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NI Health: Quarter of cancer patients diagnosed in A&E

More than a quarter of cancers in Northern Ireland are being diagnosed in hospital emergency departments, according to Cancer Research UK.

The study, published in The Lancet Oncology, was supported by NI Cancer Registry at Queen's University Belfast.

It looked at 857,068 cases diagnosed between 2012 and 2017 in six countries including Australia, Denmark and the UK.

Clare Crossey, 35, from Lurgan was diagnosed with acute myeloid leukaemia in February 2018 after being admitted to hospital as an emergency.

The 35-year-old mother-of-two, who is a domiciliary care assistant, suddenly became very unwell with symptoms including tiredness and bruising.

She told BBC News NI she had contacted her local health centre, where a GP told her she was being overly anxious.

Ms Crossey said she had panicked, fearing she may have leukaemia after looking up her symptoms on the internet.

"I had a feeling that things weren't right," she said.

"The doctor did not agree with my suspicions as they passed me the number of the Samaritans helpline, a prescription for beta blockers and told me to wait a week for blood tests."

She said: "I went to Craigavon's A&E, they did blood tests and within hours a consultant broke the news to me that I might have leukaemia."

The medical team told her that had she waited any longer to come to the emergency department, she could have died, said Ms Crossley.

Barbara Roulston, from Cancer Research UK, said the study confirmed too many people were only being diagnosed with cancer once their health had deteriorated to a point when they needed to go to their emergency department.

"We need to reduce the number of cancer diagnoses that are happening in this way," she said.

"That means renewed focus on early diagnosis and prevention through things like better awareness of symptoms, better uptake of screening programs and the way to do that is to get funding for the cancer strategy which was published recently.

"If we don't, the risk is that we will start to see cancer survival going backwards."

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Source: BBC News, 7 April 222

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Government’s obesity campaign called out for being 'ineffective' and 'irresponsible'

The Government’s national obesity campaign risked turning fat-shaming into "wilful political strategy", said two humanities researchers in a new paper published in Sociology of Health and Illness. The Tackling Obesity campaign, launched by the Government "to improve health and protect the NHS during the COVID-19 pandemic", was "unproductive", "ineffective", "irresponsible", and could have led to "fat-shaming", they said. Moreover, the Government "perpetuated the neoliberal view that good health is essentially a matter of individual achievement earned through lifestyle choices and behaviour" - ignoring "the multiple structural and socioeconomic factors that contribute to obesity".

Co-authors Dr Tanisha Spratt, lecturer in sociology in the School of Humanities and Social Sciences at the University of Greenwich, London, and Luna Dolezal, associate professor in philosophy and medical humanities at the University of Exeter, said they were using the Tackling Obesity campaign "as an illustration" to explore "the dynamics between fat shaming, neoliberalism, ideological constructions of health and the 'obesity epidemic' within the UK".

They said that fat shaming was a practice that "encourages open disdain for those living with excess weight [and] operates as a moralising tool to regulate and manage those who are viewed as 'bad' citizens". They regarded this as an example of "how the ideological underpinnings of 'health' have been transformed under neoliberalism". Fat shaming discourses that are often used as tools to promote 'healthy' lifestyle choices are "problematic", they said.

Prof Dolezal, a principal investigator on the Wellcome-funded Shame and Medicine project, also co-authored a paper published earlier this month saying that the health and care system "should be more sensitive to people's 'shame'".

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Source: Medscape, 13 October 2022

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400 excess deaths due to pulmonary embolism misdiagnoses, concludes independent investigation

Press release: London, UK, 8 December 2022

A new report published today has highlighted serious safety concerns relating to the misdiagnosis of pulmonary embolisms.[1] It states that there was a minimum of 400 deaths attributable to pulmonary embolism misdiagnosis from March 2021 to April 2022 in England and Wales, with deaths in some regions almost three times the national average.

This research has been carried out by Tim Edwards, an expert in risk management, and published by the charity Patient Safety Learning. Tim started this review following the premature death of his mother, Jenny Edwards, from a pulmonary embolism. He was concerned about the low quality of the investigation which took place following her death and the lack of assurance he received that any learning would be taken from this event.

The report highlights clear safety issues in relation to staff, training, and equipment. Concerns around resource gaps have also been expressed by the Royal College of Radiologists and its members.[2] The report also highlights evidence that the NHS is not applying pulmonary embolism guidance considered best practice in comparable European countries and sets out nine calls for action to improve pulmonary embolism care. Tim’s concerns were also highlighted in a House of Commons debate led by Halen Hayes, MP for Dulwich and West Norwood, on the 30 November 2022.[3]

Commenting on the report, Tim Edwards said:

"My research found that there are hundreds of people who, like my mother Jenny, died from pulmonary embolism following misdiagnosis. It is vital we learn from these deaths, and the errors that have occurred, so we can take action to improve pulmonary embolism care. By publishing this report, I hope to start a dialogue that leads to positive change, so others do not suffer the loss of a loved one as we have."

Helen Hughes, Chief Executive of Patient Safety Learning said:

“This new report highlights serious patient safety concerns relating to the diagnosis of pulmonary embolisms. Urgent action is now needed to ensure that guidelines and diagnostic processes are up to date and that clinicians have the resources they need to deliver safe and effective care. It is also vital that we increase awareness of the key symptoms of pulmonary embolisms among both healthcare professionals and the wider public. Patient Safety Learning are proud to be supporting Tim and his campaign for improvement in pulmonary embolism care and to reduce avoidable deaths.”

Notes to editors:

1. Independent Review of pulmonary embolism fatalities in England and Wales: Recent trends, excess deaths, their causes and risk of management concerns.

2. The Royal College of Radiologists report that 41% of clinical radiologists do not have the equipment they need, and that the UK has fewer scanners than most comparable OECD countries - 8.8 per million of population in the UK compared to 18.2 in France and 35.1 in Germany. They also raise that there is a high vacancy rate of clinical radiologists, 8%, with over 50% of vacancies unfilled for over a year. Data extracted from The Royal College of Radiologists. Clinical Radiology UK Workforce Census 2021 report. London: The Royal College of Radiologists, 2022.

3. Helen Hayes, MP for Dulwich and West Norwood, led an Adjournment Debate in the House of Commons on Wednesday 30 November 2022 highlighting patient safety concerns relating to the diagnosis of pulmonary embolisms. This was formally responded to by Helen Whately MP, Minister for Social Care at the Department of Health and Social Care. The full transcript can be found here.

4. Patient Safety Learning is a charity and independent voice for improving patient safety. We harness the knowledge, enthusiasm and commitment of healthcare organisations, professionals and patients for system-wide change and the reduction of harm. We support safety improvement through policy, influencing and campaigning and the development of ‘how to’ resources such as the hub, our free award-winning platform to share learning for patient safety.

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Suicidal and self-harming patients receive inadequate care due to overwhelmed A&E departments, doctors warn

A&E staff are unable to properly look after the most vulnerable mental health patients or treat them with compassion because emergency departments are so overwhelmed, top medics have warned.

An exclusive report shared with The Independent shows more than 40% of patients who needed emergency care due to self-harm or suicide attempts received no compassionate care while in A&E, according to their medical records.

The data, collated by the Royal College of Emergency Medicine (RCEM), prompted a warning from top doctor Dr Adrian Boyle that mental health patients are spending far too long in A&E – where they are cared for by staff who are not specifically trained for their needs – before being moved to an appropriate ward.

Dr Boyle, who is president of the RCEM, said there had been some progress in improving care for a “historically disadvantaged” group, but added: “Patients with mental health problems are still spending too long in our emergency departments, with an average length of stay of nearly 10 hours and this has not really improved.

“An emergency department is frequently noisy and agitating, the lights never go off and cannot be described as an environment that promotes recovery.”

When a patient goes to A&E after a self-harm attempt, they should receive an assessment by a clinician into the type of self-harm, reasons for it, future plans or further suicidal thoughts.

The college said it indicates a “significant gap” in the NHS’ ability to provide holistic care for mental health patients with complex needs and warned “urgent” improvements are needed.

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Source: The Independent, 25 March 2024

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Principles for good practice issued to protect patients online

Healthcare organisations including regulators, royal colleges and faculties have issued a set of principles to help protect patient safety and welfare when accessing potentially-harmful medication online or over the phone.

The jointly-agreed High level principles for good practice in remote consultations and prescribing set out the good practice expected of healthcare professionals when prescribing medication online.

The ten principles, underpinned by existing standards and guidance, include that healthcare professionals are expected to:

  • Understand how to identify vulnerable patients and take appropriate steps to protect them
  • Carry out clinical assessments and medical record checks to ensure medication is safe and appropriate
  • Raise concerns when adequate patient safeguards aren’t in place.

Charlie Massey, Chief Executive of the General Medical Council (GMC), said:

‘The flexibility of accessing healthcare online can benefit patients, but it is imperative these services do not impact on their safety, especially when doctors are prescribing high-risk medicines."

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Source: General Medical Council, 8 November 2019

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'Diabetes burnout': The mental health impact of diagnosis

"It's a full-time job that you can't quit. It's a massive burden that you didn't ask for, didn't expect."

Diagnosed with type 1 diabetes at the age of 19, Naomi, now 33, says she reached a point where she simply could not handle "the physical or mental challenges of diabetes any more", a condition known as "diabetes burnout".

About 250,000 people in England have type 1 diabetes, which means the body cannot produce insulin, the hormone that controls blood sugar levels. It can lead to organ damage, eyesight problems and - in extreme cases - limb amputation. But for many there is also a significant psychological impact of learning to manage the condition.

Naomi felt she could no longer bear testing her blood sugar levels many times each day to calculate how much insulin she needed to inject, even though she knew she was risking her long-term health and putting herself in extreme danger, at risk of developing diabetic ketoacidosis (DKA), which can lead to a coma. She became so ill she was admitted to an eating disorder unit even though she was not struggling to eat.

The head of the unit, Dr Carla Figueirdo, says of her diabetes patients: "These people are seriously unwell, seriously unwell. They are putting themselves at harm every day of their lives if they don't take their insulin."

Naomi's consultant at the Royal Bournemouth Hospital, Dr Helen Partridge, says the psychological impact of a diabetes diagnosis should not be underestimated. 

The hospital is hosting one of two NHS England pilot projects looking at how to treat type 1 diabetes patients whose chronic illness affects their mental health.

NHS England diabetes lead Prof Partha Kar says: "The NHS long-term plan commits strongly on getting mental and physical health together. If we do tackle these two together, it will help improve outcomes."

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Source: BBC News, 16 November 2020

 
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Shropshire baby deaths: Ockenden report delayed for second time

The publication of a report into failures of maternity care at an NHS trust has been delayed again.

Senior midwife Donna Ockenden has been investigating hundreds of cases in which mothers and babies may have been harmed at Shrewsbury and Telford Hospital NHS Trust (SaTh).

Her report had been due to be published on 22 March after being postponed from December.

In a letter to families, Ms Ockenden said that date "can no longer happen". She added it was down to "parliamentary processes" which have to happen before the final report can be published.

A written statement to Parliament on Tuesday by patient safety minister Maria Caulfield said the NHS had been working to get indemnity cover.

She said it would be to cover any potential legal action following the publication of the report and had been agreed in principle by the Treasury.

Ms Ockenden's team has been examining 1,862 cases and it is thought to be the largest ever review of maternity care in the NHS. Her interim report published in December 2020 found some mothers were blamed for their babies' deaths.

In her letter about the delay, Ms Ockenden said she and her team were "also very disappointed in the delay" and would be working to agree a new publication date.

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Source: BBC News, 9 March 2022

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Six NHS workers reported ‘every week’ for sexually harassing patient or colleague

Six NHS staff workers are typically reported every week in England for sexually harassing a patient or colleague, the Telegraph can reveal.

Nearly a fifth of English trusts have recorded a rise in reports of sexual harassment within their services since 2017, while millions have been spent by the NHS on legal claims specific to sexual abuse over the same time period, according to newly obtained data.

Health secretary Steve Barclay described the findings as “worrying” and urged NHS leaders to take “robust action in response to any such incidents in their organisation”.

Patient Safety Learning said the Telegraph's “deeply troubling” revelations demonstrated an abuse of the “significant power imbalance” that exists between vulnerable patients and their care providers.

“Healthcare professionals need to recognise the power they hold over patients,” said chief executive Helen Hughes. “Inappropriate behaviours undermine trust in healthcare system and the ability to deliver safe care.”

“Clinicians, managers and healthcare leaders have both a professional and moral responsibility to patients to ensure that there is a safe culture in healthcare settings and that misconduct is not tolerated," said Ms Hughes.

As part of its investigation into sexual harassment within the NHS, the Telegraph uncovered the case of a mentally incapacitated patient who was raped by her healthcare worker and subsequently fell pregnant. The healthcare worker, who is in his 30s, was recently jailed for eight months after pleading guilty to sexual activity with a mentally disordered female. 

Joe Matchett, an expert lawyer at Irwin Mitchell who has secured settlements for survivors of abuse, said his firm continues to “represent a number of patients subjected to terrible abuse at the hands of hospital staff who have betrayed their position of trust in the worst imaginable way”.

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Source: The Telegraph, 11 December 2022

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Nine in 10 professional organisations say doctors should have to register their financial interests

Nearly 90% of organisations representing doctors agree that the UK should have a mandatory and public register of doctors’ interests, a survey by The BMJ has found.

Last year the Independent Medicines and Medical Devices Safety Review, chaired by Julia Cumberlege, called for the General Medical Council (GMC) to expand its register to include a list of financial and non-pecuniary interests for all doctors.

That review investigated harmful side effects caused by the hormone pregnancy test Primodos, the anti-epileptic drug sodium valproate, and surgical mesh. One of its key conclusions was that patients had a right to know if their doctor had financial or other links with pharmaceutical or medical device companies.

The BMJ wrote to six faculties, 14 royal medical colleges, and the Academy of Medical Royal Colleges about such a register. It received responses from two faculties, 12 colleges, and the academy, a 71% response rate.

Of the organisations that responded, 13 (87%) agreed that there should be a mandatory and public register of doctors’ interests in the UK.

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Source: BMJ. 8 April 2021

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Trusts reveal thousands of new 12-hour waits

Several trusts have now started reporting thousands of 12-hour waits in their emergency departments, representing a huge difference to the numbers published nationally under a slightly different measure.

This year, trusts have started submitting data to NHS England on the number of patients waiting over 12 hours from time of arrival in ED, until discharge, admission or transfer. Many trusts are now reporting these statistics in their public board reports.

This is a slightly different measure to the publicly reported “trolley wait” figures, which count waits of over 12 hours from decision to admit until admission.

Experts have long argued the trolley wait measure does not capture the true problem of ED overcrowding and delayed care. The new data captures a far higher number of patients and has not been published nationally by NHSE.

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Source: HSJ, 2 August 2022

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Refusing Scottish help a 'grave error' in blood scandal, letter says

Hundreds of people with haemophilia in England and Wales could have avoided infection from HIV and hepatitis if officials had accepted help from Scotland, newly released documents suggest.

A letter dated January 1990 said Scotland’s blood transfusion service could have supplied the NHS in England and Wales with the blood product factor VIII, but officials rejected the offer repeatedly.

Large volumes of factor VIII were imported from the US instead, but it was far more contaminated with the HIV and hepatitis C viruses because US supplies often came from infected prison inmates, sex workers and drug addicts who were paid to give blood but not screened.

The death of scores of people with haemophilia and blood transfusion patients and the infection of thousands of others across the UK in the contaminated blood scandal has been described as the worst health disaster to hit the NHS.

The latest document was released under the Freedom of Information Act to campaigner Jason Evans, whose father died in 1993 having contracted hepatitis and HIV. In it, Prof John Cash, a former director of the Scottish Blood Transfusion Service, said the decision not to use Scotland's spare capacity to produce Factor VIII for England was "a grave error of judgement".

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Source: The Guardian, 3 January 2020

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Baby died on maternity unit months after staff warned it was unsafe

A baby died during birth because of systemic errors in one of Britain's largest NHS hospitals, months after staff had warned hospital chiefs that the maternity unit was “unsafe”, an inquest has found.

A coroner ruled that neglect by staff at Nottingham University Hospitals Trust contributed to the death of baby Wynter Andrews last year.

She was delivered by caesarean section on 15 September after significant delays. Her umbilical cord was wrapped around her neck and leg, resulting in her being starved of oxygen.

In a verdict on Wednesday, assistant coroner Laurinda Bower said Wynter would have survived if action had been taken sooner, criticising the units “unsafe culture” and warning that her death was not an isolated incident.

Wynter’s mother, Sarah Andrews, called on the health secretary, Matt Hancock, to investigate the trust’s maternity unit.

She said: “We know Wynter isn’t an isolated incident; there have been other baby deaths arising because of the trust’s systemic failings.  She was a victim of the trust’s unsafe culture and practices.”

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Source: The Independent, 7 October 2020

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‘Get a lift to hospital,’ ambulance trust tells patients with suspected heart attacks

Ambulance trusts have begun asking patients with heart attacks and strokes to get a lift to hospital with family or friends instead of waiting for an ambulance, because of high covid absences and ‘unprecedented’ surges in demand, HSJ has learned.

An internal note at North East Ambulance Service Foundation Trust said that where there was likely to be a risk from the delay in an ambulance reaching a patient, call handlers should “consider asking the patient to be transported by friends or family”.

This applies to calls including category two, which covers suspected strokes and heart attacks, according to the note seen by HSJ.

It said call handlers should “consider all forms of alternative transport” for patients. 

The note from medical director Mathew Beattie gives the example of a person with chest pain who would normally get a category 2 response – with a target of reaching them within 18 minutes – but where the ambulance response time would be two hours.

In the message to staff, Dr Mathew Beattie said: “To manage [current] unprecedented demand, we have no other option than to try and work differently which I am aware will not sit comfortably but is absolutely essential if we are to sustain a service to those who need it most."

“We need to weigh up the risk of delays for ambulances against alternative disposition or transport options. Where such risks are considered, I want you to be aware that the trust will fully support you in your decision-making under these circumstances.”

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Source: HSJ, 4 January 2022

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Shrewsbury maternity scandal: Sajid Javid’s statement to the Commons

Sajid Javid has issued an apology for the maternity service failings reported at Shrewsbury and Telford Hospital NHS Trust.

The health secretary spoke in the Commons on Wednesday after an independent inquiry into the UK’s biggest maternity scandal found that 201 babies and nine mothers could have - or would have - survived if the NHS trust had provided better care.

Speaking in the Commons, the health secretary said Donna Ockenden - a maternity expert who led the report - told him about “basic oversights” at “every level of patient care” at the trust.

He said the report “has given a voice at last to those families who were ignored and so grievously wronged”.

Javid said the report painted a tragic and harrowing picture of repeated failures in care over two decades which led to unimaginable trauma for so many people.

Rather than moments of joy and happiness for these families their experience of maternity care was one of tragedy and distress and the effects of these failures were felt across families, communities and generations.

The cases in this report are stark and deeply upsetting.

Mr Javid offered reassurances that the individuals who are responsible for the “serious and repeated failures” will be held to account.

Read full story and Sajid Javid's statement

Source: The Independent, 30 March 2022

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NHS England ‘hasn’t got long’ to develop ‘operating model’ for system working

NHS England and local leaders must urgently develop a coherent ‘operating model’ for the era of integrated care systems (ICS) or see the reforms fail, leading trust chief executives have told HSJ.

Despite ICSs formally launching on 1 July, the chiefs said there was still no clarity about how the service would be supported and held to account as the Health and Care Act reforms are rolled out and the stuttering Covid recovery continues.

The CEOs were speaking at a roundtable to mark the publication of HSJ's annual ranking of the NHS’s “top 50 trust chief executives”.

NHSE has been working on a new operating model since last year. It has confirmed it plans to keep its seven separate regional teams, and has recently indicated national programmes will be curbed as part of reductions to central staffing. 

Caroline Clarke, the chief executive of north London’s Royal Free group of trusts, said: “What’s unclear to me is, what the operating model is for [the] whole NHS? What is NHSE going to do… what’s expected of the regions and the ICSs… is the performance management line [for providers] going to go all the way through the ICS?”

Ms Clarke said she recognised “some kind of regional infrastructure” was needed and that the existing set-up made sense in widely recognised areas such as London and other “urban” conurbations. But she added: “Are [regions] just going to be aggregating features of the NHS, or are they actually going to have a kind of intent to them?”

Ms Clarke said she was “hung up” on getting an effective operating model because, without it, there was an increased chance NHSE staff would “get in the way and stop us making decisions”.

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Source: HSJ, 25 July 2022

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Anger after NHS Trust says it has no plans to publish 'independent' review into deaths of three young people

Families have blasted a NHS Trust after it said it did not intend to publish an independent review into their loved ones deaths. Three young people died in nine months at the same mental health unit.

A Coroner was told last week that the review will be "ready" this month. Rowan Thompson, 18, died while a patient at the unit, based in the former Prestwich Hospital, Bury, in October 2020, followed by Charlie Millers, 17, in December that year, and Ania Sohail, 21, in June last year.

Earlier this year, Greater Manchester Mental Health NHS Foundation Trust (GMMH), which runs the hospital, commissioned an 'external report' into the deaths. A pre-inquest hearing into the death of Rowan - who used the pronoun 'they' - heard that the full report would be available for the coroner to read 'on or around September 30'.

Asked by the Manchester Evening News if the review would be published a spokesperson for the Trust said the Trust "always act on the wishes of the family regarding publication of reports," adding "and so in line with this we have no immediate plans to make the report public."

But the parents of both Rowan Thompson and Charlie Mllers said they wanted the report publishing. Charlie's mother, Sam, said: "We want it published. It needs to be put out there, otherwise there is no point in having it. We are hoping they (The Trust) will learn lessons. We want answers but it should also be published for the benefit of the wider public - and the parents of other young people who are being treated in that unit."

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Source: The Manchester News, 13 September 2022

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Depression in British adults doubles during pandemic, new data shows

The number of adults experiencing depression has almost doubled during the pandemic, according to new figures.

Data from the Office for National Statistics showed that almost one in five adults (19.2 per cent) were likely to be experiencing some form of depression in June. This had risen from around one in 10 (9.7%) between July 2019 and March 2020, before the imposition of the nationwide lockdown.

Dame Til Wykes, a professor of clinical psychology and rehabilitation at King’s College London, warned of a looming “mental health crisis” once the pandemic passes.

“This study tells us, yet again, that we might have a mental health crisis after this pandemic. The social effects of distancing and isolation for some affects their emotional wellbeing.

Dr Billy Boland, chairman of the General Adult Faculty at the Royal College of Psychiatrists, said the UK’s mental health services would be faced with a “tsunami of referrals” in the coming months.

“Isolation, bereavement and financial insecurity are some of the reasons why the nation’s mental health has deteriorated since the start of the pandemic.

“The government must speed up the investment to mental health services if we are to treat the growing numbers of people living with depression and other mental illnesses.”

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Source: The Independent, 18 August 2020

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Procurement of PPE, diagnostics and medical devices to be in-housed by national agency

The national supply chain agency will bring management of significant areas of NHS spend in-house on a permanent basis in a major overhaul of its operating model, HSJ has been told.

NHS Supply Chain’s current operating model, which has existed since 2018, has outsourced day-to-day management of the procurement of most of the goods and services bought by trusts as part of the “category towers” structure.

Under this structure, 11 category towers each cover a different spend area with a service provider to manage the available products and services.

But, in an exclusive interview, NHSSC chief Andrew New said the 11 categories would be reduced to eight. Three of the new categories — personal protective equipment, “medical capital” (which combines large capital diagnostics equipment with smaller scale diagnostics, pathology and point of care testing categories) and “medical clinically complex” surgical products and services — would be managed in-house. 

The new model will come into effect in 2023-24 following a procurement process to find new suppliers for the revamped category structure, which starts on 11 April 2022 with the publication of the contract notice.

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Source: HSJ, 4 April 2022

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Hundreds of UK care home deaths not added to official coronavirus toll

Hundreds of people are dying in care homes from confirmed or suspected coronavirus without yet being officially counted, the Guardian has learned.

More than 120 residents of the UK’s largest charitable provider of care homes are thought to have died from the virus in the last three weeks, while another network of care homes is reported to have recorded 88 deaths.

Care England, the industry body, estimated that the death toll is likely to be close to 1,000, despite the only available official figure for care home fatalities being dramatically lower.

The gulf in the figures has prompted warnings that ministers are underestimating the impact of Covid-19 on society’s most frail, and are failing to sufficiently help besieged care homes and workers.

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Source: The Guardian, 7 April 2020

 

 

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Lockdown patients ‘put off’ GP visits after warnings about restricted care

GPs’ warnings about restricted services may have put patients off seeking treatment, delaying diagnoses and worsening existing illnesses, the health and care watchdog has said.

The Care Quality Commission (CQC) said that millions of people had struggled to see their doctors during the pandemic, which had magnified inequalities and risked “turning fault lines into chasms”.

Between March and August 119.5 million GP appointments were made in England, down from 146.2 million last year, according to NHS Digital.

Ian Trenholm, the CQC’s chief executive, said: “The number of lost GP appointments translates into millions of people potentially . . . not getting conditions diagnosed early enough, not getting those referrals on for diagnoses like cancer and other conditions.”

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Source: The Times, 16 October 2020

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NHS England: Hospitals must ‘surge’ ICU so other regions don’t have to ration care

NHS England has asked hospitals across the country to open hundreds more intensive care beds so they can take in patients from the hardest hit areas, to prevent those patches having to ration access.

A letter sent to dozens of acute trusts today by NHS England asks them to enact their “maximum surge” for critical care from tomorrow, opening up hundreds of beds, which will rely on them redeploying staff and cancelling more planned care.

The letter is to trusts in the Midlands but HSJ understands a similar approach is being taken in the other regions where critical care is not currently under as much pressure as London, the East of England and the South East.

The message to surge capacity to support a “national critical care service” was reinforced to trusts nationwide in a call with Keith Willett, NHS England covid incident director, also on Wednesday.

The letter, from the NHSE Midlands regional team, said there had been a national request for the region to surge beyond its own needs to support London and the East of England. “Significant” numbers are likely to be transferred, HSJ was told.

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Source: HSJ, 13 January 2021

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‘Flurry’ of whistleblowers raise concerns at troubled trust

A ‘flurry’ of whistleblowers have raised concerns about the culture within an NHS trust which is grappling with finance and governance problems, its directors were told today.

Staff at Cornwall Partnership Foundation Trust have reported a “command and control” culture at the trust, which last week apologised to its employees for overtime payments made to board members for extra hours worked during the first peak of the pandemic.

It comes as the trust’s new chair and interim chief executive both pledged to communicate “openly and honestly” with staff.

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Source HSJ, 12 April 2021

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‘A test from yesterday is not enough’: The perks and perils of at-home Covid testing

The spread of the Omicron variant, which is racing through the population at a staggering speed, has brought renewed focus to the value and reliability of the at-home lateral flow test (LFT).

These rapid testing devices were initially viewed with caution by some scientists, who were concerned that the LFTs simply weren’t effective enough in detecting infections.

But as more data has accumulated over the past year, the consensus around the devices has shifted and become far more positive.

Research from University College London, published in October, suggested that LFTs are likely to be more than 80 per cent effective at detecting Covid, and up to 90 per cent effective for those who are most infectious.

However, the emergence of Omicron has changed the conversation. Its rapid acceleration throughout the UK, with more than a million infections expected by next week, has placed the country’s key testing routes – both at-home (LFT) and lab-based (PCR) – under immense strain.

“Testing capacity will almost certainly fail to keep up with Omicron,” said Dr Jeffrey Barrett, director of the Covid-19 Genomics Initiative at the Wellcome Sanger Institute. “Even with best efforts we can scale supply linearly, but demand will grow exponentially.”

Experts have called on the government to temporarily drop the reliance on PCR lab testing, which typically takes 24 hours or more to return a result but is seen as more reliable, in favour of the lateral flow devices. These can be taken from the comfort of your own home and give a result in a matter of minutes.

“LFT will be good enough, especially on people showing symptoms,” said Alan McNally, a professor of microbial evolutionary genomics at Birmingham University.

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Source: The Independent, 17 December 2021

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If you don’t like it, go private: what my maternity clinic said over scans delay

After a raft of prenatal check-ups were cancelled because of Covid staff shortages, one mother asked how other mums fared. The replies shocked her.

Alison, 38, gave birth to her son in June 2021 at a busy London hospital.

“We had exemplary care during delivery, and the midwives looking after me during my antenatal care were likewise fantastic,” she recalls.

“However, I didn’t see a midwife face-to-face between my nine-week intake appointment and my 30th week of pregnancy. Then I saw nobody again until I was 34 weeks pregnant, and the next time I was seen was at 38 weeks, even though you’re supposed to be seen weekly at that stage.”

At Alison’s two-week postpartum check-up, she had to have her stitches examined in a chair as no other facilities were free.

“The ward was so full they’d had to close the birth centre; labour and delivery was full, and I met two women labouring in the early stages of their induction in the hallway. The midwives that came to do home visits were rushed and left me in tears every time,” she says.

When another mother found she was suffering from early pregnancy malaise, she reluctantly decided to go back to the London hospital where she had given birth eight years before.

Her high-risk twin pregnancy had ended in premature birth at 24 weeks and tragedy – with one baby dying after a three-month battle in intensive care. Throughout her antenatal journey, crucial appointments had been cancelled due to staffing issues, with the result that nobody picked up on early signs of premature labour, until it was too late for intervention.

Her hopes of receiving better care this time, assuming the trust would be aware of my history, evaporated quickly. By nearly 15 weeks of pregnancy, I had still not been seen by anyone, with text messages supposed to inform me of appointments failing to arrive.

When she queried why I had been given a date for a scan two weeks after the latest possible date such a screening could give a diagnosis of chromosomal abnormality, a clinic receptionist told me I should go private if I didn’t like my appointments. A complaint triggered an apology from the trust’s chief executive months later for protracted problems in the booking process, as well as an apology from the deputy head of midwifery for the receptionist’s “inappropriate” advice.

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Source: The Guardian, 30 January 2022

 

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‘Institutionalised’ staff ‘perpetuating long hospital stays’

Nearly half of NHS patients with a learning disability or autism are still being kept inappropriately in hospitals, several years into a key programme to reduce inpatient care, a national review reveals.

The newly published review by NHS England suggests 41% of inpatients, assessed over an eight-month period to May 2022, should be receiving care in the community.

Reasons given for continued hospital care in the NHSE review included lack of suitable accommodation, with 19% having needs which could be delivered by community services; delays in moving individuals into the community with appropriate aftercare; legal barriers, with one region citing “ongoing concerns for public safety” as a barrier for discharge; and no clear care plans.

In some cases, individuals were placed in psychiatric intensive care units on a long-term basis, because “there was nowhere else to go”, while another instance cited a 20-year stay in hospital.

Other key themes included concerns about staff culture, particularly “institutionalisation” and suggestions that discharge delays were not being sufficiently addressed.

The report adds: “While the process around discharge can be time consuming, staff may perpetuate this by accepting such delays as necessary or inevitable.”

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Source: HSJ, 22 February 2023

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