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GPs in England failing to urgently refer patients with ‘red flag’ signs of cancer

GPs are failing to urgently refer patients with “red flag” signs of suspected cancer to a specialist, research suggests.

Six out of 10 patients in England with key symptoms indicating possible cancer did not receive an urgent referral for specialist assessment within two weeks, as recommended in clinical guidelines, according to a new study.

Nearly 4% of these patients were subsequently diagnosed with cancer within the next 12 months. The findings were published in the journal BMJ Quality & Safety.

In the study, researchers analysed records from almost 49,000 patients who consulted their GP with one of the warning signs for cancer that should warrant referral under clinical guidelines. Of the 29,045 patients not referred, 1,047 developed cancer within a year (3.6%).

Early diagnosis and prompt treatment is crucial to survival chances. Every four-week delay in cancer treatment increases the risk of death by 10%.

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Source: The Guardian, 5 October 2021

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Clean hands for all

Today is Global Handwashing Day, a global advocacy day dedicated to increasing awareness and understanding about the importance of handwashing with soap as an effective and affordable way to prevent diseases and save lives.

hub content on handwashing:

WHO: Guidance on engaging patients and patient organisations in hand hygiene initiatives

Safety and Health Practitioner: Tips for hand hygiene 

Hand washing dance - this is how we do it

What initiatives are in your hospital to ensure "clean hands for all"? Share your tips on the hub.

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Trust accused of ‘racism, discrimination and bullying’ as staff partnership halted

The staff-side committee of a major hospital trust has stopped working with its leadership, with its chair alleging an ‘endemic’ culture of ‘racism, discrimination and bullying’.

Irene Pilia, staff-side committee chair at King’s College Hospital Foundation Trust, told colleagues that the decision was taken “in the interests of staff”, especially black, Asian and minority ethnic workers, and expressed concerns about the organisation’s disciplinary procedures. She said the decision had the backing of staff committee officers and delegates.

Ms Pilia, who is also the senior KCHFT Unite representative, said she was open to resuming partnership working again, but told trust executives: “I have lost trust and confidence in the ability of [KCHFT] to conduct fair, impartial and no-blame investigations.

“Until there is tangible and credible evidence that racist behaviour at all levels is proactively eliminated, such that perpetrators face real consequences (including to the detriment of their careers) for their actions and are no longer allowed to behave in racist ways with impunity, I take a stand for the hundreds, possibly thousands of KCHFT staff whose voices are not being heard."

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Source: HSJ, 22 October 2020

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‘Exploited’ foreign doctors worry about risk to UK patients

Doctors recruited from some of the world's poorest countries to work in UK hospitals say they're being exploited - and believe they're so overworked they fear putting patients' health at risk.

A BBC investigation has found evidence that doctors from Nigeria are being recruited by a British healthcare company and expected to work in private hospitals under conditions not allowed in the National Health Service.

The British Medical Association (BMA) has described the situation as "shocking" and says the sector needs to be brought in line with NHS working practices.

Dr Jenny Vaughan of the Doctors Association UK said, "This is a slave-type work with… excess hours, the like of which we thought had been gone 30 years ago. It is not acceptable for patients for patient-safety reasons. It is not acceptable for doctors. "

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Source: BBC News, 11 October 2022

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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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Fury at ‘do not resuscitate’ notices given to Covid patients with learning disabilities

People with learning disabilities have been given do not resuscitate orders during the second wave of the pandemic, in spite of widespread condemnation of the practice last year and an urgent investigation by the care watchdog.

Mencap said it had received reports in January from people with learning disabilities that they had been told they would not be resuscitated if they were taken ill with COVID-19.

The Care Quality Commission (CQC) said in December that inappropriate Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) notices had caused potentially avoidable deaths last year.

DNACPRs are usually made for people who are too frail to benefit from CPR, but Mencap said some seem to have been issued for people simply because they had a learning disability. The CQC is due to publish a report on the practice within weeks.

The disclosure comes as campaigners put growing pressure on ministers to reconsider a decision not to give people with learning disabilities priority for vaccinations. There is growing evidence that even those with a mild disability are more likely to die if they contract the coronavirus.

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Source: The Guardian, 13 February 2021

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Using Twitter to assess patient takes on patient experience

A qualitative study of Twitter hashtags revealed power hierarchies can damage the patient experience and clinician relationship.

In an analysis of a popular Twitter hashtag, researchers found that patients largely take umbrage when they feel their doctor does not believe their ailment or knowledge about their healthcare, and when they perceive a power hierarchy between themselves and their clinician.

Although not as many patients are using Twitter to get peer feedback on certain providers (the Binary Fountain poll showed only 21% of patients do this), the social media website still holds a lot of power, researchers from the University of California system explained. Twitter is a large platform that hosts social discourse. Healthcare professionals use Twitter to disseminate public health and patient education messages and to network, while 61% of patients use Twitter to learn more about their health, as well.

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Source: Patient Engagement HIT, 29 October 2020

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GPs’ survey finds race discrimination in NHS treatment of primary care

A survey of an area’s GPs and other primary care staff found those from a minority ethnic background feel they are less involved in decision making and less respected by their colleagues, according to results shared with HSJ.

The survey, instigated by GPs in Doncaster, South Yorkshire, also found more staff from a minority ethnic background said they had experienced some form of bullying or harassment, including “instances of physical violence”.

The work is thought to be unusual in primary care — annual “workforce race equality standard” surveys are required by NHS England for NHS trusts and, in the past year, clinical commissioning groups, but not in primary care. 

The survey in October was instigated by Doncaster Primary Care BAME Network and facilitated by Doncaster clinical commissioning group. It was sent to GPs and practice staff, community pharmacy staff, and other “healthcare professionals” in primary care. There were 136 respondents.

The report of the results said minority ethnic staff felt they were less able to make decisions to improve the work of primary care, less involved in decisions regarding their area of work and less respected by their colleagues compared with their white colleagues.

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Source: HSJ, 9 March 2021

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USA: Lawsuit alleges Strattice “pig skin” mesh is defective, resulting in need for hernia revision surgery

A hernia mesh lawsuit recently filed by a Washington woman alleges that a Strattice “pig skin” mesh product used during her hernia repair was defective and failed, resulting in the need for two additional revision surgeries.

The Strattice Reconstructive Tissue Matrix is a hernia repair mesh introduced in 2008, which is constructed from porcine, or pig skin. The mesh is then preserved in a phosphate buffered aqueous solution. It is marketed as a cross-linked graft device, which is intended to chemically link the proteins in the tissue together. However, a growing number of lawsuits allege that the design actually increases the risk of foreign body responses, infections and other complications.

Hundreds of injuries and several deaths have been linked to the Strattice hernia mesh made from pig skin, according to the lawsuit.

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Source: About Lawsuits.com, 20 January 2023

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Patients died after catalogue of errors by Priory mental health chain

NHS bosses have attacked the country’s leading private mental healthcare chain for failing to keep patients safe, The Times has learnt, as an investigation reveals the Priory Group has been criticised for failings in the care of 30 patients who have died.

An investigation by this newspaper reveals that the company, which earns at least £400 million a year from public sector contracts for looking after mentally ill patients, has been repeatedly criticised for the same failures of care over the past decade.

This week the Priory was criticised in the inquest of Eliana Hanton, 20, who died after hanging herself using a ligature point that had been highlighted as a risk in an internal audit four months earlier.

An inquest in Birmingham last week concluded that neglect by the Woodbourne Priory Hospital contributed to the death of Matthew Caseby, 23.

The company has repeatedly been criticised for the same failings in relation to patient deaths, leading to questions about whether it is learning from its mistakes, including inadequate or inaccurate risk assessments, staff's lack of training or expertise, a failure to address known ligature points or escape routes and materials which could be used to self-harm, and poor record keeping.

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Source: The Times, 29 April 2022

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

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

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

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

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Source: The Washington Post, 2 June 2021

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Private children’s unit shut down after CQC safety concerns

A privately run child and adolescent mental health unit has been closed permanently, with its residents moved elsewhere, after concerns were raised about their safety.

The Care Quality Commission (CQC) said it had taken “urgent action to ensure the provider makes immediate and significant improvements” at the Cygnet Hospital in Godden Green, outside Sevenoaks in Kent, after a series of unannounced inspections last month and this month.

The hospital had a CAMHs unit with up to 23 beds – details of which have been removed from the company’s website. However, only a small number of beds were occupied and these patients were either discharged or transferred to other hospitals before the unit closed on Monday.

Last year Cygnet Health Care also launched a 12 bed female psychiatric intensive care unit on the site. Some of these beds have been commissioned by Kent and Medway NHS and Social Care Partnership Trust since early this year, as there are no NHS female PICU sites in the county. This unit remains open, although the CQC said the concerns raised with it related to the safety of both PICU and CAMHs patients.

Karen Bennett-Wilson, the CQC’s head of hospital inspection and lead for mental health in the south, said: “CQC has also worked closely with NHSE/I, Cygnet Healthcare and other local partners who have taken the decision to close the CAMHS unit and move the young people in the service to other care appropriate to their needs."

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Source: HSJ, 20 October 2020

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Ambulance service will collapse by August, predicts its nursing director

A struggling ambulance trust could face a ‘Titanic moment’ and collapse entirely this summer if the region’s worsening problems with hospital handover delays are not taken more seriously, its nursing director has told HSJ.

Mark Docherty, of West Midlands Ambulance Service (WMAS), said patients were “dying every day” from avoidable causes created by ambulance delays and that he could not understand why NHS England and the Care Quality Commission were “not all over” the issue.

He revealed that handover delays at the region’s hospitals were the worst ever recorded, that rising numbers of people were waiting in the back of ambulances for 24 hours, and that serious incidents have quadrupled in the past year, largely due to severe delays.

More than 100 serious incidents recorded at WMAS relate to patient deaths where the service has been unable to respond because its ambulances are held outside hospitals, according to the minutes of the trust’s March quality and safety committee.

"Around 17 August is the day I think it will all fail,” he said. “I’ve been asked how I can be so specific, but that date is when a third of our resource [will be] lost to delays, and that will mean we just can’t respond. Mathematically it will be a bit like a Titanic moment.

”It will be a mathematical certain that this thing is sinking, and it will be pretty much beyond the tipping point by then.”

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Source: HSJ, 25 May 2022

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National alert as ‘coronavirus-related condition may be emerging in children’

A serious coronavirus-related syndrome may be emerging in the UK, according to an “urgent alert” issued to doctors, following a rise in cases in the last two to three weeks, HSJ has learned.

An alert to GPs and seen by HSJ says that in the “last three weeks, there has been an apparent rise in the number of children of all ages presenting with a multisystem inflammatory state requiring intensive care across London and also in other regions of the UK”.

It adds: “There is a growing concern that a [covid-19] related inflammatory syndrome is emerging in children in the UK, or that there may be another, as yet unidentified, infectious pathogen associated with these cases.”

Little is known so far about the issue, nor how widespread it has been, but the absolute number of children affected is thought to be very small, according to paediatrics sources. The syndrome has the characteristics of serious COVID-19, but there have otherwise been relatively few cases of serious effects or deaths from coronavirus in children. Some of the children have tested positive for COVID-19, and some appear to have had the virus in the past, but some have not.

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Source: HSJ, 27 April 2020

Do you work in paediatrics? Have you seen similar trends emerging? What are your thoughts on the concerns raised? Join the conversation in the hub community area: 

 

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How NHSE’s new transformation directorate will operate

Six directors will lead the different units of NHS England’s new transformation directorate created by merging NHS Digital and NHSX into the organisation.

Documents obtained by HSJ show how the transformation directorate’s senior team will be structured in the interim period until NHSD and NHSX are fully merged with NHSE.

The new directorate is led by Tim Ferris, who was appointed last year as NHSE sought to speed up the digital transformation of NHS services.

The directorate has outlined 10 draft priorities for the next few years, including ambitious proposals to install electronic patient records at every NHS trust, make electronic clinical decision support systems “the norm” for clinicians, and a huge expansion of virtual wards.

The remaining seven priorities are:

  • Expanding the functions and uptake of the NHS App;
  • Increase diagnostics capacity;
  • Data architecture and infrastructure for population health, planning and research;
  • Population health and personalised prevention;
  • Exploiting the NHS’s purchasing power;
  • NHS as a platform for rapid cycle research and innovation; and
  • Redesign pathways using digital tools.

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Source: HSJ, 8 February 2022

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Tribunal ‘astonished’ by trust’s handling of legitimate race discrimination concerns

A children’s nurse who raised legitimate concerns over racial discrimination at a major London trust was suspended and victimised by her managers for doing so, an employment tribunal has ruled.

Jeyran Panahian-Jand, who worked on a children’s ward at Whipps Cross Hospital, parts of Barts Health Trust, had raised concerns with her manager in 2019 that staff were divided on “racial lines”, with an “unfair allocation of work”, as well as bullying of two junior staff.

Her manager Heather Roberts, as well as other superiors, told Ms Panahian-Jand she should raise a formal complaint, without offering to look at the issues raised and keep the complaint informal, which the tribunal said they should have done under whistleblowing policies.

Ms Roberts later accused Ms Panahian-Jand, who identified as white, of continuing to talk about her allegations on the ward, and with the agreement of Ghislaine Stephenson, the associate director of nursing for children, Ms Panahian-Jand was suspended for the “disruption” and “upset” she was causing, the tribunal judgment said.

Ms Panahnian-Jand then lodged a formal complaint over race discrimination, as well as accusing two other bank nurses of making “racially abusive” remarks. A subsequent internal investigation supported three allegations of race discrimination made by Ms Panahian-Jand, while a separate probe into her own alleged misconduct found there was no case to answer.

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Source: HSJ, 23 February 2021

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Coronavirus ‘drive through’ testing service

The NHS is currently rolling out services on NHS sites to test people for coronavirus, including a new service now in action in west London, offering ‘drive through’ coronavirus testing.

The new service, provided by Central London Community Healthcare NHS Trust in Parsons Green, is only accessed through a referral from NHS 111, and means people worried about the virus can safely and quickly get checked close to home.

The model is one of the ways in which community testing and home testing are being rolled out nationwide, with the NHS’ strategic incident director for coronavirus, asking health services in every part of England to set up home and community testing.

After being referred through NHS 111, people are invited to an appointment in their car, during which two community nurses carry out a swab in the nose and mouth, which are checked and assessed within 72 hours.

People are asked to self-isolate while checks are completed, to prevent any potential onward transmission of the virus.

Dr Joanne Medhurst, medical director for Central London Community Healthcare NHS Trust, said: “Anyone who is worried about coronavirus should call NHS 111 for up to date advice. We’ve set up the ‘drive through’ service to make sure people in our community can get safe, convenient and quick checks for coronavirus, as part of NHS efforts to keep everyone safe."

“It’s crucial that, as a community service, we help residents in our area to get accurate, timely advice while managing extra pressure on the NHS, and so far this week we’ve had good feedback from people that the swabbing service offers reassurance at what can be a difficult time.”

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Source: NHS England, 28 February 2020

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Today sees the official launch of the hub

Today, we are proud to announce the official launch of the hub, our shared learning platform for patient safety.

We have been hard at work since launching the hub in beta in July, continuing to develop and improve the platform. Now, the hub is officially ready to be used by everyone committed to improving safety – patients and their families, clinicians, patient safety experts, and health and social care organisations.

the hub has been designed with clinicians, patient safety experts and patients following research by Carl Macrae, Professor of Organisational Behaviour and Psychology at Nottingham University Business School and a renowned specialist on patient safety.

the hub will be a crucial online repository for sharing different experiences and perspectives of what has worked well, as well as case studies, research papers, blogs, investigation reports, policy guidance and toolkits. It will provide a platform where people can ask questions, seek advice and share ideas to improve patient safety.

Registration and use of the hub are free.

Help us work towards the patient-safe future by joining the hub, sharing your learning and hearing valuable insight from others in health and social care.

Join the hub today

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"Patients are not empowered to prevent their own harm", says Sir Liam Donaldson

Today, Sir Liam Donaldson is chairing a patient safety meeting at the World Health Organization (WHO) 'A Global Consultation – A decade of Patient Safety 2020–2030' to formulate a Global Patient Safety Action Plan. His introductory address this morning focused on the task ahead – to maintain the World Health Assembly resolution momentum and patient safety as a global movement. 

"Patients are not empowered to prevent their own harm", Donaldson said, as he highlighted patient stories of unsafe care and the alarming parallels of patient and family experiences across the world. 

So where is the power? Donaldson went on to to highlight how the six current power blocks are not doing enough to improve safety and that we need to engage and motivate these power blocks to achieve change:

  • Designing of health systems – we have not seen much evidence of systems being designed for safety.
  • Health leaders are not using their power to lead for reduced harm.
  • Educational institutions – these have to happen faster to train staff in.
  • Research community – has patient safety research led to sustainable reduction in risk?
  • Data and information – how has this improved patient safety?
  • Industry – pharma doing very little on medication packaging and labelling; medical devices industry also could do more.
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Two deaths at “not fit for purpose” unit spark CQC action

The Care Quality Commission (CQC) staged an unannounced inspection after two deaths at a mental health unit which it had condemned as “not fit for purpose.”

Two earlier CQC inspections – in 2017 and 2018 – had also been prompted by deaths on the same unit.

The CQC visited the Abraham Cowley Unit, which is at St Peter’s Hospital in Chertsey and run by Surrey and Borders Partnership Foundation Trust, on 26 June. Two inpatients died in April and May on an inpatient ward for working age men.

The deaths both involved “ligature harm” and have led to the trust reviewing its ligature minimisation strategy, according to board papers.

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Source: HSJ, 8 July 2020

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Long COVID patients to get help at more than 60 clinics

Thousands of patients suffering with the long term symptoms of coronavirus can now access specialist help at more than 60 sites, NHS England announced today.

The assessment centres are taking referrals from GPs for people experiencing brain fog, anxiety, depression, breathlessness, fatigue and other debilitating symptoms.

NHS England has provided £10 million for the network of clinics, which started opening last month. There are now 69 operating across the country with hundreds of patients already getting help.

The new centres bring together doctors, nurses, physiotherapists and occupational therapists to offer both physical and psychological assessments and refer patients to the right treatment and rehabilitation services.

Ten sites are now operational in London, seven in the East of England, eight in the Midlands, South East and South West respectively, nine in the North West and a further 18 across the North East and Yorkshire.

A further 12 sites are earmarked to launch in January in the East Midlands, Lancashire, Cornwall and Isle of Wight.

The National Institute for Clinical Excellence (NICE) has today also issued official guidance on best practice for recognising, investigating and rehabilitating patients with long COVID.

Patients can access services if they are referred by a GP or another healthcare professional, so that doctors can first rule out other possible underlying causes for symptoms.

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Source: NHS England, 18 December 2020

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Patient deaths prompt ambulance chiefs to look for alternative defibrillators

Ambulance chiefs are looking at alternative defibrillators after coroners highlighted confusion over how to correctly use their existing machines.

London Ambulance Service (LAS) Trust has received two warnings from coroners since 2016 after the delayed use of Lifepak 15 defibrillators “significantly reduced” the chances of survival for patients, including a 15-year-old boy.

Coroners found some paramedics were unaware the machines had to be switched from the default “manual” mode to an “automatic” setting.

The first warning came after the death of teenager Najeeb Katende in October 2016. A report by coroner Edwin Buckett said the paramedic who arrived had started the defibrillator in manual mode and did not detect a heart rhythm that was appropriate for administering the device, so it was not used until an advanced paramedic arrived on scene 24 minutes later.

The report stated the defibrillator had been started in manual mode but it needed to be switched to automatic to detect a shockable heart rhythm. The coroner warned LAS that further deaths could occur if action was not taken to prevent similar confusion.

But another warning was issued to the LAS in March this year, following the death of 35-year-old Mitica Marin. Again, a coroner found the paramedic, who was on her first solo shift, had started the machine in manual mode and had not detected a shockable rhythm. It was suggested this caused a four minute delay in the shock being administered.

Coroner Graeme Irvine said this was “not an isolated incident” for LAS and noted the trust had reviewed other cases of delayed defibrillation. They found that the defibrillator’s manual default setting was a “contributing factor” to the delays.

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Source: HSJ, 10 August 2020

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Patients ‘put in danger so scandal-hit surgeon could perform two operations at same time’

The surgeon at the centre of a body parts scandal operated on patients who were dangerously sedated so that their procedures could be carried out simultaneously, according to a leaked investigation seen by The Independent.

Renowned hip surgeon Derek McMinn and two anaesthetists at Edgbaston Hospital, Birmingham, were accused of putting “income before patient safety” in the internal investigation for BMI Healthcare, which runs the hospital.

It comes after a separate review found that McMinn had hoarded more than 5,000 bone samples from his patients without a licence or proper permission to do so over a period of 25 years, breaching legal and ethical guidelines. Police are investigating a possible breach of the Human Tissue Act.

According to the report on sedation by an expert from another hospital, the two anaesthetists, Imran Ahmed and Gauhar Sharih, sedated patients for so long that their blood pressure fell to dangerous levels in order to allow McMinn to carry out near-simultaneous surgery.

It found this meant long delays in the operations starting, with one sedated patient being subjected to prolonged anaesthesia for longer than one hour and 40 minutes – recommended best practice is 30 minutes.

Another patient was apparently "abandoned" for an hour and 26 minutes after their surgery was only partially completed while McMinn began operating on another patient.

The report’s author, expert anaesthetist Dr Dhushyanthan Kumar of Coventry’s University Hospital, said this was unsafe practice by all three doctors and urged BMI Healthcare to carry out a review of patients to see if any had suffered lasting brain damage. Both anaesthetists work for the NHS – Ahmed at Dudley Group of Hospitals, Sharih at University Hospitals Birmingham – without restrictions on their ability to practise.

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Source: The Independent, 30 September 2020

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MHRA's response to the Cumberlege report

The Medicines and Healthcare products Regulatory Agency (MHRA) has published its response to the Independent Medicines and Medical Devices Safety Review.

In its response, the MHRA said: “Today’s publication of the Independent Medicines and Medical Devices Safety Review is of profound importance for the MHRA, since the safety of the public is our first priority."

"We therefore take this report and its findings extremely seriously. Throughout the Review’s work we have listened intently to the many distressing experiences of women and their families. We will now carefully study the findings and recommendations of the Report.

We recognise that patient safety must be continually protected and that many of the major changes recommended by the Review cannot wait. We are therefore making changes without delay to ensure that we listen to patients and involve them in every aspect of our work.

We are already taking steps to strengthen our collaboration with all bodies in the healthcare system and will strive to ensure that, working with these other bodies, the safety changes we advise are embedded without delay in clinical practice.

We wholeheartedly commit to demonstrating to those patients and families who have shared their experiences during the Review, and anyone else who has suffered, that we have learned from them and are changing and improving because of what they have told us. We are determined to put patients and the public at the heart of everything we do."

Read full statement

Source: GOV.UK, 8 July 2020

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SECAmb introduces new spinal care guidelines

South East Coast Ambulance Service NHS Foundation Trust (SECAmb) is the first ambulance service in the country to introduce new pioneering guidance aimed at improving the treatment of spinal injury patients.

The guidance includes the ending of the use of neck braces or semi-rigid collars on spinal injury patients. The ground-breaking approach is only currently in place in three other countries – Australia, Norway and Denmark. While collars are often seen as synonymous with spinal care, there is growing evidence that they could cause further harm, while providing little or no benefit.

Instead, for ‘standard patients’, spinal precautions will be undertaken with manual in-line stabilisation followed by head blocks, tape and placement on a scoop stretcher secured in a non-rigid vacuum mattress.

For a group of ‘non-standard’ patients – which may include older patients, those who are frail or have pre-existing spinal conditions, those with communication difficulties, pregnant patients, young children, bariatric patients or agitated and uncooperative patients – transport on a scoop stretcher is not beneficial. In these cases, a position of comfort approach will be used to minimise spinal motion and a special lanyard will be applied to the patient in order to alert the receiving emergency department of the patient’s status.

Soon to be adopted nationally by the Joint Royal Colleges Ambulance Liaison Committee, (JRCALC), SECAmb has been assigned as an ‘early adopter’ while the national guidelines are formalised.

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Source: South East Coast Ambulance Service, 15 July 2020

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