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Patients in need of hip and knee surgery left in agony for a year

Patients in need of a new hip or knee are increasingly being left in agony for more than a year, an investigation reveals.

The number of patients forced to endure such waits has risen by more than 50% in 12 months, NHS data shows.

Charities said that the findings were "devastating", with thousands of people left in pain and misery, with some left house-bound, and younger patients unable to work, as they waited for NHS help. 

The figures show that in 2018/19, 55,251 patients waited at least 18 weeks for hip and knee surgery – a more than doubling from 25,704 such cases in 2013/14.  In total, 2,889 patients were left waiting at least 12 months, up from 1,863 a year before, and 780 cases five years ago. 

Experts warned that even these figures from NHS Digital are an underestimate, as they only measure the wait from the point a hospital doctor decides that surgery is required, not from point of GP referral. 

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Source: The Telegraph, 22 February 2020

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Hospital ‘bed blocking’ numbers hit highest level since 2017

The number of patients stuck in hospitals because they could not be transferred is at its highest quarterly level since 2017, reversing years of progress amid ongoing crises in health and care services.

“Delayed transfers of care” – often known as “bed blocking” – rose in the mid-2010s as austerity hit council-run adult-care services, meaning hospitals were unable to discharge patients into the community.

The number of “delayed days” in the NHS increased from an average of 114,000 a month in 2012 to more than 200,000 in October 2016, before extra funding and higher council taxes brought the numbers back down.

But the latest NHS figures show the problem is returning. December 2019 saw 148,000 delayed days across England, 15% higher than the same month a year earlier. The combined figures for the last quarter of 2019 were the highest in two years.

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Source: The Guardian, 23 February 2020

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Scottish mesh implant women to be offered case reviews

Women in Scotland who have experienced complications following vaginal mesh surgery are to be offered an independent review of their case notes.

Mesh implants have been used to treat conditions some women suffer after childbirth, such as incontinence and prolapse. However, many women experienced painful, debilitating side effects.

Some of the women who have suffered complications met First Minister Nicola Sturgeon last November. She was told a number of them had understood the mesh would be completely removed but that had not happened, leaving some of the synthetic substance still attached.

After hearing about their experiences, Ms Sturgeon has now written to the women she saw, confirming that in the spring they will be given the chance to sit down with an independent clinician for a review of their case notes. That will be followed up by a report and possible referral to specialist care.

The case note review will initially only be offered to those who attended the first minister's meetings however, it may be offered more widely at a later date.

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Source: BBC News, 23 February 2020

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Regulating AI in health and care

In his latest blog post, Matthew Gould, CEO of NHSX, has reiterated the potential AI has to reduce the burden on the NHS by improving patient outcomes and increasing productivity. However, he said there are gaps in the rules that govern the use of AI and a lack of clarity on both standards and roles.

These gaps mean there is a risk of using AI that is unsafe and that NHS organisations will delay employing AI until all the regulatory gaps have been filled. Gould says, “The benefits will be huge if we can find the sweet spot” that allows trust to be maintained whilst creating the freedom for innovation but warns that we are not in that position yet.

At the end of January, the CEOs and heads of 12 regulators and associated organisations met to work through these issues and discuss what was required to ensure innovation-friendly processes and regulations are put in place.

They agreed there needs to be a clarity of role for these organisations, including the MHRA being responsible for regulating the safety of AI systems; the Health Research Agency (HRA) for overseeing the research to generate evidence; NICE for assessing whether new AI solutions should be deployed; and the CQC to ensure providers are following best practice.

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Source: Techradar, 13 February 2020

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The Paterson inquiry is a missed opportunity to tackle systemic patient safety risks in private healthcare

The Independent Inquiry into the issues raised by Paterson is yet another missed opportunity to tackle the systemic patient safety risks which lie at the heart of the private hospital business model, says David Rowland from the Centre for Health and the Public Interest in a recent BMJ Opinion article.

Although the Inquiry provided an important opportunity for the hundreds of patients affected to bear witness to the pain and harm inflicted upon them it fundamentally failed as an exercise in root cause analysis. None of the “learning points” in the final report touch on the financial incentives which may have led Paterson to deliberately over treat patients. Nor do they cover the business reasons which might encourage a private hospital’s management not to look too closely. 

He suggests that the Inquiry report threw the responsibility for managing patient safety risks back to the patients themselves in two of its main recommendations but that it should be for the healthcare provider first and foremost to ensure that the professions that they employ are safe, competent and properly supervised, and for this form of assurance to be underpinned by a well-functioning system of licensing and revalidation by national regulatory bodies.

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Source: BMJ Opinion, 20 February 2020

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Patients at risk in ‘crumbling’ mental health wards, NHS leaders warn

Patient safety is at risk in “crumbling” NHS mental health hospitals starved of the money needed to improve dilapidated buildings, new data has revealed.

Hundreds of vulnerable mentally ill patients are still being cared for in 350 old dormitory-style wards, 20 years after the NHS was told to provide all patients with en-suite rooms. A lack of funding to refurbish hospitals has also meant too many wards still have ligature points that patients can use to try to harm themselves.

NHS leaders said the lack of cash from the government meant they could not deal with warnings issued by the Care Quality Commission (CQC), the sector’s watchdog.

A survey of mental health trust leaders by NHS Providers has now found bosses are worried the state of psychiatric wards is undermining their ability to keep patients safe.

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Source: The Independent, 20 February 2020

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US medical center nurses to hold informational picket and strike vote for patient safety and a fair contract

Registered nurses at Queen of the Valley Medical Center (QVMC) in Napa, Calif, USA, will hold an informational picket followed by a vote to authorise a strike in an effort to raise patient care standards and win a fair contract, the California Nurses Association/National Nurses United, (CNA/NNU) has announced.

Nurses at QVMC will picket to highlight cutbacks and eroding patient care. Among the nurses’ top concerns is safe patient care, including safe staffing and dedicated staff for safe patient handling.

“After eight months of negotiations, it's time for Queen of the Valley nurses to bring our concerns to our community and let them know nurses are fighting to give them the best patient care,” said MaryLou Bahn, registered nurse in labour and delivery at QVMC and member of the bargaining team. “We’re fighting for adequate staffing levels because we refuse to put profits over the needs of our patients.”

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Source: National Nurses United, 20 February 2020

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NHS "took 18 months to help after suicide attempt"

Poor treatment and aftercare for people who self-harm or attempt suicide is putting their lives at risk, the Royal College of Psychiatrists says. Many patients treated in A&E for self-harm do not receive a full psychosocial assessment from a mental health professional to assess suicide risk.

Simon Rose, who has attempted suicide many times, told BBC News it once took 18 months to receive aftercare.

NHS England said reducing suicide rates was an "NHS priority".

Last year, UK suicide rates rose for the first time since 2013, with people born in the 1960s and 1970s being the most vulnerable. Experts are now calling for all self-harm patients to be offered a safety plan – an agreed set of bespoke activities and guidelines to help them deal with depressive episodes.

Dr Huw Stone, who chairs the patients' safety group at the Royal College of Psychiatrists, said patients, especially those under 30, were being systematically let down in their most vulnerable state.

"With hospital admissions for self-harming under-30s more than doubling in the last 10 years, there has never been a more important time to ensure patients are getting the care that they need," he said.

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Source: BBC News, 21 February 2020

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Scans of 1,800 patients reviewed after private contract suspended

Ultrasound scans for around 1,800 patients have had to be reviewed over concerns about the “quality and safety” of work carried out by two sonographers employed by an independent provider.

The two sonographers were employed by Bestcare Diagnostics. The company held an “any qualified provider” contract for non-obstetric ultrasound scans with Coastal West Sussex Clinical Commissioning Group (CCG) from April 2017.

This contract was suspended in September 2018 over what the CCG said were “quality issues”. However, new information came to light in spring 2019 and the CCG decided to review all 1,800 patients seen by the pair, who worked for the company between April and August 2018.

The CCG said scans for these patients were reviewed and, wherever possible, the patients were contacted. A second stage of the review will look at whether any harm was caused to the patients.

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Source: HSJ, 20 February 2020

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NHS Digital and PHIN launch consultation on next phase of Acute Data Alignment Programme

NHS Digital and the Private Healthcare Information Network (PHIN) have launched a consultation as part of the next phase of a programme to align private healthcare data with NHS recorded activity.

The consultation sets out a series of changes to how data is recorded and managed across private and NHS care, along with a series of pilot projects, based upon feedback from a variety of stakeholders. It aims to seek the views of private and NHS providers, clinicians, the public and other organisations with an interest in private healthcare and will be used to help shape the future changes.

The consultation, which has been launched following the publication of the Paterson Inquiry, will be hosted on the NHS Digital Consultation Hub.

Under the changes proposed in the Acute Data Alignment Programme (ADAPt), PHIN will share the national dataset of private admitted patient care in England with NHS Digital, creating a single source of healthcare data in England.

This recommendation has been supported by recommendations in the Paterson Inquiry to create a single repository for practice of consultants in private and public healthcare across England.

Health Secretary Matt Hancock said: “Regardless of where you’re treated or how your care is funded, everybody deserves safe, compassionate care. The recent Paterson Inquiry highlighted the shocking failures that can occur when information is not shared and acted upon in both the NHS and independent sector. We are working tirelessly across the health system to deliver the highest standards of care for patients. Trusted data is absolutely critical to this mission and the ADAPt programme will help improve transparency and raise standards for all.”

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Source: NHS Digital, 19 February 2020

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NHS to benefit from digital 'Redbook' app

As part of the NHS Digital Child Health programme, Personal Child Health Records or “Redbook” will receive a digital makeover.

NHS Digital has considered the limitations of the physical Redbook and decided that digitalisation is the way forward for parents to easily access important health and development information.

Nurturey has been evolving its product to align with NHS' Digital Child Health programme. It aims to be an app that can make the digital Redbook vision a reality and currently in the process of completing all the necessary integrations and assurances.

It is hoped that by using smart digital records, parents will be more aware of their child’s health information like weight, dental records, appointments and other developmental milestones.  

Tushar Srivastava, Founder and CEO of Nurturey, said:

“Imagine receiving your child's immunisation alert/notification on the phone, clicking on it to book the immunisation appointment with the GP, and then being able to see all relevant immunisations details on the app itself. As a parent myself, I see the huge benefit of being able to manage my child’s health on my fingertips. We are working hard to deliver such powerful features to parents by this summer.”

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Source: National Health Executive, 5 February 2020

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Abusive NHS patients to be banned from receiving non-emergency care

Patients who abuse NHS staff will be banned from receiving non-emergency care as new figures show more than one in four NHS staff have experienced harassment, bullying or abuse from patients, relatives or members of the public.

The annual survey of more than 560,000 NHS workers found one in seven staff (15%) had experienced physical violence in the last 12 months while 40,000 staff (7.2%) had faced some form of discrimination during 2019 – an increase from 5.8% in 2015.

A total of 13% of staff reported being bullied, harassed or abused by their own manager in the past 12 months and almost a fifth (19%) said they had experienced abuse from colleagues.

The health secretary Matt Hancock has written to staff condemning the abuse and warning assaults on NHS workers will not be tolerated. Under new plans NHS England said that from April NHS hospitals will be able to bar patients who inflict discriminatory or harassing behaviour on staff from receiving non-emergency care. Previously, individual NHS organisations could only refuse services to patients if they were aggressive or violent.

Hospitals will be required to act reasonably and take into account the mental health of the patient or member of the public.

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Source: The Independent, 19 February 2020

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Harry Richford inquest: 'Lives at risk' over locum doctor recruitment

Lives may be at risk unless the NHS reviews how stand-in doctors are recruited, a coroner has warned.

Harry Richford's death after a series of failings at a hospital in Margate, Kent, was ruled "wholly avoidable". An inquest heard he was delivered by an "inexperienced" locum doctor who was new to the hospital.

A national review into the recruitment, assessment and supervision of locums should be carried out, Christopher Sutton-Mattocks said in a report. The coroner wrote that particular emphasis should be considered upon the scope of locums' activities before they are left responsible for out-of-hours labour care.

He issued 19 recommendations to prevent future deaths, including a request that NHS England and the Royal College of Obstetricians and Gynaecologists consider such a review, warning "there may be a risk to other lives both at this trust and at other trusts in the future".

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Source: BBC News, 19 February 2020

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Health Foundation to explore impact of data analytics and technology

The Health Foundation will begin exploring the impact of data analytics and technology on health and care in the UK.

The independent charity has launched its Data Analytics for Better Health strategy, which aims to tackle real-world problems that affect people’s health and develop a greater understanding of the role that technology and data plays in daily life. The strategy sets out how the Health Foundation aims to help policymakers, practitioners and the wider public get to grip with “seismic changes” taking place in the health sector.

Dr Adam Steventon, Director of Data Analytics at the Health Foundation, said: “Data is being used to drive innovation in ways that can revolutionise health care, including early disease detection, easier access to care services and encouraging health promoting behaviours. But such technological advances also carry the risk of harm to patients. As a nation we need to advance our understanding of these fast-moving changes. This new programme of work will help us to do that, enabling us to explore how analytics and data-driven technology can create better heath and care for people across the UK.”

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Source: Digital Health, 6 February 2020

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Thousands of patients potentially harmed by undelivered NHS mail

The NHS has launched a patient safety inquiry after a private contractor failed to send more than 28,000 pieces of confidential medical correspondence to GPs. 

NHS bosses are trying to find out if any patients have been harmed after 28,563 letters detailing discussions at outpatient appointments were not sent because of a mistake by Cerner, an IT company. The letters should have been sent by doctors at Barnet and Chase Farm hospitals in north London to GPs after consultations with 22,144 patients between June last year and last month. However, a “clinical harm review” is under way after it was found they had not been dispatched.

The incident has prompted concern among GPs and patient representatives. “Patients who have attended these two hospitals will now be very worried about whether their care might have been compromised by this IT bungle”, said Rachel Power, the chief executive of the Patients Association.

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Source: The Guardian, 18 February 2020

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New tech allowing district nurses to digitally monitor wounds

A new app has been piloted in North East London to help district nurses document chronic wound management more efficiently. The tech has been used in community services and stores a catalogue of photographs to accurately document chronic wounds. 

District nurses can use the app on a smartphone – making it lightweight, portable and easy to clean. Using two calibration stickers placed either side of the wound, the app can scan it and capture its size and depth to build a 3D image. Nurses can then fill out further characteristics on the software such as colour, pain level, location and smell to give a full picture of the wound’s development.

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Source: Nursing Times,  12 February 2020

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Doctors using AI to predict heart attack risk more accurately

London doctors are using artificial intelligence to predict which patients with chest pains are at greatest risk of death. 

A trial at Barts Heart Centre, in Smithfield, and the Royal Free Hospital, in Hampstead, found that poor blood flow was a “strong predictor” of heart attack, stroke and heart failure. Doctors used computer programmes to analyse images of the heart from more than 1,000 patients and cross-referenced the scans with their health over the next two years. The computers were “taught” to search for indicators of future “adverse cardiovascular outcomes” and are now used in a real-time basis to help doctors identify who is most at risk.

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Source: Evening Standard, 15 February 2020

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Skin cancer apps ‘cannot be relied upon for accurate results’, study finds

Smartphone apps designed to detect the risk of skin cancer are poorly regulated and “frequently cannot be relied upon to produce accurate results”, according to a new analysis. They found the apps may cause harm from failure to identify potentially deadly skin cancers, or from over-investigation of false positive results such as removing a harmless mole unnecessarily.

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Source: Digital Health, 14 February 2020

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NHS Doctors bullied to the brink

The Doctors’ Association UK has compiled stories from 602 frontline doctors which expose a startling culture of bullying and overwork in the NHS.

The stories include:

  • a pregnant doctor who fainted after being forced to stand up for 15 hours straight and being denied water. The junior doctor was subsequently shouted at in front of colleagues and patients on regaining consciousness and told it was her choice to be pregnant and that ‘no allowances would be made’.
  • a doctor who told us that a junior doctor hung themselves in a cupboard whilst on shift and was not found for 3 days as no-one had looked for them. His junior doctor colleagues were not allowed to talk about his suicide and it was all ‘hushed up’.
  • a doctor who was denied a change of clothes into scrubs after having a miscarriage at work despite her trousers being soaked in blood.

Full press release  

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‘Shameful’ data reveals NHS treatment of minority ethnic staff

Five years after launching a plan to improve treatment of black and minority ethnic staff, NHS England data shows their experiences have got worse.

Almost a third of black and minority ethnic staff in the health service have been bullied, harassed or abused by their own colleagues in the past year, according to “shameful” new data.

Minority ethnic staff in the NHS have reported a worsening experience as employees across four key areas, in a blow to bosses at NHS England, five years after they launched a drive to improve race equality.

Critics warned the experiences reported by BME staff raised questions over whether the health service was “institutionally racist” as experts criticised the NHS “tick box” approach and “showy but pointless interventions”.

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Source: The Independent, 18 February 2020

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EFORT takes on the demanding implant and patient safety initiative

When orthopaedic surgeons plan a surgical procedure, they demand that safe implants be used. When a patient accepts to undergo surgery, he or she expects the implants used to be safe. When the manufacturer produces and delivers implantsto be used in patients, they take the implants through a meticulous investigation followed by an evaluation of the products by regulators and notified bodies, before the implant is released for free use on the European market by physicians. In this way, all “stakeholders” expect and desire to do their best to bring about safe implants that are used in surgery for patients, which fulfills patients’ expectations of receiving safe treatment.

However, history has shown that, although all participants in this process do their job to treat the patient safely, some implants may still unexpectedly fail. We need to know why this occurs and the trends associated with such failures, such as whether the implant or patient’s characteristics led to the problem or if there is some unforeseen reason that caused the implant to fail.

Incoming EFORT president Prof. Klaus-Peter Günther, of Dresden, Germany, has set up regular meetings to bring all 'stakeholders' in the safety of orthopaedic implants together to regularly discuss relevant issues related to safe implants used to safely treat patients. 

EFORT held the first such meeting, “EFORT Implant & Patient Safety Initiative. Inauguration Workshop,” on 21 January 21 in Brussels. Fifty participants from the EU Commission, notified bodies, regulators, patient organizations, European orthopaedic specialty societies, manufacturers and EFORT board participated in this first initiative. 

The next meeting on this initiative will be held on 10 June during the EFORT Congress in Vienna, Austria.

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Source: Orthopedics Today, 13 February 2020

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NHS Staff Survey 2019

Today the results of the National NHS Staff Survey 2019 are out. This is of the largest workforce surveys in the world with 300 NHS organisations taking part, including 229 trusts. It asks NHS staff in England about their experiences of working for their respective NHS organisations.

The results found that 59.7% of staff think their organisation treats staff who are involved in an error, near miss or incident fairly. While an improvement on recent years (52.2% in 2015) work is needed to move from a blame culture to one that encourages and supports incident reporting.

It also found that 73.8% of staff think their organisation acts on concerns raised by patients/service users. It is vital that patients are engaged for patient safety during their care and there is clear research evidence that active patient engagement helps to reduce unsafe care.

Patient Safety Learning has recently launched a new blog series on the hub to develop our understanding of the needs of patients, families and staff when things go wrong and looking at how these needs may be best met.

 

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Baby boy died from sepsis after doctors’ delay giving antibiotics

A three-month-old boy died from sepsis after ‘gross failures’ by medics to give him antibiotics until it was too late, an inquest ruled. Lewys Crawford died a day after he was admitted to the University Hospital of Wales in Cardiff with a high temperature last March. Jurors at Pontypridd Coroner’s Court said the failure of doctors to treat his illness with antibiotics until seven hours after his arrival had ‘significantly contributed’ to his death. They found the little boy died from natural causes contributed to by neglect in his care.

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Source: The Metro, 15 February 2020

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The NHS In England: Patient safety news roundup from Harvard Law

There is always a lot happening with patient safety in the NHS (National Health Service) in England. Sadly, all too often patient safety crises events occur. The NHS is also no sloth when it comes to the production of patient safety policies, reports, and publications. These generally provide excellent information and are very well researched and produced. Unfortunately, some of these can be seen to falter at the NHS local hospital implementation stage and some reports get parked or forgotten. This is evident from the failure of the NHS to develop an ingrained patient safety culture over the years. Some patient safety progress has been made, but not enough when the history of NHS policy making in the area is analysed.

Lessons going unlearnt from previous patient safety event crises is also an acute problem. Patient safety events seem to repeat themselves with the same attendant issues.

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Source: Harvard Law, 17 February 2020

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Not enough pharmacists are aware of the yellow card scheme

Every pharmacist must report adverse drug reactions using the yellow card scheme, says chair of the Community Pharmacy Patient Safety Group, Janice Perkins

Polypharmacy, when different medications are used by an individual at the same time, is becoming increasingly common because people are living for longer and with multiple different illnesses. One study, published in 2018 by the Oxford University Press, found that over half (54%) of those aged 65 years and above who took part in the study had two or more long-term conditions, for which they could have been taking a range of medicines.

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Source: Community Pharmacy News, 17 February 2020

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