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Alternative to epidural recommended for women in labour

Women in labour should be offered an alternative to an epidural spinal block injection, say new draft guidelines for the NHS.

The National Institute for Health and Care Excellence (NICE) is recommending remifentanil, which is a fast-acting morphine-like drug given into a vein.

Women control the medication themselves, by pressing a button to get more of the drug for pain relief. A timer ensures the user cannot administer too much of it.

Women who decide to try remifentanil and do not like it could still decide to have an epidural instead if there is no medical reason why they should not.

They can use gas and air, also called Entonox, which is a mix of oxygen and nitrous oxide, at the same time.

NICE says having remifentanil as a treatment option has advantages - it might enable women to be more mobile than with an epidural, which makes the legs numb and weak, for example.

Evidence suggests fewer epidurals might mean fewer births using instruments like forceps and ventouse vacuum suction, says NICE.

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Source: BBC News, 25 April 2023

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Priory Group whistleblowers 'concerned for patient safety'

Two former senior managers at a large mental healthcare provider have told the BBC they had concerns about the safety of patients and staff.

The whistleblowers claim they felt pressure to cut costs and fill beds.

The Priory Group, which receives more than £600m of public money each year, is the biggest single private provider of mental health services to the NHS.

The company denies the claims and says it successfully treats tens of thousands of patients each year.

It adds its services "remain amongst the safest in the UK".

The former members of the Priory Group's senior management said that, when they were working for the company, they found it difficult to recruit or retain staff, due to poor pay and conditions.

They believe this resulted in patients being placed on wards that did not have staff equipped with the right skills to handle their conditions.

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Source: BBC News, 26 April 2023

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GP is struck off for “utterly deplorable” litany of treatment failures

A senior GP has been struck off the UK medical register for an “utterly deplorable” litany of treatment failures and for “reprehensible” professional conduct that included leaving patients in the care of unprepared trainee doctors and operating without adequate professional insurance.

At least two patients suffered “grave consequences” from inaction on the part of Surraiya Zia, including a man whose deteriorating condition was effectively ignored for six months, despite the fact that he “presented to Dr Zia frequently, sometimes up to three times within a week, with red flag symptoms,” said Samantha Gray, chairing the medical practitioners tribunal.

The patient was eventually persuaded to seek private magnetic resonance imaging by his family. This showed widespread stage IV lung cancer that took his life within weeks. 

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Source: BMJ, 21 April 2023

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'Care homes are being deprived of dental services'

A care home manager said it had become an "impossibility" to get NHS dentists to visit her elderly residents when they needed treatment.

Liz Wynn, of Southminster Residential Home, near Maldon in Essex, said she had battled for years for site visits.

It comes as a health watchdog revealed that 25% of care home providers said their patients were denied dental care.

NHS Mid and South Essex said it was considering a number of approaches to improve access for housebound patients.

Ms Wynn said the shortage of NHS community dentists available to come into the home to carry out check-ups and treatment had been an "on-going concern" for almost 10 years.

Ms Wynn said the home relied on its oral care home procedures - such as checking residents' mouths daily - to prevent problems from escalating. However, she said while its residents were "our family", conditions such as dementia made it difficult to spot when patients were in pain.

She also said poor dental hygiene in the elderly could result in a number of potentially life-threatening infections.

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Source: BBC News, 24 April 2023

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Ministers in legal move to cut nurse strike short

Health Secretary Steve Barclay is to ask judges to rule whether part of the next nurse strike is unlawful.

The government wants the High Court to assess whether Tuesday - the last day of the walkout in England - falls outside the Royal College of Nursing's six-month mandate for action.

It believes the mandate will have lapsed by Tuesday - the 48-hour strike is due to start at 20:00 BST on Sunday.

The RCN accused ministers of using "draconian anti-union legislation".

Mr Barclay's decision to take legal action follows a request from hospital bosses.

The RCN argues the strike falls within the required six-month period from when votes were cast in its ballot for industrial action.

But NHS Employers said it had legal advice that the action would be unlawful.

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Source: BBC News, 24 April 2023

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NHS 'hamstrung by red tape' as it takes 50 steps to release patients

Britain is hamstrung by red tape in the NHS and workers are blighted by regulation, Boris Johnson’s former cabinet secretary has said.

Lord Sedwill, who was head of the civil service for two years, said that the UK was “failing to fulfil its great potential” because of excessive regulation.

He made the comments in a foreword to a report by the Policy Exchange think-tank which also highlights examples of regulation “passing on significant costs” to customers.

Examples in the report include NHS rules instructing hospital staff to go through 50 separate steps to discharge patients, “leading to severe delays”.

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Source: The Telegraph, 23 April 2023

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Cover-ups and lies in maternity care keep happening, says Donna Ockenden

A week after Donna Ockenden published her damning report on the catastrophic failures in maternity services at Shrewsbury and Telford Hospital NHS Trust in March last year, she was contacted by families in Nottingham asking her to investigate how dozens of babies had died or been injured in their city hospitals.

Six months later, Ockenden — herself a senior midwife — was put in charge of another inquiry by the government and yet again she is finding a culture of cover-ups and lies in maternity care.

“Of the families that I have met in Nottingham to date, some of them have expressed concerns to me that the trust were not truthful in discussions around their cases,” she tells the Times Health Commission.

“We have all the systems and structures in place that should be able to spot maternity services in difficulty and here we are again. Families are having to fight to get answers.”

The woman who has done more than anyone to highlight the problems with maternity care is reluctant to use the word “crisis” but she warns: “I think that without urgent and rapid action, from central government downwards — on funding and workforce and training — mothers and their babies are not going to be able to receive the safe, personalised maternity care that they deserve and should expect".

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Source: The Times, 21 April 2023

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Who is being hit hardest by the NHS' waiting list of 7 million people?

Seven million people in England are currently waiting for treatment on the NHS.

That's more than the entire populations of some countries, including Denmark and New Zealand.

Just under half of those referred to a specialist will have been in the queue for longer than 18 weeks — the maximum target set in 2004 by the Government. And more than 360,000 of them will have been waiting a year or more.

It's a deeply troubling state of affairs that has been thrown into sharp focus by the impact of the junior doctors' strike.

However, 'treatment delays existed long before the doctors' strike — and also the Covid-19 pandemic,' Danielle Jefferies, a senior analyst with independent think-tank The King's Fund, told Good Health.

Indeed, while the impact of the virus may have worsened the bottlenecks, the problem of rising patient demand is of longer standing. And the potential consequences are terrifying.

Studies show that for each month patients with breast, bowel or head and neck cancers have their treatment delayed, the chances of them dying from the disease increase by 6 to 13%.

Meanwhile, eye specialists fear some people may suffer permanent sight loss because they cannot get to a specialist in time to prevent the worsening of serious conditions such as glaucoma, which affects around 700,000 people in Britain.

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Source: MailOnline, 19 April 2023

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Half of UK public fear family would not be well looked after in care homes

Trust in care homes has slumped, leaving half of the British public lacking confidence that friends or family would be well looked after.

Nationwide polling for the Guardian revealed 9 out of 10 older people believe there are not enough care staff, and half have lost confidence in the standard of care homes since the start of the pandemic.

The survey conducted by Ipsos this month follows a doubling in public dissatisfaction in the NHS and exposes deepening fears about the fitness of a social care sector that had its weaknesses exposed by Covid-19, which claimed 36,000 lives in care homes in England alone.

The Relatives and Residents Association (RRA) said the polling tallied with calls to its helpline about the “harm and anguish caused by poor care and frustration at the inconsistency in standards”.

“We must weed out the poor providers and invest in skills – care workers must become our most valued workers, not the least,” said Helen Wildbore, the RRA’s chief executive. “Tomorrow, any one of us could need them.”

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Source: The Guardian, 24 April 2023

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More teenagers unprotected from serious diseases as vaccine uptake falls

More teenagers are at risk of contracting rare but serious diseases due to a fall in immunisations as a result of the pandemic, according to a report.

The uptake of vaccines among teenagers in secondary schools that protect against meningococcal disease, diphtheria, tetanus and polio has dropped since COVID affected routine school immunisation programmes provided by the NHS.

The UK Health Security Agency (UKHSA) found that 69% of children in year nine, aged 13 and 14, had the MenACWY vaccine and the Td/IPV booster in 2021-22. This marked a 7% drop in coverage for both vaccines compared to the previous year.

The 3-in-1 Td/IPV booster helps provide teens with long-lasting protection against tetanus, diphtheria and polio, diseases that can result in serious illness or even death.

Doctor Vanessa Saliba, consultant epidemiologist at UKHSA said: "In recent years we have seen vaccine uptake fall due to the challenges posed by the pandemic.

"Many young people who missed out on their vaccinations have already been caught up, but more needs to be done to ensure all those eligible are vaccinated.

"These vaccines offer the best protection as young people start their journey into adulthood and mixing more widely - whether going to college, starting work, travelling or going to summer festivals."

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Source: Sky News, 24 April 2023

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Mental health services to face surprise spot-checks after series of abuse scandals, watchdog warns

Unannounced and out-of-hours spot-checks on mental health services are set to ramp up following a string of abuse scandals, The Independent can reveal.

The Care Quality Commission’s new mental health chief Chris Dzikiti said he was “saddened” by “unacceptable” scandals in the last six months, warning the regulator “will use the powers [it has] to hold people to account.”

He said the organisation will be carrying out more unannounced inspections of providers, including inspections launched out of normal hours, with the aim to have the “majority” of spot-checks carried out this way.

In his first interview since joining the regulator in November Mr Dzikiti, who is mental health nurse by background, said: “I talk to chief execs of mental health services, I talk about [how] as a regulator, we will use the power we have, when [we] see poor practice, we will definitely hold people to account.

“In our inspection programmes, we are also increasing the unannounced inspections out of hours inspections, because we need to try and get really deep into the culture of mental health services, especially those areas where we think there’s a higher risk of poor practice.

“I will not rest until we get people safe.”

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Source: The Independent, 24 April 2023

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Northern Ireland medical negligence costs double in a year

The amount of government money spent on medical negligence cases and legal fees in Northern Ireland doubled within a year.

Just over £20m was paid out during 2020-21 but that increased to more than £40m in the 2021-22 financial year.

Last year, £30.7m was paid out in damages, while £5.9m went on plaintiff costs and £3.7m in defence costs.

The increase in cost is being attributed to the coronavirus pandemic.

Last year, 3,987 clinical negligence cases were open. Almost half (1,813) of all cases open in 2021-22 related to four specialties:

  • Obstetrics - 564
  • Accident and emergency - 456
  • Neurology - 407
  • General surgery - 386

There has been a stark increase in the number of cases relating to neurology in the past five years from 23 in 2017-18 to 407 in 2021-22.

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Source: BBC News, 24 April 2023

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Sciensus: Chronically ill patients go without vital drugs amid delays by NHS-contracted firm

Chronically ill patients across the UK allege they've had to go without vital medication amid delays by a private company contracted by the NHS to deliver drugs.

In the last year alone, Sciensus was awarded NHS contracts worth more than £5 million, despite being placed into special measures by health regulators in 2021 following widespread delivery failings.

ITV News has revealed that the CQC is currently reviewing whether to take further regulatory action against Sciensus, having been made aware of concerns about the company’s performance.

The company, which is based in Burton-on-Trent and says it "works with every NHS Trust in the country", should provide a lifeline for those who rely on specialised medications.

These include those with long-term conditions - like cancer, HIV, and haemophilia - which often require drugs that can't be collected from high street or hospital pharmacies.

One new mother with rheumatoid arthritis said she was taken to A&E after Sciensus left her without medication for three weeks.

The 37-year-old, who wishes to remain anonymous, told ITV News: "I was unable walk with a small baby... it was such a chronic flare that I couldn't walk, which I've never, ever had before in my life."

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Source: ITV News, 21 April 2023

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NHS plans new elective target after April deadline missed

System leaders are discussing pushing back the NHS’s target to virtually eliminate 78-week breaches from the waiting list by this month to ‘June or July’, HSJ understands.

The discussions come after the service missed its original targeted trajectory of clearing the backlog by this month, as first proposed in NHS England’s elective recovery plan last February, despite a steep reduction over the past 18 months.

Internal NHS forecasts suggest there will be around just over 10,000 long waiters still on the waiting list by the end of April, as HSJ first revealed last month. Senior sources said this week that this figure remained a likely position for the end of the month.

HSJ understands there has not been any official communication to trusts about pushing back the 78-week target, and it was not yet clear when the centre’s expectations would be finalised.

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Source: HSJ, 21 April 2023

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USA: Rising focus on patient safety and regulatory compliance driving growth in medical device complaint management market

The medical device complaint management market is experiencing significant growth due to the increasing focus on patient safety and regulatory compliance. As medical devices become more complex and the regulations governing them become more stringent, it has become essential for manufacturers to have effective complaint management systems in place to ensure the safety and satisfaction of their customers.

The global medical device complaint management market is expected to grow at a CAGR of 6.3% from 2021 to 2026. 

One of the key factors driving the growth of the medical device complaint management market is the increasing emphasis on patient safety. In recent years, there has been a growing awareness of the potential risks associated with medical devices, and patients are increasingly demanding higher levels of safety and quality. This has led to a greater focus on complaint management among medical device manufacturers, who are now investing in advanced complaint handling systems to ensure that they are able to identify and address issues before they become major problems.

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Source: Digital Journal, 20 April 2023

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‘National improvement board’ to be set up by NHS England

NHS England has launched a new framework for quality improvement and delivery, including a national board that will pick a “small number of shared national priorities”.

The new document says NHSE will “establish a national improvement board, to agree the small number of shared national priorities on which NHS England, with providers and systems, will focus our improvement-led delivery work”.

The review says NHSE will, among other actions: 

  • Create a “national improvement board” to “agree a small number of shared national priorities and oversee the development and quality assure the impact of the NHS improvement approach”.
  • Set an expectation that all NHS providers, working in partnership with integrated care boards, will embed a quality improvement method aligned with the NHS improvement approach”.
  • Incentivise a universal focus on embedding and sustaining improvement practice”, including with “regulatory incentives alongside clearer and more timely offers of support.
  • Work with the [Care Quality Commission] to align the revised CQC well-led [inspection method] with the improvement approach.

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Source: HSJ, 21 April 2023

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Herpes deaths: NHS trust lied about virus links, inquest hears

The mother of a young woman who died with herpes said she was "disgusted" with an NHS trust which "lied" about the potential cause of the virus.

Kim Sampson and Samantha Mulcahy died with herpes after the same obstetrician at the East Kent Hospitals University NHS Trust carried out their caesareans.

Yvette Sampson's daughter had been "fit and healthy" until she gave birth on 3 May 2018, an inquest has heard.

She said the trust had lied about links between the two mothers' deaths.

They were treated by the same surgeon and midwife six weeks apart, neither of whom were tested for herpes, the inquest in Maidstone was told.

Ms Sampson said her daughter had been "in agony" from 3 May when she gave birth to her second child, until she died on 22 May.

She told the inquest she had received "poor treatment" by midwives at the Queen Elizabeth the Queen Mother Hospital (QEQM) in Margate, which she felt also "contributed" to her daughter's death.

Ms Sampson was initially denied a Caesarean and instead told to push for almost three hours, despite repeatedly telling midwives that "something wasn't right" and "clinging to the bed in agony", her mother said.

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Source: BBC News, 20 April 2023

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NHS threatens legal action to block second day of nurses’ strike

The NHS has launched a legal challenge that could end in the high court to block the second day of an upcoming strike by tens of thousands of nurses.

Officials at NHS Employers wrote to the Royal College of Nursing (RCN) on Wednesday saying the union’s plans for a two-day strike were unlawful.

In response, it is understood the RCN has said it will “forcibly resist” employers’ attempts to seek a high court injunction designed to block the strike, which they insist is lawful.

The threat raises the possibility of a high court clash between NHS lawyers backed by the government and those of the nursing union. It also highlights the increasingly bitter relationship between the government and those representing workers on the frontline of the health service.

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Source: The Guardian, 20 April 2023

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Millions wait more than a fortnight to see a GP in England

Nearly five million patients each month in England wait more than a fortnight for a GP appointment, NHS figures show, which Labour is calling "unacceptable".

The government says it expects all patients needing a GP appointment to be seen within two weeks.

The Royal College of GPs says 85% of appointments happen within two weeks and nearly half on the same day.

Those taking longer than two weeks may be routine ones for which the wait is therefore appropriate, it says.

Prof Kamila Hawthorne, who chairs the Royal College of GPs, said: "GPs and our teams are working tirelessly to deliver safe, timely and appropriate care and to give patients the choice of appointment they want.

"We share our patients' frustration when they struggle to access our care. However, this is not down to GPs and their hard-working teams, but due to decades of underfunding and poor resource planning."

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Source: BBC News, 21 April 2023

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Child health checks failed to recover after covid, figures show

Inadequate health visiting provision has led to gaps in care for children and heaped pressure on acute services, senior clinicians have told HSJ. 

Government data suggests that a fifth of infants are not receiving one or more of their five mandatory health visiting reviews across the first two years of life, with rates still substantially below pre-covid levels.

Meanwhile, nationally about 1 in 10 children are still being seen virtually, contrary to the government’s delivery model and despite clinicians saying in-person contact is vital to spotting problems. Senior figures in children’s services told HSJ that in some areas a much higher rate was still being carried out with no in-person contact.

Clinicians said the reasons were ongoing funding and staffing constraints, and that the problems were leading to parents turning to emergency departments and GPs instead.

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Source: HSJ, 20 April 2023

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Mifepristone: US Supreme Court delays abortion pill access decision

The US Supreme Court has extended until Friday a temporary block on limits to access of a popular abortion pill.

A Texas judge suspended approval of abortion drug mifepristone on 7 April, questioning its safety.

Parts of that decision were upheld on appeal, prompting the Biden administration to make an emergency request to the Supreme Court.

It's the most significant such case since the Supreme Court last year ended the nationwide right to abortion.

The pill - used in more than half of abortions in the US - was first approved by the Food and Drug Administration (FDA) more than two decades ago. 

Critics say that by overriding the FDA's approval, the court in Texas has usurped the federal health agency's remit to regulate food, medicine, and medical devices. Legal experts warn the ruling opens the door for challenges to other approved medicines in the US and could also stifle development of future drugs.

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Source: BBC News, 20 April 2023

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Top scientists warn ‘the next pandemic is coming and we’re not ready’

The UK is not ready for the next global pandemic because public services are being dismantled and key research is being defunded, experts have claimed.

More than three years after the global outbreak of coronavirus, top scientists have warned that the UK is no better prepared for a pandemic than it was in 2020.

They say another epidemic on the scale of Covid-19 is inevitable, but that disinvestment in infection-monitoring services, dismantling of key infrastructure, and the state of the NHS mean the country is “losing ground”.

Sir John Bell, a leading immunologist and a member of the UK’s Covid vaccine taskforce during the pandemic, said it was too easy to dismiss Covid-19 as a “once in a generation crisis”.

Writing in The Independent, he warned that it is “a question of when, not if, another pandemic strikes”, adding that the nation needs to adopt an “always on” approach that includes building a more resilient healthcare system, carrying out better surveillance, and identifying future threats.

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Source: The Independent, 18 April 2023

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Medical leaders call for arbitration to resolve junior doctors’ dispute

Medical leaders have called for third-party arbitration to break the impasse on a pay dispute between junior doctors and the government after hundreds of thousands of procedures and appointments were cancelled as a result of last week’s strike in England.

The “colossal impact” of the four-day stoppage compounded by a health service already stretched by the coronavirus pandemic and facing workplace shortages has led the Academy of Medical Royal Colleges (AoMRC) to intervene and urge both parties to engage with an independent organisation.

The AoMRC, the membership body for the UK and Ireland’s 24 medical royal colleges and faculties, said in a statement it was “concerned that a solution has not yet been reached and about the anticipated impact on NHS services and patients that will potentially follow any future action”.

It added: “Both parties need to rapidly engage with an independent organisation to work out how the deadlock can be broken for the sake of patients and the wider NHS.”

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Source: The Guardian, 20 April 2023

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Forty trusts are set elective target less ambitious than last year

NHS trusts have been given targets to increase elective activity that range from 103% of pre-pandemic levels to nearly 130%, internal data seen by HSJ reveals.

The wide gap between the targets, which are based on past performance and reflect the value of activity carried out, indicate the slow pace of recovery at many trusts last year.

Forty trusts have been set the least ambitious target, to deliver 103% of pre-covid activity levels in 2023-24, including Leeds Teaching Hospitals, Barts Health, and University Hospitals Birmingham.

All providers were supposed to deliver at least 104% of pre-covid activity last year, but few managed to achieve this, with emergency pressures, the impact of covid and flu, and workforce problems hampering efforts to ramp up activity.

Amanda Pritchard has previously admitted the health service would have to “re-profile” the trajectory to achieving 130% of pre-covid activity levels by 2025.

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Source: HSJ, 20 April 2023

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National ambitions for use of NHS App undermined by plateauing performance

Take-up and usage of the NHS App in England has begun to plateau, after covid drove huge growth, figures seen by HSJ suggest.

This can be seen in the percentage of GP appointments booked or cancelled using the app; the number of records viewed; and the number of times it has been downloaded.

Rapid uptake was driven during covid restrictions, when travel and other activities often required a covid vaccination pass. Government has said it wants the growth to continue.

The number of GP appointments booked or cancelled using the app fell for a third consecutive month in March to 212,954, representing a decrease of 15% since January and 28% on October 2022, when usage peaked.

The NHS app is central to government’s plan for digital health and care, published last year, billed as the “digital front door” to the NHS which would aid the recovery of services post-pandemic.

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Source: HSJ, 19 April 2023

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