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Private hospital criticised for relying on NHS ambulance service to transfer patients

A coroner has warned that a private hospital is relying on NHS ambulances to transport patients despite “being fully aware” of the pressures on the ambulance service and resulting delays.

The warning came at the end of an inquest into a patient who died after a 14-hour wait for an ambulance to transfer him from the private Spire hospital in Norwich to the NHS-run Norfolk and Norwich university hospital a few minutes’ drive away. The last two years have seen a succession of inquests relating to ambulance delays. But in the latest case Jacqueline Lake, senior coroner for Norfolk, expressed concerns over Spire hospital’s use of NHS ambulances when complications and emergencies mean its patients need NHS care.

“Spire Norwich hospital does not deal with multi-disciplinary and emergency treatment at its hospital and transfers patients requiring such treatment to local acute trusts, usually the Norfolk and Norwich university hospital,” Lake wrote in a prevention of future deaths (PFD) report. “Spire Norwich hospital continues to rely on EEAST [East of England Ambulance Service NHS Trust] to transport such patients to the acute hospital, being fully aware of the demands placed on the EEAST generally and the delays which occur as a result.”

Research suggests that nearly 600 patients were urgently transferred from private healthcare to NHS emergency care in the year to June 2021 across the UK – around one in a thousand private healthcare patients. But previous analysis by the Centre for Health and the Public Interest (CHPI) thinktank found that some private hospitals were transferring more than one in every 250 of their inpatients to NHS hospitals.

‘“Transferring unwell patients from a private hospital to an NHS hospital is a known patient safety risk which all patients treated in the private sector face – including the increased numbers of NHS patients who are now being treated in private hospitals because of government policy,” said David Rowland, director of the CHPI. “And despite numerous tragedies and despite the fact that politicians and regulators are fully aware of this risk, nothing has been done to address it.”

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Source: The Guardian, 23 September 2023

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NHS Trusts still push women to have natural births despite maternity scandals

Hospitals are still promoting a “natural birth is best” philosophy – despite a succession of maternity scandals highlighting the dangers of the approach.

A Telegraph investigation has found a number of trusts continuing to push women towards “normal” births – meaning that caesarean sections and other interventions are discouraged.

On Saturday, the Health Secretary has expressed concern about the revelation, vowing to raise the matter with senior officials.

Guidelines for the NHS make it categorically clear that a woman seeking a caesarean section should be supported in her choice, after “an informed discussion about the options”.

Maternity services were last year warned by health chiefs to take care in the language they used, amid concern about “bias” towards natural births.

The warning from maternity officials followed concern that women were being left in pain and fear, with their preferences routinely ignored.

The findings come 18 months after Dame Donna Ockenden published a scathing report into maternity care at Shrewsbury and Telford NHS Trust, which warned that a focus on natural birth put women in danger. 

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Source: The Telegraph, 23 September 2023

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NHS England patients wait up to two-and-a-half years for an MRI

Some patients in England are waiting up to two-and-a-half years for important diagnostic tests such as ultrasound, MRI and CT scans, according to figures seen by the Guardian.

The longest waits were two-and-a-half years for an MRI scan, almost two years for an ultrasound and a year for a CT scan, responses to freedom of information requests by the Liberal Democrats show.

People with heart problems are among the worst affected. Examples from NHS trusts included a 49-week wait for an echocardiogram and a 475-day wait for an angiography.

Under the NHS constitution, patients should wait less than six weeks for diagnostic tests. The target is for only 1% to wait more than six weeks, but now 25% of all patients do so, according to research from the House of Commons library, commissioned by the Lib Dems.

Ed Davey, the leader of the Lib Dems, said: “What this Conservative government has done to the NHS is nothing short of a national scandal. Millions are forced to wait in pain and discomfort, anxiously wondering when they will get a diagnosis, let alone treatment.

“We cannot fix our economy without fixing our NHS. People can’t get back to work when they’re stuck waiting to see a GP, get a diagnosis or start treatment. The longer they wait, the worse their health gets and the greater the stress for themselves and their loved ones."

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Source: The Guardian, 24 September 2023

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Surge in hip fractures could be sign of ‘post-covid deconditioning’

A rise in hip fractures last year could be a symptom of a wider increase in general physical deconditioning in older and vulnerable people following the pandemic, senior clinicians have warned.

Around 72,000 hip fractures were recorded in 2022 compared to 66,000 in 2020 and 67,000 in 2021, according to the 2023 National Hip Fracture Database report, published this month.

The report, published by the Royal College of Physicians, said: “These additional hip fractures happened despite a fall in the size of the ‘at risk’ older population over the preceding three years, as a result of Covid-19-related mortality among older people and those living in care homes.”

“Our casemix run chart shows a slight increase in the proportion of hip fractures occurring in people aged under 80.

“This is perhaps an early indication of Public Health England’s [now the UK Health Security Agency] predictions that physical deconditioning and increased risk of falling due to the pandemic may lead to an increase in the number of people who are at risk of fragility fracture.”

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Source: HSJ. 25 September 2023

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Virtual hospital model ‘new gold standard’ for treatment

The chief executive at a trust behind one of the UK’s first ‘virtual hospitals’ has said this model is the ‘new gold standard’ for care provision and the trust is looking at a significant expansion.

West Hertfordshire Teaching Hospitals Trust boss Matthew Coats said the trust aimed to eventually have “hundreds” of virtual beds for patients to be monitored at home.

The trust has been at the forefront of NHS England’s programme to significantly expand the use of virtual wards across the NHS. It was also among the first to launch a virtual ward to monitor Covid patients at home during the pandemic.

Its virtual ward model has since evolved beyond covid, to what the trust calls its “virtual hospital”, providing remote care for patients across several different pathways and specialties, including heart failure, respiratory and frailty patients, who are admitted from either a hospital bed, the emergency department or by GPs.

Mr Coats told HSJ its virtual hospital is not only supporting better flow through the hospital, but is also leading to better patient experience.

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Source: HSJ, 25 September 2023

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US federal government to start providing free coronavirus tests once again

The Biden administration announced Wednesday that it is reviving a programme to mail free rapid coronavirus tests to Americans.

Starting 25 September, people can request four free tests per household through covidtests.gov. Officials say the tests are able to detect the latest variants and are intended to be used through the end of the year.

The return of the free testing program comes after Americans navigated the latest uptick in covid cases with free testing no longer widely available. The largest insurance companies stopped reimbursing the costs of retail at-home testing once the requirement to do so ended with the public health emergency in May. The Biden administration stopped mailing free tests in June.

The Department of Health and Human Services also announced Wednesday that it was awarding $600 million to a dozen coronavirus test manufacturers. Agency officials said the funding would improve domestic manufacturing capacity and provide the federal government with 200 million over-the-counter tests to use in the future.

“These critical investments will strengthen our nation’s production levels of domestic at-home COVID-19 rapid tests and help mitigate the spread of the virus,” HHS Secretary Xavier Becerra said in a statement.

Experts say free coronavirus testing proved to be an effective public health tool, allowing people to check their status before attending large gatherings or spending time with older or medically vulnerable people at risk of severe disease even after being vaccinated. It also enables people to start antiviral treatments in the early days of infection to prevent severe disease.

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Source: Washington Post, 20 September 2023

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CEO warns of ‘significant increase’ in patient anxiety over doctors’ strikes

A trust chief executive has warned of a ‘really significant increase’ in patient anxiety and frustration created by the ongoing doctors’ strikes. 

Lance McCarthy, the chief executive officer of Princess Alexandra Hospital Trust, made the comments during the most recent four-day junior doctors’ strike, which also coincided with two days of consultant strike action.

The trust leader told Hertfordshire and West Essex integrated care board on Friday: “We shouldn’t underestimate the impact industrial action is having.”

Mr McCarthy said this impact was not just confined to strike days but also affected the run-up and aftermath of each bout of industrial action. He said every series of strike days caused service disruption for at least another 72 hours. 

He said: “We are seeing increasing frustration [from] our colleagues around it, because we are constantly duplicating work, cancelling patients, rebooking the same patients, etc.

“We are [also] quite understandably starting to see in the last two months a really significant increase in anxiety and concern and frustration from our patients, who took it quite well the first couple of rounds but are understandably really frustrated. It is having a really significant impact.”

In a further statement to HSJ, Mr McCarthy reiterated comments that trust staff had noticed an increase in anxiety, concern and frustration among both patients and colleagues in recent months. 

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Source: HSJ, 25 September 2023

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Long Covid: MRI scans reveal new clues to symptoms

People living with long Covid after being admitted to hospital are more likely to show some damage to major organs, according to a new study.

MRI scans revealed patients were three times more likely to have some abnormalities in multiple organs such as the lungs, brain and kidneys.

Researchers believe there is a link with the severity of the illness.

It is hoped the UK study will help in the development of more effective treatments for Long Covid.

The study, published in Lancet Respiratory Medicine, looked at 259 patients who fell so ill with the virus that they were admitted to hospital.

Five months after they were discharged, MRI scans of their major organs showed some significant differences when compared to a group of 52 people who had never had Covid.

The biggest impact was seen on the lungs, where the scans were 14 times more likely to show abnormalities.

MRI scans were also three times more likely to show some abnormalities in the brain - and twice as likely in the kidneys - among people who had had severe Covid.

Dr Betty Raman, from the University of Oxford and one of the lead investigators on the study, says it is clear that those living with long Covid symptoms are more likely to have experienced some organ damage.

She said: "The patient's age, how severely ill they were with Covid, as well as if they had other illnesses at the same time, were all significant factors in whether or not we found damage to these important organs in the body."

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Source: BBC News, 23 September 2023

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BMA demands investigation into vaccination programme ‘mismanagement’

The BMA’s GP Committee (GPC) has demanded an investigation into the Government and NHS England’s ‘mismanagement’ of this year’s vaccination programmes.

A motion was passed at the GPC England meeting today which called for a review of the ‘circumstances which led to muddled and mismanaged communications’ and for reflection on how to ‘prevent a repeat occurrence’.

Last month, there was confusion over the start date for the adult flu and Covid vaccination programmes, which usually start in September.

NHS England said the programmes would start in October this year – a move which the BMA said would cause ‘serious disruption’.

But the Government then announced that vaccination will begin on 11 September, in what the BMA has called a ‘u-turn’, following the identification of a new Covid variant.

GPs were asked to vaccinate ‘as many people as possible’ by the end of October.

The GPC has said today that these ‘conflicting instructions’ led to confusion among GPs while also impacting on patient safety.

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Source: Pulse, 21 September 2023

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Provider fined record £1.5m over patient death

A private healthcare provider has been ordered to pay more than £1.5m – the largest fine issued for such a case – after pleading guilty in a criminal prosecution brought by the Care Quality Commission (CQC) over the death of a young woman at Cygnet Hospital Ealing in July 2019.

It is the highest ever fine issued to a mental health service following a prosecution by the CQC. 

The firm pleaded guilty to one offence of failing to provide safe care and treatment, acknowledging failures to: provide a safe ward environment to reduce the risk of people being able to use a ligature; ensure staff observed people intermittently in line with the company procedures; and train staff to be able to resuscitate patients in an emergency.

The offences related to the case of a young woman who was admitted to a ward in Cygnet Hospital Ealing in November 2018.

In July 2019, she took her own life while on the ward. CQC said Cygnet Ealing had been aware the young woman tried to harm herself in an almost identical way four months earlier, but had failed to mitigate the known environmental risk she was exposed to.

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Source: HSJ, 21 September 2023

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Sexual harassment: Women medics in NHS 'pressured into sex'

Senior doctors say female medics have felt pressured into sexual activity with colleagues.

Four women who head up medical royal colleges in Wales have written an open letter describing misogyny, bullying and sexual harassment in the workplace.

They told BBC Wales that female staff had been asked for sex by male colleagues while on shift.

The Welsh government said: "Harassment and sexual violence is abhorrent and has no place in our NHS."

Chairwoman of the Royal College of Psychiatrists in Wales, Dr Maria Atkins, said: "I've heard from multiple women over the years that during night-time shifts, they've been propositioned by male colleagues and felt pressured to engage in sexual acts.

"When they've refused they are penalised.

"It can be very damaging to some less experienced or younger women, because they will be discouraged from engaging with a team, which might have been the specialty of medicine that they wanted to progress their career in."

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Source: BBC News, 22 September 2023

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‘Zero harm is unachievable’, says NHS England safety chief

The national director for patient safety in England has cautioned against the ‘false hope’ of trying to achieve ‘zero harm’ from healthcare, describing it as unachievable.

Speaking at HSJ’s Patient Safety Congress earlier this week Aidan Fowler told delegates: “The dream of zero harm is appealing. It’s what we all want. But it’s unachievable in reality, it’s unmeasurable [and] it carries risk.”

Mr Fowler said what is really meant is eliminating “avoidable harm”, but also described this as “problematic”.

He said: “I challenge any one of you to define ‘avoidable’. We start to define a complex system in simplistic terms. We hear, ‘we’ve had no avoidable harm for six hears in our hospital’. And you think, ‘is that real?’”

Mr Fowler stressed the ambition should be to reduce harm to minimal levels, but said the notion that any provider could claim they had no harm for period of years was “hard to credit”.

He said by pursuing the “zero harm” ambition, the NHS was also “setting unattainable goals to our staff”.

“[We are] creating unrealistic expectations and burning them [staff] out and potentially creating moral distress when they’re not achieving something they’re told they should achieve,” he said.

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Source: HSJ, 21 September 2023

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Fear and anger of cancer patient, with months to live, whose chemotherapy was delayed due to strikes

A cancer patient with months to live has spoken of her fear and anger after chemotherapy was delayed by this week’s strikes.

Flora White, 51, began chemotherapy last month, which is required fortnightly to shrink a tumour so it can be surgically removed.

But it has now been set back, after the appointment she was due to have with her oncologist the day before was cancelled as a result of strikes.

Ms White said that until she got the devastating news about her own delays she had thought cancer patients would be protected from the impact of industrial action.

“It’s hard to deal with as it is, let alone the extra worry and stress,” she said.

“Your treatment being cancelled and delayed, they don’t understand how they’re affecting some people.”

Earlier this week,  Prof Karol Sikora, a leading consultant oncologist, said it was “against the ethics of medicine” for doctors to strike, as he urged medics to think again.

“If you miss cancer and someone goes for another two years without a diagnosis, it’s as good as leaving someone in the gutter bleeding ... people will die,” he said.

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Source: The Telegraph, 21 September 2023

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USA: Walgreens and CVS warned about selling illegal eye products

The US Food and Drug Administration (FDA) has sent warning letters to pharmacy chains Walgreens and CVS accusing them of illegally marketing eye care products.

The FDA’s warning letters said the products in question, which were falsely labelled as potential treatments for conditions like glaucoma, cataracts, and pink eye, should be modified if the companies and manufacturers that make and distribute them want to avoid legal action.

“The FDA is committed to ensuring the medicines Americans take are safe, effective and of high quality,” Jill Furman, Director of the Office of Compliance at the FDA’s Center for Drug Evaluation and Research, said in a statement. “When we identify illegally marketed, unapproved drugs and lapses in drug quality that pose potential risks, the FDA works to notify the companies involved of the violations.”

Ms Furman wrote in the letter sent to Walgreens: “Your ‘Walgreens Allergy Eye Drops,’ ‘Walgreens Stye Eye Drops,’ and ‘Walgreens Pink Eye Drops’ products are especially concerning from a public health perspective. Ophthalmic drug products, which are intended for administration into the eyes … pose a greater risk of harm to users because the route of administration for these products bypasses some of the body’s natural defences.”

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Source: The Independent, 21 September 2023

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Trans woman’s death ‘preventable with right support’, mother says

The family of a young trans woman who is believed to have taken her own life have said she was “failed by those tasked with her care”, as the coroner investigating her death described services for transgender people as “underfunded and insufficiently resourced”.

Alice Litman had been waiting to receive gender-affirming healthcare for more than three years when she died in Brighton at the age of 20 in May 2022.

Ahead of an inquest which began in Hove on Monday, her mother, Dr Caroline Litman, described Alice’s death as “preventable with access to the right support”.

Adjourning the inquest on Wednesday to give a narrative conclusion in two weeks’ time, the coroner Sarah Clarke told the court: “It seems to me that all of these services are underfunded and insufficiently resourced for the level of need that the society we live in now presents".

Describing the trans healthcare system as “not fit for purpose”, Alice's family, who are being supported by the Good Law Project, added: “We are grateful that the coroner has agreed that the conditions of Alice’s death warrant a report to prevent future deaths.”

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Source: The Guardian, 20 September 2023

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Fears more doctors’ strikes in England will push NHS ‘close to breaking point’

Hospital bosses fear that further strikes by doctors will push the NHS “close to breaking point” as it struggles to cope with its winter crisis in the months ahead.

NHS leaders are concerned that medics’ plans to continue their campaign of stoppages until February will make it even harder for the service to manage what is always its toughest period.

Four days of strikes this week in England have included the first-ever 24-hour joint strike over pay on Wednesday by consultants and junior doctors. This latest series of stoppages – two days by consultants and three days by junior doctors – has forced hospitals to reschedule many thousands of outpatient appointments and non-urgent operations because of the lack of staff.

“Winter pressures, respiratory illness and rising Covid again mean that the next six months will be exceptionally difficult. Winter always is,” said one hospital trust chief executive, who asked not to be named.

“The NHS is effective at absorbing pressure but the industrial action may, at times, take us close to breaking point and often patient harm and the impact on NHS staff is not fully recognised,” he said.

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Source: The Guardian, 20 September 2023

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Unlicensed implants made with non-medical parts used in Temple Street spinal operations – surgery suspended

Certain spina bifida-related surgeries remain suspended at Children's Health Ireland at Temple Street (CHI) for almost a year amid serious allegations that unlicensed devices made with non-medical parts have been implanted in child patients. In two cases where these devices were used, the implants had to be removed from patients after causing significant harm, while the efficacy of a third is yet to be determined.

One senior member at the hospital has raised concerns about the number of repeat operations required on young spina bifida patients and associated rates of reinfection, with disquiet in the hospital eventually leading to first an internal review of operations in October 2022 and later an external probe by US clinicians.

In June this year there were 287 children on waiting lists in Ireland for life-changing spinal surgery. Despite a commitment first given by then health minister Simon Harris in 2017 that no child would be on the waiting list for more than four months, there are still more than 120 children waiting more than a year for scoliosis surgery, according to the Ombudsman for Children.

CHI has declined to comment on allegations that one of its surgeons has used the unlicensed, failed implants, as well as its decision to cease operations on spina bifida patients.

Patient advocate Amanda Santry, who took part in the external review on behalf of Spina Bifida & Hydrocephalus Paediatric Advocacy, has said she has been denied access to the review findings and has also called for a “full investigation” into the allegations of the use of non-medical parts.

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Source: The Ditch, 15 September 2023

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NHSE director ‘concerned by 20% nursing gap’ amid push to tackle poor culture

NHS England’s national mental health director admitted she was ‘concerned’ that 20% of mental health nurse roles were unfilled and about the impact this could have on a nationwide push to improve safety and tackle closed cultures.

Claire Murdoch was speaking to HSJ a year on from a series of high-profile documentaries exposing abuse and poor care at mental health trusts. In their wake, Ms Murdoch urged providers to urgently review safeguarding, while a separate three-year quality programme was also launched to look at closed cultures and improve safety.

Now in the middle of that programme, Ms Murdoch stressed that stability in staffing is “vital” to developing safe and therapeutic care, but that many services across the country are struggling with significant nursing vacancies. 

She said: “The bit that absolutely we need to acknowledge [around changing cultures] is there are some significant workforce and staffing challenges, which I’m concerned about, with a 20%t vacancy of qualified registered mental health nurses nationally.

“There are new support roles, psychology assistant roles, physician associates – there are all sorts coming into being in inpatient care, but a lot of services are still struggling with staffing".

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Source: HSJ, 21 September 2023

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Whistleblower denied mental health treatment after suing nearby trust

A mental health provider has apologised after telling a whistleblower he was being declined treatment due to an employment tribunal he had brought against a neighbouring trust.

Andrew Wardley was among a group of staff who raised concerns over a major research project at The Christie, a prominent cancer trust in Greater Manchester.

Dr Wardley, a leading oncologist, has claimed he was sidelined and effectively bullied out after raising legitimate concerns. He has brought an employment tribunal against the specialist trust.

The ongoing case has caused him severe stress and anxiety, prompting him to seek psychological treatment with South West Yorkshire Partnership Foundation Trust, which runs services near his home in Huddersfield.

He told HSJ an initial phone conversation with trust staff had been positive and ended with an agreement he would benefit from treatment with the Improving Access to Psychological Therapies team.

But he subsequently received a letter from the trust, which said: “Given the ongoing litigation IAPT would not be in a position to offer any therapy".

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Source: HSJ, 20 September 2023

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Patient's water drinking death was preventable

The death of a mentally ill teenager who died after drinking an excessive amount of water was preventable, an investigation has found.

The 18-year-old, known at Mr D, was being detained under the Mental Health Act at the time of his death.

An inquiry by the Mental Welfare Commission said he had previously been treated for drinking too much water.

It found several areas where a different course of action could have prevented his death.

The teenager was admitted out-of-hours to an adult mental health service (AMHS) inpatient unit in a health board neighbouring his own on 5 December 2018 as there were no local beds available.

This move was described in the report as a "high-risk action".

On the evening of 7 December he suffered a seizure after drinking too much water and was transferred to intensive care. He died three days later from the consequences of water intoxication.

Suzanne McGuinness, executive director (social work) at the Mental Welfare Commission, said: "This was a tragic death of a young man while he was being cared for in hospital.

"We found that a more assertive approach to the treatment of Mr D's psychotic illness in the two years before his death was warranted. The risks associated with psychotic illness were not coherently managed."

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Source: BBC News, 21 September 2023

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Direct GP referrals may cease for many non-urgent cases under new national strategy

National leaders are looking to greatly reduce the number of direct hospital referrals made by GPs, by insisting that they first discuss cases with hospital consultants. 

The approach – known as “advice and guidance” or “A&G” – involves GPs sending a patient’s details to a consultant who specialises in their condition before making a referral. The consultant then advises on the best course of action.

“A&G’ has been voluntarily adopted by many health systems, but HSJ has now learnt that a move to significantly increase its use of it is being discussed as part of a new national strategy for outpatient services, due to be published by December.

Theresa Barnes, outpatients lead at the Royal College of Physicians, is part of a group of clinicians helping to develop the strategy in partnership with NHS England, and said there is a case for A&G to be used “in preference” to direct referrals in a vast number of cases where it is clinically appropriate.

She told HSJ: “I think there should be a push to use advice and guidance in preference to direct referrals, so we can maximise that pre-referral interaction and deliver as much care as close to patients’ homes as they can get it and without the delay of potentially waiting for a secondary care appointment.”

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Source: HSJ, 20 September 2023

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Republic of Ireland: Parents endure ‘absolute horror’ as 19 spina bifida patients suffer ‘significant’ surgery complications

It is still unclear how unauthorised metal parts came to be implanted in a number of the 19 children with spina bifida who suffered significant complications after spinal surgery.

But it has emerged that one child died and 18 others suffered a range of complications after surgery at Temple Street Children’s Hospital – with several needing further surgery, including the removal of metal parts which were not authorised for use.

Parents of the children undergoing complex surgery were left distraught by the disclosures that emerged yesterday, after campaigning for years while the young patients in need of operations deteriorated on waiting lists.

Gerry Maguire, of Spina Bifida Hydrocephalus Ireland, said “absolute horror is being visited on parents and their advocates”.

He condemned as disturbing the information which is “being drip-fed to his group and “more alarmingly the families concerned”. One mother expressed concern about further delays in surgery and said children are too complex to be taken for care abroad.

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Source: Irish Independent, 19 September 2023

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Hospital drug policies could ‘put Parkinson’s patients at risk’

Patients with Parkinson’s disease are being put at risk when they have spells in hospital due to a lack of timely medication, according to a new report.

Some 58% of people with Parkinson’s disease who were admitted to hospital in England last year said that they did not receive their medication on time during their stay.

Parkinson’s UK said that medication for people with the condition is “time critical” and a delay of 30 minutes can mean the difference between functioning well and being unable to move, walk, talk or swallow.

The charity also conducted freedom of information requests on English hospitals and found that one in four (26%) NHS trusts do not have policies that allow people with Parkinson’s to take their own medication in hospitals.

Only half (52%) require staff responsible for prescribing and administering medication to have training on time critical medication, the charity found.

Parkinson’s UK has called for a number of measures to be put in place to make sure patients in hospital can get access to medications when needed including: ensuring there are medication self-administration policies for patients where it is safe to do so; more training for staff and better use of e-prescribing to keep on track of medication timings.

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Source: The Independent, 19 September 2023

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Strikes caused 22 ‘critical incidents’, government claims

The NHS has declared 22 ‘critical incidents’ due to disruption caused by industrial action since December, including having to transfer critical care patients, according to the Department for Health and Social Care.

Critical care and gynaecology patients have had to be moved to other hospitals due to staffing shortages, urgent cancer surgery and chemotherapy appointments have had to be rescheduled and urgent surgery on trauma patients “could not go ahead” during critical incidents declared in periods of strike action since December, the Department of Health and Social Care said.

There have been strikes by both doctors and Agenda for Change staff over pay during 2023, and Wednesday sees junior doctors and medical consultants strike on the same day for the first time.

The DHSC has not previously revealed critical incidents caused by strikes, nor details of them. Trusts typically have different triggers for declaring critical incidents, but they indicate severe strain on services, and it is not unusual for them to happen during high winter pressures. 

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Source: HSJ, 20 September 2023

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Sepsis often missed as 50% of screening tools don’t work, study finds

Paramedics and A&E doctors often miss signs of sepsis and two of the four ways health professionals screen for the killer condition do not work, a new study claims.

Doctors, NHS bosses and health charities have been concerned for years that too many cases of sepsis go undiagnosed, leaving people badly damaged or dead, because sepsis is so hard to detect.

Unless a patient is diagnosed quickly, their body’s immune system goes into overdrive in response to an infection and then attacks vital tissues and organs. If left untreated, sepsis can cause shock, organ failure and death.

Research from Germany, presented at this week’s European Emergency Medicine Congress in Barcelona, claims to have uncovered significant flaws in two of the four screening tools that health workers use worldwide to identify cases of the life-threatening illness.

The four systems are NEWS2 (National Early Warning Score), qSOFA (quick Sequential Organ Failure Assessment), MEWS (Modified Early Warning Score) and SIRS (Systemic Inflammatory Response Syndrome).

The researchers analysed records of the care given to 221,429 patients in Germany who were treated by emergency health workers outside hospital settings in 2016.

“Only one of four screening tools had a reasonably accurate prediction rate for sepsis – NEWS2. It was able to correctly predict 72.2% of all sepsis cases and correctly identified 81.4% of negative, non-septic cases,” they concluded.

NHS England stressed that it already deploys NEWS2, which emerged as the best system.

An NHS spokesperson said: “This study shows the NHS actually is using the best screening tool available for detecting sepsis – NEWS2 – and as professional guidance for doctors in England sets out, it is essential that any patient’s wishes to seek a second opinion are respected.”

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Source: Guardian, 20 September 2023

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