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Governance scandal trust failing to manage complaints

A trust which is facing major governance issues is failing to respond to hundreds of complaints properly, with patients and families waiting more than twice as long as the NHS target for responses to their concerns, an external review has found.

Cornwall Partnership Foundation Trust, which is subject to regulatory action by NHS England, was found to be “not classifying complaints, concerns and comments accurately”, while staff had “no formal training”, meaning complaints were “not investigated appropriately”.

Last year, the trust was embroiled in a governance scandal in which NHSE investigated multiple allegations of finance and governance failings, resulting in the departure of former CEO Phil Confue.

Rachel Power, chief executive of the advocacy group Patients Association, told HSJ  patient complaints often contain “vital intelligence” on how trusts can improve services and “essential warnings about any area where things might be going wrong”.

According to the review, the backlog had stemmed from several factors. These included more work being needed on investigations that had not been thorough enough, and the relevant service teams not responding to enquiries by the complaints team.

Additionally, there was a “lack of formal monitoring and review” to ensure complaint points were reported appropriately and consistently, and an “apparent lack of accountability by local teams for complaints” triaged through the trust’s patient liaison and complaints team.

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Source: HSJ, 12 April 2022

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Dr Michael Watt: Suspended neurologist offers 'sympathy' to patients

Suspended Belfast neurologist Michael Watt has offered his "sincere sympathy" to those affected by Northern Ireland's biggest patient recall.

Dr Michael Watt worked at the Royal Victoria Hospital as a neurologist diagnosing conditions like epilepsy and Parkinson's Disease. He was suspended after 3,000 patients were given recall appointments last year.

Dr Watt said he recognised the "distress these events have caused".

On Tuesday, a BBC Spotlight investigation found that he had carried out hundreds of unnecessary procedures on patients.

The programme also obtained details of a Department of Health report, as yet unpublished, that said one-in-five patients of the consultant neurologist were misdiagnosed.

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Source: BBC News, 22 November 2019

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Covid-19: Doctors are told not to perform CPR on patients in cardiac arrest

Healthcare staff in the West Midlands have been told not to start chest compressions or ventilation in patients who are in cardiac arrest if they have suspected or diagnosed covid-19 unless they are in the emergency department and staff are wearing full personal protective equipment (PPE).

The guidance from the University Hospitals Birmingham NHS Foundation Trust says that patients in cardiac arrest outside the emergency department can be given defibrillator treatment if they have a “shockable” rhythm. But if this fails to restart the heart “further resuscitation is futile,” it says.

If a patient with suspected covid-19 is in cardiac arrest they should be given cardiac compressions and be ventilated only if they are in the emergency department and the person attending them is wearing aerosol generating procedures (AGP) PPE. That means wearing an FFP3 mask, full gown with long sleeves, gloves, and eye protection.

The advice rests on the premise that performing cardiac compressions risks virus particles being released into the air that could infect staff.

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Source: BMJ, 29 March 2020

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Man plans to sue NHS after cancer surgery delayed due to coronavirus

A former senior NHS official plans to sue the organisation after he had to pay a private hospital £20,000 for potentially life-saving cancer surgery because NHS care was suspended due to COVID-19.

Rob McMahon, 68, decided to seek private treatment after Worcestershire Acute Hospitals NHS trust told him that he would have to wait much longer than usual for a biopsy. He was diagnosed with prostate cancer after an MRI scan on 19 March, four days before the lockdown began.

McMahon was due to see a consultant urologist on 27 March but that was changed to a telephone consultation and then did not take place for almost two weeks.

“At that appointment, the consultant said: ‘Don’t worry, these things are slow-growing. You’ll have a biopsy but not for two or three months.’ I thought, ‘that’s a long time’, so decided to see another consultant privately for a second opinion.”

A PET-CT scan confirmed that he had a large tumour on both lobes of the prostate and a biopsy showed the cancer was at risk of breaking out of the prostate capsule and spreading into his body. He then paid to undergo a radical prostatectomy at a private Spire hospital.

“This is care that I should have had on the NHS, not something that I should have had to pay for myself. I had an aggressive cancer. I needed urgent treatment – there was no time to waste,”, he said. “With the pandemic, he added, “it was almost like a veil came down over the NHS. He worked for the NHS for 17 years as a manager in hospitals in London, Birmingham and Redditch, Worcestershire, and was the chief executive of an NHS primary care trust in Leicester.”

Mary Smith of Novum Law, McMahon’s solicitors, said: “Unfortunately, Rob’s story is one of many we are hearing about from cancer patients who have been seriously affected by the disruption to oncology services as a result of COVID-19."

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Source: The Guardian, 11 July 2020

 

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NHS Trusts spent £20 million battling whistleblowers, workplace discrimination claims and employment disputes

NHS Trusts have spent nearly £20 million in four years battling whistleblowers, defending claims of workplace discrimination and fighting employment disputes, the Sunday Telegraph can disclose.

Data obtained through Freedom of Information (FOI) has revealed that a minority of healthcare trusts, often advised by the same law firms, are repeatedly running up huge legal bills.

Former health minister Sir Norman Lamb said some of the NHS employment cases he has witnessed in the last eighteen months involved ‘scandalous’ uses of public money. “It is not all NHS trusts in the country, but there are a small number where the culture is clearly wrong,” said Sir Norman.

Commenting on the findings, Tim Farron, former leader of the Liberal Democrats, who has fought for whistleblowers in his own constituency,  said: “Millions of pounds of tax payers’ money is being spent across our health service by NHS Trusts defending their actions in employment tribunals in cases of discrimination and unfair dismissal. It is only right that questions are being asked."

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Source: The Telegraph, 1 February 2020

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NHS orders new chair of review into baby deaths

The NHS has ordered a new chair for the Nottingham maternity scandal review which is looking into hundreds of cases of alleged poor care.

In a letter published late on Friday the NHS said there needed to be “urgent” changes to the way the review was being carried out and this included appointing a former NHS trust chair Julie Dent to lead the review.

More than 100 bereaved families wrote to the health secretary Sajid Javid on 7 April calling for the review, to be overhauled and the chair Cathy Purt, to be replaced by Donna Ockenden who chaired the Shrewsbury maternity scandal inquiry.

The Nottingham review, dubbed an “independent thematic review”, was launched in July 2021 and is being led by local NHS commissioners and NHS England.

It was announced after The Independent and Channel 4 revealed millions had been paid out by the trust over 30 baby deaths and 46 incidents of babies left permanently brain damaged by Nottingham University Hospitals Foundation Trust.

Sir David Sloman, the NHS chief operating officer, said in his letter on Friday: “Following discussions at both a regional and national level, it is clear that urgent changes to how the review is being delivered need to be made. A new chair needs to lead this review with sufficient senior experience to address the concerns and challenges faced at Nottingham University Hospitals, to speed up the process and to deliver a review that can bring about real change for women and babies in Nottingham.

“It has therefore been agreed that the review will now have enhanced national oversight by NHS England and NHS Improvement and I am pleased to announce that Julie Dent CBE has agreed to take on the role of chair for this review and she will begin this work with immediate effect.”

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Source: The Independent, 23 April 2022

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NHS England considers ‘mandated’ system-level waiting lists

NHS trusts could be asked to create shared waiting lists for elective care under plans being considered by national leaders.

HSJ understands that NHS England chief executive Sir Simon Stevens is to write to all NHS organisations early next month to lay out plans for phase three of the recovery from covid. The letter is expected to focus on the importance of working at a system level to get more services up and running.

Senior NHS sources said the recovery plans are likely to include proposals for creating pooled system-level waiting lists between trusts, but there is still internal debate over the extent to which changes could effectively be mandated; for example, by attaching significant incentive funds. The move appears to be aimed at ensuring an “equitable level of care” across a patch.

In a statement, NHSE said individual providers’ would ultimately still have responsibility and accountability for their waiting lists, even where this might be “supplemented” by system-wide arrangements.

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Source: HSJ, 19 June 2020

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Boosting staff wellbeing improves NHS trusts’ CQC ratings, report finds

Initiatives to increase staff engagement and make leadership teams more approachable have helped to improve NHS trusts’ ratings from the health and social care watchdog, a report by NHS Providers has found.

Trusts’ performance has gradually improved, showed the results of inspections by the Care Quality Commission (CQC). In 2014, the year that the CQC began rating trusts, 24 of 35 trusts inspected (68%) were designated “requires improvement” or “inadequate.” Five years later, most of the 224 trusts inspected (59%) were rated “good” or “outstanding.”

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Source: BMJ, 10 October 2019

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Region used ‘clinically unsafe’ healthcare app for three years

A healthcare app which was investigated over failing to meet clinical and governance standards has been dropped by north London commissioners after it was deemed “clinically unsafe”.

The Health Help Now app, currently used in eight north London boroughs, will be scrapped by the end of June and patients will be directed to the NHS app.

In a statement, the North West London Collaboration of Clinical Commissioning Groups said it decided to carry out a review of the app as it had low uptake and dwindling funds, despite reporting in 2017 that it was being used by 500,000 patients. 

During the reivew, stakeholders told commissioners that a lack of clinical oversight meant the app was “unsafe” and financial constraints meant it was unsustainable.

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Source: HSJ, 26 June 2020

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Scientists create guide to building truth ‘sandwich’ to combat Covid misinformation

In a bid to fight against misinformation about the coronavirus vaccines, a group of scientists from all over the world have created an online guide to building a ‘truth sandwich’.

The guide serves to arm people with practical tips, up-to-date information and evidence to talk reliably about the vaccines, and enable them to constructively challenge associated myths.

The scientists, led by the University of Bristol, are appealing to everyone to understand the facts set out in the 'COVID-19 Vaccine Communication Handbook', follow the guidance and spread the word.

Professor Stephan Lewandowsky, the lead author of the guide, said: “Vaccines are our ticket to freedom and communication about them should be our passport to getting everyone on board."

“The way all of us refer to and discuss the COVID-19 vaccines can literally help win the battle against this devastating virus by tackling misinformation and improving uptake, which is crucial."

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Source: The Independent, 7 January 2021

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HRT medicine to be sold over the counter for first time

Previously offered as prescription only, estradiol tablets, sold under the brand name Gina10, will now be available to women over the age of 50 who have not had a period for more than a year, as part of hormone replacement therapy treatment (HRT).

Pharmacists have been offered training to identify who needs the tablets.

The Medicines and Healthcare products Regulatory Agency (MHRA) made the decision as part of a strategy to make menopause treatment more accessible for women.

Estradiol tablets treat vaginal symptoms caused by a lack of oestrogen, such as dryness, soreness, itching, burning and uncomfortable sex.

The product is inserted into the vagina rather than taken by mouth.

MHRA chief healthcare quality and access officer Dr Laura Squire called the move a "landmark reclassification for millions of women in the UK".

"In reaching this decision, we have seen positive support from a wide range of people, including many women aged 50 years and above who could benefit from this decision," she said.

The MHRA hopes the move will relieve pressure on front-line NHS services and give women more freedom in choosing treatments that work for them.

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Source: BBC News, 8 September 2022

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Injured patient left in urine-soaked bed sheets and labelled ‘lazy’ by nurses after botched surgery

A second “mutilated” patient left with life-changing injuries after botched hospital surgery has described how she was left in urine-soaked bed sheets for days by nurses who called her lazy when she was unable to get out of bed.

Lucy Wilson told The Independent she believes she would have been better looked after at a veterinary practice compared to the level of care she received from nurses at Norfolk and Norwich Hospital Trust in January last year.

She was one of three patients harmed by surgeon Camilo Valero in the same week and almost died after Dr Valero and other staff failed to recognise her life-threatening injuries following the operation to remove her gall bladder.

Dr Valero is under investigation by the General Medical Council but is still practising under supervision at the trust, which has refused to say whether the third patient survived their ordeal.

After requests by The Independent, bosses at the NHS trust have now committed to publishing details of a secret review carried out by the Royal College of Surgeons into Dr Valero’s work and the wider surgical services at the trust.

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Source: The Independent, 31 May 2021

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CQC closes ‘inadequate’ children’s unit

An NHS children’s mental health unit has been closed down by the Care Quality Commission after being rated “inadequate” last week.

A child and adolescent mental health ward run by Tees, Esk and Wear Valley’s Foundation Trust has been closed after the CQC took enforcement action to protect the safety of patients.

In a statement today, a CQC spokesman said: ”[We have] taken urgent enforcement action at Tees, Esk and Wear Valley’s Foundation Trust which will lead to the closure of the child and adolescent mental health service units at West Lane Hospital. The Holly unit at West Park Hospital and Baysdale Unit at Roseberry Park are unaffected. The action follows continued concerns identified at earlier inspections in June and August, and the recent inspection on 20 and 21 August 2019."

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Source: HSJ, 23 August 2019

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CQC launches criminal investigation into medication incidents at major acute trust

A major acute trust has confirmed the health service inspectorate has begun a criminal investigation into three incidents at its hospitals.

University Hospitals Birmingham FT told HSJ the Care Quality Commission (CQC) has started a criminal investigation into incidents involving potential errors around the provision of anti-coagulant medication.

The trust received a letter from the CQC this month informing it that the regulator has begun the investigation under regulation 22 of the Health and Social Care Act 2008 (regulated activities) regulations 2014. The incidents happened at Queen Elizabeth Hospital in Birmingham and Good Hope Hospital — the trust’s two main sites.

Regulation 22 says: “In order to safeguard the health, safety and welfare of service users, the registered person must take appropriate steps to ensure that, at all times, there are sufficient numbers of suitably qualified, skilled and experienced persons employed for the purposes of carrying on the regulated activity.”

The CQC launched a prosecution into East Kent Hospitals University FT this month for failing to meet fundamental standards of care. The regulator also successfully prosecuted University Hospitals Plymouth Trust in September after it pleaded guilty to breaching the duty of candour. 

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Source: HSJ, 23 October 2020

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"I’m a doctor, and tried the new GP app. My experience was terrifying"

Dr Max Pemberton, columnist for the Daily Mail, gives his opinion of the app that offers patients a GP consultation via their mobile phone. In theory, it sounds great: the patient can dial up, speak to and (via phone camera) see a doctor, who could be anywhere. However, how effective can such consultations be?  "I have been able to test this service for myself — and what I have experienced left me worried", says Dr Pemberton.

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Source: The Spectator, 20 July 2019

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NHS casualty bungles cost £400m

Accident and emergency has become the top source of negligence claims by patients. Delays, misdiagnosis and poor treatment in accident and emergency (A&E) departments are now the top cause of NHS negligence claims, overtaking orthopaedic surgery for the first time. Bungled operations on backs, bones, joints, ligaments, nerves and muscles usually lead to the most claims, but a 41-page NHS strategy document for the next 12 months reveals that emergency units have become the main source of litigation against the service.

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Source: The Times, 7 July 2019

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Woman awarded £8m after doctors left sponge inside her during surgery

A woman has been awarded $10.5 million (£8m) in damages after medical staff left a sponge inside her body.

The sponge – which measured 18-by-18 inches and was left behind during surgery – was inside the woman's body for years before she realised.

It had been left in her body after she underwent heart surgery at a Kentucky hospital in 2011. The bypass surgery is said to have gone wrong, leaving a mess – and as nurses rushed to deal with the problems, the sponge was left inside her body. 

It was not discovered for four years, until she had a CT scan in 2015. In the meantime, the sponge had moved around the woman's body, shifting around her intestines and causing pain as it did so. She had her leg amputated and was left with gastrointestinal issues after the sponge eroded into her intestine.

The patient's lawyers said the case should be a reminder to hospitals to ensure that objects such as needles and other sharp objects, as well as sponges, are removed from patients after surgery.

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Source: The Independent, 1 January 2020

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Non-acute services to receive 30 million PPE products

Adult social care services are to receive millions of personal protective equipment products following a national audit of personal protective equipment (PPE), HSJ can reveal.

The government will deliver more than 30 million items to local resilience forums in the coming days, for distribution among social care and other front-line services, according to a letter seen by HSJ.

The stock should not be sent to acute trusts or ambulance services, the letter, from health and social care secretary Matt Hancock and housing, communities and local government secretary Robert Jenrick, stated.

Describing an “urgent need” for PPE in front-line services, Mr Hancock and Mr Jenrick asked local planners to distribute this latest batch of stock “only where there is a clear and pressing need”.

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Source: HSJ, 6 April 2020

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Sajid Javid: Doctors too often ‘ignore’ women’s pain

Doctors too often "ignore" women's pain, Sajid Javid said as he called for change in the wake of the Shrewsbury maternity scandal.

Writing for The Telegraph, the Health Secretary said the wider NHS needed to do much more to listen to women, adding that too many are left in pain and ignored by clinicians.

On Wednesday, the Ockenden report revealed that the deaths of 201 babies and nine mothers at Shrewsbury and Telford NHS Trust could have been avoided, citing a failure to listen to women.

Mr Javid wrote: "This week we have seen the tragic reality of what can happen when women's voices are not listened to when it comes to their care. 

"Donna Ockenden's report into maternity failings at Shrewsbury and Telford Hospitals raises specific concerns for maternity services, but more widely we must address issues across the whole of the health and care system when it comes to listening to women's concerns and recognising their pain."

In the joint piece with Maria Caulfield, the minister for women’s health, Mr Javid welcomed a "shift in the way we talk about women's health", with more open discussions about areas once seen as taboo.

But the pair said more needed to be done – specifically to improve the treatment of endometriosis, an extremely painful gynaecological condition.

"We must ensure all women feel confident in going to their GP when they experience symptoms of endometriosis and, when they do, that they are listened to," they said. Too many were "spending too long in pain waiting for a diagnosis, often feeling ignored by clinicians", they warned.

Later this year the Government will publish a women's health strategy, which will examine issues including fertility, menopause, and prevention and treatment of diseases.

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Source: The Telegraph, 31 March 2022

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India: When a ‘never event’ hits a patient

A young woman was left with a retained foreign object, after surgery in an India hospital. A checklist could have avoided her death. The response from the health officials was: “We have issued a show-cause notice to the staff seeking an explanation. We will initiate departmental action based on their replies and finding of our inquiry.”

In the fields of healthcare quality and patient safety, such punitive measures of “naming and shaming” have not worked.

T.S. Ravikumar, President, AIIMS Mangalagiri, Andhra Pradesh, moved back to India eight years ago with the key motive to improve accountability and safety in healthcare delivery. He believes that we have a long way to go in reducing “preventable harm” in hospitals and the health system in general.  "We need to move away from fixing blame, to creating a 'blame-free culture' in healthcare, yet, with accountability. This requires both systems design for safe care and human factors engineering for slips and violations".

"Providing safe care without harm is a 'team sport', and we need to work as teams and not in silos, with mutual respect and ability to speak up where we observe any deviation or non-compliance with rules, says Ravikumar. Basic quality tools and root-cause analysis for adverse events must become routine. Weekly mortality/morbidity conferences are routine in many countries, but not a routine learning tool in India.

He proposes acceleration of the recent initiative of the DGHS of the Government of India to implement a National Patient Safety Framework, and set up an analytical “never events” or sentinel events reporting structure.

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Source: The Hindu, 12 January 2020

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Trust blames behaviour ‘from top of the NHS’ for bullying

Leadership behaviour from the “very top of the NHS” has led to an increase in bullying, according to an official strategy document produced by an acute trust.

East and North Hertfordshire Trust published its new people and organisation strategy in its January board papers. Within it, the report said: “Leadership behaviour from the very top of the NHS, during this time of pressure has led to an increase in accusations of bullying, harassment and discrimination.”

In a separate section, the paper noted the difficulties of being a healthcare professional, saying “many staff leave before they need to and many more cite bullying, over work and stress, as reasons for absence and mistakes”.

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Source: HSJ, 13 January 2020

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Antidepressants can cause 'chemical castration'

Antidepressants can cause severe, sometimes irreversible, sexual dysfunction that persists even after discontinuing the medication. 

Sufferers have described it as ‘chemical castration’ – a type of genital mutilation caused by antidepressants, mainly selective serotonin reuptake inhibitors (SSRIs).

The condition is known as post-SSRI sexual dysfunction (PSSD), a condition largely unrecognised, and the true incidence of which is unknown.

David Healy, psychiatrist and founder of RxISK.org said, “I saw my first patient with PSSD in 2000, a 35-year-old lady who told me that three months after stopping treatment, she could rub a hard-bristled brush across her genitals and feel nothing.”

David Healy, psychiatrist and founder of RxISK.org said, “I saw my first patient with PSSD in 2000, a 35-year-old lady who told me that three months after stopping treatment, she could rub a hard-bristled brush across her genitals and feel nothing.”

Josef Witt-Doerring, psychiatrist and former FDA medical officer said, “This condition is so devastating that it will cause serious changes to your life and to those around you.”

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Source: Maryanne Demasi, 13 June 2023

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Pressure on NHS is breaking doctors’ morale, says psychiatrist

Dr Julia Patterson of campaign group EveryDoctor tells why she quit health service "cut back to its very bones". 

“Doctors love their jobs, and most wouldn’t do anything else,” she said. “It’s our vocation to care for our patients. However, the level of stress endured by frontline NHS staff is unbelievable. Understaffing leaves doctors feeling isolated and stretched. There is often pressure to take on more patients, to work extra shifts, to stretch themselves thinner and thinner.”

New findings shared exclusively with the Observer by legal support service the Medical Protection Society (MPS) confirm the deep discontent in Britain’s medical profession. It has found that 52% of doctors working in the UK are dissatisfied with their work-life balance, 46% feel guilty about taking time off, and almost 40% believe their employer does not give them the support they need to do their job well.

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Source: The Guardian, 29 September 2019

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NHSE review accuses outstanding trust of ‘dismissive’ attitude to whistleblowers

The leadership of a prominent cancer trust acted in a ‘defensive and dismissive’ manner when serious concerns were raised about bullying behaviours and multiple failings in the handling of a major research contract, an external review has found.

As previously revealed by HSJ, NHS England commissioned the review into events at The Christie Foundation Trust after whistleblowers raised numerous concerns over a research project with pharmaceutical giant Roche, and about the way they were treated as a result of speaking out.

The NHSE review, which was led by Angela Schofield, chair of Harrogate and District FT, was published earlier today within trust board papers. It described the trust’s research division as “ineffective” and said it had “allowed inappropriate behaviours to continue without challenge”.

The review added: “It may… be thought to be surprising that NHSE/I found it necessary to commission an external rapid review to look into concerns which had been raised by colleagues within the research and innovation division."

“The root cause of this seems to be an apparent failure by those people in leadership positions who were aware of the concerns that had been raised, in the circumstances covered by the review, to listen to and take notice of a number of people who have some serious issues about the way they are treated and wish to contribute to an improvement in the culture."

It also summarised the experiences of 20 current and former staff members who said they suffered “detriment as a result of raising concerns”, although it did not make a clear judgement on whether their claims were justified.

They said: “An experience of bullying, harassment and racial prejudice was described along with lack of respect at work… Patronising behaviour, humiliation and verbal aggression by managers and clinicians in public and private spaces contributed to the perception that working environments were emotionally unsafe.”

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Source: HSJ, 27 January 2022

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