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Flu and COVID-19 at same time significantly increases risk of death

Having flu and COVID-19 together significantly increases your risk of death, say government scientists who are urging all those at risk of getting or transmitting flu to get the vaccine in the coming weeks and months.

The evidence for the double whammy is currently limited and comes mostly from a study with small numbers – 58 people – carried out in the UK during the early phase of the pandemic.

“As I understand it, it’s 43% of those with co-infection died compared with 26.9% of those who tested positive for Covid only,” said England’s deputy chief medical officer, Prof Jonathan Van-Tam. These were people who had been hospitalised and had been tested for both viruses, he said, and so were very ill – but the rate of death from Covid alone in the study between January and April was similar to the known rate of Covid hospital mortality generally of around 25% or 26%.

"I think it is the relative difference in size of those rates that’s rather more important than the absolute rate,” he said. The study may have been small and they would be doing further studies this season, but the findings tallied with other work that has been done, he said.

“If you get both, you are in some serious trouble, and the people who are most likely to get both of these infections may be the very people who can least afford to in terms of their own immune system, or their risk for serious outcomes. So please protect yourself against flu, this year,” says said Prof Yvonne Doyle, medical director of Public Health England

The government has bought 30,000,000 doses of flu vaccine, which is more than ever before. They will arrive in batches, so the elderly – over 65 – and those with medical conditions will be called for immunisation first. Relatives of those who are on the shielding list will also be called up. The letters will begin to go out this week.

Because of the threat of Covid and the risk that people with flu could be infected if admitted to hospital, all those aged 50-64 will be offered flu vaccination, but not straight away. They should wait to be called by their GP.

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Source: The Guardian, 22 September 2020

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Overcrowded A&Es ‘much more dangerous now because of covid’

Emergency departments across England are reporting ‘dangerous’ overcrowding similar to levels seen pre-covid, and struggling to maintain social distancing, A&E leaders have warned.

The Royal College of Emergency Medicine said it was concerned about covid spreading among the most vulnerable patients, as overall transmission rates continue to rise sharply across the UK.

It was always anticipated that A&E activity would return to pre-covid levels this winter, following a significant drop-off in A&E activity during the spring and early summer, and that service transformation would be needed to help maintain social distancing. But the emergence of widespread overcrowding so far ahead of winter is of serious concern to system leaders.

A&E staff were already being forced to make difficult trade-offs over which patients to isolate, the college’s vice president told HSJ. He also urged NHS leaders not to place unrealistic expectations on the impact a new model involving walk-in patients booking slots by phone could make on addressing overcrowding in emergency departments.

RCEM vice president Adrian Boyle said the NHS was “largely back to the pre-covid levels of crowding” but it was “much more dangerous now because of covid”.

He said: “We are hearing that most emergency departments can’t maintain social distancing safely and staff are having to make fairly difficult trade-offs about which people need to be isolated. No one can be safely social distanced in a corridor.”

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Source: HSJ, 21 September 2020

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'I'm traumatised now': Covid bereaved call for inquiry into NHS 111

Hundreds of people believe the helpline failed their relatives. Now they are demanding their voices be heard. 

Families whose relatives died from COVID-19 in the early period of the pandemic are calling for an inquiry into the NHS 111 service, arguing that many critically ill people were given inadequate advice and told to stay at home.

The COVID-19 Bereaved Families for Justice group says approximately a fifth of its 1,800 members – more than 350 people – believe the 111 service failed to recognise how seriously ill their relatives were and direct them to appropriate care.

“We believe that in some cases it is likely these issues directly contributed to loved ones dying, due to causing a delay in receiving treatment, or a total lack of treatment leading to them passing away at home,” said the group’s co-founder Jo Goodman, whose father, Stuart Goodman, died on 2 April aged 72.

Many families have said they had trouble even getting through to the 111 phone line, the designated first step, alongside 111 online, for people concerned they may have COVID-19.

The service recorded a huge rise in calls to almost 3m in March, and official NHS figures show that 38.7% were abandoned after callers waited longer than 30 seconds for a response. Some families who did get through have said the call handlers worked through fixed scripts and asked for yes or no answers, which led to their relatives being told they were not in need of medical care.

“Despite having very severe symptoms including skin discolouration, fainting, total lack of energy, inability to eat and breathlessness, as well as other family members explaining the level of distress they were in, this was not considered sufficient to be admitted to hospital or have an ambulance sent out,” Goodman said.

Some families also say their relatives’ health risk factors, such as having diabetes, were not taken into account, and that not all the 111 questions were appropriate for black, Asian and minority ethnic people, including a question to check for breathlessness that asked if their lips had turned blue.

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Source: The Guardian, 21 September 2020

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Jeremy Hunt: It’s crazy that six people can meet in a pub while mums endure the misery of lone births

Covid has brought many hidden tragedies: elderly residents in care homes bereft of family visits, families in quarantine missing loved one’s funerals, and mums forced to go through labour alone. 

Much of this has been necessary, however painful, but Jeremy Hunt fears we’re getting the balance badly wrong in maternity care. That’s why he is backing The Mail on Sunday’s campaign to end lone births, which has been championed in Parliament by Alicia Kearns.

Infection control in hospitals is critically important, but mothers’ mental health can’t be pushed down the priority list. 

Imagine the agony of a new mum sent for a scan on her own, only to be told that her much longed-for baby has no heartbeat. Or the woman labouring in agony for hours who is told she is not yet sufficiently dilated to merit her partner joining her for moral support.

"I have heard some truly heartbreaking stories, which quite frankly should have no place in a modern, compassionate health service. One woman who gave birth to a stillborn baby alone at 41 weeks; another woman who was left alone after surgery due to a miscarriage at 12 weeks," says Jeremy.

Perhaps most concerningly of all, there are reports of partners being asked to leave their new babies and often traumatised mothers almost immediately after birth. That means they miss out on vital bonding time and mums lose crucial support to help them recover mentally and physically, in some cases with partners not allowed back to meet their new child properly for several days.

"This is a question of basic compassion and decency – the very values that the NHS embodies and the reason we’re all so proud of our universal health service – so we need every hospital to commit to urgent action without delay."

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Source: MailOnline, 19 September 2020

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BAME Britons still lack protection from Covid, says doctors' chief

A third of coronavirus patients in intensive care are from black, Asian and minority ethnic backgrounds, prompting the head of the British Medical Association to warn that government inaction will be responsible for further disproportionate deaths.

Chaand Nagpaul, the BMA Council chair, was the first public figure to call for an inquiry into whether and why there was a disparity between BAME and white people in Britain in terms of how they were being affected by the pandemic, in April.

Subsequent studies, including a Public Health England (PHE) analysis in early June, confirmed people of certain ethnicities were at greater risk but Nagpaul said no remedial action had been taken by the government.

Nagpaul told the Guardian: “We are continuing to see BAME people suffering disproportionately in terms of intensive care admissions so not acting means that we’re not protecting our vulnerable communities. Action was needed back in July and it’s certainly needed now more than ever.

“As the infection rate rises, there’s no reason to believe that the BAME population will not suffer again because no action has been taken to protect them. They are still at higher risk of serious ill health and dying.”

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Source: The Guardian, 20 September 2020

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Coronavirus: Care regulator warns hospitals and nursing homes over infection risk as it urges the public to give more feedback

Watchdog chief says increasing patient feedback will be the fuel to drive improvements in patient safety

Some hospitals and care homes are failing to take action to protect patients from coronavirus as cases rise across the country, the head of the care watchdog has warned.

In an interview with The Independent, Ian Trenholm, the chief executive of the Care Quality Commission (CQC), said a series of inspections had revealed a minority of homes and hospitals were not doing enough to prevent infection. 

He said in one case a care home appeared to have made a “conscious decision” not to follow the rules on wearing masks and gloves and was now in the process of being closed down by the watchdog due to safety fears.

Mr Trenholm also revealed the CQC would be looking closely at patients struggling to access services because of the impact of COVID-19 and he warned it would act if some groups were disproportionately affected.

The CQC is being forced to move away from its regular inspections of hospitals, care homes and GPs due to the pandemic but Mr Trenholm said it would be redoubling efforts to encourage patients to give feedback on the care they received, adding the watchdog would be more explicit in future about the action it takes.

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Source: The Independent, 21 September 2020

 

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Some hospitals in England to be kept Covid-free in second wave

A series of hospitals will be designated as coronavirus-free zones during the second wave of the outbreak in a significant policy shift designed to ensure the NHS continues treatment for cancer and other conditions, the Guardian has learned.

NHS England is determined not to repeat the widespread suspension of normal service that occurred in the first wave, which doctors and charities have criticised for damaging patients’ health, leading to more deaths and creating a backlog of millions of treatments.

In a tacit admission that the March shutdown denied patients vital care, NHS bosses have drawn up plans for certain hospitals – mainly small district generals – to treat no COVID-19 patients and focus instead on common planned operations such as cancer surgery, hip and knee replacements, and cataract removals.

Under NHS plans, such “clean” hospitals will as far as possible be kept free of coronavirus patients in a reversal of the approach taken in spring. That should reduce the risk of patients admitted for normal care becoming infected with COVID-19 while on wards.

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Source: The Guardian, 21 September 2020

 

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Cases of 'long Covid' on the rise as patients suffer after-effects months after recovery

'Long Covid' is leaving people with so-called ‘brain fog’ for months after their initial recovery, NHS experts have revealed.

Dr Michael Beckles, consultant respiratory and general physician at The Wellington Hospital, and the Royal Free NHS Foundation, said he has seen a number of patients suffering from ongoing effects of the disease. He said the main symptom being reported is breathlessness, with patients also describing a brain fog.

Dr Beckles said: "I'm seeing more and more patients who have had Covid-19 infection confirmed in the laboratory and on X-ray, who have cleared the infection, and are now still presenting with persistent symptoms. "Some of those symptoms are respiratory, such as breathlessness, chronic cough. "And some have other symptoms such as what the patients describe as brain fog, and I understand that to be a difficulty in concentration."

"Some still have loss of sense of taste or smell."

He added that it can be frustrating for patients because investigations after the infection can be normal, yet the symptoms persist.

Dr Beckles is part of a team of specialists at the new post-COVID-19 rehabilitation unit at The Wellington Hospital.

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Source: The Telegraph, 21 September 2020

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Medics missing mental illness diagnosis in more than one in four patients, data suggests

More than one in four patients with severe mental health conditions are missing diagnosis when they are admitted to hospital for other reasons, new research suggests.

According to data analysed by scientists at University College London, those who are missing these mental illness diagnoses are more likely to be from ethnic minority groups or have a previously diagnosed mental illnesses.

However, the situation has improved – in 2006 it was found that mental health diagnoses were missed in more than 50% of cases.

"We found encouraging signs that clinicians are more frequently identifying severe mental illnesses in hospital patients than they were a decade ago,” Hassan Mansour, a research assistant at UCL psychiatry, said.

“But there's a lot more that can be done, particularly to address disparities between ethnic groups, to ensure that everyone gets the best care available.

Training in culturally-sensitive diagnosis may be needed to reduce inequalities in medical care."

The researchers have suggested these findings may be due to language barriers or stigma felt by patients. It was also suggested that clinicians may be less able to detect these conditions in people from other ethnic and cultural groups.

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Source: The Independent, 18 September 2020

 

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Hospitals told not to test staff or patients for COVID-19

NHS hospitals have been banned from launching their own coronavirus testing for staff and patients who have symptoms – despite a nationwide shortage in tests.

Leaked NHS documents, passed to The Independent, show the Department of Health and Social Care (DHSC) has now capped funding for COVID-19 testing in the health service, even though the lack of tests has left hospital doctors, nurses, teachers and other key workers forced to stay at home.

The diktat warned hospitals that, if they did choose to go ahead, the six figure costs would have to come from their own budgets.

The warning was sent just a day after testing tsar Baroness Dido Harding admitted to MPs that demand for coronavirus tests is three to four times the number available.

One senior NHS director told The Independent that NHS trusts had the ability to buy Covid-19 test capacity in local laboratories but now faced the risk of not getting the money to pay for it.

They said: “This is just barmy at a time when we have cases rising and we need to get test results for staff and patients who are isolating at home waiting for results.

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Source: The Independent, 18 September 2020

 

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Doctor error contributed to anorexic woman's death

A decision not to "urgently" refer an anorexic woman whose condition had significantly deteriorated contributed to her death, a coroner said.

Amanda Bowles, 45, was found at her Cambridge home in September 2017.

An eating disorder psychiatrist who assessed her on 24 August apologised to Ms Bowles' family for not organising an admission under the Mental Health Act.

Assistant coroner Sean Horstead said the decision not to arrange an assessment "contributed to her death".

Mr Horstead told an inquest at Huntingdon Racecourse that also on the balance of probabilities the "decision not to significantly increase the level of in-person monitoring" following 24 August "contributed to the death".

In his narrative conclusion, Mr Horstead said it was "possible... that had a robust system for monitoring Ms Bowles in the months preceding her death been in place, then the deterioration in her physical and mental health may have been detected earlier" and led to an earlier referral to the Adult Eating Disorder Service.
 
He said this absence "was the direct consequence of the lack of formally commissioned monitoring in either primary or secondary care for eating disorder patients".
 
 
Source: BBC News, 17 September 2020

 

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Hospital admissions for seven major non-Covid illnesses, including heart attacks, slump by 173,000

Tens of thousands of people avoided going to hospital for life-threatening illnesses such as heart attacks during Britain's coronavirus crisis, data has revealed. 

Shocking figures reveal that admissions for seven deadly non-coronavirus conditions between March and June fell by more than 173,000 on the previous year. 

Previous data for England shows there were nearly 6,000 fewer admissions for heart attacks in March and April compared with last year, and almost 137,000 fewer cancer admissions from March to June.

Analysis by the Daily Mail found that the trends were alarmingly similar across the board for patients who suffered strokes, diabetes, dementia, mental health conditions and eating disorders. 

Health experts said the statistics were 'troubling' and warned that many patients may have died or suffered longterm harm as a result.  

Gbemi Babalola, senior analyst at the King's Fund think-tank said: "People with some of the most serious health concerns are going without the healthcare they desperately need. Compared with the height of the pandemic, the NHS is seeing an increase in the number of patients as services restart, and significant effort is going into new ways to treat and support patients."

"But the fact remains that fewer people are being treated by NHS services."

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Source: Daily Mail, 13 September 2020

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Stillbirths and neonatal deaths could be avoided with more government investment

Yesterday marked the second World Patient Safety Day, and this year’s theme shined a light on health worker safety – those on the frontline of the pandemic have been selfless in their sacrifices to care for an ailing global population. What has become ever clearer is that a health system is nothing without those who work within it and that we must prioritise the safety and wellbeing of health workers, because without safe health workers we cannot have safe patients.

Improving maternity safety has been a priority for some time – although rare, when things go wrong the consequences are unthinkable for families and the professionals caring for them. Maternity negligence makes up 50% of the total value of negligence claims across all NHS sectors, according to the latest NHS Resolution annual report and accounts. It states there were claims of around £2.4 billion in 2019/20, which is in the region of £6.5 million a day. This cost says nothing of the suffering families and professionals associated.

However, without investing in the maternity frontline we cannot hope to make integral systemic changes to improve maternity safety and save mothers’ and babies’ lives, writes Sara Ledger, head of research and development at Baby Lifeline in the Independent.

"We owe it to every mother and baby to rigorously and transparently scrutinise the safety of maternity services, which will be in no small way linked to the support staff receive."

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Source: The Independent, 17 September 2020

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Good perioperative care can cut post-surgery complications by up to 80%, review shows

Patients who receive good perioperative care can have fewer complications after surgery, shorter hospital stays, and quicker recovery times, shows a large review of research.

The Centre for Perioperative Care, a partnership between the Royal College of Anaesthetists, other medical and nursing royal colleges, and NHS England, reviewed 27 382 articles published between 2000 and 2020 to understand the evidence about perioperative care, eventually focusing on 348 suitable studies.

An estimated 10 million or so people have surgery in the NHS in the UK each year, with elective surgery costing £16bn a year.

A perioperative approach can increase how prepared and empowered people feel before and after surgery. This can reduce complications and the amount of time that people stay in hospital after surgery, meaning that people feel better sooner and are able to resume their day-to-day life.

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Source: BMJ, 17 September 2020

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More than 1,500 NHS breast reconstructions delayed due to Covid

More than 1,500 breast cancer patients in UK face long waits to have reconstructive surgery after hospitals could not operate on them during the pandemic because they were tackling COVID-19.

The women are facing delays of “many months, possibly years” because the NHS has such a big backlog of cases to get through, according to research by the charity Breast Cancer Now.

When the lockdown began in March the NHS stopped performing breast reconstructions for women seeking one after a mastectomy as part of its wider suspension of care. That was because so many operating theatres were being used as overflow intensive care units and because doctors and hospital bosses feared that patients coming into hospital might catch Covid.

The NHS started doing them again in July, but not everywhere and not in the same numbers as before.

“We are deeply concerned by our finding that over 1,500 breast cancer patients may now face lengthy and extremely upsetting delays for reconstructive surgery,” said Delyth Morgan, the chief executive of Breast Cancer Now. “This will leave many women who want to have reconstruction with one breast, no breasts or asymmetric breasts for months, possibly even years.”

Lady Morgan said: “Reconstructive surgery is an essential part of recovery after breast cancer for those who choose it.

“Women with breast cancer have told us these delays are causing them huge anxiety, low self-esteem and damaged body confidence, and all at a time when the Covid-19 pandemic has denied them access to face to face support from healthcare professionals and charities.”

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Source: The Guardian, 18 September 2020

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Accidents on maternity wards cost NHS £1bn a year

Accidents on maternity wards cost the NHS nearly £1 billion last year, Jeremy Hunt, the chairman of the Commons health committee, has revealed.

The former health secretary said the bill for maternity legal action was nearly twice the amount spent on maternity doctors in England. It was part of the NHS’s £2.4 billion total legal fees and compensation bill, up £137 million on the previous year.

Mr Hunt has also told the Daily Mail there is evidence that hospitals are failing to provide details of avoidable deaths despite being ordered to do so three years ago as he highlighted “appalling high” figures which showed that up to 150 lives are being lost needlessly every week in public hospitals.

Responding to the figures, Mr Hunt said: "Something has gone badly wrong."

In 2017, he told trusts to publish data on the number of avoidable deaths among patients in their care. But freedom of information responses from 59 hospital trusts, about half the total, found less than a quarter gave meaningful data on avoidable deaths.

Mr Hunt cited “major cultural challenges” which he blamed for preventing doctors and nurses from accepting any blame. He blamed lawyers who get involved “almost immediately” once something goes wrong with a patient’s care.

“Doctors, nurses and midwives worry they could lose their licence if they are found to have made a mistake. Hospital managers worry about the reputation of their organisation,” he added.

Mr Hunt said: “We have appallingly high levels of avoidable harm and death in our healthcare system. We seem to just accept it as inevitable.”

An NHS spokesman said: “Delivering the safest possible health service for patients is a priority, and the national policy on learning from deaths is clear that hospitals must publish this information every three months, as well as an annual summary, so that they are clear about any problems that have been identified and how they are being addressed.

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Source: The Telegraph, 18 September 2020

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Providers ‘missed opportunities’ in outbreak which killed 15

An investigation into the outbreak of a bacterial infection that killed 15 people has found there were several “missed opportunities” in their care.

Mid Essex Clinical Commissioning Group has released the outcome of a 10-month investigation into a Strep A outbreak in 2019, which killed 15 people and affected a further 24. The final report was critical of Provide, a community interest company based in Colchester, as well as the former Mid Essex Hospital Services Trust (now part of Mid and South Essex Foundation Trust).

It said: “This investigation has identified that in some cases there were missed opportunities where treatment should have been more proactive, holistic and timely. These do not definitively indicate that their outcomes would have been different.”

Investigators found that 13 of the 15 people that died had received poor wound care from Provide CIC. They reported that inappropriate wound dressings were used and record keeping was so poor that deterioration of wounds was not recognised.

Even wounds that had not improved over 22 days were not escalated to senior team members for help or referred to the tissue viability service for specialist advice, with investigators told this was often due to concerns over team capacity.

The report, commissioned by the CCG and conducted by consultancy firm Facere Melius, said: “[Some] individuals became increasingly unwell over a period of time in the community, yet their deterioration either went unnoticed or was not acted upon promptly. Sometimes their condition had become so serious that they were very ill before acute medical intervention was sought”.

Other findings included delays in the community in the taking of wound swabs to determine if the wound was infected and by which bacteria. It said in one case nine days elapsed before the requested swab took place. Even after Public Health England asked for all wounds to be swabbed following the initial outbreak, this was only conducted on a single patient.

In other cases there were delays in patients being given antibiotics and this “could have had an adverse impact on the treatment for infection”.

It also found that sepsis guidelines were not accurately followed, wounds were not uncovered for inspection in A&E, and some patients were given penicillin-based antibiotics despite penicillin allergies being listed in their health records.

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Source: HSJ, 17 September 2020

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New funding to help hospitals introduce digital prescribing

More patients and healthcare staff will benefit from single electronic patient records as 7 hospital trusts receive a share of £8.7 million to introduce digital records and e-prescribing, Minister for Patient Safety Nadine Dorries announced today on World Patient Safety Day.

The roll-out has already been introduced to over 130 NHS trusts, and is part of a £78 million investment to deliver the ambition set out in the NHS Long Term Plan to introduce electronic prescribing systems across the NHS.

NHS trusts will now be able to more quickly access potentially lifesaving information on prescribed medicines and patient history, and build a more complete, single electronic patient record, which reduces duplication of information-gathering, saves staff time and can reduce medication errors by up to 30%.

The funding was announced at a virtual conference organised by Imperial College London to mark World Patient Safety Day. 

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Source: Gov.uk, 17 September 2020

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Patient Safety Movement Foundation holds demonstration In Washington, D.C. to unite for safe care

Today, the nonpartisan nonprofit Patient Safety Movement Foundation will lead a demonstration in the nation’s capital to raise awareness for the patient safety crisis that claims more than 200,000 lives annually in the U.S. due to preventable medical harm.

The demonstration begins from Freedom Plaza and participants will walk down Pennsylvania Avenue to the Capitol Lawn, where they will hold a remembrance of loved ones lost needlessly to preventable medical errors. The demonstrators will also demand the creation of a National Patient Safety Board to implement data-driven standards, transparency, accountability, and aligned incentives.

“COVID-19 has exposed the safety gaps in our healthcare system that already cause 200,000 deaths a year,” said Dr. David B. Mayer, CEO of the Patient Safety Movement Foundation. “Many of us also have very personal stories of loss and tragedy related to preventable medical harm. Now is the time for change and improvement as we work toward zero preventable patient deaths by 2030.”

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Source: Patient Safety Movement

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Coronavirus: Trial urges people to call 111 before going to A&E

People requiring A&E will be urged to book an appointment through NHS 111 under a trial in parts of England. The aim is to direct patients to the most clinically-appropriate service and to help reduce pressure on emergency departments as staff battle winter pressures, such as coronavirus and flu.

The pilots are live in Cornwall, Portsmouth, Hampshire and Blackpool and have just begun in Warrington. 

If they are successful, they could be rolled out to all trusts in December. However, people with a life-threatening condition should still call 999.

Under the new changes, patients will still be able to seek help at A&E without an appointment, but officials say they are likely to end up waiting longer than those who have gone through 111.

More NHS 111 call handlers are being brought in to take on the additional workload, alongside extra clinicians, the Department of Health and Social Care said.

A campaign called Help Us Help You will launch later in the year to urge people to use the new service.

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Source: BBC News, 17 September 2020

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Some care home staff in England not using PPE, find health inspectors

Health inspectors have uncovered multiple problems with infection control and the use of personal protective equipment (PPE) in care homes in England ahead of a second spike in COVID-19, which is starting to be detected in care facilities across the country.

The Care Quality Commission (CQC) found homes where PPE was not being worn and that had out-of-date infection prevention policies and were failing to take steps to protect black and minority ethnic residents and staff who have been identified as potentially more vulnerable to the virus.

The checks took place last month in 59 English care homes and were triggered by concerns about safety and quality or complaints by residents, staff and relatives.

The checks precede a government announcement within days of a winter infection control fund that is expected to broadly match the £600m already committed this year. The fund will pay additional staff costs stemming from using fewer highly mobile temporary workers, who have been shown to spread the virus.

However, the CQC inspections found PPE being worn inconsistently by staff members, limited supplies of masks in some places, and a failure to store PPE safely away from infection risk.

“We found examples of infection prevention and control policies that were out of date,” the inspectors said. “Some had been updated early on in the Covid-19 outbreak but had not been amended since and so contained out-of-date information. This posed a risk to the staff and people who live in the care home. Others had not been updated since 2019. One care home had completed a [contingency] plan, but it only covered the hot weather and did not include preparations for autumn and winter.”

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Source: The Guardian, 16 September 2020

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Covid disruption leaves thousands of UK stroke patients disabled

Thousands of stroke patients have suffered avoidable disability because NHS care for them was disrupted during the pandemic, a report claims.

Many people who had just had a stroke found it harder to obtain clot-busting drugs or undergo surgery to remove a blood clot from their brain, both of which need to happen quickly.

Rehabilitation services, which are vital to help reduce the impact of a stroke, also stopped working normally as the NHS focused on Covid, the Stroke Association said. It is concerned “many could lose out on the opportunity to make their best possible recovery”.

Juliet Bouverie, the charity’s chief executive, said: “Strokes didn’t stop because of the pandemic. Despite the tireless efforts of frontline clinicians who have gone to herculean efforts to maintain services under extremely difficult conditions, some treatments still became unavailable and most stroke aftercare ground to a halt. This means more stroke survivors are now living with avoidable, unnecessary disability.”

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Source: The Guardian, 17 September 2020

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“Mass hysterectomies” were carried out on migrants in US detention centre, claims whistleblower

Detainees held in an immigration centre in the US have been subjected to potentially unnecessary hysterectomies performed without informed consent, a nurse whistleblower has alleged.

Dawn Wooten, who filed a whistleblower complaint with the inspector general of the Department of Homeland Security, says she was demoted and her hours slashed after she complained about substandard medical care, questionable surgeries on women, and failure to protect detainees and staff from COVID-19.

A report of the charges1 was filed by four non-profit rights and welfare groups on behalf of the detained immigrants at the Irwin County Detention Center in Georgia, which is operated by the private prison company, LaSalle Corrections.

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Source: BMJ, 16 September 2020

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Government steps towards new A&E targets

Ministers have given the green light for NHS England and Improvement to consult before December on a proposed new basket of metrics to replace the four-hour accident and emergency target.

The Department of Health and Social Care announced the move, a significant step towards ditching the target, while confirming another batch of winter capital funding allocations, and confirming a national “111 first” model.

The announcement does however mean the process of replacing the four-hour target with new A&E standards will move slower than NHSE/I had outlined this summer. It said in July it wanted the new A&E standards in place before winter, a plan also backed by the Royal College of Emergency Medicine as revealed by HSJ.

These moves come amid mounting concern that people unable to get COVID-19 tests are heading to emergency departments; and that some emergency departments are now becoming busy with growing non-covid demand. 

The proposals for the consultation have not yet been finalised. HSJ understands they will consist of work largely drawn up by NHSE’s clinical review of standards group before March but put on hold when the COVID-19 outbreak hit the UK.

Likely choices for the metrics are: time to initial clinical assessment in A&E, time to emergency treatment for critically ill, mean waiting time, and a new 12-hour metric where the clock starts from when the patient arrives at the emergency department rather than at decision to admit as is currently the case.

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Source: HSJ, 17 September 2020

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Trust reports sharp spike in covid patients

An acute hospital in Greater Manchester is now experiencing a spike in coronavirus patients, following weeks of high infection rates in the community. 

Figures released by Bolton Foundation Trust today said it currently has 26 suspected covid patients, including three in critical care. These are the highest numbers reported by the trust since the end of May.For most of July, August and early September, the trust had fewer than five covid patients on its wards at any one time.

The borough of Bolton has reported high infection weeks for several weeks, with the latest figures suggesting 200 infections per 100,000 people, the highest rate in the country.

Dr Francis Andrews, the trust’s medical director, said: “We are seeing more people being admitted with confirmed or suspected covid-19 as a result of the very high rate of infections in Bolton.

“This is not a shift we want to see. The situation at the hospital is under control and we were well prepared for this. However, the rate continuing to rise is of concern, and we continue to urge the people of Bolton to consider others when making decisions that could jeopardise their safety."

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Source: HSJ, 15 September 2020

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