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Woman with anorexia 'faced delays' before death

A woman described as a "high risk" anorexia patient faced delays in treatment after moving to university, an inquest has heard.

Madeline Wallace, 18, from Cambridgeshire, was told there could be a six-week delay in her seeing a specialist after moving to Edinburgh.

The student "struggled" while at university and a coroner said there appeared to be a "gap" in her care. Ms Wallace died on 9 January 2018 due to complications from sepsis.

A parliamentary health service ombudsman report into her death was being written at the time of Ms Wallace's treatment in 2017 and issues raised included moving from one provider to another and higher education.

Coroner Sean Horstead said Ms Wallace only had one dietician meeting in three months, despite meal preparation and planning being an area of anxiety she had raised.

Dr Hazel said she had tried to make arrangements with the Cullen Centre in Edinburgh in April 2017 but had been told to call back in August. The Cullen Centre said it could only accept her as a patient after she registered with a GP and that an appointment could take up to six weeks from that point.

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Source: BBC News, 10 February 2020

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‘Dr. Checklist’ Peter Pronovost gets chance to transform University Hospitals

The ghosts of medical errors haunt Dr. Peter Pronovost. Two deaths, both caused by mistakes. First, his father’s, who died as the result of a cancer misdiagnosis. Then a little girl, a burn victim who succumbed to infection and diagnostic missteps at the hospital where Pronovost worked early in his career.

Those deaths led Pronovost to pursue a medical career dedicated to patient safety, and to create the medical checklist he has become known for worldwide.

Now, he’s implementing his second act, at University Hospitals in the USA, as its Chief Transformation Officer, a job he has held since late 2018. His goal: To transform a $4 billion health care system by reducing shortcomings in medical care and increasing the quality of treatment.

The challenge fits Pronovost, says one of his former Johns Hopkins University professors, Dr. Albert Wu. “He’s one of the few people for whom the title might be appropriate, because his work has led to significant changes and innovations in how we deliver health care in the United States.

“He’s a once-in-a-generation guy.”

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Source: Cleveland.com, 9 February 2020

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Hospital patients die from starvation and thirst because nurses are over-stretched

It has been revealed that three patients a day are dying from starvation or thirst or choking on NHS wards. 

In 2017, 936 hospital deaths were attributed to one of those factors, with starvation the primary cause of death in 74 cases.The Office for National Statistics data reveals malnutrition deaths are 34% higher than in 2013.

Over-stretched nurses are simply too busy to check if the sick and elderly are getting nourishment. 

However, Myer Glickman from the ONS says the data is not conclusive proof of poor NHS care. He said:“There has been an increase over time in the number of patients admitted to hospital while already malnourished. This may suggest that malnutrition is increasingly prevalent in the community, possibly associated with the ageing of the population and an increase in long-term chronic diseases.”

Yet campaigners say too many vulnerable people are being “forgotten to death” in NHS hospitals and urgent action is needed to identify and treat malnutrition.

In a recent pilot scheme the number of deaths among elderly patients with a fractured hip was halved by simply having someone to feed them. Six NHS trusts employed a junior staff member for each ward tasked with getting 500 extra calories a day into them. More survived and the patients spent an average five days less in hospital, unblocking beds and saving more than £1,400 each.

It wasn’t just the calories though – it helped keep their morale up.

Because, as one consultant said: “Food is a very, very cheap drug that’s extremely powerful.”

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Source: Mirror, 4 February 2020

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Dying doctor warns of asbestos ‘hidden epidemic’ caused by NHS failures

A doctor and mother of two with just months left to live has warned of a “hidden epidemic” of asbestos-related cancers among NHS staff and patients because hospitals have failed to properly handle the toxic material.

Kate Richmond, 44, has spoken out to raise awareness after she won a legal case against the NHS for negligently exposing her to asbestos while she was working as a medical student and junior doctor.

An investigation by The Independent has learnt there have been 13 prosecutions linked to NHS breaches of regulations for the handling of asbestos since 2010, while 381 compensation claims have been made by NHS staff for work-related diseases, including exposure to asbestos, since 2013, costing the health service more than £26m.

According to data from the Health and Safety Executive, between 2011 and 2017, a total of 128 people working in health and social care roles died from mesothelioma, the same asbestos-related cancer which is killing Kate Richmond.

She described how maintenance staff removed asbestos ceiling tiles with no protective measures, allowing dust and debris to fall on to wards where patients were in their beds and staff were working. Managers at the Walsgrave Hospital in Coventry failed to heed warnings by workers that they were putting people at risk.

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Source: The Independent, 9 February 2020

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Teeth-whitening: Reports of illegal procedures up 26%

Reports of illegal teeth-whitening that could leave patients at risk of health problems including burns or lost teeth have increased, the BBC has found.

General Dental Council (GDC) figures showed a 26% rise in reports last year.

Teeth-whitening can only be performed legally in the UK by professionals registered with the GDC. One beauty school claimed to have provided "thousands" of candidates with illegitimate qualifications, an undercover investigation found. Failure to comply with the requirement to be registered can result in a criminal record and an unlimited fine.

Untrained beauticians using teeth-whitening kits have been known to cause tooth loss, burns and blisters.

Dr Ben Atkins, president of the Oral Health Foundation, said: "When things go wrong in dentistry, they can really go wrong. I've been that dentist with the full back up service when the patient's had that heart attack. It would be catastrophic for the patient and the person who's been trained and told it's legal to do it."

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Source: BBC News, 10 February 2020

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East of England Ambulance Service staff 'silenced' over bullying

Concerns have been raised that NHS ambulance staff are being "silenced" over bullying allegations.

Hundreds of East of England Ambulance Service (EEAS) employees reported bullying in 2018, while 28 non-disclosure agreements (NDAs) have been issued since 2016. The GMB union said the figures showed a "heavy-handed culture".

The service said it took bullying and harassment "extremely seriously" and had policies to prevent such behaviour.

EEAS faced scrutiny in November when it emerged three members of staff died in 11 days. One, Luke Wright, 24, is believed to have taken his own life. An independent investigation, which dealt in part with bullying claims, has been carried out with the results reported to the trust in January.

The 28 NDAs had been made in cases where bullying, harassment or abuse by colleagues had been reported, according to figures obtained under the Freedom of Information Act. These involved an individual agreement, often with a payment, which prevented the person speaking about their case.

In the latest staff survey from 2018, 23% of staff reported bullying, up from 21% in the previous year.

The GMB said NDAs were seen as a "method of silencing rather than resolving" and called on the trust to discuss more meaningful ways of dealing with problems.

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Source: BBC News, 10 February 2020

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Police investigating video of NHS staff allegedly assaulting elderly patient with Alzheimer’s

A police investigation has been launched into an alleged assault against an elderly patient with Alzheimer’s by NHS staff at the troubled East Kent Hospitals University NHS Foundation Trust.

The Independent can reveal nurses and carers at the William Harvey Hospital have been suspended after being filmed by hospital security staff for eight minutes allegedly holding down the man’s arms and legs as well as his face while they inserted a catheter.

The trust has confirmed it has launched an investigation and alerted police after the incident on 15 December on the Cambridge J ward at the William Harvey Hospital in Ashford. A spokesperson “apologised unreservedly” for the incident and said it was being treated with the “utmost seriousness”.

A whistleblower spoke out to The Independent about the incident, fearing it was being covered up by the trust after staff were told “don’t discuss it, don’t refer to it at all”.

The senior clinician said they had decided to go public after the “horrific” incident because of the trust’s toxic culture and concerns for the welfare of other patients on wards.

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Source: The Independent, 7 February 2020

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GP Manish Shah jailed for 90 sex assaults on patients

A GP has been given three life sentences for 90 sex assaults on female patients.

Manish Shah assaulted 23 women and a 15-year-old girl while working in London - carrying out invasive examinations for his own gratification. The Old Bailey heard he used Angelina Jolie and Jade Goody as examples to frighten patients about their health.

Judge Anne Molyneux described him as a "master of deception who abused his position of power". "You made up stories which got into heads and caused panic," she said.

Shah, from Romford, convinced his victims to have unnecessary checks between May 2009 and June 2013.

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Source: BBC News, 7 February 2020

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Patients harmed by delays at special measures trust

Patients were harmed at a Midlands trust because of delays in receiving outpatients and diagnostics appointments, the Care Quality Commission (CQC) has warned.

Following the inspection at Northern Lincolnshire and Goole Foundation Trust in September and October last year, the CQC has lowered the trust’s rating in its safety domain from “requires improvement” to “inadequate”. It warned there were insufficient numbers of staff with the right skills, qualifications and experience to “keep patients safe from avoidable harm”.

The report noted the trust had identified incidents in 2018 and 2019 where patients had come to harm due to delays in receiving appointments in outpatients, particularly in ophthalmology. Ten patients were found to have come to low harm, one patient moderate harm and two patients severe harm.

The CQC also issued a Section 31 letter of intent to seek further clarification in relation to incidents where patients had come to harm because of delays to receiving appointments in outpatients and diagnostic imaging, although it has confirmed the trust has provided details on how it is going to manage the issues raised. The watchdog said it would continue to monitor the issue.

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Source: HSJ, 7 February 2020

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Complete vaginal-mesh removals 'leaving material behind'

Dozens of women who thought they were having a "complete mesh removal" have discovered material has been left behind, the BBC's Victoria Derbyshire programme has been told.

Some women have been left unable to walk, work or have sex after having the initial vaginal-mesh implants.

Specialist surgeons say in some cases total or partial mesh removal can be beneficial. But some women said their symptoms had become worse. One was left suicidal.

Vaginal-mesh implants remain available on the NHS in England but only when certain conditions are met. In Scotland, the use of mesh was halted in 2018.

One paitent said her surgeon had promised her a "full mesh removal", but she has now been told more than 10cm (4in) could have been left behind. She had the mesh implanted several years ago to treat urinary incontinence and said she had woken after the surgery with "chronic pain in my legs, my groin and my hips". It is believed she suffered nerve damage.

A year later – after being told by one expert a mesh removal would be unlikely to resolve her pain – she found a surgeon who told her the implant could be completely removed. She had two operations, each taking her half a year to recover from, and was told there had been a full removal. But "within a few months" the pain began to return and her health deteriorated and she found out that only 5–8cm had been removed.

"My whole world turned upside down," she said, breaking into tears.

She has since been told by a separate specialist her form of mesh was one of the most difficult to remove and could cause significant nerve damage if not removed properly. She said she had never been told this by her surgeon.

The number of women affected is unknown but the Victoria Derbyshire programme understands there are at least dozens of such cases.

The Royal College of Obstetricians and Gynaecologists said in a statement that it took "each and every complication caused by mesh very seriously". It said: "Women must be informed of all options available and the benefits and risks of each so they can make the best decision about their care."

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Source: BBC News, 6 February 2020

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Contraception shortage 'causing utter chaos'

A shortage of contraception is causing chaos and risks unplanned pregnancies and abortions, doctors are warning.

Leading sexual health experts have written to ministers warning that the supply shortage of contraceptives is beginning to lead to serious problems across the UK.

A number of daily pills and a long-acting injectable contraceptive are thought to be affected, including Noriday, Norimin and Synphase. The problem follows a shortage of hormone replacement therapy for menopausal women last year.

It is unclear how many women use these types of contraception - overall around three million women take daily pills, and more than 500,000 use long-acting contraception, such as coils, implants and injections.

The Royal College of GPs said its members were doing their best to help women find alternatives - there are many different types of daily pill available.

Faculty president Dr Asha Kasliwal said; "We are aware that women are sent away with prescriptions for unavailable products and end up lost in a system. This is causing utter chaos."

The faculty has teamed up with the Royal College of Obstetricians and Gynaecologists and the British Menopause Society to write to ministers, asking them to set up a working group to address the problems. The letter warns women are becoming distressed by having to find alternative products that might not necessarily suit them or go without contraception altogether.

It said this was affecting the "physical and mental wellbeing of girls and women" and could lead to a "rise in unplanned pregnancies and abortions".

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Source: BBC News, 7 February 2020

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Report highlights ‘toxic’ risk of beta blocker to prevent overdose deaths

The toxicity of a commonly prescribed beta blocker needs better recognition across the NHS to prevent deaths from overdose, a new report warns today.

The Healthcare and Safety Investigation Branch (HSIB) report focuses on propranolol, a cardiac drug that is now predominately used to treat migraine and anxiety symptoms. It is highly toxic when taken in large quantities and patients deteriorate quickly, making it difficult to treat. The investigation highlighted that these risks aren’t known widely enough by medical staff across the health service, whether issuing prescriptions to at risk patients, responding to overdose calls or carrying out emergency treatment.

Dr Stephen Drage, ICU consultant and HSIB’s Director of Investigations, said: “Propranolol is a powerful and safe drug, benefitting patients across the country. However, what our investigation has highlighted is just how potent it can be in overdose. This safety risk spans every area of healthcare – from the GPs that initially prescribe the drug, to ambulance staff who respond to those urgent calls and the clinicians that administer emergency treatment."

The report also emphasises that there is a link between anxiety, depression and migraine, and that more research is needed to understand the interactions between antidepressants and propranolol in overdose.

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Source: HSIB, 6 February 2020

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NHS England urgently appeals to GPs to staff triage service

A key element in the new covid-19 response service run by NHS 111 urgently needs more doctors, NHS England has said.

The national covid-19 clinical assessment service, or CCAS, serves a cohort of patients with coronavirus symptoms deemed by 111 as needing a clinical assessment over the phone or online.

An email to GPs from NHSE’s primary care directors on Friday evening said: “We urgently need more GPs help to staff this service, especially as covid-19 cases increase over coming days, because of your expertise and experience.”

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Source: HSJ, 6 April 2020

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‘Culture of blame’ found at troubled health trust

The former police chief who investigated mental health services in a crisis-hit health board was “shocked” by the poor working relationships and “blame shifting” he uncovered.

David Strang, who led the independent inquiry into the issues in NHS Tayside, said staff felt isolated and unsupported and people complained about each other’s practices without coming together to sort the issues out.

He described asking staff questions based on information he had received and being met with the response: “Who told you?” He added: “A lot of staff felt there was a real blame culture and that risk and blame fell to the front line.”

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Source: 6 February 2020, The Times

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Mental health: 'Urgent action needed over epidemic'

The new executive must act urgently if it is to "divert the current mental health epidemic among young people", Northern Ireland's children's commissioner has said.

Koulla Yiasouma said progress in implementing recommendations in a report on children and young people's mental health services, produced 12 months ago, had been "too slow". 

The stark read captured the scale of youth mental health problems in Northern Ireland. The report found that young people are waiting too long to ask for help and even longer to access the right support.

Health Minister Robin Swann said his aim was that young people do not wait longer than nine weeks to see a CAMHS (child and adolescent mental health services) professional."I take the mental health and wellbeing of our children and young people very seriously and I am committed to working with my colleagues in a new executive working group on mental well-being, resilience and suicide prevention," he said.

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Source: 6 February 2020

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Hospital whistleblower raised alarm over doctor seen injecting himself

A whistleblower raised the alarm over patient safety at West Suffolk Hospital because of concerns about the behaviour of a doctor who had been seen injecting himself with drugs, the Guardian has revealed.

The incident had already prompted internal complaints from senior staff at West Suffolk hospital, but the whistleblower decided to take matters a step further when the same doctor was later involved in a potentially botched operation. The whistleblower then wrote to relatives of a dead patient and urged them to ask questions about the conduct of the doctor and his background.

When they did this, the hospital launched a widely criticised “witch-hunt” in an attempt to find out the identity of the leaker.

The doctor’s drug use, which the trust has never acknowledged until now, helps explain why it demanded fingerprint and handwriting samples from staff – tactics which the NHS regulator roundly condemned in a hard-hitting report last week.

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Source: Guardian, 5 February 2020

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Coronavirus: Every hospital in England must create secure zones for patients

All NHS hospitals in England have been ordered to create secure areas for coronavirus testing to “avoid a surge in emergency departments”, according to a leaked NHS letter.

Hospitals have been told to create “coronavirus priority assessment pods”, where people will be checked for the virus, which will need to be decontaminated each time they are used.

The letter, seen by The Independent and dated 31 January, instructs all chief executives and medical directors to have the pods up and running no later than Friday 7 February.

It comes as the global death toll from the virus has reached 565 with around 28,000 infected.

One hospital chief executive told The Independent he believed the requirement was “an overreaction”, adding: “I think we should be sending teams out to swab in patients homes as the advice is to stay at home and self-manage as with any other flu".

In the letter, Professor Keith Willett, who is leading the NHS’s response to coronavirus, told NHS bosses: “Plans have been developed to avoid a surge in emergency departments due to coronavirus. “Although the risk level in this country remains moderate, and so far there have been only two confirmed cases, the NHS is putting in place appropriate measures to ensure business as usual services remain unaffected by any further cases or tests of coronavirus.”

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Source: 5 February 2020

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Paterson scandal: Is the NHS learning from mistakes?

Shipman, Mid Staffordshire, Morecambe Bay, and now Ian Paterson, the breast surgeon that performed botched and unnecessary operations on hundreds of women. The list of NHS-related scandals has got longer. It's tempting to say the health service has not learned lessons even after a string of revelations and reviews. But is that fair? asks BBC Health Editor Hugh Pym.

The inquiry, chaired by Bishop Graham James, makes clear there were failings at every level of a dysfunctional health system when it came to patient safety.

The public and private health systems did not compare notes about suspicious behaviour by a consultant. Staff working with Paterson thought that his surgical methods were unusual but, perhaps cowed by being ignored after raising concerns, kept their heads down. Add to that the power and status of a surgeon in the medical world and, in the words of the report, Paterson was "hiding in plain sight".

So could it happen again?

James says it's clearly impossible to eliminate the activities of determined criminals in any profession. He acknowledges that some improvements have been made on policing. But he says that a decade on from the Paterson scandal, he is not convinced that medical regulators, with a combined budget of half a billion pounds a year, are doing enough collectively or collaboratively to make the system safe for patients.

The review chair notes tellingly that while regulators spoke of major improvements which should identify another Paterson, some doctors and nurses had told the inquiry that it was "entirely possible that something similar could happen now".

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Source: BBC News, 4 February 2020

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Scotland's A&E waiting times hit record high

A&E waiting times have hit a record high, as more than 1,000 people waited at least 12 hours to be seen by a doctor for the first time since records began.

Official statistics released yesterday show the proportion of people left waiting more than eight and 12 hours in December were at the worst level for a single month since records started in 2007. Patients who were seen within the four-hour waiting time target also reached the lowest level on record.

Scottish Conservatives health spokesman Miles Briggs described the figures as "an utter disaster".

Mr Briggs said: "Patients are waiting in pain, discomfort and distress which in turn significantly affects staff."

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Source: The Telegraph, 4 February 2020

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The Chinese doctor who tried to warn others about coronavirus

In early January, authorities in the Chinese city of Wuhan were trying to keep news of a new coronavirus under wraps. When one doctor tried to warn fellow medics about the outbreak, police paid him a visit and told him to stop. A month later he has been hailed as a hero, after he posted his story from a hospital bed.

It's a stunning insight into the botched response by local authorities in Wuhan in the early weeks of the coronavirus outbreak.

Dr Li was working at the centre of the outbreak in December when he noticed seven cases of a virus that he thought looked like SARS - the virus that led to a global epidemic in 2003. On 30 December he sent a message to fellow doctors in a chat group warning them about the outbreak and advising they wear protective clothing to avoid infection. What Dr Li didn't know then was that the disease that had been discovered was an entirely new coronavirus.

Four days later he was summoned to the Public Security Bureau where he was told to sign a letter. In the letter he was accused of "making false comments" that had "severely disturbed the social order". "We solemnly warn you: If you keep being stubborn, with such impertinence, and continue this illegal activity, you will be brought to justice - is that understood?" 

He was one of eight people who police said were being investigated for "spreading rumours".

At the end of January, Dr Li published a copy of the letter on Weibo and explained what had happened. In the meantime, local authorities had apologised to him but that apology came too late.

For the first few weeks of January officials in Wuhan were insisting that only those who came into contact with infected animals could catch the virus. No guidance was issued to protect doctors.

"A safer public health environment… requires tens of millions of Li Wenliang," said one reader of Dr Li's post.

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Source: BBC News, 4 February 2020

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Ian Paterson: Surgeon wounded hundreds amid 'culture of denial'

A culture of "avoidance and denial" allowed a breast surgeon to perform botched and unnecessary operations on hundreds of women, an independent inquiry has found.

The independent inquiry into Ian Paterson's malpractice has recommended the recall of his 11,000 patients for their surgery to be assessed.

Paterson is serving a 20-year jail term for 17 counts of wounding with intent. One of Paterson's colleagues has been referred to police and five more to health watchdogs by the inquiry.

The disgraced breast surgeon worked with cancer patients at NHS and private hospitals in the West Midlands over 14 years.

His unregulated "cleavage-sparing" mastectomies, in which breast tissue was left behind, meant the disease returned in many of his patients. Others had surgery they did not need - some even finding out years later they did not have cancer.

Patients were let down by the healthcare system "at every level" said the inquiry chair, Bishop of Norwich the Rt Revd Graham James, who identified "multiple individual and organisational failures".

One of the key recommendations from the report is that the Government should make patient safety a the top priority, given the ineffectiveness of the system identified in this Inquiry. 

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Source: BBC News, 4 February 2020

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Surrey hospital trust becomes first in country to appoint nurse to prevent patient falls

A Surrey hospital trust has become the first in the country to appoint a nurse dedicated to preventing patient falls and medication mix-ups.

The consultant nurse has been appointed by Ashford and St Peter's (ASP) Hospital NHS Foundation Trust to reduce the number of patients who are injured while being treated at its sites.

This includes looking at ways to reduce the amount of people who fall over, suffer with venous thromboembolism or experience tissue damage while in hospitals in north west Surrey.

The trust says the harms prevention nurse will be the first in the country hired for such a role and will also work with the team who look at incidents of medication mix-ups and mistakes.

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Source: Surrey Live, 4 February 2020

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Doctors in row with HSE over claims children's transgender care is 'unsafe'

A number of doctors have claimed a service under which adolescents with gender dysphoria can be given puberty-suppressing hormone blockers is "unsafe" and must be immediately stopped, but their concerns were suppressed.

The service is provided in Ireland by flying in two clinicians from an NHS trust in London to run clinics at Crumlin Children's Hospital. But the Irish Independent has learned at least three doctors working in the gender area expressed grave concerns over the service provided by the Tavistock and Portman NHS Foundation Trust at Crumlin.

The concerns over standards of clinical care and governance were raised at a meeting of doctors and hospital officials in Crumlin last March. These included that children had been started on hormone treatment when they did not appear to be suitable. However, the issues raised and calls by the doctors for the service to be "terminated with immediate effect" were omitted from draft minutes of the meeting.

News of their concerns comes days after it emerged a lawsuit was being taken by a former nurse, a parent, and a former patient against the trust in the London High Court. The action is challenging the clinic's practice of prescribing hormone blockers and cross-sex hormones to children under the age of 18.

The trust has also been hit by a series of resignations by psychologists amid disquiet about the alleged "over-diagnosis" of gender dysphoria.

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Source: Irish Independent, 3 February 2020

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Prime Minister urged to give NHS 100 new hospitals plus an extra £7bn a year

NHS leaders have urged Boris Johnson’s government to build 100 new hospitals and give the service an extra £7bn a year for new facilities and equipment. They want the Prime Minister to commit to far more than the 40 new hospitals over the next decade that the Conservatives pledged during the general election.

So many hospitals, clinics and mental health units are dilapidated after years of underinvestment in the NHS’s capital budget that a spending splurge on new buildings is needed, bosses say. Too many facilities are cramped and growing numbers are unsafe for patients and staff, they claim.

Johnson has promised £2.7bn to rebuild six existing hospitals and pledged to build 40 in total and upgrade 20 others, although has been criticised for a lack of detail on the latter two pledges.

The call has come from NHS Providers, which represents the bosses of the 240 NHS trusts in England that provide acute, mental health, ambulance and community-based services.

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Source: The Guardian, 3 February 2020

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NHS hospitals bring in sleep pods to help tired staff take a break

Help is arriving for overworked NHS staff as a growing number of hospitals bring in sleep pods for doctors and nurses to grab power naps during their shifts.

Pods have been installed or are being trialled by a dozen hospitals in England. Royal Wolverhampton NHS trust was the first to try them, in June 2018. “Too many staff end up exhausted because they have long, busy, sometimes stressful shifts, often with little chance to grab a break because pressure on the NHS is so intense,” said Prof Steve Field, the trust’s chair.

“We know that doctors provide better, safer care when they are fresh and alert. We have found [the pods] to be very popular with staff and also very effective in helping them get more rest,” said Field, a former GP.

Dr Mike Farquhar, a consultant in sleep medicine at the Evelina children’s hospital in London, who has persuaded NHS chiefs to take staff slumber more seriously, said hospitals were finally taking practical action.

“Air traffic controllers are only allowed to work for two hours and then they must take a 30-minute break, because if they were tired and made a mistake, bad things could happen,” he said. “But in the NHS, where the pressure is often high and sustained, the problem is that the people delivering care will usually choose to prioritise everything else – especially patients – over themselves and sacrifice things like breaks and sleep.”

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Source: The Guardian, 3 February 2020

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