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Pressure ramps up on CQC to suspend inspections

NHS Confederation has called on the Care Quality Commission (CQC) to suspend planned inspections of front-line services so busy staff can focus on the coronavirus outbreak.

NHS Confederation told HSJ it will write to CQC chief executive Ian Trenholm, asking for the regulator to immediately call off inspections over fears the visits could pull staff’s focus from the covid-19 outbreak.

NHS Confederation Chief Executive Niall Dickson told HSJ: “Our members recognise the value of regulation but given the current and future impact of covid-19 infections on front-line services, a temporary suspension of planned inspections would be the right move."

“Front-line staff and managers do not need any distraction as they confront one of the greatest challenges the NHS has faced in its history.”

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Source: HSJ, 11 March 2020

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Coronavirus: NHS bosses warn hospitals over intensive care demand surge

NHS hospitals have been told to expect a “several-fold” increase in demand for intensive care beds during a serious coronavirus outbreak.

Professor Keith Willett, NHS England’s incident director for the coronavirus outbreak, told a secret briefing of chief nurses from across the NHS that they needed to prepare now for the unprecedented demand which could overwhelm existing critical care services.

Sources who were in the briefing told The Independent Prof Willett warned the demand was likely to be not just double but “several fold” the existing 4,000 intensive care beds in the NHS.

Prof Willett said the NHS will also be holding large-scale simulations next week for an expected coronavirus surge in an effort to “stress test the system” ahead of rising cases of infection.

If the predictions are right the NHS will likely be forced to cancel large numbers of operations and re-deploy nurses and doctors.

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Source: The Independent, 12 March 2020

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Coronavirus confirmed as pandemic by World Health Organization

The coronavirus outbreak has been labelled a pandemic by the World Health Organization (WHO).

WHO chief Dr Tedros Adhanom Ghebreyesus said the number of cases outside China had increased 13-fold in two weeks. He said he was "deeply concerned" by "alarming levels of inaction".

A pandemic is a disease that is spreading in multiple countries around the world at the same time.

Dr Tedros said that calling the outbreak a pandemic did not mean the WHO was changing its advice about what countries should do. He called on governments to change the course of the outbreak by taking "urgent and aggressive action".

"Several countries have demonstrated that this virus can be suppressed and controlled," he said.

"The challenge for many countries who are now dealing with large clusters or community transmission is not whether they can do the same - it's whether they will."

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Source: BBC News, 11 March 2020

 

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Trainee nurses to join coronavirus fight

Third year undergraduate trainee nurses will be invited into clinical practice to support the coronavirus effort, while routine care quality inspections are “going to need to be suspended”, the Chief Executive of NHS England has said.

Speaking at the Chief Nursing Officer’s summit event in Birmingham this morning, Sir Simon Stevens told delegates NHSE was working with the Nursing and Midwifery Council to “see how many of the 18,000 [relevant] undergraduates are available”.

It is understood they would be paid, and follows government moves to pass emergency legislation to relax rules around working in healthcare. 

Asked about Care Quality Commission inspections during the outbreak, Sir Simon said: “There will be a small number of cases where it would be sensible to continue for safety related reasons… but the bulk of their routine inspection programmes is clearly going to need to be suspended and many of the staff who are working as inspectors need to come back and help with clinical practice.” 

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Source: HSJ, 11 March 2020

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Menstrual cup misuse 'can cause pelvic organ prolapse'

Incorrect use of menstrual cups could be resulting in some women suffering pelvic organ prolapse, the Victoria Derbyshire programme has been told. The Chartered Society of Physiotherapy wants some manufacturers to include better safety advice.

Menstrual cups fit into the vagina and collect period blood. They are not currently regulated in the UK, and there is no safety testing. Menstrual cups, which can last up to 10 years, have grown in popularity as a more sustainable alternative to single-use tampons and pads. But there are claims that more education is needed before women decide to use them.

There is limited research on the products, but in a report by the Lancet Public Health journal last year – which looked at 43 studies involving 3,300 women and girls living in rich and poor countries – the authors concluded menstrual cups were a "safe option".

But the Chartered Society of Physiotherapy is calling for the cups, which are produced by a growing number of manufacturers worldwide, to be better regulated. Currently they are not safety-tested, and there is no industry standard or body responsible for collating complaints.

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Source: BBC News, 11 March 2020

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Coronavirus: NHS to ramp up testing capacity

With the number of UK coronavirus cases set to rise, NHS England says it is scaling up its capacity for testing people for the infection.

It means 10,000 tests a day can be done – 8,000 more than the 1,500 being carried out currently.

Confirmation of any positive test results will be accelerated, helping people take the right action to recover or quickly get treatment. Most of the people tested should get a result back within 24 hours.

Scotland, Wales and Northern Ireland will be expected to roll out their own testing services, but there will be some shared capacity between nations, depending on need.

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Source: BBC News, 11 March 2020

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The cost of patient safety inaction: Why doing more of the same is unsustainable

On January 2020, Patient Safety will be on the G20 agenda (among other five health key priorities), but Abdulelah M. Alhawsawi, Saudi Patient Safety Center, asks "what is patient safety doing on an economic forum like the G20?"

Patient harm is estimated to be the 14th leading cause of the global disease burden. This is comparable to medical conditions such as tuberculosis and malaria. In both US and Canada, patient safety adverse events represent the 3rd leading cause of death, preceded only by cancer and heart disease. In the US alone, 440,000 patients die annually from healthcare associated infections. In Canada, there are more than 28,000 deaths a year due to patient safety adverse events. In low-middle income countries,  134 million adverse events take place every year, resulting in 2.6 million deaths annually. 

In addition to lives lost and harm inflicted, unsafe medical practice results in money loss. Nearly, 15 % of the health expenditure across Organization of Economic Cooperative Development countries is attributed to patient safety failures each year, but if we add the indirect and opportunity cost (economic and social), the cost of harm could amount to trillions of dollars globally.

When a patient is harmed, the country loses twice. The individual will be lost as a revenue generating source for society and the individual will become a burden on the healthcare system because he or she will require more treatment. Unless we do something different about patient safety, we would risk the sustainability of healthcare systems and the overall economies. 

Alhawsaw proposed establishing a G20 Patient Safety Network (Group) that will combine Safety experts from healthcare and other leading industries (like aviation, nuclear, oil and gas, other), and economy and fFinancial experts

This will function as a platform to prioritise and come up with innovative patient safety solutions to solve global challenges while highlighting the return on investment (ROI) aspects. 

This multidisciplinary group of experts can work with each state that adopts the addressed global challenge to ensure correct implementation of proposed solution.

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Source: The G20 Health & Development Partnersip, 10 February 2020

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Missing records hamper NHS complaint probes, watchdog says

Complaints about NHS care cannot always be investigated properly because of medical records going missing, the public services watchdog has said.

Ombudsman Nick Bennett said many people were left "suspicious" and thought there was a "darker motivation".

One woman whose notes went missing said she no longer trusted what doctors said and had lost faith in NHS transparency.

The Welsh NHS Confederation said staff were "committed to the highest standards of care".

In a report called Justice Mislaid: Lost Records and Lost Opportunities, Mr Bennett found 70% of 17 cases he looked at in Welsh NHS hospitals and care settings could not be properly investigated because of lost documents.

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Source: BBC News, 10 March

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New Chairman appointed for Patient Safety Movement Foundation

Mike Ramsay has been appointed new Chairman of the Patient Safety Movement Foundation, taking over from Joe Kiani.

The Patient Safety Movement's goal is to get to ZERO preventable deaths. In their latest newsletter, Mike discusses how he intends to build on the tremendous momentum gained so far. 

"We are not competing with any organization but strongly support entities with the patient safety goal and hope that we can all pull together and use all our resources to reach zero preventable deaths and zero harm. Zero is our target and we can get there!"

Read Mike's Letter in the March Patient Safety Movement Foundation newsletter

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Impaired consciousness: new guidelines aim to ensure people aren’t “lost in system”

Doctors who look after patients in a vegetative or minimally conscious state must ensure they initiate regular conversations with relatives about what is in the best interests of the person so that they do not get “lost in the system,” says new guidance.

The Royal College of Physicians has published new and revised guidelines on prolonged disorders of consciousness (PDOC) to take into account changes in the law and developments in assessment and management.

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Source: BMJ, 6 March 2020

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Covid-19: out-of-hours providers are drafted in to manage non-urgent patients in community

Regional NHS leaders in England have been ordered to immediately organise a primary care management service to care for covid-19 patients who “do not require immediate admission” to hospital.

In a letter sent on 8 March, seen by The BMJ, NHS England and NHS Improvement’s strategic incident director for coronavirus, Keith Willett, has ordered regional primary care and public health directors to set up a 24 hour, seven day a week service to manage patients in the community. This service should be delivered by an out-of-hours provider, and every part of England must be covered by Tuesday 10 March, the letter said.

The service will be used to manage patients who are deemed well enough to be isolated at home, with active monitoring for people who are at high risk of developing severe illness, and advice to those not deemed high risk on what to do if their illness deteriorates.

The letter advises that patients “remain in isolation until 5 days after resolution of symptoms, unless [they are a] healthcare worker or work with high risk groups, in which case require one negative sample 5 days after resolution of symptoms before return to work.”

People with mild illness and not in a high risk group will be told to isolate themselves at home and will be given health advice on how to identify deterioration. All patients managed at home will be given a phone number to call if they feel more unwell.

The letter said that the community service should be provided by a nurse and GP team and that all clinical information should be recorded and transferred to the patient’s general practice.

Providers must also provide regular situation reports, including confirmed numbers of patients cared for under the service, numbers of patients who deteriorate, and numbers of patients admitted to and discharged from the service.

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Source: BMJ, 9 March 2020

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Former minister says government would lose human rights challenge

Sir Norman Lamb, chair of South London and Maudsley Foundation Trust and a former Liberal Democrat MP, has suggested the government would lose a legal challenge over its national programme for patients with learning disabilities and said the national Transforming Care programme was at the “very least a partial failure”.

“I regard this as a human rights issue. We’re locking people up when we don’t need to lock them up. We’re subjecting them to force, when we shouldn’t do so, and this is how I think we need to frame it. If the government were challenged in court on this, I think there’s a very good chance, as an ex-lawyer, that they would lose.”

Transforming Care was launched in 2011 following the Winterborne View scandal and aimed to discharge patients with learning disabilities and autism out of institutional inpatient units into the community. However, the most recent figures, from NHS Digital, show there were still more than 2,000 patients within inpatient units, ahead of the national programme’s expiration this month.

Kevin Cleary, deputy chief inspector for hospitals and lead for learning disability and mental health services for the CQC, said: “We have allowed our patients to be placed within places like Whorlton Hall.  I think the NHS provides very few services of this type, it has withdrawn from providing these services, and has become comfortable with providing that service, within the independent sector, several hundred miles away and that’s not right… absolutely not right."

“We cannot say we are providing patient centred care or say we are placing the patient at the heart of everything we do and have that response from the system. We are all responsible for that.”

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Source: HSJ, 10 March 2020

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Coronavirus: Visitors steal hand sanitiser gel from hospital

Visitors to a hospital are stealing hand sanitising gel daily – as demand for the product surges amid fears over coronavirus.

Bottles have been taken from patients' beds and dispensers ripped off walls at Northampton General Hospital. Bosses said the gel was "disappearing every day" and they have had to limit the supply on wards.

"Nothing like this has ever happened in all the years we've had the gel," said a hospital spokeswoman.

"Over the past week we've seen stocks on wards disappear from the end of beds every single day," Sally-Anne Watts, associate communications director, told the BBC.

"Three wall-mounted dispensers have been ripped off and we've even seen people coming in and topping up their own dispensers with our product," she said.

Since the hospital's supplies have been going missing, Mrs Watts said, bottles were no longer being put at the end of all beds.

"We don't have an unlimited supply and would ask that visitors to the site respect the fact that we are doing all we can to keep our patients, visitors and staff safe, and we need their support," she added.

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Source: BBC News, 6 March 2020

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Patient Safety Awareness Week

PatientSafetyAwarenessWeek_510px.jpg.7861b96af71ab93aad6623cc27221098.jpg

This week is Patient Safety Awareness Week, an annual recognition event intended to encourage everyone to learn more about healthcare safety. During this week, the Institute for Healthcare Improvement (IHI) seeks to advance important discussions locally and globally, and inspire action to improve the safety of the health care system — for patients and the workforce.

Patient Safety Awareness Week serves as a dedicated time and platform for growing awareness about patient safety and recognising the work already being done.

Although there has been real progress made in patient safety over the past two decades, current estimates cite medical harm as a leading cause of death worldwide.

The World Health Organization estimates that 134 million adverse events occur each year due to unsafe care in hospitals in low- and middle-income countries, resulting in some 2.6 million deaths. Additionally, some 40 percent of patients experience harm in ambulatory and primary care settings with an estimated 80 percent of these harms being preventable, according to WHO.

Some studies suggest that as many as 400,000 deaths occur in the United States each year as a result of errors or preventable harm. Not every case of harm results in death, yet they can cause long-term impact on the patient's physical health, emotional health, financial well-being, or family relationships.

Preventing harm in healthcare settings is a public health concern. Everyone interacts with the health care system at some point in life. And everyone has a role to play in advancing safe healthcare.

Learn more about IHI's work to advance patient safety.

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Warning over 'nursing staffing crisis' after NHS trust told to improve

The Royal College of Nursing (RCN) has issued a warning about insufficient staffing in the NHS in the wake of a mental health trust being downgraded.

Earlier this week, Tees, Esk and Wear Valleys (TEVW) NHS Foundation Trust being rated as "requiring improvement" by the Care Quality Commission. It had previously been rated as "good" but inspectors said some services had deteriorated. Among the concerns raised were ones over staffing, workload and delays. 

Glenn Turp, Northern Regional Director of the RCN: "The CQC has rightly highlighted some very serious concerns and failings which call into question whether this trust can provide safe patient care. After the very tragic and sad deaths of two vulnerable patients last year and the findings of the CQC, the trust and NHS commissioners must take immediate action to ensure patient and staff safety."

"They have a responsibility not to commission and open new beds with insufficient nursing staff to provide safe patient care. Having the right number of nursing staff with the right skills in the right place at the right time is critical to protecting patients. It also protects those staff who too often find themselves struggling to maintain services in the face of nursing vacancies."

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Source: The Northern Echo, 7 March 2020

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Call for bosses to quit at hospital that tried to conceal blunders

Executives in charge of the health secretary’s crisis-hit local hospital are facing calls to step down after The Sunday Times raised serious questions about attempts to cover up catastrophic medical mistakes.

West Suffolk Hospital in Bury St Edmunds had placed Dr Patricia Mills, one of its most senior consultants, under disciplinary investigation after she had voiced concerns about blunders that had killed one patient and left another seriously brain-damaged. A number of doctors have claimed that a bullying management culture has led to staff being too afraid to speak up about patient safety concerns at the hospital.

Executives were accused of being obsessed with maintaining the hospital’s “outstanding” status in annual Care Quality Commission. One of the governors said their were "frustrations and concerns" among his fellow council members that they were being kept in the dark by the hospital's executives.

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Source: The Sunday Times, 8 March 2020

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Maternity safety campaigners head to Downing Street to demand action

More than 20 leading NHS doctors and experts back Baby Lifeline demand for safety training for maternity staff to cut £7m a day negligence costs

The Independent’s maternity safety campaign goes to Downing Street today as senior figures from across the health service deliver a letter demanding action from prime minister Boris Johnson.

Charity Baby Lifeline will be joined by bereaved families, Royal Colleges and senior midwives and doctors in Downing Street to hand in a letter calling on the government to reinstate a national fund for maternity safety training.

Baby Lifeline, which has also launched an online petition today, said the government needed to find £19m to support training of both midwives and doctors to prevent deaths and brain damage, which can cost the NHS millions of pounds for a single case.

The letter to Mr Johnson has also been signed by Dr Bill Kirkup, who led the investigation into baby deaths at the Morecambe Bay NHS trust and is investigating poor care at the East Kent Hospitals University Trust.

He said: “There have been real improvements in maternity services, but as recent events in Kent and Shropshire have shown only too clearly, much more remains to be done. The Maternity Safety Training Fund is badly needed.”

Sir Robert Francis QC, Chairman of the public inquiry into poor care at Stafford Hospital, who also signed, said: “The cost in lost and broken lives, not to mention the unsustainable financial burden and the distress of staff caused by these avoidable mistakes, is indefensible.”

Other signatories included former health secretary Jeremy Hunt, the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists and a number of senior maternity figures, charities and clinical associations.

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Source: The Independent, 6 March 2020

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Feeling the strain: UK GPs the least satisfied with amount of time they have with patients

Just 1 in 4 UK GPs are satisfied with time they are able to spend with patients – appointment times are among the shortest of 11 countries surveyed.

A report published today by the Health Foundation paints a picture of high stress and low satisfaction with workload among UK GPs. The report is an analysis of an international survey of GPs from 11 high-income countries, including 1,001 UK GPs, undertaken by the Commonwealth Fund in 2019.

Among 11 high-income countries included in the study, only France has lower levels of overall satisfaction with practising medicine, and only Sweden reported higher levels of stress. Over half of UK GPs (60%) say they find their job 'extremely' or 'very' stressful, and almost half (49%) plan to reduce their weekly hours in the next three years.

UK GPs also reported significantly shorter appointment lengths than their international colleagues. The average length of a GP appointment in the UK is 11 minutes, compared with a 19 minute average appointment for GP and primary care physicians in the other countries surveyed. 

Dr Rebecca Fisher, one of the Health Foundation report's authors and a practising GP, says: "These findings illustrate the pressures faced by general practice, and the strain that GPs are under. Right now the health system is in unprecedented territory and mobilising to meet the challenge of Covid-19. This survey shows that over the long term we need concerted action to stabilise general practice. Despite performing strongly in some aspects of care, many GPs consider that appointments are simply too short to fully meet the needs of patients. Too many GPs are highly stressed and overburdened – to the point of wanting to leave the profession altogether."

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Source: The Health Foundation, 5 March 2020

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Shropshire baby deaths: Trust will return £1m it received for 'good care'

An NHS trust at the centre of an inquiry into preventable baby deaths will repay money it received for providing good maternity care.

In 2018, Shrewsbury and Telford NHS Trust received almost £1m, weeks before its services were rated inadequate. The BBC revealed in December the trust had qualified for the payment under the NHS's Maternity Incentive Scheme.

The trust said an "incorrect submission" had been made and it had ordered an independent review.

Shrewsbury and Telford NHS Trust (SaTH) is at the centre of England's largest inquiry into poor maternity care, with more than 900 families contacting a review looking into concerns over preventable deaths and long-term harm.

Former health secretary Jeremy Hunt wrote to ministers questioning if improvements to the Maternity Incentive Scheme were needed in light of payments made to both Shrewsbury and Telford and East Kent Hospitals, despite both facing serious questions over the safety of maternity services.

The trust in Shropshire was paid £963,391 after certifying it had met the 10 safety standards demanded by the scheme, which is run by NHS Resolution.

In the letter, seen by the BBC, Mr Hunt suggested one improvement would be to link payments to CQC maternity and safety ratings.

"The whole approach is likely to be discredited if trusts can meet all 10 actions and yet still be delivering poor standards of care," the letter said.

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Source: BBC News, 6 March 2020

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Late diagnosis of ectopic pregnancy 'putting women at risk'

Women are at risk of serious harm and death because hospitals are not always diagnosing ectopic pregnancies quickly enough, an investigation reveals.

About 12,000 women a year in the UK suffer an ectopic pregnancy – when a fertilised egg grows outside the womb – putting them at risk if a fallopian tube containing the foetus ruptures and causes potentially fatal heavy bleeding.

An investigation by the Healthcare Safety Investigation Branch (HSIB)  has found flaws in the treatment women receive. It has highlighted late diagnosis and consequent delay in treatment as a major concern, especially as a result of the condition being mistaken for a urinary tract infection.

NHS patient safety data shows that 30 ectopic pregnancies were missed and led to “serious harm” between April 2017 and August 2018.

As well as the risk to life, an ectopic pregnancy can also damage a woman’s chances of conceiving again and have serious psychological effects.

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Source: The Guardian, 5 March 2020

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"The public has a right to the truth": NHS staff speak out on coronavirus fears

The health service lacks the beds, staffing and resources to cope with a serious outbreak of the coronavirus, The Independent has been told by senior doctors and nurses.

NHS staff from across the country warned hospitals are already unable to cope, with patients being looked after in spill-over wards and waiting hours for a bed, with one doctor saying it was already a “one in, one out mentality” for intensive care.

Other staff reported delays in lab tests, rationing of protective masks and equipment, and a lack of isolation areas for suspected coronavirus patients.

Suggestions from the Health Secretary Matt Hancock that the NHS would use “home ventilation kits”, and that an extra 5,000 intensive care beds could be created, were labelled “fanciful” by the chair of the British Association of Critical Care Nurses today.

Nicki Credland said: “If you already have a system running at 100 per cent capacity, the idea you can get a significant amount of additional beds is just not realistic. There simply aren’t enough beds for them. We will need to make difficult decisions about which patients are going to be admitted to intensive care."

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Source: The Independent, 5 March 2020

 

 

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Hundreds of women left ‘distressed’ by hysteroscopies

Hundreds of women have said they’ve undergone “distressing” diagnostic tests at NHS hospitals which were not carried out in line with recommended practice.

Around 520 women who attended NHS hospitals in England to undergo hysteroscopies — a procedure which uses narrow telescopes to examine the womb to diagnose the cause of heavy or abnormal bleeding — have told a survey their doctors carried on with their procedures even when they were in severe pain.

This is despite the Royal College of Obstetricians and Gynaecologists advising clinicians should offer to reschedule with the use of general anaesthetic, epidural or sedation if the pain becomes unbearable. 

The Campaign Against Painful Hysteroscopy patient group has surveyed 860 women who had had the procedure at an English NHS hospital, and shared the results with HSJ. Of them, 750 said they were left distressed, tearful or shaken by the procedure, with around 466 of them saying that feeling remained for longer than a day.

Many of the women said their painful hysteroscopies damaged their trust in healthcare professionals, had made cervical smears more painful and had a negative impact on sexual relationships.

Patient Safety Learning have connected with the campaigning group 'Hysteroscopy Action' on this issue. We have seen stories and comments posted on the hub from patients who have suffered similar distressing experiences. We are using this feedback and evidence to help campaign for safer, harm-free care. We welcome others to join in the conversation.

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Source: HSJ, 2 March 2020

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Distance not always factor in ambulance response times

There is significant variation in ambulance response times to patients with serious conditions such as suspected strokes or heart attacks, which is not fully explained by how rural an area is, an HSJ analysis has revealed.

The exclusive analysis represents the first time ambulance performance for category two calls, which have an 18-minute response time target, have been broken down to clinical commissioning group level. Category two, known as emergency calls, covers a wide range of conditions, including suspected stroke and heart attacks (except cardiac arrests), major burns and epileptic seizures. They account for well over half of ambulance responses.

The findings — described as “alarming” by the Stroke Association — lay bare the incredibly long waits which are usually hidden, because average waiting time data is usually published for ambulance trusts, which cover far larger areas than CCGs.

Mark MacDonald, Deputy Director of Policy at the Stroke Association, said: “It is alarming to hear that in some cases ambulance staff are taking over an hour to reach patients because when it comes to stroke, being assessed quickly and then, if necessary, transferred to hospital, is really important.”

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Source: HSJ, 5 March 2020

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East Kent baby deaths: "Hospital did not learn from mistakes"

The parents of a baby who nearly died after a series of failings during his birth said they were "heartbroken" mistakes continued to be made

East Kent Hospitals told Harry Halligan's parents they would learn lessons from his delivery in 2012. But similar failings recently came to light after the death of Harry Richford in 2017 and the trust is now being probed over up to 15 baby deaths.

The trust said it made "many changes to the maternity service" after 2012.

Parents Dan and Alison Halligan, from New Romney, said watching news coverage of an inquest into Harry Richford's death earlier this year, which laid bare the failings, had brought back stressful memories.

Mr Halligan said the trust "clearly haven't learned from [the] mistakes" made in his son's care, adding that it was "heartbreaking" to see "the same mistakes being repeated".

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Source: BBC News, 5 March 2020

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NHS 'failing' patients living with HIV

The failure to address the mental-health needs of people with HIV could lead to an increase in infections, a cross-party group of MPs suggests.

People with HIV are twice as likely to experience mental-health difficulties. However, in those with depression, support raises adherence to medication by 83%. But most HIV clinics have no mental-health professionals on staff, which, the MPs say, could be reversing progress made over the past decade toward ending the epidemic in the UK.

The All-Party Parliamentary Group (APPG) on HIV and AIDS met with patients living with HIV at a range of hospital trusts throughout England, as well as numerous healthcare professionals.

Unless serious mental-health treatment shortfalls are addressed, the government will fail to achieve its target of zero transmissions by 2030, its report says.

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Source: BBC News, 5 March 2020

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