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All NHS hospitals could get tougher guidelines on using ventilators after deaths of THREE Covid patients who were given wrong equipment at make-shift Nightingale in London

After three Covid-19 patients died at the make-shift Nightingale Hospital in London following a breathing tube mix-up, NHS trusts in England could be issued tougher ventilation guidance. In each of the cases, filters which prevent the build-up of fluid were not attached to the machines, resulting in dangerous blockages, but it has not yet been determined if these incidents contributed to their deaths. 

Coroner Nadia Persaud has said the way the machines vary from model to model can be "confusing" and may lead to future deaths, also ruling that the classification and colour coding was "worthy of review, simplification, and standardisation". 

The original coroners report, carrying advice from an independent expert said "In my opinion, the non-standardised colour coding used by manufacturers of these filters, the number of different types of filters with different names, the variable optimal position of the filters, and whether a wet or a dry breathing system is being used, results in an extremely confusing situation. One of the leading manufacturers of these filters produces HMEs that are blue, which is the same colour as the non-HME filters supplied by another company. In my experience, few doctors and nurses working in ICU are knowledgeable about all these different filters and which ones should be used for any given breathing system."

Inquests into the deaths are scheduled for October. 

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Source: The Daily Mail, 17 August 2021

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All NHS board members to get equality objectives

Trusts and systems must draw up plans to improve the diversity of their executive and senior leadership teams over the next 12 months, and evidence progress against them by summer 2025, NHS England has announced.

A new equality, diversity and inclusion (EDI) improvement plan also says every board and executive team member will have EDI objectives they will be assessed against during annual appraisals by spring 2024.

The targets form part of six “high impact actions,” each with set targets that aim to address the “widely known intersectional impacts of discrimination and bias” within the NHS.

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Source: HSJ, 8 June 2023

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All new hospitals must have single rooms only, government rules

All new hospitals built in England must have only single patient rooms, health infrastructure chiefs have confirmed, requiring an overhaul of many trusts’ current proposals.

Leaders of the New Hospitals Programme said the NHS needed to be “brave”, with the move marking an end for multi-bed bay wards and representing a major change in hospital design.

Previously, NHS trusts were expected to consider a minimum of 50% single rooms when refurbishing or building new facilities, but HSJ revealed in September that officials were considering a 100 per cent requirement.

Natalie Forrest, senior responsible officer for NHP, said England was “behind the times” on single patient rooms.

She said: “If we really want to look for evidence of why patients should have the ability to sleep in privacy and choose to socialise in social areas… we need not look very far. Scotland, Wales, Ireland, Europe, the US – where they wouldn’t dream of building a hospital that didn’t provide single bedroom occupancy.”

Ms Forrest, who is also a nurse, acknowledged an “anxiety” among NHS staff that they can’t care for patients in single rooms as well, and stressed the need to combine them with “digital technology”.

“I have said we need to be brave and take on new challenges, and this is one of those brave decisions the NHS needs to stand up and move forward with.”

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Source: HSJ, 13 December 2022

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All neighbourhoods need “single, urgent care teams” offering same day access, says review

Proposals for primary care networks to evolve into more collaborative “integrated neighbourhood teams” to improve access to care have been broadly welcomed.

A “stocktake” report commissioned by NHS England, published on 26 May, called for urgent same day appointments to be dealt with by “single, urgent care teams” for every neighbourhood with greater use of a range of health and social care professionals. 

The report, written by Claire Fuller, a general practitioner and chief executive of Surrey Heartlands Integrated Care System, undertaken by Dr Claire Fuller, Chief Executive-designate Surrey Heartlands Integrated Care System and GP on integrated primary care, looks at what is working well, why it’s working well and how we can accelerate the implementation of integrated primary care (incorporating the current 4 pillars of general practice, community pharmacy, dentistry and optometry) across systems.

Doctors’ leaders welcomed many of the report’s recommendations but emphasised that they could only work if the government resourced primary care practices better and tackled workforce shortages.

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Source: BMJ, 27 May 2022

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All GPs to receive direct access to cancer tests

All GP practices in England will be able to book cancer tests directly for their patients from later this month, NHS bosses say.

The option of GPs booking CT scans, ultrasounds and MRIs has been gradually rolled out in recent years, as community testing centres have opened.

NHS England chief executive Amanda Pritchard will announce later all GPs will now be able to do this. 

GPs have previously relied on referring on to specialist hospital doctors. Before referring, they have to identify clear symptoms the patient may have a specific type of cancer.

But only one out of every five cancer cases is diagnosed through these urgent GP referrals. Patients with less clear symptoms face long waits for check-ups or are diagnosed only after presenting at an accident-and-emergency (A&E) unit or being referred to hospital for something else.

And Ms Pritchard will tell delegates at the NHS Providers annual conference of health managers, in Liverpool, today, she hopes the new initiative will lead to tens of thousands of cancer cases every year being detected sooner.

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Source: BBC News, 16 November 2022

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All GP surgeries in England to have digital phone lines by March 2024

Patients at all general practices across England will soon benefit from new digital phone lines designed to make booking GP appointments easier.

Backed by a £240 million investment, more than 1,000 practices have signed up to make the switch from analogue systems - which can leave patients on hold and struggling to book an appointment - to modern, easy-to-use digital telephones designed to make sure people can receive the care they need when they need it.

It is expected every practice in the country will have the new system in place by the end of this financial year, helping put an end to the 8am rush - a key pillar of the Prime Minister’s primary care recovery plan to improve patient access to care.

Patients will be able to contact their general practice more easily and quickly - and find out exactly how their request will be handled on the day they call, rather than being told to call back later, as the government and NHS England deliver on the promises made in the primary care recovery plan announced in May. If their need is urgent, they will be assessed and given appointments on the same day. If it is not urgent, appointments should be offered within 2 weeks, or patients will be referred to NHS 111 or a local pharmacy.

The upgraded system will bring an end to the engaged tone, see care navigators direct calls to the right professional, and the use of online systems will provide more options and help those who prefer to call to get through.

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Source: Department of Health and Social Care, 18 August 2023

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All GP consultations should be remote by default, says Matt Hancock

All GP appointments should be done remotely by default unless a patient needs to be seen in person, Matt Hancock has said, prompting doctors to warn of the risk of abandoning face-to-face consultations.

In a speech setting out lessons for the NHS and care sector from the coronavirus pandemic, the health secretary claimed that while some errors were made, “so many things went right” in the response to Covid-19, and new ways of working should continue. He said it was patronising to claim that older patients were not able to handle technology.

The plan for web-based GP appointments is set to become formal policy, and follows guidance already sent to GPs on having more online consultations. But the Royal College of GPs (RCGP) hit back, saying it would oppose a predominantly online system on the grounds that both doctors and patients benefited from proper contact.

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All adults with learning disability to be offered Covid vaccine in priority u-turn

All adults with a learning disability will be offered the vaccine against coronavirus after new advice from government experts warned they were at greater risk from the virus.

The decision is a major win for disability charities and campaigners. The decision will mean as many as 150,000 more people could be offered the vaccine.

The government’s Joint Committee on Vaccination and Immunisation (JCVI) has issued new advice saying any adult on GP Learning Disability Register should be prioritised for vaccination along with adults with related conditions such as cerebral palsy.

The JCVI had previously said only those were severe learning disabilities and those living in care homes should be prioritised for vaccinations. Disability rights campaigners and charities warned this left vulnerable people at increased risk from the virus.

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Source: The Independent, 24 February 2021

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Alfreton's Field House mental health unit in special measures

A mental health unit where a patient was found dead has been placed into special measures over concerns about safety and cleanliness.

Field House, in Alfreton, Derbyshire, was rated "inadequate" by the Care Quality Commission (CQC) following a visit in August. A patient died "following use of a ligature" shortly after its inspection, the CQC said.

Elysium, which runs the unit for women, said it was "swiftly" making changes.

The inspectors' verdict comes after the unit was ordered to make improvements, in January 2019.

Dr Kevin Cleary, the CQC's mental health lead, said: "There were issues with observation of patients, a lack of cleanliness at the service and with staffing.

"There were insufficient nursing staff and they did not have the skills and experience to keep patients safe from avoidable harm. Bank and agency staff were not always familiar with the observation policy."

"It was also worrying that not all staff received a COVID-19 risk assessment, infection control standards were poor, and hand sanitiser was not available in the service's apartments."

The CQC said a follow-up inspection on Monday had showed "areas of improvement" but it would continue to monitor the service.

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Source: BBC News, 22 October 2020

 
 
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Alert over steep rise in handover delays

An ambulance trust is warning that delays handing patients over to hospitals have “significantly deteriorated” in the past two months, with one waiting nearly 20 hours.

West Midlands Ambulance Service University Foundation Trust said October was set to be its second worst month on record for hours lost to delays outside hospitals.

It said the delays were set to amount to 42,000 crew hours in October for the region, the equivalent of 130 vehicles each day. In August the figure fell to 20,000 hours but they have since surged towards a level seen in the worst months of the past two winters.

This has pushed average response times for category 2 calls – which include suspected heart attacks and strokes – to well over the 30-minute “interim” target, the trust said.

The trust said it had been trying to use an “immediate offload” protocol to speed up handovers – which is backed by NHS England where there are category 1 or 2 calls waiting – but only 43% of its 1,259 requests were accepted by the acute trust involved, in the first three weeks of October.

Every day at least one person had to wait more than eight hours to be offloaded; and one wait in Worcester reached 19h35m. 

Staff are raising concerns about getting food and drink for patients and themselves; working shifts of up to 17 hours; lost training opportunities; as well as difficulties providing care in the vehicles.

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Source: HSJ, 1 November 2024

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Alert over hospital air devices after 120 ‘never events’

NHS trusts are to be told to remove devices linked to more than 120 never events caused by ‘unconscious errors’.

A national patient safety alert from NHS England which urges trusts to remove all air flowmeters from wall medical gas outlets. It is likely to be published next month.

The alert comes after 121 never events in the last three years involved staff members accidentally connecting patients to air instead of oxygen. This number is close to 10% of all never events recorded during that period.

These types of never events have been recorded by 57 NHS organisations during 2018-19, 2019-20 and 2020-21.

The incidents took place mostly on medical wards and in emergency departments. They occurred despite NHSE issuing a patient safety alert in 2016, which recommended removing the flowmeters from wall outlets when not in active use.

According to NHSE documents - seen by HSJ - the never events often went undetected “for some time”, even when other staff responded to deteriorating patients or took over their care. The regulator concluded this makes it more likely that there have been other unreported incidents.

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Source: HSJ, 17 May 2021

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Alert issued to hospitals as intensive care drugs run low

Doctors have been warned that crucial drugs used to help sedate and ventilate patients in intensive care are running out due to the demand caused by coronavirus.

An alert to hospitals from NHS England today said there were “limited supplies” of muscle relaxant drugs atracurium, cisatracurium and rocuronium, which are used during intubation when patients are sedated and paralysed with a ventilator used to help them breathe.

As a result of the shortages, and to help maintain supplies, NHS England said it would now manage existing supplies “centrally”.

Its said supplies of atracurium and cisatracurium were likely to be exhausted in coming days, and hospitals would need to switch to alternatives that were still available.

A critical care nurse working in ICU in the south of England told The Independent they were already using alternatives but that this had to be used at different concentrations and run for longer to achieve the same sedation.

She said changes like this with staff overstretched could increase the likelihood of drug errors.

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Source: The Independent, 17 April 2020

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Alder Hey NHS Trust must pay boy £27m over brain injuries

A boy who suffered "catastrophic brain injuries" when doctors failed to see he had a virus and sent him home after he had a seizure has been awarded £27m.

The boy, who cannot be identified but is now 13, suffered seizures as a toddler more than a decade ago.

Details of the settlement between the boy's father and Liverpool's Alder Hey Children's NHS Foundation Trust were published in a written ruling.

High Court judge Mr Justice Fordham said it was a "sensible settlement".

Trust bosses admitted "breach of duty" and "causation of loss and damage", the judge said.

The judgment, from the hearing in Manchester, said the boy had suffered a seizure at 17 months old on 19 September 2009 and was taken to Alder Hey Children's Hospital.

He suffered a second seizure in the accident and emergency department which was seen by medical staff. The boy was sent home and, despite going back to hospital, was not diagnosed with a virus until 24 September.

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Source: BBC News, 12 November 2021

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Alder Hey leads study for early warning system for children

Alder Hey is leading on a new study called DETECT (Dynamic Electronic Tracking and Escalation) to reduce critical care transfers and to record vital signs.

The study has received £1.25m in funding from the National Institute for Health Research Invention for Innovation Programme (NIHR i4i) and involves The University of Liverpool, Edge Hill University, Lancaster University and System C.

Healthcare professionals at Alder Hey are currently using electronic devices to record breathing rate, effort of breathing, oxygen saturation, oxygen requirement, heart rate, blood pressure, capillary refill time, temperature and nurse or parental concerns.

The DETECT Study is the first research study of its kind in the UK as an early warning system for children.

The recorded data will automatically calculate an age-specific paediatric early warning score (PEWS), which categorises the risk of developing serious illness into low, medium, high or critical. These scores and signs suggestive of sepsis are automatically flagged to staff to help them recognise the early signs of deterioration, with a view to reducing emergency admissions to critical care.

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Source: Health Tech Newspaper, 11 November 2019

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Alder Hey children’s hospital explores ‘data breach’ after ransomware claims

A ransomware gang claims to have stolen data from the Alder Hey children’s hospital in Liverpool, allegedly including patient records.

The INC Ransom group said it had published screenshots of data on the dark web that contained the personal information of patients, donations from benefactors and procurement information.

Sources confirmed that snapshots of spreadsheets purporting to be from Alder Hey’s systems had been displayed on the INC site carrying the message “evidence of large scale data”. There were 11 screenshots, understood to contain names, addresses, medical reports and financial papers.

The Alder Hey children’s NHS foundation trust said it was aware of the alleged leak and was working to verify whether the data belonged to the hospital.

“We are aware that data has been published online and shared via social media that purports to have been obtained illegally from systems shared by Alder Hey and Liverpool Heart and Chest hospital NHS foundation trust. We are working with partners to verify the data that has been published and to understand the potential impact,” the trust said.

Alder Hey treats more than 450,000 patients a year making it one of Europe’s busiest children’s hospitals. It said its services were operating as normal and patients should continue to attend appointments.

The hospital said it was working with the National Crime Agency to secure its IT systems and that the alleged data theft was not linked to another “cyber incident” that occurred this week at the nearby Wirral university teaching hospital NHS trust. 

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Source: The Guardian, 29 November 2024

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Alcoholic anaesthetist's error that killed Briton unforgivable, court told

An anaesthetist who had been drinking before an emergency caesarean that led to the death of a British woman should serve the maximum three years in jail if convicted and should be banned from working as a doctor, a French prosecutor has demanded.

Helga Wauters is on trial in Pau, south-west France, for the manslaughter of Xynthia Hawke in 2014. She is accused of starving Hawke of oxygen for up to an hour after pushing a ventilation tube into the wrong passageway.

Orlane Yaouang, prosecuting, described the scene in the operating theatre when Hawke turned blue as “carnage” and spoke of the “surreal situation” in which the panicked hospital staff called the emergency services.

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Source: The Guardian, 9 October 2020

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Alcohol-related deaths jumped to highest level during Covid pandemic

The highest number of alcohol-related deaths in England and Wales since records began was seen in 2020, official data shows. 

A survey by the Office for National Statistics (ONS) showed that alcohol killed more people in 2020 than in any of the previous 20 years. The data also showed a rise of 20 per cent compared to 2019.

Overall, there were 7,423 deaths from alcohol misuse last year, compared to 6,209 in 2019. Deaths increased from March 2020 onwards, when the coronavirus pandemic forced the UK into a series of national lockdowns. 

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Source: The Independent, 6 May 2021

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Alarming decline in vaccine update must be tackled, say MPs

The UK’s status as a global leader on vaccination is at risk because of falling uptake rates among children and an “alarming” decline in clinical trial activity, MPs have warned.

The Health and Social Care Committee said in a report that it was concerned that England did not meet the 95% target for any routine childhood immunisations in 2021-22.1

Committee chair Steve Brine MP said that new spikes in measles cases in London and the West Midlands because of low uptake of MMR vaccines should be a “massive wake-up call” for the government to take action. “Vaccination is the one of the greatest success stories when it comes to preventing infection. Unless the government tackles challenges around declining rates of childhood immunisations and implements reform on clinical trials, however, the UK’s position as a global leader on vaccination risks being lost,” he said.

The Health and Social Care Committee said, “It is unacceptable that there are people who are unable to take advantage of the important protection that vaccination offers because of practical challenges of time and location that can and must be tackled.”

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Source: BMJ, 27 July 2023

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Alarm raised years before hospital’s ‘inadequate’ rating

Multiple concerns were being raised about an inpatient hospital for several years before it was rated ‘inadequate’ by the Care Quality Commission (CQC), HSJ has learned.

Huntercombe Hospital in Maidenhead, which provides NHS-funded mental healthcare for children, was put into special measures in February after an inspection raised serious concerns over the apparent over-use of medication to sedate patients, among other issues. It has since received a further warning notice.

The unit, which predominantly treats female patients, had previously been rated “good” by the CQC in 2016 and 2019.

Five former patients and four parents have now told HSJ of poor care and practices at the unit between 2016 and 2020. Two of the families raised concerns directly to Huntercombe, as well as NHS England, local authorities and the local community provider, Berkshire Healthcare FT.

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Source: HSJ, 18 May 2021

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Alarm raised at decline in women’s maternity experiences in England

The Care Quality Commission (CQC) has sounded the alarm over a “concerning decline” in women’s experiences with maternity services.

Fewer women feel they always got the help they needed during labour and birth, many were disappointed at the amount of time their partners could stay with them after the delivery of their babies, and a significant number reported that they did not feel listened to when they raised concerns.

The CQC said it has noticed a “deterioration” over the last five years in the ratings women gave their care. 

It came as a major new national poll showed a “statistically significant downward trend” on most measures examined to track maternity care across the country. In particular, concerns were raised about staff availability, confidence and trust, as well as kindness and understanding of staff. Ratings also tumbled for whether women felt they had been treated with dignity and respect, the amount of information provided to mothers, and their concerns about being listened to.

Victoria Vallance, from the CQC, said: “These results show that far too many women feel their care could have been better. This reflects the increasing pressures on frontline staff as they continue in their efforts to provide high-quality maternity care with the resources available.”

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Source: The Guardian, 11 January 2023

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Alarm over Liz Truss raid on NHS

Hospital bosses have warned that they face “impossible choices” under Liz Truss’s plan to divert £10 billion a year from the NHS to social care.

They say that her pledge to remove cash earmarked for the health service will “slam the brakes” on efforts to tackle record waiting lists, with patients bearing the brunt.

An extra £36 billion has been ring-fenced for health and care spending over the next three years, of which less than £2 billion a year is due to go towards social care. Truss, the frontrunner in the Conservative leadership contest, has announced that as prime minister she will divert the entire amount to local authorities to pay for older people’s care. This would create a £10 billion shortfall in annual NHS spending, the equivalent of imposing a 7 per cent budget cut on the service.

NHS bosses say that they would have no choice but to cut services as they face the worst winter crisis in living memory, forcing patients to wait longer for treatment. There are already 6.7 million people on waiting lists, while patients are dying because of a sharp increase in ambulance response times and accident and emergency waiting times are the worst on record.

Truss told a Times Radio hustings: “I still would spend the money. I would just take it out of general taxation rather than raising national insurance. But I would spend that money in social care. Quite a lot has gone to the NHS. I would give it to local authorities.”

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Source: The Times (25 August 2022)

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Alarm over ‘serious’ delays in diagnosing childhood cancer in England

Health experts have raised the alarm over “serious” delays in diagnosing children and young people with cancer, as a study reveals the number found to have the disease during the pandemic fell by almost a fifth.

The University of Oxford found a “substantial reduction in childhood, teenage and young adult cancer detection” in England last year. The research, being presented on Friday at the National Cancer Research Institute (NCRI) festival, showed a 17% drop in cases diagnosed in the under-25s last year compared with previous years.

The impact of Covid on adults with cancer is well known. However, previously little has been known about the toll on younger patients.

As well as the fall in the overall numbers of children diagnosed with cancer, researchers found that even those whose cancer was spotted last year were more likely to have been diagnosed only after being admitted to intensive care. That suggests long delays in accessing care may have made them much sicker, experts say.

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Source: The Guardian, 12 November 2021

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Alarm in health service over Palantir staff being given NHS email accounts

Health service staff have expressed alarm that engineers working for controversial tech company Palantir have been given NHS email accounts.

Employees using NHS.net email accounts have access to a directory with the contact details of up 1.5 million staff. Sources believe Palantir staff were granted the same access.

Palantir staff working on the introduction of its Federated Data Platform (FDP) for NHS England have also been given access to NHS SharePoint filesharing systems and internal Microsoft Teams groups.

Hospital trusts and integrated care boards across the country are being encouraged to adopt FDP, which Palantir won a £300m contract to provide in 2023. NHS England says FDP allows NHS organisations to connect patient records historically held across different systems, allowing staff to manage waiting lists, allocate appointments, speed up diagnoses and personalise treatment more effectively. It is part of the government’s plan to “reinvent the NHS” through “radical shifts”, including moving systems from “analogue to digital”.

The use of NHS email accounts and internal systems by private contractors is not unusual. However, Palantir’s association with AI-powered surveillance and war technology has made some staff, patients and human rights campaigners question the ethics and implications of allowing the spy-tech company to become embedded in the UK public sector.

Rory Gibson, a resident doctor, said: “I – as a doctor – absolutely don’t want my personal email and number to be accessible to someone who works for Palantir on the NHS, and might next month be working on systems for drone strikes. NHS staff have not consented to sharing their email addresses with Palantir staff.”

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Source: The Guardian, 8 April 2026

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Alarm at rise in use of mixed-sex wards in NHS England hospitals

NHS England has recorded more than 120,000 breaches of its mixed-sex hospital accommodation guidance in the past six years, a 257% increase.

Guidance added to the NHS constitution in 2012 states that hospital patients will not share sleeping accommodation with members of the opposite sex “except where appropriate”. Exemptions include critical care wards or patients receiving treatment, such as chemotherapy, where they “may derive comfort from the presence of other patients with similar conditions”.

The guidance also says patients should not share toilet or bathroom facilities with members of the opposite sex and should not “have to walk through an area occupied by patients of the opposite sex to reach toilets or bathrooms”.

However, data from NHS England analysed by the Observer shows thousands of breaches every month, with patient dignity and safety put at risk. 

Caitlin (not her real name) worked on an acute mental health ward in a private hospital which switched from 12 women-only beds to 15 mixed beds. “Women on our ward often had a history of sexual or domestic abuse,” she said. “Some had tried to end their life in the wake of this, and a lot of them felt intimidated by the level of aggression shown by some men on the ward.”

Women and men had separate wings but shared a communal area. “A lot of the women were really fearful of the men,” she added.

Caitlin said the use of mixed-sex accommodation had a negative impact on some women’s recovery. “Women would stay in their rooms, not even coming out to watch TV,” she says. “Some acutely unwell women would display sexually disinhibited behaviour in the communal areas, which is a symptom of their diagnosis. They were put in a position where their dignity could not be protected.”

“Women make hundreds of conscious and unconscious decisions to keep ourselves safe from men,” said Karen Ingala-Smith, author of Defending Women’s Spaces. “Women should not have to be on their guard like this when they are in hospital.” 

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Source: The Guardian, 15 October 2023

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Alarm at failure to inspect 60% of England homecare providers in four years or longer

Care leaders have warned of a serious safety risk as research revealed 60% of homecare providers had not been inspected for at least four years, or ever.

As the government prepares to receive a report on profound failings at its Care Quality Commission (CQC) that triggered the chief executive’s removal this summer and a public apology, the Homecare Association warned 37% of providers of domiciliary care services had not been rated for at least four years and 23% had never been rated.

Inspectors are supposed to check staff are caring, properly trained and not harming the vulnerable people they look after.

Dr Jane Townson, the chief executive of the Homecare Association, whose members look after about 800,000 people in England in their own homes, said: “Insufficient inspections are jeopardising service quality, safety and public confidence.

“The state of homecare regulation in England is like a ship taking on water, with a crew using buckets instead of pumps to bail it out. People relying on care services are at risk of being left adrift.”

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Source: The Guardian, 30 August 2024

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