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Man suffered psychosis after Trust failed to inform him of steroids side-effects

A man who suffered a psychotic episode which lasted for weeks was not fully informed about potential extreme side-effects of taking steroids medication, England’s health service Ombudsman has found.

Andrew Holland was prescribed steroids in early January 2022 by Manchester Royal Eye Hospital after losing vision in his left eye and suffering a severe infection in his right eye.

The 61-year-old from Manchester was given the medication as treatment for eye inflammation, but soon began suffering from disrupted sleep and severe headaches.

These side-effects developed into more serious ones, including becoming aggressive, psychotic, and inexplicably wandering the street at different times of the day and night.

After several hospital visits due to his symptoms, Andrew attended Manchester University NHS Foundation Trust’s emergency department in mid-January with a severe headache and later became an inpatient.

He was diagnosed with steroid induced psychosis, with symptoms including hallucinations, insomnia and behaviour changes.

Though no failings were found with Manchester University NHS Foundation Trust in prescribing Andrew with steroids for the eye condition, the Ombudsman discovered a missed opportunity to fully inform him of potential extreme side-effects. He was therefore unable to make a fully informed decision about whether to take them or not.

The Trust apologised for an ‘unsatisfactory experience’. However, the Ombudsman found relevant guidelines were not followed. Moreover, there had been no acknowledgement of mistakes in communication about the side-effects. Nor was any attempt made to correct them.

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Source: PSHO, 10 April 2024

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Thousands of children unsure of gender identity ‘let down by NHS’, report finds

Thousands of vulnerable children questioning their gender identity have been let down by the NHS providing unproven treatments and by the “toxicity” of the trans debate, a landmark report has found.

The UK’s only NHS gender identity development service used puberty blockers and cross-sex hormones, which masculinise or feminise people’s appearances, despite “remarkably weak evidence” that they improve the wellbeing of young people and concern they may harm health, Dr Hilary Cass said.

Cass, a leading consultant paediatrician, stressed that her findings were not intended to undermine the validity of trans identities or challenge people’s right to transition, but rather to improve the care of the fast-growing number of children and young people with gender-related distress.

But she said this care was made even more difficult to provide by the polarised public debate, and the way in which opposing sides had “pointed to research to justify a position, regardless of the quality of the studies”.

“There are few other areas of healthcare where professionals are so afraid to openly discuss their views, where people are vilified on social media, and where name-calling echoes the worst bullying behaviour. This must stop.”

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Source: The Guardian, 10 April 2024

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England falls short on early cancer diagnosis goals

The ambition to diagnose cancer in its earliest stages in England is “seriously off target”, according to a new report by QualityWatch, a research programme by the Nuffield Trust and The Health Foundation

A rise in urgent referrals in recent years has contributed to delays, along with patients finding it difficult to raise concerns about cancer with GPs. Inequalities in diagnosis, particularly among young people, those in deprived areas, and patients from ethnic minorities, was also highlighted by researchers.

Experts said that while family doctors are “highly trained” to identify cancers, the issue remains a challenge in primary care because some symptoms can be vague.

The NHS Long Term Plan said the health service is aiming to diagnose 75% of cancer patients when the disease is in its early stages by 2028.

However, analysis of NHS data by QualityWatch said “our current course shows we are seriously off target”.

More than 320,000 people in England were diagnosed with cancer in 2021 – the equivalent of some 900 a day – the report said, with the number of urgent cancer referrals rising since 2009 to more than two million in 2020/21.

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Source: Medscape, 24 April 2024

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Rats and cockroaches among thousands of pests found at English hospitals

Thousands of pests including rats, cockroaches and bedbugs have been found at NHS hospitals in England as the health service buckles under a record high repair bill.

Hospital bosses are having to spend millions of pounds on pest control after discovering lice, flies and rodents in children’s wards, breast clinics, maternity units, A&E departments and kitchens, in the most graphic illustration yet of the dismal and dangerous state of the NHS estate.

NHS bosses have repeatedly warned ministers of the urgent need to plough cash into fixing rundown buildings in order to protect the safety and dignity of patients and staff. The maintenance backlog now stands at £11.6bn in England.

Figures obtained under freedom of information laws and reviewed by the Guardian suggest the NHS is struggling to cope with an army of pests plaguing decrepit hospitals.

There were more than 18,000 pest incidents in the last three years, the NHS data reveals. There were 6,666 last year, equivalent to 18 a day. The figures also show NHS bosses are having to spend millions of pounds calling out pest control and dealing with infestations, with £3.7m spent in the last three years.

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Source: The Guardian, 9 April 2024

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One in three health workers suffering ‘burnout’ amid NHS staffing crisis

Almost one in three NHS employees have had to take time off work suffering poor mental health in the past year, new research suggests.

The Unison union said its survey of 12,000 health workers shows the impact of a staffing crisis, with many suffering “burnout”.

Panic attacks, high blood pressure, chest pains and headaches are among the physical signs of stress reported by nurses, porters, 999 call handlers and other NHS staff who completed the survey.

The news comes as more than half of the mental health hubs launched for NHS workers after the pandemic have closed since last year, according to the British Psychological Society.

Unison said workforce pressures are taking a huge toll as staff tackle a waiting list backlog, with many struggling to look after their wellbeing.

Of those who were off with mental health problems, one in five said they did not tell their employer the real cause of their absence, mainly because they did not feel their manager or employer would be supportive.

The union said staff feel undervalued and frustrated, with many quitting for less stressful jobs that pay more.

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Source: The Independent, 8 April 2024

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Urology inquiry: Waiting lists greatest source of harm

A former consultant at the Southern Health Trust has told an inquiry into urology services that waiting lists are the "greatest source of patient harm".

The inquiry was established in 2021 and is examining the trust's handling of urology services prior to May 2020.

Aidan O'Brien became a consultant urologist in Craigavon Area Hospital in July 1992.

His work is at the centre of the inquiry.

Giving evidence on Monday, he said waiting list figures highlighted what "myself and my colleagues [have said] for decades" and described it as a "grossly inadequate service".

"If you look at four-and-a-half years for urgent surgery, it is appalling," he told the inquiry.

"I don't have a magic solution to the current situation, which is dire."

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Source: BBC News, 8 April 2024

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Sexual harassment of NHS staff widespread

NHS staff including ambulance workers, porters, nurses and cleaners have been shown pornographic images, offered money for sex, and assaulted at work, according to new research.

The widespread incidents of sexual harassment are revealed in a wide-ranging survey published by the Unison union on the first day of its annual health conference in Brighton.

In the study of more than 12,200 health workers, one in 10 reported unwanted incidents including being touched or kissed, demands for sex in return for favours, and derogatory comments.

Royal College of Nursing chief nurse Professor Nicola Ranger said: “These figures paint an incredibly disturbing picture."

In the survey, sexual assault was reported by 29% of respondents who had experienced harassment, while half said they have been leered at or been the target of suggestive gestures.

One in four who had been harassed said they have suffered unwelcome sexual advances, propositions or demands for sexual favours.

Half the staff had not reported sexual harassment to their employer, amid concerns of being considered “over-sensitive” or feeling complaints would not be acted on.

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Source: BBC News, 8 April 2024

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Black people who spot cancer symptoms are taking twice as long to be diagnosed

Black and Asian people who spot cancer symptoms are taking twice as long to be diagnosed as white people, a shocking new study shows.

Research by Bristol Myers Squibb (BMS) and Shine Cancer Support shows that people from minority ethnic backgrounds face an average of a year’s delay between first noticing symptoms and receiving a diagnosis of cancer.

These groups report more negative experiences of cancer care than white people, limited knowledge about the diseases and lack of awareness of support services, which all contribute to later diagnostic rates.

“In a year that’s revealed that the UK’s cancer survival lags behind comparable countries, I am saddened but unsurprised that people from minority ethnic groups face additional hurdles that delay their diagnosis.” said Ceinwen Giles, co-ceo of Shine Cancer Support.

“We know that catching cancer earlier saves lives, yet with year long waits for some people, collaborative efforts between health leadership, advocacy groups and the pharmaceutical industry are required.”

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Source: The Independent, 9 April 2024

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Plans for Royal Mail delivery cuts could risk patient safety, NHS leaders warn

NHS leaders have warned that Royal Mail’s plans to cut second-class deliveries to two days a week could risk patient safety.

The changes are part of wider measures announced by Royal Mail’s parent company, International Distributions Services (IDS), including cuts of up to 9,000 routes, which could take more than two years to implement, saving £300m a year. IDS has assured the Royal Mail workforce that there will be no compulsory redundancies and they will request only 100 voluntary redundancies.

In a letter sent to the Telegraph, executives from the NHS, Healthwatch England, the Patients Association and National Voices said the Royal Mail proposals would increase the cost of missed appointments, which already exceeds £1bn.

The letter said: “Provisional Healthwatch data suggest that more than 2 million people may have missed medical appointments in 2022-23 due to late delivery of letters, and this will only deteriorate under the proposed new plans.”

Sir Julian Hartley, the chief executive of NHS Providers, said the proposed delays were “extremely unhelpful”.

“It’s really important that patients be updated at the earliest opportunity on developments in their care and treatment,” he said.

“An efficient, punctual postal service remains a key part of that process. At a time when far too many patients already face long delays – the last thing any trust leader wants – anything that adds to that uncertainty, and possibly the worsening of conditions, would be extremely unhelpful.”

Jacob Lant, the chief executive of health charity National Voices, said: “The proposals being consulted on risk further delaying vital communications and worsening digital exclusion, therefore unfairly widening health inequalities. NHS mail must remain a priority service.”

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Source: The Guardian, 6 April 2024

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Long Covid blood clues could prompt future trials

People with long Covid have evidence of continuing inflammation in their blood, which could help understanding of the condition and how it may be treated, a UK study suggests.

It found the presence of certain proteins increased the risk of specific symptoms, such as fatigue, in people sick enough to need hospital treatment.

It is unclear whether milder cases of Covid have the same effect on the body.

A test remains a long way off - but the findings may prompt future trials.

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Source: BBC News, 8 April 2024

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New CQC inspections put on hold by ministers

The Care Quality Commission’s assessments of integrated care systems (ICSs) have been put on hold at the last minute, as the government declined to sign off on the process.

They were due to begin this month, following pilots in Birmingham and Solihull and Dorset ICSs, but the Care Quality Commission (CQC) has put the brakes on assessments elsewhere until it receives government approval.

Under the legislation brought in when ICSs were set up in 2022, the CQC can review and assess systems, but ministers must approve its methodology.

Interim chief inspector of adult social care and integrated care James Bullion wrote to integrated care board chiefs this week stating that, following discussions with the Department of Health and Social Care, the CQC had agreed to a “short delay… to allow for further refinements to our approach”.

He added: “In particular we have been working with NHS England on their strengthened approach to performance evaluation and rating of the ICB elements of the ICS which we will take into account as evidence for our scoring and reporting approach.”

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Source: HSJ, 8 April 2024

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Fire warnings yet to be fully dealt with at eight hospitals

Eight hospitals in England have fire safety warnings attached to them, with half in place since 2022 or earlier, HSJ can reveal.

All are enforcement notices issued by fire brigades when serious risks are not being managed. Issues raised include risk assessments, maintenance, and emergency routes.

There were more than 1,300 fires across the NHS trust estate in 2022-23, according to official estates data, which was an increase of 18% on the year before.

NHS Providers deputy chief executive Saffron Cordery said the figures highlighted the “urgent need” to address maintenance backlog – which includes fire safety – across the NHS estate. The overall backlog figure has been growing yearly and is approaching £12bn.

Ms Cordery said: “Greater capital investment is essential to enabling a safe environment for patients and staff.”

Rory Deighton from NHS Confederation said more than a decade of underinvestment was behind the “dilapidated” state of the NHS estate.

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Source: HSJ, 5 April 2024

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Tenfold rise in A&E patients waiting more than 24 hours for a bed

More than 150,000 patients had to wait a day in A&E before getting a hospital bed last year, according to new data.

Freedom of information data compiled by the Liberal Democrats from 73 hospital trusts – about half the total – found that the number of patients forced to wait more than 24 hours in A&E before a bed could be found for them has increased by tenfold since 2019. The majority of those forced to wait were elderly or frail, with two-thirds of the patients over the age of 65.

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Source: Guardian 8 April 2024

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‘I had no idea my baby was at risk’: The fight to raise awareness of pre-eclampsia

Pre-eclampsia affects between 1% and 5% of pregnant women, but more can be done to inform people about its dangers.

While pregnant with her son in 2015, Chipiliro Kalebe-Nyamongo’s pregnancy was generally smooth – until she reached about 33 weeks. She started to develop high blood pressure, and was admitted to hospital to be monitored. It was during this period that Kalebe-Nyamongo became concerned when she didn’t feel her baby’s movements as usual.

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Source: Guardian, 8 April 2024

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NHS testing initiative to eliminate hepatitis C in England by 2025

Thousands of people who are unknowingly living with hepatitis C in England could be identified and treated due to an expanded NHS testing initiative.

The initiative includes new liver scanning and portable testing units to be rolled out in communities where people may be at a higher risk of contracting the infection.

Also included in the initiative are testing events happening at GP surgeries and community outreach at drug and alcohol support services.

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Source: Guardian 8 April 2024

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Black women in England suffer more serious birth complications, analysis finds

Black women are up to six times more likely to experience some of the most serious birth complications during hospital delivery across England than their white counterparts, with the figures being described as “stark” and disheartening”, according to analysis.

Black women made up 26% of women who experienced the birth complication pre-eclampsia superimposed on chronic hypertension during delivery, despite making up just 5% of all deliveries across England, according to a Guardian analysis of NHS figures for 2022-23.

They were six times more likely to experience this pregnancy complication than their white counterparts, who made up 47.2% of these cases despite making up 70% of all deliveries.

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Source: Guardian, 8 April 2024

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Spire Healthcare: Death of NHS-funded private patient raises safety concerns

A woman died when a major private healthcare provider failed to transfer her to NHS intensive care quickly enough after she became critically ill.

Sabrina Khan said Spire Healthcare staff "should have known something was wrong" with her mother, Nafisa.

The BBC also obtained testimony from doctors - contracted by the company to work up to 168 hours a week - who say long hours could put patients at risk.

Spire Healthcare has apologised for failings in Nafisa Khan's care.

The death of Mrs Khan from east London is one of several deaths following surgery at Spire Healthcare, looked at by BBC Panorama.

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Source: BBC News, 8 April 2024

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Firefighters rescue gran, aged 83, after seven-hour ambulance delay

A gran was left lying outside in the cold facing a seven hour wait for an ambulance following a fall before finally being rescued — by firefighters. Betsy Hulme, 83, was left in agony with a broken hip when she tumbled in her back garden in Leek, Staffordshire.

Son Steve, 60, a former ambulance technician, dialled 999 only to be told it would be several hours until paramedics could get to them due to long handover delays. After a further three hours of Betsy waiting on cold concrete slabs while soaked in rain water, desperate Steve decided to drive to a nearby fire station to ask for help.

Fire crews then came to rescue to lift gran-of-four Betsy into her son's car who took her to hospital where she remains after undergoing a hip repair operation. Dad-of-two Steve, of Leek, has now branded emergency response times as “absolutely disgusting”.

He said: "It’s opened my eyes if I’m honest. It’s absolutely disgusting. I’m so grateful and thankful to the fire service - but it really isn’t their job. I can't remember in my time working as an ambulance technician going to someone and saying, 'I’m sorry it’s taken us twelve hours to get here'."

“It was never anywhere near those ridiculous times when I worked there until 2000 and something has gone drastically wrong since. I can't speak highly enough of the boys and girls who work in the NHS, it's the people above them. Its systemic change that's needed."

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Source: Wales Online, 4 April 2024

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USA: Hospitals' safety culture gap

Healthcare workers' perceptions of safety at their organisations is improving, though a gap still remains between senior leaders and front-line workers, according to a Press Ganey report.

Press Ganey surveyed more than 1 million employees from 200 health systems in the USA in 2023. The poll included 19 questions related to safety culture across three domains: prevention and reporting, pride and reputation, and resources and teamwork.

Three takeaways:

  1. Staff safety culture scores have risen from an all-time low of 3.96 (out of 5) in 2021 to 4.01 in 2023. This increase was largely driven by improvements around staff members' perceptions of resources and teamwork, including views on adequate unit staffing. "While these improvements are encouraging, there's still a lot of work to do," Press Ganey said. "Pre-pandemic rates were never the desired end state, and it’s important to note that nearly half (48.5%) of employees still have a low perception of safety culture." 
  2. Senior management reported the highest perceptions of safety culture at 4.53, while registered nurses and advanced practice providers reported the second- and third-lowest at 3.95 and 3.92, respectively. Security team members had the lowest perceptions of safety at 3.91.
  3. large gap was also seen between senior leaders and registered nurses regarding perceptions of workplace violence protections. Senior management gave their organizations a 4.30 out of 5 for having strong security measures in place to prevent violence, compared to just 3.36 for nurses. 

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Source: Becker's Hospital Review, 3 April 2024

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One of UK's best doctors died from a condition he was an expert in as he lay on understaffed hospital ward

One of the best doctors in the UK died on an understaffed Manchester hospital ward after falling sick with a condition he was an expert in treating, an inquest has heard.

Professor Amit Patel was among the ‘best doctors in the UK’, the first person in the country to be qualified in stem cell transplantation and cellular therapy, and intensive care medicine. He was also a beloved husband and father-of-two.

“He looked liked a corpse, 70 per cent of his blood was in his lungs, he was freezing cold and he looked like he was dead," his heartbroken wife told an inquest at Manchester Coroners Court. "I told my daughters, ‘daddy is dead’ – I didn’t have much hope he would be able to come out of that.”

Professor Patel's condition was being investigated by doctors at Wythenshawe Hospital, Manchester Royal Infirmary, and across the country. But, he was in the unimaginable position of being a nationally recognised expert in the illness. During his career, he had formed ‘national guidance’ on the illness and sat on the national multi-disciplinary panel to which the most serious cases, including his own, were referred.

 The court heard how he was experiencing the symptoms of hemophagocytic lymph histiocytosis (HLH) – a rare and life-threatening immune disorder where the body reacts inappropriately to a 'trigger’, such as an infection or cancer, and leads to inflammation. Patients can be predisposed to HLH by Still’s disease, another rare autoimmune condition also causing inflammation, which Professor Patel was suspected to have had.

Full article here.

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WHO launches new toolkit empowering health professionals to tackle climate change

Climate change presents one of the most significant global health challenges and is already negatively affecting communities worldwide. Communicating the health risks of climate change and the health benefits of climate solutions is both necessary and helpful. To support this, the World Health Organization (WHO) in collaboration with partners has developed a new toolkit designed to equip health and care workers with the knowledge and confidence to effectively communicate about climate change and health.

The toolkit aims to fill the gaps in knowledge and action among health and care workers – all those who are engaged in actions with the primary intent of enhancing health, as well as those occupations in academic, management and scientific roles. Despite their recognized trustworthiness and efficacy as health communicators, many health and care workers might not be fully equipped to discuss climate change and its health implications. This toolkit seeks to change that narrative.

“Health and care workers play a key role in addressing climate change as a health crisis. Their unique position enables them to raise awareness, advocate for policy changes, and empower communities to mitigate and adapt to climate change,” said  Dr Maria Neira, Director, Department of Environment, Climate Change and Health. “By engaging in dialogue and action, health and care workers can catalyse efforts to safeguard human health as well as ensuring a resilient and sustainable future for all.”

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Source: WHO, 22 March 2024

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Trust appoints chair to lead independent suicides review

A trust has appointed a chair to lead an independent review into dozens of suicides that was sparked by allegations of record tampering.

Following questions from HSJ about the review’s chair and terms of reference, Cambridgeshire and Peterborough Foundation Trust said Ellen Wilkinson, a former medical director at Cornwall Partnership FT and its current chief clinical information officer, would chair the review. 

The trust, which is looking for a substantive CEO following Anna Hills’ departure earlier this year, said the review “will not examine individual patient deaths but will take a thematic approach and look at the learnings we can take from these tragic incidents”.

The trust told HSJ the terms of reference for the review of more than 60 cases of patients who died by suicide since 2017 were still being finalised.

The decision not to investigate individual cases has been criticised by the whistleblower whose concerns prompted the review in the first place, as HSJ reported in October.

While an employee of the trust, Des McVey, a consultant nurse and psychotherapist, carried out an investigation in July 2021 into the case of 33-year-old Charles Ndhlovu, who died by suicide in 2017.

Mr McVey told HSJ his review found Mr Ndhlovu’s patient record had been tampered with and “his care plans were created on the day after his death” – a conclusion he stands by.

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Source: HSJ, 3 April 2024

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NHS watchdog to review patient safety at Glasgow A&E department

Patient safety in the Accident & Emergency unit at the Queen Elizabeth University Hospital in Glasgow will be reviewed by an NHS watchdog.

Healthcare Improvement Scotland (HIS) was first contacted by 29 A&E doctors in May 2023 warning that safety was being "seriously compromised".

HIS last month apologised for not fully investigating their concerns.

The review will consider leadership and operational issues and how they may have impacted on safety and care.

In the letter to HIS, the 29 consultants highlighted treatment delays, "inadequate" staffing levels and patients being left unassessed in unsuitable waiting areas.

They claimed this resulted in "preventable patient harm and sub-standard levels of basic patient care".

The doctors also said critical events had occurred including potentially avoidable deaths.

The consultants said repeated efforts to raise the issues with health board bosses "failed to elicit any significant response".

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Source: BBC News, 4 April 2024

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GMC will no longer launch FTP proceedings for ‘minor’ concerns

The General Medical Council (GMC) has relaxed its fitness to practise (FTP) processes for doctors so that ‘minor’ concerns such as ‘pushing a colleague’ are not taken to tribunal. 

In an update to its guidance, the regulator has given FTP decision makers and case examiners ‘more discretion’ to throw out complaints if they represent a lower risk to public protection. 

Concerns which are ‘minor in nature and did not impact patient care’ will fall under this guidance.

This is part of the GMC’s efforts to carry out ‘more efficient and proportionate investigations’ and to ‘minimise’ stress for doctors during the FTP process. 

Two examples of concerns which will no longer need to be investigated, if there are ‘no aggravating factors’,  are:

  • A doctor giving false details to a market research company, in order qualify for free products.
  • A doctor pushing a colleague out the way following a heated argument. 

The regulator has said: "Decision makers will now be able to weigh the full circumstances of a concern earlier in the fitness to practise process to assess the overall risk to public protection including to public confidence in the profession– meaning some concerns may not need to be investigated or referred to a tribunal."

However, the guidance, which covers concerns relating to violence and dishonesty, emphasises that allegations which raise a risk to public protection will continue to be investigated. 

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Source: Pulse, 4 April 2024

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Private ambulance service charging £99 opens to tackle patient delays amid concerns over a ‘two-tier’ system

A new private ambulance service will offer faster travel to A&E for those caught out by half-day waits for NHS ambulances, The Independent can reveal, in a sign of a growing “two-tier” health service.

MET Medical ambulance service will begin by charging £99 for a call-out, and could serve thousands of people a week, its chief executive Dave Hawkins has said.

Mr Hawkins, who is a paramedic himself, said he launched the service after seeing his elderly relatives wait too long for NHS ambulance services following falls.

It comes as waiting times for ambulance service reached a crisis point in the last year, with frail and vulnerable people waiting hours for an ambulance.

Ambulance response times hit record highs over 2022-23, with people who should have an ambulance within 20 minutes waiting an hour and 30 minutes in December 2023.

According to estimates from the Association of Ambulance Chief Executives, 34,000 patients were likely to have suffered harm due to these delays – this hit a high of more than 60,000 in December 2022.

MET Medical will still have to wait to deliver patients if they are seen as a priority, but it said its patients are likely to be lower priority and can be dropped at A&E without waiting for a handover.

Mr Hawkins said vulnerable patients waiting for an ambulance can wait up to 12 hours.

“It’s that moment when you’re out of options, it’s really a horrible place to be, particularly if it’s a loved one … It is a shame, like we’ve seen from the stats and everything, that the health service is failing us."

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Source: The Independent, 3 April 2024

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