billion,” says Jacobs, assistant professor of pharmacy practice, School of Pharmacy and Pharmaceutical Sciences.

“High readmission rates are linked to several quality-of-care and patient-safety factors, such as medication-related problems, inaccurate information transfer, and lack of care coordination with primary care,” he says. “Our focus will be to apply innovative informatic techniques to the development of risk prediction models for hospital readmissions that ultimately personalizes care management interventions.”

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Source: UBNow, 21 May 2021

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Twin crisis of access and affordability calls for a radical rethink of NHS dentistry

New data indicates the dental crisis shows no signs of slowing, with four in five people (80%) struggling to access timely care during the last COVID-19 lockdown.

Access to NHS dental care continues to be a problem for people across England, with Healthwatch recording a 22% rise in calls and complaints about dentistry between January and March 2021.   

A review of 1,375 people’s experiences shared with Healthwatch found a lack of consistency across the country when it comes to accessing a dental appointment. Whilst some people were asked to wait an unreasonable time of up to three years for an NHS appointment, those able to afford private care could get an appointment within a week. 

Healthwatch are calling for greater ambition and urgency from NHS dental reform plans to create more equitable and affordable dental care. 

Imelda Redmond CBE, National Director of Healthwatch England, said: “The twin crisis of access and affordability hitting NHS dentistry means many people are not able to access timely care – and the poorest are hardest hit. Those human stories show that oral health is a social justice and equity issue."

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Source: Healthwatch, 24 May 2021

 

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‘Robot paramedics’ carry out chest compressions on patients in ambulances

A robot paramedic is to be used for the first time to carry out chest compressions on ambulance patients to free up the emergency team who can perform other vital treatments.

The device is known as LUCAS 3 and is able to deliver consistent, high-quality CPR chest compressions whilst the patient is on their journey to hospital. CPR is essential to maintaining oxygen levels in the body and flow of blood when someone is no longer breathing.

South Central Ambulance Service (SCAS) is the first ambulance service in the country to use the robots, which cost about £12,000.

An SCAS spokesman said: “Once paramedics arrive and begin CPR or take over from bystanders who may have initiated it, the transition from manual compressions to LUCAS can be completed within seven seconds, ensuring continuity of compressions.”

Data of the event can also be collected which can be reviewed at a later date.

Dr John Black, medical director at SCAS, said: “We know that delivering high quality and uninterrupted chest compressions in cardiac arrest is one of the major determinants of survival to hospital discharge but it can be very challenging for a number of reasons.

“People can become fatigued when performing CPR manually which then affects the rate and quality of compressions, and patients may need to be moved from difficult locations, such as down a narrow flight of stairs, or remote places which impedes the process.”

Dr Black went on to explain that these devices don’t “fatigue or change” their delivery as a human might. This means “high quality CPR can be delivered for as long as is required.”

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Source: The Independent, 22 May 2020

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Secrecy over care home deaths breakdown branded 'shameful' and 'shocking'

The refusal of an arm of the Scottish Government to release information about deaths in individual care homes during the pandemic has been branded “shameful” and “shocking” by opposition parties.

National Records of Scotland, which is responsible for the official recording of deaths in Scotland, breached Freedom of Information legislation by refusing to release the number of confirmed and suspected COVID-19 related deaths in each of Scotland’s care homes, the Scottish Information Commissioner has ruled.

While care home death figures have been published, the NRS refused to break these down by care home, citing “speculative” arguments about this release impacting care workers and the commercial interests of care home operators, the commissioner said.

“This is another devastating blow for the care home residents and families who have been denied justice,” he said.

“Those responsible must be held accountable and lessons must be learned.

“We need a Scottish public inquiry without delay.”

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Source: The Scotsman, 21 May 2021

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NHS plans to keep electives at 80% in next covid surge

NHS England has asked hospitals to prepare for a potential further surge of covid cases reaching around half the level of first wave of the virus last year – and to seek to deliver 80% of normal elective activity throughout it, HSJ has learned.

Well-placed sources said NHSE officials have held meetings in recent weeks discussing the possibility of a fourth wave of covid later this year, which modelling suggests could see up to 50% of the patient numbers seen in April last year.

Trusts have been asked by NHSE officials, as part of the planning process, what resources they would need to run at 80 per cent of previous volumes of elective work if this scenario occurred. They are also taking into account that it is likely to come on top of greater non-covid emergency care demand, which has been lower then normal over the past 15 months. 

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Source: HSJ, 21 May 2021

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Racial ‘disparity ratios’ created for each trust to root out ‘racist practice’ in NHS systems

‘Disparity ratios’ highlighting how staff with minority ethnic backgrounds are represented at different levels in each trust have been created by the national workforce race equality standard programme to help tackle ‘racist practice’ in the NHS.

NHS England head of WRES Professor Anton Emmanuel said the data had been created to indicate the differences in progression between white people and those from an ethnic minority background through the ranks of each organisation.

Detail of the methodology used to calculate the ratios has not been published, but it appears they have been determined by comparing the share of staff by ethnicity in different bands. 

Speaking at the Ambulance Leadership Forum last week, professor Emmanuel, said: “We have gone through each of the seven regions of the country and presented to them the local disparity ratios for each trust and put that into a heatmap…The whole point is to make that data digestible and actable on.”

The data can be adapted to look at different points in a trust’s progression routes and can also be used with other groups, such as disabled staff. 

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Source: HSJ, 24 May 2021

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People in England ‘face three-year waits for dentist appointments’

People are being told to wait until 2024 for dentist appointments while others are being removed from their practice lists for not making appointments sooner, according to a damning report into the state of dentistry.

Dental surgeries have reported that they have thousands of people on their waiting lists, while patients are unable to access care after ringing round numerous dental surgeries, a watchdog has warned.

Delays have resulted in the worsening of painful symptoms and in one instance even led to a patient needing hospital treatment after overdosing on painkillers, it said.

But Healthwatch England said that some people are being offered swift private care as an alternative at the same dental practice, with some patients reporting that they felt pressured to pay for their treatment.

Some practices appeared to be prioritising private care, it added.

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Source: The Guardian, 24 May 2021

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Infected blood scandal: Hancock pledges payouts if advised by inquiry

Matt Hancock has said compensation will be paid to people people infected by contaminated blood products and their relatives if is recommended by the public inquiry into the scandal.

Appearing at the inquiry on Friday, the health secretary agreed the government had a “moral responsibility” to address what had happened.

As many as 30,000 people became severely ill after being given factor VIII blood products contaminated with HIV and hepatitis C imported from the US in the 1970s and 80s. Others were exposed to tainted blood through transfusions or after childbirth. On average one person is dying every four days, with approximately 3,000 haemophiliacs having died to date.

The government set up a support scheme offering ex-gratia payments without any admission of liability, but has been urged to create a compensation scheme.

The health secretary told the inquiry: “I respect the process of the inquiry and I will respect its recommendations, and should the inquiry’s recommendations point to compensation, then of course we will pay compensation, and Sir Robert Francis’s review on compensation is there in order that the government will be able to respond quickly to that.

“But it would be wrong to pre-empt the findings of the inquiry on that basis by me giving a policy recommendation in the middle of it.”

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Source: The Guardian, 21 May 2021

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England test-and-trace glitch blamed for spread of India Covid variant

A glitch in the government’s £37bn test-and-trace system may have helped fuel the spread of a highly-transmissible Covid variant in one of the UK’s worst-hit towns, it has emerged.

The software error meant that more than 700 infected people and their close contacts were not promptly passed on to local health teams, allowing them to potentially spread the disease further.

The number of missing cases was highest in Blackburn with Darwen, where about 300 people are believed to have been lost in the system during a faulty IT upgrade. The Lancashire town is battling one of the UK’s largest outbreaks of the fast-spreading variant first identified in India. Labour has described the news as “jaw-dropping”.

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Source: The Guardian, 20 May 2021

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University Hospitals Sussex urged to release review findings

An NHS trust has been urged to publish the full findings of an independent review of its services after it released a heavily redacted report.

University Hospitals Sussex has refused to reveal the recommendations made after a review by the Royal College of Surgeons in 2019.

A patients' group said the findings should be "in the public domain".

The trust said the review of its neurosurgery department "did not highlight any safety concerns".

The review was discovered as part of a BBC Panorama investigation into unpublished patient safety reports. A heavily edited report was released under freedom of information laws.

It showed the trust asked the Royal College of Surgeons to look at "concerns raised in respect of clinical outcomes, allocation of sub-specialties and governance arrangements".

All issues and recommendations were obscured, with only positive feedback disclosed.

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Source: BBC News, 20 May 2021

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Almost 7,000 junior doctors at risk of falling behind on training after helping to fight Covid

Almost 7,000 junior doctors who treated patients during the Covid pandemic are at risk of falling behind with their training, potentially causing staffing shortages and costing taxpayers a potential £260m.

The worst-case scenario estimate of the impact of the pandemic on frontline medics has prompted ministers to inject an extra £30m to try to help doctors finish training so they can progress their careers.

Ensuring medics progress into their next roles is viewed as crucial to ensuring the health service has the doctors it needs to try and reduce the massive waiting list for operations caused by the pandemic.

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Source: The Independent, 20 May 2021

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New Covid wave could worsen NHS surgery backlog, experts warn

A new wave of coronavirus infections could throw into jeopardy efforts to clear a backlog of surgery in the NHS, experts have warned.

They say the relaxation of Covid restrictions is expected to cause a rise in infections, while at least some resurgence in hospital admissions and deaths is also expected at some point. However, the sharp rise in cases of a variant of concern first discovered in India, B.1.617.2, has caused consternation, with modelling suggesting that if it is as transmissible as some estimates suggest, it could fuel a serious “third wave”.

Now experts have said that a new wave of infections may cause further problems, exacerbating what has already been described as “a truly frightening backlog” of care.

“We are anticipating that as lockdown is eased that cases are going to go back up slightly, that is with or without the Indian variant,” Dr David Strain, a senior clinical lecturer at the University of Exeter medical school, told the Guardian. “The biggest concern we’ve got is that if these [Covid case] numbers do start to go up, it will put a strain on trying to get other services up and running.”

“GPs are crying out under the stress at the moment … we still have people not having their operations: we have had procedures postponed for over 12 months, and we have got longer waiting lists that ever before,” he said.

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Source: The Guardian, 20 May 2021

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Contaminated blood inquiry: Matt Hancock to give evidence

The health secretary will face questions about compensation for victims of the contaminated blood scandal on Friday afternoon. Matt Hancock will give evidence at a public inquiry into what's been called the worst NHS treatment disaster.

Around 3,000 people have died after being given blood containing HIV and hepatitis C in the 1970s and 1980s.

Ministers announced a public inquiry into the scandal in 2017 after decades of campaigning by victims and their families. Nearly 5,000 people with the blood disorder haemophilia were infected with potentially fatal viruses after being given a clotting agent called Factor VIII.

Much of the drug was imported from the US, where prisoners and other at-risk groups were often paid to donate the plasma used to make it.

Victims included dozens of young haemophiliacs at a boarding school in Hampshire who died after contracting HIV as a result.

Tens of thousands more victims may have been exposed to viral hepatitis through blood transfusions after an operation or childbirth.

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Source: BBC News, 21 May 2021

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GPs should not switch off online consultations, NHSE says

GP practices should not switch off their online consultation systems outside of core hours as it will “reduce patient satisfaction”, according to NHS England.

It comes in controversial new guidance issued amid a row over GP access. NHSE issued the new “standard operating procedures” this afternoon.

HSJ revealed last month that large numbers of overwhelmed GP practices were turning off their online consultation services at weekends after the recent boom in digital appointments uncovered an ‘unmet demand’, leading to large numbers of queries to deal. 

But the new SOP says: “Patients should be able to make requests in an online system at any time.”

Disabling the system outside of core hours, which some practices have done to help manage demand, is “less convenient” for patients and would “reduce satisfaction”, it says.

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Source: HSJ, 20 May 2021

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Covid: Stillbirth and prematurity risks may be higher

A large UK study suggests having coronavirus around the time of birth may increase the chance of stillbirths and premature births - although the overall risks remain low.

Scientists say while most pregnancies are not affected, their findings should encourage pregnant women to have jabs as soon as they are eligible.

The majority are offered vaccines when they are rolled out to their age group.

The study appears in the American Journal of Obstetrics and Gynecology. The research, led by the National Maternity and Perinatal Audit, looked at data involving more than 340,000 women who gave birth in England between the end of May 2020 and January 2021.

Researchers say a higher risk of stillbirth and prematurity, as well as a greater chance of having a Caesarean section, remained even once factors such as the mother's age, ethnicity, socio-economic background and common health conditions were taken into account.

Babies born to women who tested positive were more likely to need special neonatal intensive care because they were born early and needed more support - rather than being infected with coronavirus itself.

Professor Asma Khalil, co-author of the paper, said it was important for women and healthcare workers to be aware of the potential risks.

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Source: BBC News, 21 May 2021

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NHS warned multiple times that imaging shortages may kill

Coroners have warned the NHS nearly a dozen times in recent years that a lack of imaging capacity could lead to more deaths, HSJ can reveal.

Five of these warnings followed deaths at a single site, Tameside General Hospital in Greater Manchester. The most recent case concerned a patient that died after developing covid during a prolonged wait for an MRI scan.

Sir Mike Richards last year warned in a major report for NHS England about the lack of imaging equipment, and the Royal College of Radiologists has highlighted national shortages of radiology staff on numerous occasions in recent years.

HSJ combed through more than 100 prevention of future death reports and responses published between 2018 and 2021 in an effort to quantify harm linked to these shortages.

Of dozens of reports mentioning imaging issues, including software problems, poor note-taking and incorrect interpretation of results, HSJ identified 11 cases where coroners specifically warned either the trust or system concerned, and/or NHS England or the Department for Health and Social Care, that capacity issues could lead to future deaths.

In some of the cases, coroners concluded that shortages likely contributed to a patient’s death. 

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Source: HSJ, 20 May 2021

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Long Covid symptoms ease after vaccination, survey finds

COVID-19 vaccines tend to alleviate the symptoms of long Covid, according to a large survey of more than 800 people that suggests mRNA vaccines, in particular, are beneficial.

Although COVID-19 was initially understood to be a largely respiratory illness from which most would recover within a few weeks, as the pandemic wore on increasing numbers of people reported experiencing symptoms for months on end. There is no consensus definition of the condition of these people who have symptoms ranging from chronic fatigue to organ damage, let alone a standardised treatment plan.

As vaccines hit the mainstream, concerns arose that vaccination could precipitate relapses or a worsening of symptoms. But conversely, anecdotal reports suggested that vaccines helped some people with long Covid.

The analysis, which is yet to be peer reviewed, was conducted on the basis of a survey of 812 people (mostly white, female participants) with long Covid in advocacy groups in the UK and internationally who were contacted via social media. The participants (a small proportion of whom also said they had ME/CFS) were asked to wait at least a week after their first dose to avoid their responses conflating with side-effects of the vaccine.

In general, those who received mRNA vaccines (Pfizer/BioNTech or Moderna) reported more improvements in symptoms, compared with those who got an adenovirus vaccine (Oxford/AstraZeneca). In particular, those who received the Moderna vaccine were more likely to see improvements in symptoms such as fatigue, brain fog and muscle pain, and less likely to report a deterioration, the analysis found.

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Source: The Guardian, 18 May 2021

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