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New patient safety research by Northumbria University achieves global accolades

Looking to improve practice through learning

Errors, mishaps and misunderstandings are surprisingly common in medicine and around one in 10 patients suffer avoidable harm, impacting on patients, their families, health care organisations, staff and students. However a research project seeking to improve patient safety across Europe, led by Newcastle-based Northumbria University, has received international acclaim as it looks to improve practice through learning.

The SLIPPS (Shared Learning from Practice to improve Patient Safety) project is Co-funded by the Erasmus+ Programme of the European Union, and is led by Professor Alison Steven, a Reader in Health Professions Education at Northumbria University.  Professor Steven has a longstanding interest in the use of education to raise standards of care and ensure patient safety. Considering the rapid spread of Covid 19, she says improving patient safety and standards of care across Europe and beyond, has never been more important.

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How to support loved ones in hospital during the coronavirus pandemic

To help stop the spread of the coronavirus that causes COVID-19, the majority of hospitals have stopped or severely restricted visits. This article explains how you can still help a loved one even when you can't see them face to face.

During the coronavirus crisis, most hospitals and care homes in the UK have stopped visits. If you have a loved one in a healthcare setting, not being able to go to see them will be incredibly difficult. But these temporary measures have not been taken lightly. Restricting visits to hospitals and care homes is important to reduce the spread of the virus that causes COVID-19 as much as possible. This way hospital and care home residents, and healthcare staff, can be better protected during the pandemic.

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Covid-19: Government failed to protect staff during height of pandemic, experts tell MPs

Healthcare staff working at the height of the covid-19 pandemic in England were not properly protected and were forced to work in an unsafe environment, MPs have been told.

Appealing before the health and social care committee on 21 July, experts criticised the government and NHS management for their failure to provide staff with sufficient testing and personal protective equipment (PPE). The committee was gathering evidence for its inquiry into the management of the COVID-19 outbreak.

Paul Nurse, director of the Francis Crick Institute, said he believed that the failure to implement better testing systems in the early days of the pandemic had contributed significantly to the problems.

He said, “At the height of the pandemic, our own research—which backs up what’s been done elsewhere—found that up to 45% of healthcare workers were infected and they were infecting their colleagues and infecting patients, yet they weren’t being tested systematically.

“In the healthcare environment we weren’t providing proper protection, and it’s important because it protects the most vulnerable in our society and it protects our healthcare workers. They deserve to work in a safe environment, and some of them are dying because of what they do. They deserve better.”

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Source: BMJ, 22 July 2020

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A third of GP practices may take year or longer to return to pre-Covid capacity

A third of GPs believe it will take up to a year or longer for their practice to return to pre-Covid levels of capacity, even with ‘no future spikes’ of the virus.

The data comes from the BMA’s latest COVID-19 tracker survey, which polled almost 2,000 GPs in England and Wales.

GPs have previously warned that they are battling a backlog of referrals and patients who have been ‘overlooked’ during the coronavirus crisis.

Around 26% of the 1,770 GP respondents said consultations would take between three and 12 months to return to normal when asked how quickly their practice will ‘return to full pre-Covid levels of capacity... assuming there are no future Covid spikes’.

And a further 7% of GPs believed it could take ‘longer’ than a year or that consultations would ‘never’ return to pre-Covid levels.

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Source: Pulse, 23 July 2020

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Regulator launches independent review into care of vulnerable man

NHS England and Improvement have launched an independent review into the care and death of a man with learning disabilities, following concerns raised by HSJ. 

The regulator has appointed Beverley Dawkins to carry out an independent review of the case of Clive Treacy, as part of the learning disability mortality review programme.

Clive, who died in 2017, had previously been denied a review under LeDer and, according to emails seen by HSJ, his death was never officially recorded by the programme, which is meant to record all deaths of people with a learning disability.

NHS England and Improvement overturned the decision earlier this year after HSJ presented evidence of a series of failures in his care between 2012 and 2017.

Today, it was confirmed to us that Ms Dawkins has been commissioned to carry out the review, and that it would review his care throughout his life, as well as his death.  

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Source: HSJ, 23 July 2020

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Mental health leave for paramedics in England nearly triples since 2011

The number of paramedics taking time off with mental health conditions has almost tripled over the last decade, a Guardian analysis has found.

In 2019, paramedics took 52,040 days off due to anxiety, stress, depression and other psychiatric illnesses, up from 18,184 in 2011 – an increase of 186%.

While the overall number of paramedics has increased slightly over the period, the rate of mental health leave has increased more, resulting in the average number of days taken off per paramedic in a year rising from 2.8 to 5.8.

Unison’s head of health, Sara Gorton, said: “Crisis-level staffing has increasingly become the norm within the NHS in recent years, even before the pandemic. Working long hours without breaks, in demanding conditions, it’s no wonder it’s taken a toll on the mental health of workers across the health service. And the coronavirus challenges have piled on more pressure.”

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Source: The Guardian, 23 July 2020

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All patients' Covid test results to become visible to GPs

GP systems will now be updated in 'near-real time' to reveal the result of Covid-19 tests taken by all of their patients.

GPs will not need to act on the information, which will be visible on systems whether the patient tested positive or negative. This will apply to all patients where it has been possible to identify the patient's NHS number, NHS Digital said.

EMIS Health chief medical officer Shaun O’Hanlon said: "Technology has played a pivotal role in the response to COVID-19 across the board and keeping the medical record up to date with COVID-19 test results means everyone who can share that record has a full picture of the patient’s health, including the patient themselves via Patient Access."

"This will not only help day to day patient care, and it will also help on a wider population health level, as data-led insight relies on full and complete medical records as analysts continue to research COVID-19 and its short- and long-term impact on the nation."

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Source: Pulse, 20 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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Four in ten anaesthetists fear for safety of their hospitals, poll finds

More than 4 in 10 anaesthetists are not convinced their hospitals would be able to provide safe services should there be a second wave of COVID-19, a new survey has indicated.

A survey of members of the Royal College of Anaesthetists (RCOA) showed 44% of respondents were not confident their hospitals would be able to provide safe covid and non-covid services should there be a second surge of infections.

The survey also showed levels of mental distress and morale were worsening among anaesthetists – many of whom were drafted into intensive care units during the first wave. Almost two-thirds of respondents (64%) said they had suffered mental distress in the last month due to the pressures faced during the COVID-19 pandemic.

Now the college is calling on the NHS to plan intensively for a second covid wave and to identify, train and maintain the skills of cross-specialty “reservists” – including current clinicians, recent retirees and senior trainees — who can support the health service in the event of future surges. 

One anaesthetist told the RCOA they were “exhausted with constantly having to think about covid and protecting yourself” and “struggling with the realisation that PPE is here to stay for some time.” Another said: “We have burned out our human resource. We need a period of rebuilding or patient harm will result.”

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Source: HSJ, 22 July 2020

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Coronavirus: NHS nurses told 'lives would be made hell'

Hospital nurses were told their "lives would be made hell" if they complained over conditions on a coronavirus ward, a union has claimed.

Unison has raised a group grievance for 36 employees, most of them nurses, at Nottingham University Hospitals Trust. It said staff on the Queen's Medical Centre ward were not trained properly, faced bullying for raising concerns and denied PPE "as punishment".

The trust said the allegations were "very troubling".

The union said the staff, which included nurses, senior nurses and healthcare assistants, volunteered to work on the hospital's only ward dealing with end-of-life coronavirus patients. It claimed they were not given any specialist training or counselling for dealing with dying patients and their grieving relatives.

An anonymous member of staff described it as "incredibly stressful".

Another worker said a board with everyone's record of sickness was put on display in a break room to intimidate staff.

Dave Ratchford from Unison said: "This is absolutely shocking stuff. We're talking about a very high-performing team who fell foul of a culture that permits bullying and fails to address it"

"Staff were told their lives would be made hell for complaining."

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Source: BBC News, 21 July 2020

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Shrewsbury maternity scandal: Hospital bosses ‘softened’ damning safety report

Hospital bosses at scandal-hit Shrewsbury and Telford Hospital Trust were more concerned with reputation management than addressing patient safety concerns in its maternity department, according to a new NHS investigation.

Families harmed by poor care at the trust have called for chairman Ben Reid to resign after the report by NHS England revealed how senior figures in the trust, including the former chief executive, tried to soften a report into maternity services that raised serious concerns over safety.

The Royal College of Obstetricians and Gynaecologists (RCOG) report was not published until after the college had agreed to an “unprecedented” addendum report 12 months after its inspection in 2017, that presented the trust in a more positive light.

When the final report was made public in July 2018 the addendum was placed at the front of the report.

The original RCOG report warned: “Neonatal and perinatal mortality rates will not improve until areas of poor / substandard care are addressed.”

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Source: The Independent, 22 July 2020

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Global accolades for patient safety research

Research into patient safety across Europe, led by Northumbria University, has received international acclaim.

The SLIPPS (Shared Learning from Practice to improve Patient Safety) project is a major EU-funded project led by Professor Alison Steven, a Reader in Health Professions Education at Northumbria University. It seeks to improve European patient safety and education across a range of clinical settings.

Errors, mishaps and misunderstandings are common and around one in 10 patients suffer avoidable harm. These incidents impact upon patients, their families, health care organisations, staff and students. SLIPPS is responding to the challenge to improve patient safety education.

Professor Steven has a longstanding interest in the use of education to raise standards of care and ensure patient safety. Considering the rapid spread of COVID-19, she says improving patient safety and standards of care across Europe and beyond, has never been more important.

“Patient safety is paramount in these extreme circumstances,” said Professor Steven. “The SLIPPS project is unique in that it taps into students’ experiences. These students on practice placements have the potential to offer fresh perspectives on clinical practices, and with so many final-year students treating patients on the front line during this global pandemic, their current views on patient safety are more important than ever.”

The project utilises real-life experiences and students’ reflections on them as the basis for a range of educational resources which feed into an open access virtual learning centre for international, multi-professional learning about patient safety.

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Source: Northumbria University Newcastle, 20 July 2020

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Hundreds more potentially avoidable baby deaths found at Shropshire NHS trust

Hundreds more cases of potentially avoidable baby deaths, stillbirths and brain damage have emerged at an NHS trust, raising concerns about a possible cover-up of the true extent of one the biggest scandals in the health service’s history.

The additional 496 cases raise further serious concerns about maternity care at Shrewsbury and Telford hospital NHS trust since 2000.

The cases involving stillbirths, neonatal deaths or baby brain damage, as well as a small number of maternal deaths, have been passed to an independent maternity review, led by the midwifery expert Donna Ockenden. They bring the total number of cases being examined to 1,862.

They will also be passed to West Mercia police, which last month launched a criminal investigation into the trust’s maternity services. Detectives are trying to establish whether there is enough evidence to bring charges of corporate manslaughter against the trust or individual manslaughter charges against staff involved.

The extra 496 cases had not emerged until now because an “open book” initiative led by the NHS in 2018 asked only for digital records of cases identified as a cause for serious concerns. The vast majority of the 496 further cases were recorded only in paper documents.

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Source: The Guardian, 21 July 2020

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Kent and Medway: Dermatology patients 'exposed to risk of harm'

A private company carrying out dermatology services has had its contract suspended by the NHS over concerns about patients safety.

DMC Healthcare ran the service which oversaw the care of almost 2,000 patients in north Kent and Medway for more than a year. NHS bosses says those patients may have been harmed and the contract was suspended in June.

A helpline has been set up to ensure affected patients are seen by GPs and follow-up treatment can be arranged.

Paula Wilkins, Chief Nurse at Kent and Medway Clinical Commissioning Group, said: "In mid-June we suspended most of DMC's dermatology service when we became concerned about patient safety."

"I'm very sorry to say, we now know there have been delays in appointments, including for the diagnosis and treatment of cancers, and that has exposed people to the risk of harm."

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Source: BBC News, 21 July 2020

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‘Almost half of healthcare workers had covid-19’ at some hospitals

Almost half of healthcare workers at some hospitals were infected with COVID-19 during the height of the first wave, the director of a biomedical research centre has told MPs.

Sir Paul Nurse, director of the Francis Crick Institute, told MPs today that COVID-19 had infected up to 45% of healthcare workers during ”the height of the pandemic” at some hospitals, according to the centre’s research.

Chief medical officer Chris Whitty also told the Health and Social Care Committee that there was more evidence that COVID-19 was transmitted between staff, rather than from patients to staff, and there was “just as much risk as people being in their break rooms than on wards”.

Sir Paul told MPs the Francis Crick Institute contacted Downing Street in March and wrote to health secretary Matt Hancock in April to emphasise the importance of regular systematic testing for all healthcare workers as it was “quite clear” that those without symptoms were likely to be transmitting the disease.

He said hospital staff “were infecting their colleagues, they were infecting their patients, yet they were not being tested systematically.”

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Source: HSJ, 21 July 2020

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COVID-19: Shielding doctors express concerns about returning to work

Doctors who have been shielding during the covid-19 pandemic have said they are worried for their safety when they return to work.

From 1 August those who are at high risk of serious illness if they contract covid-19 will no longer be advised to shield in England, Scotland, and Northern Ireland.123 But doctors who have been shielding during the pandemic have expressed concerns about their safety when they return to work, and say they feel forgotten by their employers.

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Source: BMJ, 21 July 2020

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Coronavirus may cause 3,500 deaths in England from four main cancers

About 3,500 people in England may die within the next five years of one of the four main cancers – breast, lung, oesophageal or bowel – as a result of delays in being diagnosed because of COVID-19, say the researchers in the Lancet Oncology journal.

“Our findings demonstrate the impact of the national Covid-19 response, which may cut short the lives of thousands of people with cancer in England over the next five years,” said Dr Ajay Aggarwal from the London School of Hygiene & Tropical Medicine, who led the research.

Routine cancer screening was suspended during the lockdown, the authors said. So was the routine referral to hospital outpatient departments of people with symptoms that could be something else but also might possibly be cancer. Only those deemed to need emergency care by the GP or those who go to A&E are being picked up. Inevitably, those are people with more advanced cancers. If cancer is picked up at an earlier stage, successful treatment and survival are much more likely.

“Whilst currently attention is being focused on diagnostic pathways where cancer is suspected, the issue is that a significant number of cancers are diagnosed in patients awaiting investigation for symptoms not considered related to be cancer. Therefore we need a whole system approach to avoid the predicted excess deaths,” said Aggarwal.

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Source: The Guardian, 20 July 2020

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Unit put into special measures after ‘inadequate’ rating

A low secure unit for people with learning disabilities and autism has been put into special measures after inspectors found the use of restraint and segregation affected the quality of life for some patients.

Cedar House, in Barham near Canterbury, houses up to 39 people and had been rated “good” by the Care Quality Commission early last year.

But at an inspection in February this year inspectors rated the service – run by the Huntercombe Group — “inadequate,” saying it was not able to meet the needs of many of the patients at the unit. It was issued with three requirement notices.

One patient had been subject to prolonged restraint 65 times between September and February. Each time he was restrained by between two and 19 staff, for an average of nearly two hours. On one occasion, this restraint lasted for eight hours.

But the inspectors were told that in the six months before the inspection 29 staff had been injured during these restraints, and the hospital had been trying to refer the patients to a more secure environment.

“The impact of this inappropriately placed patient was considerable for both the patients and the hospital,” the report said. “The staff who were regularly involved in restraining the patient were tired and concerned about the welfare and dignity of the patient.”

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Source: HSJ, 21 July 2020

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Coronavirus vaccine: Oxford trial is ‘safe’ and produces immune reaction, first study results show

The coronavirus vaccine candidate being developed by AstraZeneca and Oxford University induces a strong immune response and appears to be safe, according to preliminary trial results.

The early stage trial, which involved 1,077 people, has found that the vaccine trains the immune system to produce antibodies and white blood cells capable of fighting the virus. It also causes few side effects.

Professor Sarah Gilbert, co-author of the Oxford University study, described the findings as promising but said there “is still much work to be done before we can confirm if our vaccine will help manage the Covid-19 pandemic”.

The results came as the UK secured 90 million doses of other promising Covid-19 vaccines, while clinical trials of a new inhaled coronavirus treatment showed it significantly reduced the number of hospitalised patients needing intensive care.

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Source: The Independent, 21 July 2020

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Have your say in shaping the future of NHS complaint handling

The Parliament and Health Service Ombudsman (PHSO) been working with the NHS and other public service organisations, members of the public and advocacy groups to develop a shared vision for NHS complaint handling. We've called this the Complaint Standards Framework. 

Now they want to hear from you.

Have your say in shaping the future of NHS complaint handling by taking part in their survey. 

Read the Complaint Standards Framework: Summary of core expectations for NHS organisations and staff

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NHS staff to receive ‘air accident’ safety training to reduce patient harm

Frontline NHS staff will be given specialist ‘air accident investigation’ style training to help improve the way the health service learns from patient safety incidents.

Cranfield University, which has been training air, maritime and rail safety investigators for more than 40 years, is to launch the first intensive course for NHS staff responsible for investigating safety incidents in hospitals.

It is part of a growing effort to install a safety science approach to avoidable harm in the NHS, with the service increasingly looking to other industries to adopt new approaches based on the science of human factors and just culture.

Traditionally the NHS has focused on simpler investigations that too often miss systemic causes of mistakes and instead target individual nurses and doctors for blame.

The new one week intensive course, run in partnership with the charity Baby Lifeline, will start in January and will give students a basic grounding in the science of investigation and using real-life actors and a maternity based scenario, show participants how to get to the real causes of what went wrong.

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Source: The Independent, 20 July 2020

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African American children three times more likely to die after surgery than white peers

African American children are three times more likely than their white peers to die after surgery despite arriving at hospitals without serious underlying conditions, the latest evidence of unequal outcomes in health care, according to a study published in the journal Pediatrics,

“We know that traditionally, African Americans have poorer health outcomes across every age strata you can look at,” said Olubukola Nafiu, the lead researcher and an anaesthesiologist at Nationwide Children’s Hospital in Columbus, Ohio. “One of the explanations that’s usually given for that, among many, is that African American patients tend to have higher comorbidities. They tend to be sicker.”

But his research challenges that explanation, he said, by finding a racial disparity even among otherwise healthy children who came to hospitals for mostly elective surgeries.

Out of 172,549 children, 36 died within a month of their operation. But of those children, nearly half were black – even though African Americans made up 11% of the patients overall. Black children had a 0.07% chance of dying after surgery, compared with 0.02% for white children.

Postoperative complications and serious adverse events were also more likely among the black patients and they were more likely to require a blood transfusion, experience sepsis, have an unplanned second operation or be unexpectedly intubated.

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Source: The Independent, 20 July 2020

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Inspectors were so concerned about what they saw at an Oldham GP practice, they immediately banned it from operating for four months

A GP practice serving one of Greater Manchester’s most deprived communities has been banned from operating for four months after regulators uncovered a catalogue of basic failures - including failing to follow up on a child reporting breathing difficulties for three days.

Jarvis Medical Practice in Glodwick has had its registration with the Care Quality Commission (CQC) suspended after ‘serious concerns’ passed to the body led to a snap inspection last month.

Inspectors found the practice, based at Glodwick Primary Care Centre, was failing 20 separate standards, many of them relating to patient safety.

It noted ‘poor quality’ and conflicting records that were sometimes impossible to properly understand and urgent home visits delayed or not carried out at all.

In one case a patient with a lump apparently received no physical examination and was not referred for tests or scans ‘due to Covid-19’.

Inspectors also found examples of patients with breathing difficulties, including a child, who were not dealt with for days after they got in touch. In one case no further contact was made for 11 working days, with no explanation provided in the patient's notes.

The practice, which serves more than 5,000 patients in the Oldham neighbourhood of Glodwick, has now been suspended by the CQC until October 11.

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Source: Manchester Evening News, 17 July 2020

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Babies dying from treatable infections because of avoidable NHS errors, warns safety watchdog

Babies are at risk of dying from common treatable infections because NHS staff on maternity wards are not following national guidance and are short-staffed and overworked, an investigation has revealed.

The Healthcare Safety Investigation Branch (HSIB), a national safety watchdog, has warned that NHS staff on maternity wards face sometimes conflicting advice on treating women who are positive for a group B streptococcus (GBS) infection.

They are also making errors in women’s care because of the pressure of work and a lack of staff, with antibiotics not being administered when they should be.

HSIB’s specialist investigators examined 39 safety incidents in which GSB had been identified, and found that the infection had contributed to six baby deaths, six stillbirths and three cases of babies being left with severe brain damage.

In its report, the watchdog warned that the problems on maternity wards meant that even in cases where mothers were known to be positive for GBS infection, this wasn’t shared with the mother or noted in the record, resulting in the standard care and antibiotics not being provided.

It added: “The identification and escalation of care for babies who show signs of GBS infection after birth was missed. This has resulted in severe brain injury and death for some of the affected babies.”

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Source: The Independent, 19 July 2020

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Dentists warn of looming dental and mouth cancer crisis after months of lockdown measures

Dentists are warning of a looming dental and mouth cancer crisis after months of delays and patients being unable to get check-ups and repair work.

It comes as surgeries begin to reopen more widely but dentists are still facing significant restrictions on how they can operate, with rooms having to be vacated for an hour after any treatment is done using a drill.

For Maezama Malik, who is the principal dentist of her surgery in Croydon, south London, this has caused a big backlog of patients.

She said the biggest worry is that a patient might have "something minor that could progress in a few months" without them seeing a dentist.

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Source: Sky News, 18 July 2020

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