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BMA ‘rate card’ wipes out elective recovery gains, claims trust

A struggling acute trust says its failure to hit its elective care targets is directly linked to doctors’ demanding overtime rates in line with the British Medical Association’s rate cards, as national tensions around the issue intensify.

University Hospitals of Morecambe Bay Foundation Trust’s January performance report said its elective activity was down by around 1,000 cases over a two-month period, due to the issue.

Last summer, the BMA published a “rate card” outlining the “minimum” hourly pay consultants should receive for additional work, such as waiting list initiatives and weekend shifts. Some accused the union of “acting like football agents” by trying to inflate their members’ pay.

NHS chiefs have long been warning of the risk the rate card poses to elective recovery. But there are few examples of a trust making such an explicit link between their struggle to staff overtime shifts because of the rate card and subsequent failure to hit their elective targets, and placing a number on how many patients they were forced to add to the list because of the issue.

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Source: HSJ, 1 March 2023

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‘Toxic working environment’ exposed at troubled unit

Staff endured a “toxic and difficult working environment” at a maternity unit an employment tribunal has found.

The tribunal panel said that the case of a black midwife, Kemi Akinmaji, who partially won her case against East Kent Hospitals University Foundation Trust for racial discrimination showed “there were wider issues beyond the specific allegations before us and which were possibly related to race”.

The tribunal judgment said: “The evidence we heard reflected a toxic and difficult working environment generally where the claimant and colleagues were shouted and sworn at over differences of professional opinion. There was some evidence before us that there were wider issues beyond the specific allegations before us and which were possibly related to race…

“There is evidence of wider bullying of the claimant in the way the group of colleagues treated the claimant… We’ve also heard that the previous grievance had highlighted risks in respect of unconscious bias and identified recommendations which were not actioned.

“The race champion was not appointed and the unconscious bias training not sufficiently followed through. We also heard evidence of staff being wary of further such complaints. These matters were all concerning but we had to limit ourselves to the specific allegations brought by the claimant and which the respondent had been given an opportunity to address.”

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Source: HSJ, 1 March 2023

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Inquiry exaggerated trust death toll, claims CEO

A trust chief executive has suggested an inquiry team looking at 2,000 deaths is lacking in “expertise” and has created a “disproportionate impression” of the problems at his trust.

Essex Partnership University Trust is at the centre of a high-profile inquiry into the deaths of patients over a 20-year period, which was sparked after serious concerns were raised over specific cases.

The inquiry, led by Geraldine Strathdee, a former national clinical director for mental health, is reviewing the cases of 2,000 people who died while they were patients on a mental health ward in Essex or within three months of being discharged.

In a letter to the inquiry, obtained by HSJ through a freedom of information request, trust chief executive officer Paul Scott wrote: “The headline number of c.1,500 or c.2,000 deaths used in publicity by the inquiry is, in my opinion, not a fair reflection of the deaths that would be of interest to the inquiry.”

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Source: HSJ, 1 March 2023

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Doctors pressured not to make a fuss over Lucy Letby, trial told

A consultant has said that doctors were put under pressure by hospital management not to make a fuss when they raised concerns about nurse Lucy Letby.

Dr Ravi Jayaram said his team first raised concerns about unusual episodes involving babies in October 2015 but nothing was done

Ms Letby, 33, is accused of murdering seven babies and attempting to murder 10 others at the Countess of Chester Hospital between 2015 and 2016.

He told the court the matter was raised again in February 2016 and the hospital's medical director was told at this point.

The consultants asked for a meeting but did not hear back for another three months, the court heard.

Ms Letby was not removed from front-line nursing until summer 2016.

Dr Jayaram told jurors that he wished he had bypassed hospital management and gone to the police.

He said: "We were getting a reasonable amount of pressure from senior management at the hospital not to make a fuss."

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Source: BBC News, 28 February 2023

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Medical body NICE backs online mental health treatments

The National Institute for Health and Care Excellence (NICE) has recommended eight online therapies for anxiety and depression.

NICE says the therapies have the potential to help more than 40,000 people in the UK.

Each therapy must come with a formal assessment from an NHS therapist in order for it to be recommended.

According to NHS Digital, there is a six-week waiting list for patients who need mental health support in England. There are hopes that introducing online digital therapies could ease pressure on the NHS.

The treatments can help those with depression, anxiety, PTSD and body dysmorphia and are centred on the use of cognitive behavioural therapy (CBT) - a talking therapy which can help a patient manage their problems by suggesting alterations to their thought process and behaviour.

The therapies have been conditionally recommended by NICE - meaning early assessments have taken place to identify promising medical technology but more evidence needs to be gathered.

However, Professor Dame Til Wykes, of the School of Mental Health and Psychological Sciences at London's King's College, cautioned "we don't know enough" about the effectiveness of online therapies and whether the therapies will offer sufficient support for mental health patients.

Her view was echoed by mental health charity Mind, with content manager Jessica D'Cruz asserting "the majority" of people needing support "will struggle to benefit from this".

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Source: BBC News, 1 March 2023

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Woman died after breathing tube put in food pipe

A mother-of-one died after a breathing tube was put into her food pipe, despite staff raising concerns it was inserted incorrectly, an inquest heard.

Emma Currell, 32, had just received dialysis and was heading home to Hatfield, Hertfordshire, in an ambulance when she had a seizure. 

An anaesthetic team was called to sedate her as her tongue had swelled and she was bleeding from the mouth.

Dr Sabu Syed, who was a trainee anaesthetist, told the hearing: "I used suction to remove blood and I was able to push the tongue to the side and got a partial view."

She said she believed she inserted the tube into the trachea - the windpipe - and had asked her senior colleague Dr Prasun Mukherjee to check the position of the tube.

"Dr Mukherjee was busy doing other tasks," she added.

Technician Nicholas Healey said he flagged his concerns when there was no carbon dioxide reading on the ventilator, which was not faulty.

He said that both he and Dr Syed had raised concerns about the tube being in the wrong place.

The court heard the hospital had drawn up a guideline checklist for trachea procedures since Ms Currell's death and staff were due to have "no trace = wrong place" training on the warning signs of incorrect insertion.

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Source: BBC News, 27 February 2023

 

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Cybersecurity strategy among dozens of tech promises missed by government

The government has failed to meet most of its own deadlines for commitments to improve how the NHS uses data, including developing a cybersecurity strategy, HSJ can reveal.

The delays include work to store and analyse patient data more securely, building public trust in the NHS’ use of patient data, and agreeing national strategies on cybersecurity and cloud technology.

The strategy and its commitments were published following the Goldacre Review, which called for an overhaul of how NHS patient data is collected, stored and used.

It came after the government was forced to indefinitely halt a controversial plan to collect all GP-held patient data in 2021, which resembled the fate of a similar data scheme in 2016.

Several data projects have also come under scrutiny from doctors and campaigners in recent years, such as NHS England’s procurement of a new Federated Data Platform and a much-criticised trust’s data-sharing scheme with a credit rating company.

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Source: HSJ, 28 February 2023

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Half of men with eating disorders don’t get any help: 8 warning signs somebody needs support

Over half of men with an eating disorder have never had any treatment, according to new research.

Despite typically being linked with females, males account for a quarter of all eating disorder cases – and many are not getting any support, the eating disorder charity Beat is highlighting

“Eating disorders affect 1.25 million people in the UK, and we estimate one in four of those are men,” says Tom Quinn, Beat’s director of external affairs – speaking to mark this year’s Eating Disorders Awareness Week (February 27 – March 5).

“We surveyed men across the UK about their experiences of an eating disorder and, alarmingly, we discovered over half have never had treatment for their eating disorder, and one in three have never tried to get treatment in the first place.

“There’s a harmful misconception that eating disorders are female illnesses, which creates a great deal of shame and can entrench harmful behaviours for men who are unwell,” Quinn adds.

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Source: The Independent, 27 February 2023

Further reading on the hub: Top picks: Eight resources on eating disorders

 

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Patients losing out amid slump in NHS clinical trials, warn top clinicians

The state of clinical trials in the NHS is “much worse than it has been in years” with patients losing access to cutting-edge cancer and dementia treatments, one of the UK’s most senior clinicians has warned.

Sir John Bell, the regius professor of medicine at the University of Oxford and a government life sciences adviser, said the UK’s approach needed “a full overhaul, top to bottom” to prevent a collapse in the number of clinical trials being conducted in the NHS.

“I don’t think there’s any doubt that companies are choosing not to evaluate their drugs in the UK,” he said. “The risks [to patients] are much bigger than have been alluded to.”

The intervention comes after the government launched an independent review led by the former health minister James O’Shaughnessy into why the NHS had seen a 44% drop in participants recruited to commercial clinical trials in the past five years. The UK is rapidly losing ground to countries such as Spain, Poland and Australia, falling from fourth to 10th internationally for phase III trials.

Reduced access to trials is particularly concerning for patients with limited routine treatment options, such as the roughly 3.5 million people living with rare diseases and patients with dementia and advanced cancer.

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Source: The Guardian, 27 February 2023

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Covid inquiry: Race should be at its core, say campaigners

Race should be made a central part of the UK's independent public inquiry into the pandemic, campaigners say.

A letter seen by BBC News, sent to the chairwoman of the Covid-19 inquiry, calls for it to look at "racism as a key issue" at every stage.

Ethnic minorities were significantly more likely to die with Covid-19, according to official figures.

An inquiry spokesperson said the unequal impacts of the pandemic would be at the forefront of its work.

People from ethnic minority backgrounds who lost loved-ones during the pandemic also told BBC News they felt "sidelined" by the process so far.

The letter to Baroness Hallett, who is chairing the inquiry, has been co-ordinated by the group Covid-19 Bereaved Families for Justice and race equality think tank Runnymede. It calls for ethnic minority communities to be "placed firmly at the centre" of the inquiry.

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Source: BBC News, 28 February 2023

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CCTV to be used ‘pro-actively’ by trusts to combat abuse

Mental health trusts are exploring wider use of CCTV to review incidents of seclusion or restraint in response to high-profile abuse scandals, HSJ  has learned.

All providers of mental health, learning disability and autism services were ordered to review safety and asked to feed back to NHS England’s national team. The request was made in a letter from national director Claire Murdoch  sent in response to abuse allegations aired by BBC Panorama and Channel 4’s Dispatches.

The review is taking place alongside NHSE’s launch of a £36m three-year quality programme. This aims to identify providers and systems needing support, commission a culture and leadership development programme for all trusts, and produce a new model for safe inpatient care.

Results of trust-level reviews, seen by HSJ, show at least five providers aim to use CCTV more “pro-actively”, as a tool for boosting safety. 

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Source: HSJ, 27 February 2023

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One patient dies every 23 minutes in England after long delay in A&E

One patient is dying every 23 minutes in England after they endured a long delay in an A&E unit, according to analysis of NHS figures by emergency care doctors.

In all, 23,003 people died during 2022 after spending at least 12 hours in an A&E waiting for care or to be admitted to a bed, according to the Royal College of Emergency Medicine (RCEM).

That equates to roughly 1 every 23 minutes, 63 every day, 442 a week or 1,917 each month.

The college said its findings, while “shocking”, were also “unsurprising” and reflected the fact that emergency departments are often overwhelmed and unable to find patients a bed in the hospital.

Rosie Cooper, the Liberal Democrats’ health spokesperson, said “patients are now dying in their droves” due to successive Conservative governments neglecting the NHS, and added that the lives lost due to A&E snarl-ups constituted a “national disaster”.

“Long waiting times are associated with serious patient harm and patient deaths,” said Dr Adrian Boyle, RCEM’s president. “The scale shown here is deeply distressing.”

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Source: The Guardian, 28 February 2023

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Northampton: Maternity unit needs 37 more midwives

A criticised maternity service needs 37 more midwives, about a fifth of its total midwifery workforce.

The Care Quality Commission has said Northampton General Hospital did not always have enough qualified and experienced staff to keep women safe from avoidable harm.

Figures obtained by the BBC show that 49 serious incidents have occurred in its maternity services in four years.

The hospital said it had undertaken "a lot of work" in the past 18 months and a recruitment process was under way.

According to a Freedom of Information Act response, between November 2018 and November 2022, the hospital had 278 serious incidents, with the highest level coming across maternity services, including gynaecology and obstetrics.

There are currently 37 vacancies for midwives but the trust said it manages staffing levels "closely and ensure that all shifts are covered by bank or midwives working altered shift patterns, to ensure that we are able to provide a safe maternity experience".

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Source: BBC News, 27 February 2023

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Eating disorder patients ‘repeatedly failed’, says England watchdog

Urgent action is needed to prevent people dying from eating disorders, the parliamentary and health service ombudsman for England has warned, as he said those affected are being “repeatedly failed”.

The NHS needs a “complete culture change” in how it approaches the condition, while ministers must make it a “key priority”, according to Rob Behrens.

Little progress has been made since the publication of a devastating report by his office in 2017, which highlighted “serious failings” in eating disorder services, he said.

Lives continue to be lost because of “the lack of parity between child and adult services”, and “poor coordination” between NHS staff involved in treating patients. There remain issues with the training of medical professionals, Behrens added.

“We raised concerns six years ago in our ignoring the alarms report, so it’s extremely disappointing to see the same issues still occurring,” he said. “Small steps in improvements have been taken, but progress has been slow, and we need to see a much bigger shift in the way eating disorder services are delivered."

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Source: The Guardian, 27 February 2023

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UK spent only £15m on brain tumour research after promising £40m

Ministers have spent only £15m in five years on research into tackling brain tumours, the biggest killer of adults and children under 40, while boasting about delivering £40m, MPs have found.

The revelation emerged in a damning report seen by the Guardian that is due to be published this week by the all-party parliamentary group (APPG) on brain tumours after a two-year inquiry.

The research system is “unfit for purpose”, patients are being denied access to clinical trials, and families have been let down by promises of “millions of pounds of investment which hasn’t materialised”, the report says.

The APPG report also highlights a “valley of death” in which potential new treatments developed in the laboratory “fail to reach patients” because of unnecessary red tape. Some children are being denied access to clinical trials, and the national brain tumour research database is “not reliable”.

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Source: The Guardian, 27 February 2023

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60% of US patients uncomfortable with AI in healthcare settings, survey finds

The adoption of AI tools to simplify processes and workflows is slowly occurring across all industries, including healthcare — though patients largely disagree with clinicians using those tools when providing care, the Pew Research Center survey found.

The potential for AI tools to diminish personal connections between patients and providers is a key concern, according to the survey, which included responses from over 11,000 adults in the USA collected in December. Patients also fear their health records could become less secure.

Respondents, however, acknowledged potential benefits, including that AI could reduce the number of mistakes providers make.

They also expressed optimism about AI’s potential impact on racial and ethnic biases in healthcare settings, even as the technology has been criticised for exacerbating those issues.

Among respondents who believe racial biases are an issue in healthcare, about half said they think the tools would reduce the problem, while 15% said it would make it worse and about 30% said it would stay the same.

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Source: Healthcare Dive, 23 February 2023

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Lateral flow tests being prepared for UK outbreaks of avian flu

British health officials are preparing plans to deploy lateral flow tests if signs emerge that avian flu has begun to spread from one person to another.

The programme would provide rapid information about the dangers posed by the disease.

The UK Health Security Agency (UKHSA) is also working on blood tests to detect antibodies against the virus and officials will analyse the disease’s genetic mutations to reveal data about the increased risk to human health from avian flu.

The moves follow last week’s news that an 11-year-old girl in Cambodia has died from H5N1, the flu strain that is being spread around the globe by migrating birds and is infecting poultry farms.

At present, evidence suggests the H5N1 virus does not pass easily to people although scientists have urged care and caution. “The risk to humans is still very low, but it’s important that we continue to monitor circulation of flu in both bird and mammal populations", said Prof Jonathan Ball, of Nottingham University.

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Source: The Guardian, 26 February 2023

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Gas and air ban in hospitals leaves mums-to-be in agony

When Amy Fantis gave birth to her first child two years ago, the labour was rapid, lasting only about four hours, and she was reliant on gas and air. Her second baby is due in just a few days — but the hospital has, like others around Britain, imposed a ban on the popular form of pain relief.

Fantis, 36, from Broxbourne, Hertfordshire, is one of many women affected by the decision of several NHS trusts to suspend the use of the gas because of fears that midwives and doctors have been exposed to unsafe levels for prolonged periods. In some hospitals, levels of the nitrous oxide and oxygen mix are more than 50 times higher than the safe workplace exposure limits.

In a survey of more than 16,600 women who gave birth last year, the Care Quality Commission found that 76% of respondents used gas and air at some point during labour.

Although short-term use of the gas in childbirth is harmless to women and their babies, long-term exposure for midwives and doctors can affect the body’s ability to absorb vitamin B12, damaging nerves and red blood cells and causing anaemia. It is not believed that any NHS staff have become ill as a result of long-term exposure to gas and air.

NHS England and the Health and Safety Executive recently warned other hospitals that they need to check the ventilation on maternity wards and ensure staff are kept safe. NHS England is planning to send out new guidance to trusts on the issue after a series of hospitals had to stop using the gas.

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Source: The Times, 25 February 2023

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Depth of NHS crisis is revealed by coroners’ courts reports

NHS waiting times, staff shortages and service backlogs have been flagged as concerns in relation to dozens of patient deaths across England and Wales since the start of last year, the Observer can reveal, with coroners facing a succession of inquests concerning ambulance delays.

Coroners issue prevention of future deaths reports (PFDs) when they believe preventive action should be taken, and send them to relevant individuals or organisations, which are expected to respond.

Among 55 cases identified by the Observer are 24 patient deaths where coroners raised concerns about ambulance delays – all of them occurring before this winter’s ambulance crisis, when response times rocketed to their worst-ever levels.

Wes Streeting, shadow health and social care secretary, said: “The NHS is in the biggest crisis in its history – and the crisis has a cost in lives. Patients are waiting for far longer than is safe, with terrible consequences.”

But the issues highlighted by coroners in relation to patient deaths are wider than ambulance delays. They include: lengthy elective surgery backlogs; high referral thresholds and long waiting times for children’s mental health services; a national shortage of neurologists; long waiting times for psychological therapies; a lack of mental health beds and unfilled mental health staff vacancies; and a shortage of cardiologists compounded by a shortage of theatre capacity and beds.

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Source: The Guardian, 26 February 2023

Further reading on the hub - see a selection of Prevention of Future Deaths reports in our dedicated coroner's report section of the hub.

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Abortion UK: Women 'manipulated' in crisis pregnancy advice centres

Women are being misled and manipulated about abortion by some crisis pregnancy advice centres in the UK, according to evidence from a BBC Panorama investigation.

The centres operate outside the NHS and tend to be registered charities.

Most say they don't refer women for abortions, but offer support and counselling for unplanned pregnancies.

But the BBC's investigation reveals more than a third of these services give misleading medical information or unethical advice, and sometimes both.

Pregnancy counselling is available through the NHS and regulated abortion providers, but searching online, Panorama identified 57 crisis pregnancy advice centres advertising.

The BBC decided to investigate after hearing from women who had been to these centres. One said she had been "traumatised" and that the centre had tried to "manipulate" her into not having an abortion.

Some 21 centres gave misleading medical information and/or unethical advice about abortion

  • Seven centres said having a termination could lead to "post-abortion syndrome" - a mental health condition likened to post traumatic stress disorder, which is not recognised by the NHS.
  • Eight centres linked abortion to infertility and problems carrying future pregnancies to term.
  • Five centres linked abortion to an increased risk of breast cancer.

Leading medic in the field of obstetrics, and director of an abortion provider, Dr Jonathan Lord, said women needed an "informed choice" which required "good quality unbiased information".

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Source: BBC News, 27 February 2023

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NHS staff cried in safety interviews, says watchdog

The health safety watchdog has said that doctors, ambulance dispatchers and other NHS staff in England have faced "significant distress" and harm over the past year as a result of long delays in urgent and emergency care.

The Healthcare Safety Investigation Branch (HSIB), which monitors safety in the health service in England, said many staff it interviewed for a national investigation "cried or displayed other extreme emotions" when asked about their working environment.

"The bad sides [of my job] give me nightmares, flashbacks and fear, but they can also make me hyperactive, sleepless and sometimes not care about the danger I put myself in," one paramedic told the BBC.

Sarah, not her real name, has worked in the ambulance service for more than a decade, but describes the last 12 months as the most difficult she can remember.

"Over the winter I have witnessed and helped with cardiac arrests in the corridors of hospitals and in the back of ambulances," she said.

"I spent four hours with an end-of-life patient. There was no hospice or district nurse available, so I had to make the choice to give them meds for a peaceful, expected death and prepare the family.

"I felt ashamed that I could not stay till the end, but I had to move on to the next job as I had done all I could."

The HSIB found NHS staff were reporting increased levels of stress, worry and exhaustion because they were not always able to help the sickest patients. HSIB has now urged trusts to do more to protect workers’ mental health, saying there is an “intrinsic link” between patient safety and staff wellbeing.

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Source: BBC News, 27 February 2023

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Tees, Esk and Wear Valley NHS Trust prosecuted after three patients died

A mental health trust is to be prosecuted after three patients died in its care.

The Care Quality Commission (CQC) is bringing charges against the Tees, Esk and Wear Valleys (TEWV) NHS Trust.

It is thought they relate to the deaths of Christie Harnett, 17, Emily Moore, 18, and a third person.

The trust is said to have failed "to provide safe care and treatment" which exposed patients to "significant risk of avoidable harm".

Both Christie Harnett and Emily Moore had complex mental health issues and took their own lives.

The CQC said the trust "breached" the Health and Social Care Act, which relates to healthcare providers' responsibility to "ensure people receive safe care and treatment".

In response, a spokesperson for the trust said: "We have fully cooperated with the Care Quality Commission's investigation and continue to work closely with them.

"We remain focused on delivering safe and kind care to our patients and have made significant progress in the last couple of years."

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Source: BBC News, 25 February 2023

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Nasal decongestants safety review due to rare brain risk

Experts are assessing a very rare but potentially serious brain side effect of nasal decongestants bought on the High Street.

Ones containing pseudoephedrine are being reviewed because they may cause vessels supplying the brain to contract or spasm, reducing blood flow.

The concern is this could lead to seizures and even a stroke. However, drug regulators stress the likelihood of this happening is extremely low.

The UK-wide review for pseudoephedrine was initiated after regulators in France alerted European drugs regulator the EMA, which is also conducting a review, about some recent, rare cases.

Experts say anyone with concerns about medication should speak to a doctor or pharmacist. 

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Source: BBC News, 23 February 2023

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O2 Academy Brixton crush: Claims of not enough medical cover

Only half the recommended number of medical staff were on duty at the O2 Brixton Academy on the night of a crush at the south-west London venue.

Industry guidelines suggest there should have been medical cover of at least 10 people, including a paramedic and a nurse, but no paramedics or nurses were present.

Rebecca Ikumelo, 33, and security guard Gaby Hutchinson, 23, died in hospital following the crowd surge on 15 December 2022 at the concert.

The medical provider, Collingwood Services Ltd, said it was "fully confident" its team had "responded speedily, efficiently and with best practice".

Two whistleblowers who regularly work for Collingwood Services Ltd at Brixton told BBC Radio 4's File on 4 programme that medical cover at the south London gig had been "inadequate".

Neither of them was there when the crush happened, but one said he had spoken to colleagues who were.

"[They] had two student paramedics, so they're basically unqualified," said one whistleblower. "They have to be supervised by a paramedic, not by anybody of a lower grade. They didn't have appropriate supervision."

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Source: BBC News, 23 February 2023

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Ambulance staff afraid to speak out amid a culture of sexism, racism and bullying, report warns

NHS Ambulance service have a “fear of speaking up” amid pervasive “cliquey”, sexist, racist and homophobic cultures, a watchdog has warned.

A national guardian has warned of negative cultures in trusts preventing workers from raising concerns as she called for a “cultural review” of ambulance organisations.

The review into whistleblower concerns, by the Freedom to Speak Up Guardian’s office, has found widespread cultural issues including clique-like behaviour and bullying and harassment.

Dr Jayne Chidgey-Clark, the NHS National Freedom to Speak Up Guardian, has now called on ministers and the NHS to independently review ambulance services, after speaking with ambulance staff across five NHS trusts.

The report has called for a cultural review of the ambulance service by NHS England, the Care Quality Commission, the Association of Ambulance Chief Executives and ministers.

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Source: The Independent, 24 February 2023

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