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Bullying, bad behaviour and broken IT uncovered at worst trusts for junior doctors

Regulators have uncovered multiple examples of patients being put at risk when junior doctors are left with tasks they are not trained for, lacking support, and facing bullying and inappropriate behaviour.

Inspection teams have had to intervene – in some cases contacting senior trust staff – to ensure urgent issues are addressed, after the inspections.

Health Education England oversees training nationally, which includes making the checks at trusts which have been put under “enhanced monitoring” by the professional regulator, the General Medical Council, because of concerns from trainees.

HSJ has obtained and examined 20 reports, all produced since the beginning of 2019. Themes running through the reports included:

  • Lack of support from consultants.
  • Trainees struggled to contact consultants out of hours. 
  • Bullying and inappropriate behaviour was reported at several trusts. 
  • Inspectors found a reluctance to report concerns and/or a lack of knowledge of how to do it. 
  • Teaching was often of poor quality or cancelled – and sometimes trainees struggled to attend sessions because of how their shifts and rotations were scheduled.
  • Trainees in several trusts reported IT problems, such as being locked out of systems so being unable to access clinical notes and blood tests, and IT systems taking up to 30 minutes to start up, sometimes delaying patient care. 

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Source: HSJ, 29 June 2020

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Coronavirus: Survivors 'at risk of PTSD'

People who were seriously ill in hospital with coronavirus need to be urgently screened for post-traumatic stress disorder (PTSD), leading doctors say.

The Covid Trauma Response Working Group, led by University College London and involving experts from south-east England, said those who had been in intensive care were most at risk.

The experts said regular check ups should last at least a year.

More than 100,000 people have been treated in hospital for the virus. The experts say tens of thousands of these would have been seriously ill enough to be at risk of PTSD.

The working group highlighted research which showed 30% of patients who had suffered severe illnesses in infectious disease outbreaks in the past had gone on to develop PTSD, while depression and anxiety problems were also common.

Tracy is just one of many people who has been left with psychological scars from her coronavirus experience. She was admitted to Whittington Hospital in north London in March and spent more than three weeks there - one of which was in intensive care.

"It was like being in hell. I saw people dying, people with the life being sucked from them. The staff all have masks on and all you saw was eyes - it was so lonely and frightening."

Since being discharged in April the 59-year-old has been struggling to sleep because of the thought she will die and she has constantly suffered flashbacks. She is now receiving counselling.

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Source: BBC News, 29 June 2020

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COVID-19 may cause brain complications in some, say doctors

Brain complications, including stroke and psychosis, have been linked to COVID-19 in a study that raises concerns about the potentially extensive impact of the disease in some patients.

The study, published in Lancet Psychiatry, is small and based on doctors’ observations, so cannot provide a clear overall picture about the rate of such complications. However, medical experts say the findings highlight the need to investigate the possible effects of COVID-19 in the brain and studies to explore potential treatments.

“There have been growing reports of an association between COVID-19 infection and possible neurological or psychiatric complications, but until now these have typically been limited to studies of 10 patients or fewer,” said Benedict Michael, the lead author of the study, from the University of Liverpool. “Ours is the first nationwide study of neurological complications associated with Covid-19, but it is important to note that it is focused on cases that are severe enough to require hospitalisation.”

Scientists said the findings were an important snapshot of potential complications, but should be treated with caution as it is not possible to draw any conclusions from the data about the prevalence of such complications.

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Source: The Guardian, 26 June 2020

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Region used ‘clinically unsafe’ healthcare app for three years

A healthcare app which was investigated over failing to meet clinical and governance standards has been dropped by north London commissioners after it was deemed “clinically unsafe”.

The Health Help Now app, currently used in eight north London boroughs, will be scrapped by the end of June and patients will be directed to the NHS app.

In a statement, the North West London Collaboration of Clinical Commissioning Groups said it decided to carry out a review of the app as it had low uptake and dwindling funds, despite reporting in 2017 that it was being used by 500,000 patients. 

During the reivew, stakeholders told commissioners that a lack of clinical oversight meant the app was “unsafe” and financial constraints meant it was unsustainable.

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Source: HSJ, 26 June 2020

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'Unacceptable' drop in care at Kettering home with 12 COVID-19 deaths

A dramatic collapse in standards at a care home where a dozen people died from COVID-19 has been revealed by inspectors who discovered hungry and thirsty residents living with infected wounds in filthy conditions.

Infection control was inadequate, residents with dementia were left only partially dressed and one family complained of finding their loved one smeared in dried faeces at Temple Court care home in Kettering, which is operated by Amicura, a branch of Minster Care which runs more than 70 homes in the UK.

Amicura said the home had been “completely overwhelmed” by COVID-19 infections which it said arrived with 15 patients discharged from hospitals in the second half of March.

They were overrun,” one relative told the inspectors. “They were short-staffed and then with the influx of people, they couldn’t cope.”

Residents’ wounds had become necrotic and infected, requiring hospital treatment and several people had experienced falls, some of which resulted in injuries needing hospital treatment, the inspectors found.

The conditions discovered by the Care Quality Commission on 12-13 May were so poor that surviving residents were moved out immediately. The CQC report into the service, published on Friday, found multiple breaches of the health and social care act. Northamptonshire police have launched an investigation to identify whether any offences may have been committed.

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Source: The Guardian, 26 June 2020

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NHS treatment delays linked to more child deaths than coronavirus

More children died after failing to get timely medical treatment during lockdown than lost their lives because of coronavirus, new research by the Royal College of Paediatrics and Child Health (RCPCH) suggests.

Six children under the age of 16 have died from COVID-19 in Britain since the pandemic began, according to the Office for National Statistics (ONS). 

However, seeking medical help too late was a contributory factor in the deaths of nine children in paediatric care new analysis has found, with the figure likely to be higher.

A survey of 2,433 paediatricians, carried out by the RCPCH, found that one in three handling emergency admissions had dealt with children who turned up later than usual for diagnosis or treatment.

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Source: The Telegraph, 25 June 2020

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NHS test and trace unable to reach almost 30% of people with COVID-19

The government’s contact-tracing programme failed to reach almost 30% of people who tested positive for the coronavirus in England last week, the latest figures show.

Only 70% of the 6,923 people who tested positive for COVID-19 during the period were reached by NHS Test and Trace staff, according to the Department of Health and Social Care.

This means that 2,054 people with the virus – and potentially thousands of their close contacts – could not be traced by the new system.

The fact that one in four people with the virus had not been reached since the launch was “surprising and worrying”, said Keith Neal, emeritus professor of the epidemiology of infectious diseases at the University of Nottingham.

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Source: The Independent, 26 June 2020

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Coronavirus: 70% of BAME pharmacists have had no risk assessment

More than two-thirds of black, Asian and minority ethnic pharmacists have not had workplace risk assessments for coronavirus, a survey suggests.

Of the 380 hospital and community-based pharmacists surveyed by the Royal Pharmaceutical Society and the UK Black Pharmacists Association, 236 were from a BAME background.

Of those, 166 (70%) said they had not been approached by their employer to have a risk assessment.

The RPS called the results "shocking". It has called on employers to take urgent action to ensure ethnic minority pharmacists are risk assessed.

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Source: BBC News, 26 June 2020

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The serious care failings the NHS tried to keep secret

The NHS has kept secret dozens of external reviews of failings in local services – covering possible premature deaths, unnecessary and harmful operations, and rows among doctors putting patients at risk – an HSJ investigation has found.

At least 70 external reviews by medical royal colleges were carried out from 2016 to 2019, across 47 trusts, according to information provided by NHS trusts, but more than 60 of these have never been published – contrary to national guidance – while several have not even been shared with the Care Quality Commission (CQC) and other regulators. These include reviews which uncovered serious failings.

Bill Kirkup’s review into the Morecambe Bay scandal in 2015 recommended trusts should “report openly” all external investigations into clinical services, governance or other aspects of their operations, including notifying the CQC. 

Since then the CQC has asked trusts for details of external reviews when it reviews evidence, and in July 2018 it began to ask for copies of their final reports, but HSJ’s research suggests this does not always happen.

James Titcombe, the patient safety campaigner whose son’s death led to the inquiry by Bill Kirkup into the Morecambe Bay maternity care scandal, said a review was now needed of whether its recommendations had been implemented.

“It is not acceptable that five years [on], there are still secretive royal college reports and patients are kept in the dark,” he said.

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Source: HSJ, 25 June 2020

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Coronavirus: Antibody test lacks 'proper assessment'

COVID-19 antibody tests for NHS and care staff are being rolled out without "adequate assessment", experts warn.

The tests could place an unnecessary burden on the NHS, the 14 senior academics say in a letter in the BMJ,

Last month, the government said it had bought 10 million antibody tests and asked NHS trusts and care homes to make them available to staff in England. Officials say the blood tests - to see if someone has had the virus - will play an "increasingly important role".

The group of scientists say as a positive result is unable to prove immunity, the tests offer "no benefit" to hospitals and care staff. The results do not change what personal protective equipment staff must wear, for example.

The academics also suggest there is little data on how well the test works for people at highest risk - including people belonging to some ethnic minorities and older patients. Instead, they call for other carefully designed strategies to help monitor the spread of the virus.

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Source: BBC News, 25 June 2020

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CQC investigates its own response to concerns over troubled service

The Care Quality Commission (CQC) has launched a review into its own regulatory response to a troubled autism service.

The CQC has asked its head of inspection for child and justice services, Nigel Thompson, to examine its response to concerns that were raised about an autism service in south Staffordshire in 2019.

Concerns were reported directly to the CQC in early 2019, by parents of children under the services, while similar issues were highlighted in a report from the local Healthwatch branch last July.

In a statement, the CQC said: “Following concerns raised with us by families, in relation to The Hayes autism service run by Midlands Psychology, we are looking at the evidence we received about this service and how we assessed this to inform our regulatory response.

“We are looking into these concerns in accordance with our complaints process. As a learning organisation, we welcome all feedback and we have already met with some of the families, but some meetings have been delayed due to the covid-19 pandemic.”

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Source: HSJ, 25 June 2020

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People still avoiding hospital visits

Commenting on the newly-released Office for National Statistics (ONS) data on deaths registered weekly in England and Wales, the Health Foundation’s Chief Executive, Dr Jennifer Dixon, has expressed concerns that people are still avoiding visiting hospitals over fear of catching COVID-19.

Hospital admissions have plummeted in the wake of the coronavirus outbreak as people look to avoid exposure to the virus, but as we begin to emerge out of the other side of the pandemic and begin the restoration of services there has been a need to rebuild that faith in patients.

Dr Dixon said: “Today’s data show that deaths from COVID-19, and overall excess deaths, are decreasing. But while deaths in hospital are now below normal levels, deaths at home – just over 900 excess deaths in the week ending 12 June – remain higher than usual for this time of year.

“As COVID-19 now recedes from hospitals, a key question is whether enough has been done to reassure people of their safety when accessing care, balanced against the risks of not seeking care.”

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Source: National Health Executive, 24 June 2020

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NHS trust was negligent in failing to recognise child’s serious bacterial infection, says High Court

A High Court judge has ruled that an NHS trust was negligent in failing to consider early enough that a toddler with fever, lethargy, and vomiting might have had a serious bacterial infection and to give her intramuscular antibiotics.

Mr Justice Johnson said that doctors from University Hospital Southampton NHS Foundation Trust should have ordered a lumbar puncture on the 15 month old girl on the day she was first seen or the next day.

The girl, referred to in court as SC, was sent by her GP to the hospital by ambulance on 26 January 2006 with a note describing his findings on examination and ending “?meningitis.” The GP, Mark Dennison, had given her intramuscular penicillin.

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Source: BMJ, 22 June 2020

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Cancer charities fear 18,000 extra deaths a year due to test delays

Almost half a million people are waiting at least six weeks for tests which could diagnose cancer – up from just 30,000 before lockdown, new analysis shows.

Ministers have been urged to urgently bring forward plans to tackle the backlog of patients waiting for care, with calls for weekly testing of staff to keep coronavirus infections off the wards.

Cancer charities fear there will be an extra 18,000 deaths a year because those with symptoms are not receiving prompt diagnosis and treatment.

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Source: The Telegraph, 23 June 2020

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Coronavirus: Warning thousands could be left with lung damage

Tens of thousands of people will need to be recalled to hospital after a serious OVID-19 infection to check if they have been left with permanent lung damage, doctors have told the BBC.

Experts are concerned a significant proportion could be left with lung scarring, known as pulmonary fibrosis. The condition is irreversible and symptoms can include severe shortness of breath, coughing and fatigue.

Research into the prevalence of lung damage caused by COVID-19 is still at a very early stage. It's thought those with a mild form of the disease are unlikely to suffer permanent damage. But those in hospital, and particularly those in intensive care or with a severe infection, are more vulnerable to complications.

In a study from China, published in March, 66 of 70 patients still had some level of lung damage after being discharged from hospital.

Radiologists in the UK say, based on the early results of follow-up scans, they are concerned about the long term-effects of a serious infection.

Prof Gisli Jenkins, of the National Institute for Health Research, is running assessment clinics for those discharged from hospital with COVID-19. He said: "My real concern is that never before in our lifetime have so many people been subject to the same lung injury at the same time."

NHS England has said it is planning to open a number of specialist COVID-19 rehabilitation centres to help patients recover from long-term effects, including possible lung damage.

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Source: BBC News, 24 June 2020

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Private provider’s contract suspended pending safety review

An independent provider’s NHS contract has been suspended, and a harm review is to be carried out on patients who have faced a long wait.

Kent and Medway Clinical Commissioning Group suspended DMC Healthcare’s contract to provide dermatology services in north Kent “to ensure patient safety” on Friday. It said it had showing some patients had been on waiting lists longer than they should have been.

It is unable to say how many patients are likely to be involved in the harm review, but it is expected to focus on those who have waited longer than they should or where harm is suspected.

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Source: HSJ, 24 June 2020

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Coronavirus: UK must prepare for second virus wave says health leaders

Health leaders are calling for an urgent review to determine whether the UK is properly prepared for the "real risk" of a second wave of coronavirus.

In an open letter published in the BMJ, ministers were warned that urgent action would be needed to prevent further loss of life.  The presidents of the Royal Colleges of Surgeons, Nursing, Physicians, and GPs all signed the letter.

It comes after Boris Johnson announced sweeping changes to England's lockdown.

Following the prime minister's announcement, health leaders called for a "rapid and forward-looking assessment" of how prepared the UK would be for a new outbreak of the virus.

"While the future shape of the pandemic in the UK is hard to predict, the available evidence indicates that local flare-ups are increasingly likely and a second wave a real risk," they wrote in the letter.

"Many elements of the infrastructure needed to contain the virus are beginning to be put in place, but substantial challenges remain."

The authors of the letter, also signed by the chair of the British Medical Association, urged ministers to set up a cross-party group with a "constructive, non-partisan, four nations approach", tasked with developing practical recommendations.

"The review should not be about looking back or attributing blame," they said, and instead should focus on "areas of weakness where action is needed urgently to prevent further loss of life and restore the economy as fully and as quickly as possible".

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Source: BBC News, 24 June 2020

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PHSO to restart their work on NHS complaints

NHS England and Improvement have announced changes to the NHS’s complaints process during the coronavirus emergency.

Individual NHS organisations are being told to ensure complaints are still taken, and monitored for patient safety issues. However, NHS organisations have been given latitude over whether they launch full investigation processes in the short term, and being advised to ‘manage expectations’ about investigations being launched. Complaints that are logged will remain open until further notice.

The advice to NHS providers also says that where patients have been waiting over six months for a resolution to their complaint, consideration should be given now to making an effort to see if the complaint can be resolved.

NHS England and Improvement have announced that they will be advising NHS bodies to end their 'pause' in complaints handling from 1 July onwards. 

Similarly, the Parliamentary and Health Service Ombudsman (PHSO) reduced its complaints-handling activity during the emergency period. It is not accepting new complaints, and its helpline is temporarily closed. PHSO has announced that it will recommence work on existing complaints, and begin accepting new ones from 1 July.

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Source: The Patients Association, 15 June 2020 

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Governments and corporations need to guarantee safety of COVID-19 whistleblowers

Over 90 civil society groups and individual signatories are calling on all public authorities and private sector organisations to protect those who expose harms, abuses and serious wrongdoing during the COVID-19 crisis.

Since the beginning of the COVID-19 emergency, worrying reports concerning hospitals and public authorities retaliating against healthcare professionals for speaking out about the realities of COVID-19 have emerged worldwide, from China to the United States.

Transparency International urges decision-makers at the highest level to resist the temptation to control the flow of information and instead offer assurances to individuals who witness corruption and wrongdoing to blow the whistle.

Marie Terracol, Whistleblowing Programme Coordinator at Transparency International said: “The need for transparency and integrity, heightened in this time of crisis where abuses can cost lives, illustrates the essential role of those who speak up in the public interest."

“National governments, public institutions and companies should listen to workers and citizens who come forward and report abuses they witness and protect them from retaliation, including in countries which still do not offer robust legal whistleblower protection. If people feel they can safely make a difference by speaking up, more instances of abuses will be prevented and addressed, and lives might be saved.”

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Source: Transparency International. 22 April 2020

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New tool could be used to identify those most at risk from coronavirus

A new risk tool could be used to identify those most at threat from COVID-19, so GPs can give patients tailored advice, health officials have said. 

Scientists at Oxford University are working on a clinical risk prediction model, which aims to give individuals more precise information about the likely impact of the disease on them, instead of a blanket approach. 

Health officials said the plans aimed to allow “very individualised discussions” between patients and their doctors, in the event of future outbreaks, particularly as winter approaches. 

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Source: The Telegraph, 23 June 2020

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Health official defends discharging patients into English care homes

Discharging patients into care homes in England in early April, when the number of coronavirus cases was rapidly increasing, was neither reckless nor wrong, the Department of Health and Social Care’s (DHSC) most senior civil servant has claimed.

Faced with aggressive questioning from MPs on the powerful public accounts committee on Monday, Sir Chris Wormald, permanent secretary at the DHSC, said the guidance for discharge was correct based on the information available at the time.

Conservative MP Sir Geoffrey Clifton-Brown said to Wormald: “You were discharging them from hospital into care homes when care homes were already in dire trouble, some of the most vulnerable people in society, the testing wasn’t available, PPE [personal protective equipment] wasn’t available, the training wasn’t available. Wasn’t this a pretty reckless policy by the government?”

Wormald replied: “We don’t believe that. Now, as Prof [Stephen] Powis [national medical director of NHS England] described, at this point Covid was not considered to be widespread in the community.”

A clearly frustrated Clifton-Brown interrupted him saying there were already 1,000 care homes with coronavirus cases at the beginning of April. He also questioned why detailed advice in relation to coronavirus for the social care sector had not been issued until 15 April, almost a month after the equivalent information was provided to the NHS.

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Source: The Guardian, 23 June 2020

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Shielding to stop at end of July in England

The 2.2 million people who have been self-isolating in England during the pandemic will no longer need to shield from 1 August.

From 6 July, they will be able to meet up outdoors, in a group, with up to five others and form 'support bubbles' with other households.

The measures can be eased because infection rates are falling, the government says.

Among the list of people who should be shielding are solid organ transplant recipients, cancer patients undergoing chemotherapy, pregnant women with heart disease and people with severe respiratory conditions such as cystic fibrosis and severe asthma.

The government says it has worked with clinicians, GPs, charities, the voluntary sector and patient groups on the changes, but some charities are criticising the relaxing of the advice, saying many of the people they support do not feel it is safe to stop shielding.

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Source: BBC News, 23 June 2020

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Doctors warn ‘culture of fear’ in NHS could prevent whistleblowing

Doctors have warned that a “culture of fear” in the NHS may prevent life-saving lessons being learned about COVID-19 after a leading hospital consultant emailed scores of staff saying those responsible for “leaks” would be found and fired.

Dr Daniel Martin OBE, head of intensive care for serious infectious diseases at the Royal Free hospital, emailed a report to colleagues at the peak of the pandemic with a note claiming that the trust would “track any leaks to the media” and then “offer you the chance to post your P45 on Facebook for all to see.”

The email, which described journalists at one respected newspaper as “parasites”, was sent to dozens of nurses and junior doctors. It has been examined by Liberty Investigates, the investigative journalism unit of the civil rights group Liberty, and the Guardian, after being shared by a recipient who said they found the language “intimidating”.

 Whistleblowers UK, the non-profit group, said it had been made aware of the email by a separate individual who was also concerned about its contents.

The Royal Free London trust said the email was “badly worded” and did not reflect trust policy. However, the trust said it was an open and transparent organisation that “does everything it can to encourage our staff to raise concerns and, if necessary, whistleblow”.

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Source: The Guardian, 22 June 2020

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10 million on NHS waiting lists by Christmas

Leading clinicians have written to Boris Johnson warning the UK faces a "second health catastrophe" because so many non-Covid patients are missing out on treatment as a result of the pandemic.

The letter warns that “lives are being put at risk” and that action is needed immediately. It comes as new figures show as many as one in six (10 million) people will be on the NHS waiting list by the end of the year.

The letter, signed by ten specialists, including cancer doctors, patient safety experts, CQCs and medical negligence lawyers, states: “We are increasingly concerned about the impact, including avoidable harm and death caused by the continuing unavailability of urgent diagnostics and treatment for thousands of non-COVID patients. 

“The backlog of such cases is now significant and worsening. We implore the central and devolved Governments of the UK to take urgent strategic action, including in co-ordination and co-operation with each other, to prevent this becoming a second and perhaps even more serious health catastrophe arising from the pandemic in the UK.”

The letter was also signed by barrister Theo Huckle QC, Professor John Fairclough of Swansea and Cardiff Met Universities, Nick Brown of Doughty Street Chambers and Helen Hughes, Chief Executive, Patient Safety Learning.

Cases which have come to the attention of the signatories include Sherwin Hall, 27, a father of one from Leeds, who made 13 visits to hospital during the COVID-19 lockdown before getting a cancer diagnosis for the pain in his groin.

He said of his case: “I am very angry at the way I have been treated due to COVID-19 and the delay on my cancer treatment and now I am fighting for my life.

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Source: Express, 21 June 2020

 

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‘White leaders under pressure’ to prove black lives matter

Incoming Health Education England chief executive Navina Evans said the momentum created by the death of George Floyd and the Black Lives Matter movement meant there was now increased “pressure on white leaders” to act on racism and discrimination in the service.

Dr Evans praised a letter written by Birmingham and Solihull Mental Health Foundation Trust chief executive Roisin Fallon-Williams, in which she admitted to being “culpable” and “complicit” in failing to fully understand the inequality and discrimination faced by people with black, Asian or other minority ethnic backgrounds.

“That was great to see, and as you can see from the reactions to her letter people were really, really pleased to have it acknowledged,” she said.

However, Dr Evans added: “As well as that [acknowledgement] there needs to be action”.

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Source: HSJ, 22 June 2020

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