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NHS doctors to stop issuing prescriptions for 35 minor medical conditions

THE NHS has announced plans to scrap prescriptions for 35 conditions in a bid to save the money it spends on drugs available over-the-counter (OTC). The body said it will no longer issue treatments for a range of minor conditions, such as diarrhoea, oral thrush and ailments associated with pain.

The health body will no longer prescribe drugs for 35 conditions listed below, which patients will have to purchase from their local pharmacy or supermarket going forward. The plan to dial back on prescriptions was devised with the aim of allocating funds to treatments for more serious conditions, according to the health body. Many of the conditions are able to resolve on their own, but prescriptions may still be issued if an exemption applies.

  • Acute sore throat
  • Conjunctivitis
  • Coughs, colds, and nasal congestion
  • Cradle cap
  • Dandruff
  • Diarrhoea
  • Dry eyes / sore tired eyes
  • Earwax
  • Excessive sweating
  • Haemorrhoids
  • Head live
  • Indigestion and heartburn
  • Infant colic
  • Infrequent cold sores of the lip
  • Infrequent constipation
  • Infrequent migraine
  • Insect bites and stings
  • Mild acne
  • Mild burns and scalds
  • Mild cystitis
  • Mild dry skin
  • Mild irritant dermatitis
  • Mild to moderate hay fever
  • Minor conditions associated with pain, discomfort and fever (e.g. aches and pain, headache, period pain, back pain)
  • Mouth ulcers
  • Nappy rash
  • Oral thrush
  • Prevention of tooth decay
  • Ringworm/athlete’s foot
  • Sunburn
  • Sun protection
  • Teething / mild toothache
  • Threadworms
  • Travel sickness
  • Warts and verrucae

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Source: Express, 20 May 2022

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Trust ‘reviewing hundreds of patients’ after failings discovered

The suicide of a woman with severe mental illness has prompted a review into the care of hundreds of other patients, according to her family.

Frances Wellburn, 56, was under the care of Tees, Esk and Wear Valley Foundation Trust’s community mental health team in York, which before the coronavirus pandemic had categorised her as “medium risk”.

This meant she should have had regular contact from the service, but an internal serious incident report into her death, seen by HSJ, found no contact was made with her for three months.

In June 2020 she required admission to an inpatient unit for three weeks, but she deteriorated again after being discharged and took her own life in August.

Her family have said Ms Wellburn was making a “good recovery” from episodes of psychosis prior to the pandemic, but the lack of support in the spring of last year had contributed to a major deterioration in her condition.

According to sister, Rebecca Wellburn, the trust’s director of nursing Elizabeth Moody confirmed in a meeting with the family that a wider review had now been launched into the care of hundreds of patients under its York-based community services.

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Source: HSJ, 28 April 2021

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Trust CEO asks for ‘scientific evidence’ on covid vaccine safety to reassure staff

NHS trust chief executives have told HSJ  they need more clarity the Pfizer-BioNTech covid vaccine is safe to reassure their worried staff. 

Trusts were told last week they need to be ready to start vaccinating their staff from early next month. On Tuesday, it was confirmed that they would initially be asked to use the covid vaccine produced by Pfizer and BioNTech, assuming it is granted a licence by the Medicines and Healthcare products Regulatory Agency.

Speaking at the HSJ Provider Virtual Summit, St George’s University Hospitals Foundation Trust chief executive Jacqueline Totterdell said there was a lot of “anxiety” around the vaccine among her staff. Leeds Community Healthcare Trust chief Thea Stein added leaders in her city feel “anxious and uncertain”.

Ms Totterdell said: “As a responsible officer for 9,000 staff, I also need to be clear that the vaccination is safe. That bit of narrative just needs to come out from the centre, about the reasons why they think it is safe.

“I think there is a lot of anxiety, and some of the polls we’ve done around south west London show that as little as 50 per cent of people are willing just to have it without any of that [assurance]."

Northumbria Healthcare FT chief executive Sir Jim Mackey, who also spoke at the summit, admitted he was “a bit surprised” by some staff who said they were not going to get the vaccine.

The former NHS Improvement chief added: “I think when it actually comes to it, and we get the messaging right about it, not just the responsibility for you but also your responsibility for the people you work with… then the vast majority of people will get it and take confidence in the fact that it’s been developed really quickly and effectively.

“These things don’t get signed off if they’re dangerous, so we need to embrace it as the thing that’s going to get us back to normal.”

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Source: HSJ, 26 November 2020

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Bullying among top surgeons sparks two national investigations

‘Horrifying and upsetting’ reports of bullying in prestigious heart units are being probed by national officials and professional leaders, HSJ can reveal.

Health Education England told HSJ it was “undertaking a national thematic review of training in cardiothoracic surgery”, while the Society for Cardiothoracic Surgery separately revealed it was investigating concerns about “bullying, harassment and undermining behaviour” in the specialty following high-profile recent cases in Newcastle and Wales.

Society president consultant surgeon Simon Kendall, who is based at James Cook University Hospital in Middlesbrough, told HSJ he has been made aware of wider problems beyond those identified in the North East and Wales.

Mr Kendall revealed allegations reported to the society have included people being shouted at in public, problems resulting from a “legacy culture of sarcasm and public humiliation”, and more personal disputes between individuals.

The consultant surgeon told HSJ: “The job is hard enough for all of us, without picking on each other and making it worse."

He added: “It’s the extended team that is affected by these behaviours and it will have an impact on patient safety and patient care.

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Source: HSJ, 1 April 2022

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Coroner raps trust for not realising woman was in ‘imminent danger’

A coroner has criticised an ambulance trust after it took nearly four hours to reach a woman who had taken an overdose. 

Taking the unusual step of publishing a prevention of future deaths report before an inquest had concluded, coroner for Gateshead and South Tyneside Terence Carney said “the real and imminent danger of [the deceased Maureen Wharton’s] admitted actions does not appear to have been appreciated and readily reacted to in a meaningful way”.

Ms Wharton called North East Ambulance Service Trust to say she was dying of cancer and had taken prescribed drugs, including an opioid-based medication and sleeping pills. She threatened to take more and later called back, appearing drowsier.

North East Ambulance Service graded the 61-year-old’s call as “category three”, which meant she should have received a response within two hours. It took three hours and 45 minutes for the ambulance service to access her flat, by which time she was already dead. 

Mr Carney pointed out no attempts had been made to identify family or other support for her, or to contact other agencies which could have responded. The inquest into her death is expected to conclude later this year. 

In a statement, NEAS said it has already made changes to safeguard patients in mental health cases, including implementing greater oversight in its control rooms, improving call transfers to crisis teams, mapping available local mental health services, introducing more staff training, and telling patients in a crisis but not at risk of physical harm about other, more appropriate, services. 

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Source: HSJ, 14 January 2020

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Deaths of two children spark ‘urgent’ investigations at leading trust

  • Five serious incidents, including the deaths of two children, spark “urgent” investigations at specialist trust
  • Great Ormond Street Hospital FT has linked the incidents partly to what it described as a “faulty” batch of a type of glue used to close wounds during surgery
  • Supplier says it followed the correct recall processes for the product

Five serious incidents, including the deaths of two children, have sparked ‘urgent’ investigations into the processes through which clinicians are alerted to potential safety concerns over medical products used on patients.

Great Ormond Street Hospital Foundation Trust has been investigating the incidents which happened between December 2020 and April 2021. The trust has linked the incidents partly to what it described as a “faulty” batch of a type of glue used to close wounds during surgery. The glue, called Histoacryl, is produced by B. Braun Medical Ltd, and the company issued three separate “field safety notices”, relating to different batches of the product, in March and April this year. The company has stressed that it followed the correct recall processes throughout.

According to a report to GOSH’s public board meeting on 29 September, Histoacryl has been used for the endovascular treatment of brain arteriovenous malformations for more than 30 years, but earlier this year batches of the product were identified as hardening less rapidly than expected. The trust told HSJ in a statement: “A comprehensive serious incident investigation has been carried out to determine the impact of the faulty glue on all patients treated with it.

“The investigation found that whilst the passage of glue through the intended vessel may have been contributory in some instances of harm, it was unlikely to be the sole or main factor. “Both patients who died had serious and complex medical conditions and the procedure to correct these always carries a high degree of risk which is discussed extensively with the families before any treatment takes place.”

Read full article here (paywalled)
Original source: Health Service Journal

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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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Staff in ‘near revolt’ over protective gear crisis

Lack of staff testing, workforce shortages and running out of personal protective equipment (PPE)are the three biggest concerns for trusts fighting the coronavirus outbreak, according to an HSJ chief executive survey conducted over the last 36 hours.

Thirteen of the 34 trust chief executives who responded to the snap survey, who were from trusts across England, also warned they would run out of intensive care capacity by next week as the number of coronavirus cases continue to rise.

The survey also revealed some trusts were already being forced to dilute safe staffing ratios and ration facilities. One chief warned: “We are preserving ventilation capacity by ensuring that only those who may survive are considered.”

However, the majority of respondents were supportive of system leaders’ guidance so far. Several respondents praised the “impressive pace and detail of the advice."

The three biggest areas of concern raised by the chiefs surveyed were:

  • Lack of staff testing, raised by 26 of the 34 respondents (77%);
  • Staff shortages, raised by 26 of the 34 respondents (77%); and
  • PPE shortages, raised by 23 of the 34 respondents (68%.

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Source: HSJ, 24 March 2020

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Wards at trust facing patient deaths inquiry downgraded to ‘inadequate’

Wards at a trust facing an inquiry over the deaths of vulnerable patients have been downgraded to ‘inadequate’ over fresh patient safety concerns. 

The Care Quality Commission said five adult and intensive wards across three hospitals run by Tees, Esk and Wear Valleys (TEWV) Foundation Trust “did not manage patient safety incidents well”. It also criticised the trust’s leaders for failing to make sure staff knew how to assess patient risk.

The watchdog rated the trust’s acute wards for adults of working age and psychiatric intensive care units as “inadequate” overall as well as for safety and leadership. The trust was also served a warning notice threatening more enforcement action if the patient safety issues are not urgently addressed. At the previous inspection in March 2020, the service was rated “good”.

TEWV said it has taken “immediate action” to address the issues, including a rapid improvement event for staff and daily safety briefings, and will also spend £3.6m to recruit 80 more staff. The trust’s overall rating of “requires improvement” remains unchanged after this inspection.

Brian Cranna, CQC’s head of hospital inspection for the North (mental health and community health services), said: “We found these five wards were providing a service where risks were not assessed effectively or managed well enough to keep people safe from harm."

“Staff did not fully understand the complex risk assessment process and what was expected of them. The lack of robust documentation put people at direct risk of harm, as staff did not have access to the information they needed to provide safe care."

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Source: HSJ, 26 March 2021

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Government to review the future of CQC and NHS England

NHS England, the Care Quality Commission and other arm’s length bodies will be subject to an efficiency and performance review led by the Cabinet Office.

The terms of a review into all government arm’s length bodies were set out this week, with minister Jacob Rees-Mogg insisting there is an “urgent need for public service reform”.

The ‘public bodies review’ programme will consider whether ALBs “should be abolished or retained”, should continue to deliver all their functions, and whether they have an “effective relationship” with their relevant departments.

Other ALBs include the National Institute for Health and Care Excellence, Health Education England, and the UK Health Security Agency.

A guidance document says: “The outcome of this work should see powers returned to accountable ministers, greater efficiency and where appropriate, the state stepping back both financially and from people’s lives…

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Source: HSJ, 29 April 2022

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‘Drug policy isn’t working... we need to try a completely different approach’

In a recent interview in The Times, former Chief Medical Officer, Professor Sir Harry Burns considers the symptoms of the country’s drug deaths epidemic. The total of 1,187 fatalities in 2018 represents 218 drug deaths per million of the population and a 27% year-on-year rise. The death rate is three times higher than in the UK as a whole and worse than that of the United States. Politicians should listen to people working on the front line to tackle rising deaths, according to Sir Harry. The trouble is, he says, “public policy tends to be made because someone has a clever idea which then gets picked up by a politician. Very few outcomes in society are determined by one thing.” He believes that health and social benefit on a national scale comes with incremental change over an extended period of time. 

When asked what one thing would you do to improve the health of the nation, Sir Harry said "Scotland has made enormous strides in improving patient safety using the concepts of improvement science in which front line staff have tested many different ideas and applied at scale the changes which they have seen work. It’s the principle of marginal gains that has been successful in sport. I would use this approach to improve wellbeing across society."

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Source: The Times, 20 July 2019

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Diversity in digital health ‘is a matter of patient safety’

Encouraging diversity in the NHS isn’t simply a matter of inclusion, it’s a matter of patient safety, delegates at the Healthcare Excellence Through Technology (HETT) conference have heard.

Speaking on 2 October, Heather Caudle and Ijeoma Azodo, both members of the Shuri Network, stressed the importance of diversity when developing new technologies like artificial intelligence (AI). Without a diverse and inclusive team, “unconscious bias” can be built into technology, ultimately putting patients at risk.

The next step in ensuring inclusive digital health solutions is including technology teams throughout the whole process, Heather Caudle, Chief Nursing Officer at Surrey and Borders Partnership NHS Foundation Trust said. “In health what we have done really well is developed multidisciplinary teams when looking at the patient,” she told the audience at ExCel London.

“I think our technology colleagues are the next member of our multidisciplinary teams. If you think about AI and these new ways of doing things, how are we including the creators and the developers when thinking about patient care?

“We will have unintended consequences of artificial intelligence that hard-wires things like unconscious biases, that we are only going to treat people that are this age, this weight, this colour, because that’s how we think.

“Having that diversity on the team will help.”

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Source: Digital Health, 2 October 2019

 

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New trust’s ‘inexperienced’ leadership criticised as CQC serves warning

The Care Quality Commission (CQC) has criticised a new trust’s leadership after issuing it with a warning notice to improve care in its two emergency departments.

The watchdog warned North Cumbria Integrated Care Foundation Trust that patients were not always receiving timely and appropriate care, while delayed transfers of care had “resulted in significant delays in admitting patients on to wards”.

The CQC — which carried out focused inspections at the trust in August and September after concerns were raised about risks to patient and staff safety — added there was evidence of “insufficient numbers of suitably qualified, skilled, competent and experienced clinical staff”.

The CQC also said there was a lack of an effective system to mitigate risks, including infection control in the emergency department escalation areas and on some medical wards.

Of the trust’s Cumberland Infirmary and West Cumberland hospitals, the CQC said: “People could not access the urgent and emergency care and medicine service when they needed them and often had long waits for treatment.”

The CQC’s inspection report, published today, also said the trust had an “inexperienced leadership team” which “did not always have the necessary skills and abilities to lead effectively”. It added there were “few examples of leaders making a demonstrable impact on the quality or sustainability of services”.

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Source: HSJ, 30 November 2020

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Patient Safety Learning launches Oscar, the friendly health chatbot

We’re living in an unprecedented time and facing new challenges. We’re asking questions we’ve never had to ask before – questions that differ according to our unique circumstances, concerns and needs.

With an increasingly complex health and social care system, Patient Safety Learning wants to continue working towards a future that is safe for both patients and staff.

It’s for this reason that we’ve launched Oscar, the friendly health chatbot. Available on the hub, Oscar answers the public’s question about their safety – or that of their family members and friends – during the coronavirus pandemic.

Oscar is not a diagnostic tool. We at Patient Safety Learning are not medical experts ourselves, but we want to connect patients to the best guidance currently in the public domain. This is what Oscar seeks to do, in pointing visitors to helpful and trustworthy answers, relevant to their specific situations.

Whether you’re a well adult seeking general information about how to stay safe from coronavirus, a concerned woman about to give birth and wanting to know your options, or a carer looking for advice, Oscar is here to help you find the answers you need. In time, as we see how the public uses Oscar – and especially as we hear your feedback – we plan to build on the range of information Oscar currently offers. 

Like everything else on the hub, Oscar is free to use.

Please do send us any feedback, including information you’d like Oscar to provide, by emailing feedback@pslhub.org

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Not wearing a mask a ‘serious conduct issue’, CEO warns staff

A London acute trust has told its staff they may not be paid for time at home self-isolating if it transpires they were not wearing a mask near someone with coronavirus.

Staff at Chelsea and Westminster Hospital Foundation Trust were told that if they have to stay at home self-isolating because they were not wearing a mask, that time would have to be taken as annual or unpaid leave.

Chief executive Lesley Watts told all staff in an email today, seen by HSJ, that a worker had tested positive for COVID-19, and that four staff members had spent more than 15 minutes with them “without appropriate [personal protective equipment]” and must all now isolate themselves at home for 14 days.

The trust considers it “a serious conduct issue not to wear a mask where you are putting colleagues or our patients at risk – this will be dealt with under our formal processes going forward”, Ms Watts said in the email.

“If you are sent home to isolate for two weeks because you have not worn a mask, I am now informing you that you will be required to take this as annual or unpaid leave. The four staff members “would not be having to go home to isolate if the use of face masks and social distancing had been in place appropriately”.

A Chelsea and Wesminster Hospital spokesman told HSJ: “The guidance around PPE has changed a number of times over the course of the pandemic and we felt it was important to be clear on the trust’s position and to reiterate how seriously we take staff and patient safety."

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Source: HSJ, 28 August 2020

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CQC guilty of maladministration in £200k fit and proper person case

The Care Quality Commission (CQC) has been found guilty of maladministration over its handling of a fit and proper person test complaint which led to a £200,000 investigation by an NHS trust. A Parliamentary and Health Service Ombudsman (PHSO) investigation identified “several instances of maladministration” in the CQC’s handling of a complaint by former consultant paediatrician David Drew. 

Ombudsman Rob Behrens has now written to the Health Secretary, NHS England, Chair of the Commons Health Committee Sarah Wollaston, and Chair of the Parliamentary and Constitutional Affairs Committee Bernard Jenkin with a copy of the PHSO investigation. In his letter. Mr Behrens said: “I believe this case exemplifies the damaging impact that poor handling of allegations can have on people’s faith in the ability of the CQC to identify and act on misconduct when whistleblowers come forward. This underlines the need for reform to the [fit and proper person] system and the recommendations from the Kark review to be swiftly implemented.”

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Source: HSJ, 24 July 2019

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Coronavirus reveals limits of AI health tools

Technology and healthcare companies are racing to roll out new tools to test for and eventually treat the coronavirus epidemic spreading around the world. But one sector that is holding back are the makers of artificial-intelligence-enabled diagnostic tools, increasingly championed by companies, healthcare systems and governments as a substitute for routine doctor-office visits.

In theory, such tools, sometimes called “symptom checkers” or healthcare bots,sound like an obvious short-term fix: they could be used to help assess whether someone has Covid-19, the illness caused by the novel coronavirus, while keeping infected people away from crowded doctor’s offices or emergency rooms where they might spread it.

These tools vary in sophistication. Some use a relatively simple process, like a decision tree, to provide online advice for basic health issues. Other services say they use more advanced technology, like algorithms based on machine learning, that can diagnose problems more precisely.

But some digital-health companies that make such tools say they are wary of updating their algorithms to incorporate questions about the new coronavirus strain. Their hesitancy highlights both how little is known about the spread of Covid-19 and the broader limitations of healthcare technologies marketed as AI in the face of novel, fast-spreading illnesses.

Some companies say they don’t have enough data about the new coronavirus to plug into their existing products. London-based symptom-checking app Your.MD Ltd. recently added a “coronavirus checker” button that leads to a series of questions about symptoms. But it is based on a simple decision tree. The company said it won’t update the more sophisticated technology underpinning its main system, which is based on machine learning.

“We made a decision not to do it through the AI because we haven’t got the underlying science,” said Maureen Baker, Chief Medical Officer for Your.MD. She said it could take 6 to 12 months before sufficient peer-reviewed scientific literature becomes available to help inform the redesign of algorithms used in today’s more advanced symptom checkers.

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Source: The Wall Street Journal, 29 February 2020

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Integrated care systems to be CQC-rated, says Hancock

Health secretary Matt Hancock has said integrated care systems (ICS) will be rated by the Care Quality Commission (CQC).

The government’s recent white paper for a new NHS bill did not discuss any change in the CQC’s legal framework to allow it to rate ICSs, which sparked uncertainty around how ICSs would be regulated.

However, speaking in the House of Commons today of the “crucial” role the regulator plays in rating hospitals, Mr Hancock said: “I think that it is vital that the CQC has a similar role when it comes to ICSs.”

The CQC has not confirmed what, if any, legal changes it is seeking. Currently, if the regulator wants to inspect how well a system is working, it must ask permission from the secretary of state to do so.

It has carried out around 25 inspections of systems since 2017, but has not issued ratings.

Giving evidence at a Parliamentary committee meeting earlier today, Sir Robert Francis, Healthwatch England chair, said: “A rating [from the CQC] that summarises the performance of the organisation to the public is a form of accountability. It doesn’t affect patient choice in quite the same way as a provider rating does, but it may be a way of explaining to the public how their system is doing.”

He added that if inspectors are “continually being directed to go to the places the secretary of state chooses” then they may not carry the authority or credibility of an independent process.

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Source: HSJ, 2 March 2021

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Self-harm in over-65s ‘needs post-pandemic focus’

Self-harm among the over-65s must receive greater focus because of the increased risks associated with the pandemic, a leading expert has said.

Loneliness, bereavement and reluctance to access GPs can all be causes in older adults, said Prof Nav Kapur, who has produced guidelines on the subject.

He warned that in over-65s, without the right help, self-harm can also be a predictor of later suicide attempts.

The NHS's mental health director said it had expanded its community support.

Claire Murdoch added that its services, including face-to-face appointments, had "continued for all who needed them", and 24/7 crisis lines had been established.

Over-65s are hospitalised more than 5,000 times a year in England because of self-harm and self-poisoning, figures obtained from NHS Digital show.

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Source: BBC News, 3 June 2021

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'One in a million’ matron is crowned RCN Nurse of the Year

Royal College of Nursing (RCN) member Tara Matare has won the coveted title of RCN Nurse of the Year 2019. She scooped the leadership category at the RCNi Nurse Awards before being crowned the overall winner. Tara has tackled short staffing, improved workplace culture and enhanced patient care at her ophthalmology unit at Whipps Cross Hospital in London. Over a 14-year mission to overhaul the unit, there have been a steady stream of challenges, including fighting ophthalmology’s corner to ensure it wasn’t overlooked in favour of higher-profile inpatient services and tackling an ingrained culture of bullying.  

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Source: Royal College of Nursing, 4 July 2019

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Women forced to wait more than five times ‘longer than men for heart failure diagnosis’

Women are forced to wait more than five times longer than men for a heart failure diagnosis, a new study has found.

Researchers discovered women are 96 per cent more likely to get an incorrect diagnosis of heart failure than men – attributing sharp disparities to such problems being wrongly viewed as “a man’s disease”.

The study, conducted by leading heart failure charity the Pumping Marvellous Foundation, found men said they waited an average of just over three and a half weeks to get a formal diagnosis after their first GP visit, but women waited just over 20 weeks instead.

Researchers warned such delays were linked to “poorer quality of life, financial losses, mental health issues and avoidable deaths” – adding that health professionals do not give heart failure the same attention and gravity as cancer and other diseases.

"One of them [GP] actually said, your symptoms are probably not to do with your heart because you’re young and you’re female. Even though my father had a heart condition," says Sarah, who was diagnosed at the age of 42.

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Source: The Independent, 27 August 2020

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UK’s biggest GP chain replacing doctors with less qualified staff

The UK's biggest chain of GP practices lets less qualified staff see patients without adequate supervision, an undercover BBC Panorama investigation has found.

Operose Health is putting patients at risk by prioritising profit, says a senior GP.

The company, with almost 600,000 NHS patients, is owned by US healthcare giant Centene Corporation. 

BBC Panorama sent undercover reporter Jacqui Wakefield to work as a receptionist at one of the UK company's 51 London surgeries. 

A GP working at the practice said they were short of eight doctors. The practice manager said they hired less qualified medical staff called physician associates (PAs), because they were "cheaper" than GPs.

Physician associates were first introduced by the NHS in 2003, so that doctors could deal with more complex patient needs. PAs are healthcare professionals who have completed two years of post-graduate studies on top of a science degree, as opposed to 10 years education and training for GPs. They support GPs in the diagnosis and management of patients, but should have oversight from a doctor.

Panorama gathered evidence that PAs were not being properly supervised at the Operose practice. The PAs told the undercover reporter they saw all sorts of patients, sometimes without any clinical supervision. They said the practice treated them as equivalent to GPs.

Prof Sir Sam Everington, a senior practising GP at an unconnected partner-run practice, reviewed BBC Panorama's undercover footage and said he was concerned for patient safety.

During the undercover investigation at the London practice, administrative workers also revealed a backlog of thousands of medical test results and hospital letters on Operose computer systems. 

One worker said they were tasked with getting through 200 documents a day, deciding which were important enough to be seen by a GP or pharmacist and which would be filed to the patient's records. One member of staff, worried about making mistakes said they sometimes used Google to help them work out what to do with the documents.

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Source: BBC News, 11 June 2022

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Autism diagnosis six years longer for girls, research finds

"I knew I always felt different, but I didn't know I was autistic."

For Rhiannon Lloyd-Williams, it would take until she was 35 to learn just why she felt different.

Now research by Swansea University has found it takes on average six years longer to diagnose autism in women and girls than in males.

A study of 400 participants found that 75% of boys received a diagnosis before the age of 10 - but only 50% of girls.

It also found the average age of diagnosis in girls was between 10 and 12 - but between four and six for boys.

Now charities in Wales are calling for greater investment into services to help better understand autism in females and speed up a diagnosis.

"The parents responding to the study said there was a marked impact on the girls mental health while waiting for a diagnosis," said Steffan Davies, who carried out the research.

"Girls represented in the study had a lot more pre-existing diagnosis, which suggests they are being misdiagnosed with anxiety disorders, eating disorders, and that tends to defer from the root diagnosis which tends to be autism."

Autism UK said this gender gap has long been an issue and is the down to the diagnosis criteria and research used, which has been focused around young boys.

"Many girls end up missing out on education, because the environment they're expected to learn in is just too overwhelming, while accessing healthcare can be difficult. Women are often not believed," said executive director Willow Holloway.

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Source: BBC News, 23 May 2022

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