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Health NHS patient feedback is not being used to improve services, report warns

The NHS is spending millions of pounds encouraging patients to give feedback but the information gained is not being used effectively to improve services, experts have warned.  

Widespread collection of patient comments is often “disjointed and standalone” from efforts to improve the quality of care, according to a study by the National Institute for Health Research (NIHR).

Nine separate studies of how hospitals collect and use feedback were analysed. They showed that while thousands of patients give hospitals their comments, their reports are often reduced to simple numbers – and in many cases, the NHS lacks the ability to analyse and act on the results.

The research found the NHS had a “managerial focus on bad experiences” meaning positive comments on what went well were “overlooked”.

The NIHR report said: “A lot of resource and energy goes into collecting feedback data but less into analysing it in ways that can lead to change, or into sharing the feedback with staff who see patients on a day-to-day basis.

NHS England's chief nurse, Ruth May, said: "Listening to patient experience is key to understanding our NHS and there is more that that we can hear to improve it. This research gives insight into how data can be analysed and used by frontline staff to make changes that patients tell us are needed."

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Source: 13 January 2020

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Scans of 1,800 patients reviewed after private contract suspended

Ultrasound scans for around 1,800 patients have had to be reviewed over concerns about the “quality and safety” of work carried out by two sonographers employed by an independent provider.

The two sonographers were employed by Bestcare Diagnostics. The company held an “any qualified provider” contract for non-obstetric ultrasound scans with Coastal West Sussex Clinical Commissioning Group (CCG) from April 2017.

This contract was suspended in September 2018 over what the CCG said were “quality issues”. However, new information came to light in spring 2019 and the CCG decided to review all 1,800 patients seen by the pair, who worked for the company between April and August 2018.

The CCG said scans for these patients were reviewed and, wherever possible, the patients were contacted. A second stage of the review will look at whether any harm was caused to the patients.

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Source: HSJ, 20 February 2020

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UK to give emergency approval to any Covid vaccine breakthrough

Any new and effective Covid vaccine will be given emergency approval for use in the UK and an expanded workforce will be trained to give the injections to immunise as much of the population as possible quickly, the government has said.

A change in the law will allow the UK regulator, the Medicines and Healthcare Products Regulatory Agency (MHRA), to grant temporary approval for a vaccine from October, before it has been given a licence by the European authorities, which would be the normal procedure. The UK will be out of the EU from January and will approve drugs and vaccines without Brussels’ involvement.

Ministers say there will be no shortcut on safety or effectiveness, and that any vaccine will be approved for the UK only if it meets the highest standards.

The deputy chief medical officer for England, Prof Jonathan Van-Tam, said: “We are making progress in developing COVID-19 vaccines, which we hope will be important in saving lives, protecting healthcare workers and returning to normal in future.

“If we develop effective vaccines, it’s important we make them available to patients as quickly as possible but only once strict safety standards have been met. The proposals consulted on today suggest ways to improve access and ensure as many people are protected from Covid-19 and flu as possible without sacrificing the absolute need to ensure that any vaccine used is both safe and effective.”

The MHRA has the power to grant an unlicensed medicine or a vaccine temporary authorisation where a product is proven safe and effective and in the best interest of the patient on the basis of available evidence.

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Source: The Guardian, 28 August 2020

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Shortages of staff and equipment weigh on doctors’ decisions, survey reveals

Staff shortages and a lack of equipment are affecting the day-to-day decisions about patient care by doctors and nurses, a new YouGov survey has revealed.

The representative survey of NHS clinicians revealed more than half, 54%, admitted that factors such as a lack of staff played a role in their decisions about patients beyond what was in their best interests.

Almost a third of staff, 31%, said staffing levels were the top factor affecting decisions about patients. A fifth said the availability of services such as key tests were a significant factor; 16% cited a lack of equipment; and 12% cited beds. 10% of clinicians said a fear of being sued was part of their decision-making.

YouGov carried out the research for JMW Solicitors and weighted the responses to be representative of the NHS workforce population.

It also revealed more than two-fifths of clinicians, 42%, believe a “blame culture” in the NHS plays a top role in preventing staff admitting to mistakes in care.

In maternity services specifically, 68% of nurses and midwives said at least one factor other than what was in patients’ best interest played a role in their decisions.

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Source: The Independent, 20 December 2020

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Patients ‘treated in ambulances as there was no space in A&E’

A London hospital is being forced to send patients back to ambulances for treatment due to an ‘overwhelming’ number of Covid patients on ICU wards, according to a frontline doctor.

The medic, who asked to remain anonymous, said A&E staff are "running" into waiting ambulances to treat patients there until space becomes available.

He said: "It’s not the fault of the staff, but the sheer numbers are so unprecedented and being full like this means that you just have to do your best to adapt. But it’s not the standard (of care) I signed up to."

"It’s extremely stressful for us to be doing our best but knowing that significant patient harm is happening because there isn’t space and the patient load is too high." 

He raised concerns that "significant patient harm" was occurring due to a lack of beds available and the emergency system means medics are limited in the care they can provide.

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Source: The Metro, 14 January 2021

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Calls for compensation scheme for UK frontline workers with long Covid

Boris Johnson is being urged to launch a compensation scheme for frontline workers who are suffering from the long-term effects of coronavirus.

The all-party parliamentary group on coronavirus said the prime minister should recognise long Covid as an occupational disease, saying some sufferers have found it hard to return to work. 

A letter, signed by more than 60 MPs and peers, has been sent to Johnson.

Layla Moran, the APPG’s chair, said: “Long Covid is the hidden health crisis of the pandemic, and it is likely to have an enormous impact on society for many years to come.

“When it comes to frontline NHS, care and key workers, they were specifically asked to go to work and save lives while everyone else was asked to stay at home."

“They were exposed to an increased level of risk of catching the virus, often without adequate levels of PPE.”

The group wants the government to follow France, Germany, Belgium and Denmark, which have formally recognised Covid as an “occupational disease”.

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Source: The Guardian, 18 February 2021

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NHS Digital receive approval for the pathology information standards

In a positive step towards the future of pathology, NHS Digital has received approval from the Data Alliance Partnership Board (DAPB) for a new set of pathology information standards, and as part of NHS England CCIO7 workstreams, NHS Digital are delivering the ability to share pathology results across health and care.

This move will enable clinicians to share and access critical information about pathology tests and results and receive the right information when they need it, which will help support improved clinical decision making and patient safety. 

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Source: Wired Gov, 19 August 2021

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Leaders ‘pay lip service’ to public engagement, NHSE director says

Health leaders ‘pay lip service’ to engaging with patients and "do not look like or live the lives of the people they are making decisions about", an NHS England director has said.

Olivia Butterworth, NHSE’s deputy director of people and communities, told a public event hosted by the New Local think tank there is a “whole load of work” going on around reforming patient-reported outcome measures.

But she said that “none” of this work “starts with conversations with people about what do they value and what they want to measure.”

Asked whether NHS England’s top leadership is “paying lip service” to patient engagement, Ms Butterworth said: “I think often everybody pays lip service to it. We all use the right words. But whether it’s local government, whether it’s the NHS we know the words to use, but do we really live that in our actions in the way that we really like to change things?

“Or do we just blame the system for being too complex and it is the system that won’t let us, without recognising that we are the system, we make the system, we run the system, the system is people.”

Elsewhere in the session, Ms Butterworth said that “our decision makers do not look like or live the lives of the people they are making decisions about.”

She added that health services need to “join up around people” and that integrated care systems and partnerships offer the opportunity to “cut the crap of the organisational boundaries that stopped us doing things”.

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Source: HSJ, 8 April 2022

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Barclay calls urgent ‘hackathons’ over ambulance crisis

The new health and social care secretary has asked officials to hastily organise several “hackathons” to try to address the crisis in ambulance performance.

The first, which was instigated just last week, will take place tomorrow (28 July), and a second is planned for August, sources told HSJ.

Messages from officials described the work as a “request from our new secretary of state” and explained the short notice by saying he was “pushing… quite strongly for something before the end of the month”.

The aim is said to be to examine what is driving poor performance, and the Department of Health and Social Care is “particularly interested in understanding which factors reduce risk to patients”, according to one message seen by HSJ.

Hackathons are short, time-limited collaborative design events, typically involving computer programmers and data scientists or analysts, which aim to result in working software or product on the chosen theme by the end.

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Source: HSJ, 27 July 2022

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21-year-old died after dialling 999 from his hospital bed

A young NHS patient suffering a sickle cell crisis called 999 from his hospital bed to request oxygen, an inquest into his death was told.

Evan Nathan Smith, 21, died on 25 April 2019 at North Middlesex Hospital, in Edmonton, north London, after suffering from sepsis following a procedure to remove a gallbladder stent.

The inquest heard Smith told his family he called the London Ambulance Service because he thought it was the only way to get the help he needed.

Nursing staff told Smith he did not need oxygen when he requested it in the early hours of 23 April, despite a doctor telling the inquest he had “impressed” on the nurses he should have it.

Smith’s sepsis is thought to have triggered the sickle cell crisis – a condition that causes acute pain as blood vessels to certain parts of the body become blocked.

Barnet Coroner's Court heard Smith, from Walthamstow in east London, might have survived if he had been offered a blood transfusion sooner but the hospital’s haematology team were not told he had been admitted.

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Source: The Independent, 3 April 2021

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Major trust faces bullying concerns from hundreds of senior doctors

Concerns over bullying and discrimination have been raised in a survey of hundreds of doctors at a major hospital trust, HSJ  can reveal.

University Hospitals of North Midlands Trust’s medical staff committee carried out a survey of its doctors earlier this year, after bullying concerns were raised by members of the British Association of Physicians of Indian Origin at the trust.

A summary of the survey findings, published in a newsletter sent to all doctors at the trust last week and seen by HSJ, showed more than two-thirds of the 348 respondents claimed to have experienced bullying, harassment or victimisation at work. Nearly 80% said they had witnessed bullying or harassment, while 50 per cent of respondents said the bullying and harassment was due to race or ethnicity.

Fifty-five per cent of those answering the survey also said they had not reported concerns as they had “no confidence in the investigative process within the organisation”.

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Source: HSJ, 2 June 2021

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Nurse shortage ‘delaying treatment for 21% of UK cancer patients’

More than 600,000 cancer patients in the UK are facing treatment delays or missing out on vital support because of a shortage of specialist nurses, a new report from Macmillan Cancer Support reveals.

One in five of all those living with cancer (21%) are lacking dedicated support. The NHS is suffering from a “shocking” shortfall of 3,000 specialist nurses in England alone, according to the analysis by Macmillan Cancer Support.

As a result, cancer patients are struggling with medication, having hospital appointments cancelled because there are not enough staff or experiencing devastating delays to chemotherapy. In some cases, patients are ending up in A&E.

Patricia Marquis, England director of the Royal College of Nursing, warned the workforce crisis was having a “devastating impact” on people living with cancer. “Expertise built up over many years is lost very quickly and it is patients who pay the price, as this report shows,” she added.

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Source: The Guardian, 8 September 2021

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Pregnant women at risk from NHS workers’ mixed messages over safety of jab

Pregnant women are being advised by some health professionals not to have the Covid vaccine despite an edict from the NHS that they should encourage them to get the jab. One in six of the most critically ill Covid patients requiring life-saving care are unvaccinated pregnant women, figures released last week show.

Yet messages sent to the Vaccines and Pregnancy helpline, launched on 20 August to help pregnant women navigate information about the vaccine, suggest that some midwives are advising against the jab.

One said: “I was initially keen to have the vaccine and then advised by a midwife not to have it.” Another wrote: “I had my first dose before I knew I was pregnant. Now I’m pregnant I’ve been told I’m not allowed my second.” Another reported: “I’ve been advised by midwives not to get the vaccine due to the impact on ovulation and menstruation.”

The helpline was set up by the organisation Full Fact in partnership with the campaign group Pregnant Then Screwed. Many of those contacting it complained of conflicting advice while others were pushed from pillar to post. One said: “I’m pregnant and really confused about getting the vaccine. I’ve spoken to my health visitor, who said speak to your GP, the GP said speak to your midwife, and the midwife said they can’t advise me.”

Full Fact’s deputy editor, Claire Milne, said the helpline was established to counter misinformation about the vaccine. She explained: “It’s not right so many pregnant women have been left scared for their safety and that of their unborn children.

“Messaging around the safety of the vaccines in pregnancy has been, at times, confused. It’s vital that up-to-date information is available – especially when speaking with health professionals.”

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Source: The Guardian, 17 October 2021

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NHS warns of scam Covid-test texts

The NHS is warning about widespread scam text messages telling recipients they have been in close contact with a Covid case.

"We've seen reports of fake NHS text messages about ordering Omicron Covid-19 test kits," it tweeted.

Close contacts of people who have tested positive are no longer advised to test.

The aim of the messages appears to be harvesting financial and personal information.

In its alert, the NHS says it will "never ask for bank details, so please be aware of suspicious messages".

Most people are no longer advised to test for Covid and are ineligible for free tests - but some some pharmacies and shops sell them.

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Source: BBC News, 22 June 2022

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‘Buckling’ NHS fails to treat 250,000 children with mental health problems

A quarter of a million children in the UK with mental health problems have been denied help by the NHS as it struggles to manage surging case loads against a backdrop of a crisis in child mental health.

Some NHS trusts are failing to offer treatment to 60% of those referred by GPs, the research based on freedom of information request responses has found.

The research carried out by the House magazine and shared with the Guardian also revealed a postcode lottery, with spending per child four times higher in some parts of the country than others, while average waits for a first appointment vary by trust from 10 days to three years.

Olly Parker, head of external affairs at YoungMinds, said the freedom of information findings showed a “system is in total shutdown” with “no clear government plan to rescue it”, after the 10-year mental health plan was scrapped.

“In the meantime, young people are self-harming and attempting suicide as they wait months and even years for help after being referred by doctors,” he said. “This is not children saying ‘I’m unhappy.’ They are ill, they are desperate and they need urgent help.”

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Source: The Guardian, 16 April 2023

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Kidney condition detected in minutes by app

A mobile phone app has speeded up the detection of a potentially fatal kidney condition in hospital patients. Acute kidney injury is caused by serious health conditions, including sepsis, and affects one in five people admitted to hospital. It accounts for around 100,000 deaths every year in the UK.

During a trial at London's Royal Free Hospital, doctors and nurses received warning signals via a mobile phone app in an average of 14 minutes, when patients' blood tests indicated the condition. The new alerting system, known as Streams, developed by the Royal Free with technology firm DeepMind, sends results straight to front-line clinicians in the form of easy-to-read results and graphs.

This could could save the NHS an average of £2,000 per patient by alerting clinicians to acute kidney injury sooner. However, although the findings, published in the journal Nature Digital Medicine, led to earlier recognition, it did not lead to any improvements in the primary outcome measure (renal recovery) or in secondary outcomes, which included survival, length of stay in hospital, and admission to the intensive care unit.

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Source: BBC News, 1 August 2019

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Report details failings over Swindon patient's fall from ward roof

NHS bosses knew that a low roof at a Swindon mental health unit was a safety risk before a patient slipped off it 11 hours after scaling the building.

The woman, who suffered paranoia, needed emergency surgery after breaking her jaw, hip, pelvis and nose in the fall from the roof. 

Avon and Wiltshire Mental Health Partnership (AWP) NHS Trust has since apologised for the incident. In August, the trust was fined £80,000 by magistrates after bosses admitted failing to provide safe care at Sandalwood Court psychiatric hospital.

Now, an internal report on the incident has been published demonstrating AWP bosses knew the low roof was a risk. But it was agreed to manage that risk clinically, with ward staff assessing whether a patient was likely to abscond. The authors of the report, released by AWP following a freedom of information request, said there was a systematic fault.

“The risk was on the health and safety register, it was highlighted annually and escalated trust-wide,” they wrote.

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Source: Swindon Advertiser, 18 October 2019

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Hospice receives outstanding CQC rating

The Care Quality Commission (CQC) has awarded 'Outstanding' ratings to St Giles Hospice in Walsall and Whittington. 

The CQC, an independent regulator of health and social care services in England, has recently introduced a new regime holding hospices to the same level of scrutiny as hospitals, making this outstanding rating all the more impressive.

St Giles hospice, founded in 1983, started as a charity caring for local people dying from cancer and now supports people living with incurable illnesses and their families for free.

Care providers from the hospice work on-site and in patients’ own homes, and their level of care has made them one of only a handful of hospices to ever have been awarded this accolade.

In the CQC report inspectors complimented the hospice for its “compassionate” range of speciality services. 

Inspectors added: “People were truly respected and valued as individuals. They were empowered as partners in their care, practically and emotionally, by an exceptional and distinctive service.”

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Source: National Health Executive, 16 January 2020

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Infected Blood Enquiry: Timetable and factsheet for expert hearings

This is the independent public statutory inquiry into the use of infected blood. 

The timetable and factsheet to provide information for those attending the hearings in London on 24-28 February have just been published.

Go to this link for more information >> https://www.infectedbloodinquiry.org.uk/news 

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COVID-19: Liverpool to pilot city-wide coronavirus testing

People in Liverpool will be offered regular COVID-19 tests under the first trial of whole city testing in England.

Everyone living or working in the city will be offered tests, whether or not they have symptoms, with follow-up tests every two weeks or so. Some will get new tests giving results within an hour which, if successful, could be rolled out to "millions" by Christmas, the government says.

Liverpool has one of the highest rates of coronavirus deaths in England. The latest figures show the city recorded 1,754 cases in the week up to 30 October. The average area in England had 153.

The pilot aims to limit spread of the virus by identifying as many infected people as possible, and taking action to break chains of transmission.

It is thought around four-fifths of people who are infected with coronavirus show no symptoms.

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Source: BBC News, 3 November 2020

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Publish figures on long Covid to show ‘untold suffering’, MPs urge

The number of people suffering with long Covid should be published routinely, as happens with those infected with or hospitalised with coronavirus, MPs and peers are urging Boris Johnson.

The cross-party group of parliamentarians want the prime minister to ensure that the “untold human suffering” that the condition involves helps shape future government policy towards the pandemic.

Thirty-two MPs and 33 peers have signed a letter urging Johnson to give greater priority to the potential harm posed by long Covid following the Office for National Statistics’ finding last week that an estimated 1.1m people are suffering its effects – far more than previously thought.

The signatories come from eight parties and include the Tory MP Dr Dan Poulter, a former health minister; Lord Darzi, the surgeon and ex-health minister; and the SNP MP Dr Philippa Whitford, who is an NHS breast surgeon.

In the letter, coordinated by the all-party parliamentary group on coronavirus, they say: “Cases, hospitalisations and deaths are not the only measure of this pandemic. We urge the government to also count the number of people left with long Covid, many of them whose lives have been devastated by this pandemic.

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Source: The Guardian, 9 April 2021

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CQC threatens to suspend licence of ‘large scale’ GP provider

A major GP group in Plymouth covering tens of thousands of patients could have its licence removed after failing to make ‘substantial improvements’ ordered by the Care Quality Commission (CQC).

In August, the CQC rated the Mayflower Medical Group “inadequate” and last month the regulator said it had served a “letter of intent” on the group after another inspection. Such a letter is the last step the CQC takes before a provider’s licence is suspended.

Licence suspension would affect around 40,000 people (a sixth of Plymouth’s population), who live in one of the highest areas of deprivation in the country – according to Public Health England (now the UK Health Security Agency).

Among the CQC’s concerns were safety fears about the way medicines were prescribed, poor management of high-risk patients, coding issues, limited monitoring of the outcomes of care and treatment, and patients experiencing difficulties accessing care and treatment.

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Source: HSJ, 2 December 2021

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Non-compliant online STI tests put patients at risk, experts warn

Patients are being put at risk in the UK because very few sexually transmitted infection (STI) tests offered online meet official standards, experts have warned.

The NHS provides free in-person tests for STIs via its network of sexual health and genitourinary medicine clinics. Patients can also order tests via the internet from both NHS-commissioned and private providers, a practice that has become increasingly popular during the pandemic.

However, new research in the Sexually Transmitted Infections journal published by the BMJ found that few online STI test services meet national recommended standards, with independent sector providers the least likely to be compliant.

Online tests involve the user ordering a kit and either self-sampling by posting the specimen for laboratory analysis, or self-testing by interpreting the test themselves.

The research found that the commercial self-sample providers, which advertised to those with symptoms, did not differentiate by STI symptom severity, and eight – seven private and one NHS-commissioned provider – offered no advice on accessing preventive treatment after exposure to HIV as recommended.

Self-test providers did not appear to offer any form of order of treatment for patients and five offered tests that were intended for professional use only.

The research concluded: “Regulatory change is required to ensure that the standard of care received online meets national guidelines to protect patients and the wider population from the repercussions of underperforming or inappropriate tests."

“If we do not act now, patients will continue to receive suboptimal care with potentially significant adverse personal, clinical and public health implications.”

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Source: The Guardian, 12 April 2022

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Surgeon damaged dozens of patients by misplacing screws in their backs

Every day Sharon Smith has to take a strong morphine tablet to dull the excruciating pain she has lived with for more than a decade. 

“I am in chronic pain every day. It’s affected our whole family and I’ve lost all my independence,” said Smith, from Leigh, Greater Manchester.

Over four years from 2009, she endured three operations on her spine at Salford Royal Hospital, which as an NHS trust was once fêted as England’s safest.

But the hospital had a dark secret: an incompetent leading surgeon who, an independent review would later find, had already “contributed” to the death of a girl in 2007.

Now a wider investigation has confirmed that dozens of other patients who went under John Bradley Williamson’s knife were harmed or received poor care.

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Source: The Times, 30 July 2023

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