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Speaking up requires a supportive organisational culture to be effective

Frontline staff are well placed to identify failings in care, but speaking up requires a supportive organisational culture to be effective, say Russell Mannion and Huw Davies in a recent analysis published in the BMJ.

Concerns about care are raised and ignored, staff are denigrated or bullied, the situation escalates into whistleblowing to outside authorities, and eventually, often years later, a formal inquiry is set up to get to the bottom of things. The long line of inquiries in the UK and elsewhere highlights the sentinel role of staff “speaking up” when they see unsafe or poor quality care.  But exhortations to speak up (encapsulated by the statutory duty of candour introduced in the NHS after the Francis inquiries into failures at Mid Staffordshire NHS Trust) belie the complexity and ambiguity that it creates for staff.

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Source: BMJ, 19 August 2019

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New NHS plan to help patients avoid long hospital stays

Action to help tens of thousands more people avoid lengthy spells in hospital is being rolled out nationwide as part of the NHS Long Term Plan.

NHS doctors, nurses and other staff are being encouraged to ask themselves ‘Why not home? Why not today?’ when planning care for patients recovering from an operation or illness, as part of a campaign – called ‘Where Best Next?’ – which aims to see around 140,000 people every year spared a hospital stay of three weeks or more.

The campaign will see posters and other information placed in hospitals aimed at different staff groups, encouraging them to take practical steps every day to help get patients closer to a safe discharge – whether to their own home or a more suitable alternative in the community.

Dr Taj Hassan, President of the Royal College of Emergency Medicine, said: “The ‘Why not home? Why not today?’ campaign is really important in helping staff to make sure patients are discharged promptly if it is medically appropriate... A greater length of stay increases the risk of hospital acquired infections and further illness. We know that extended stays in a hospital bed can lead to significant muscle loss, particularly in older people, so ensuring that patients do not stay any longer than they need really is vital."

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Source: NHS England, 19 August 2019

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Nurses in Wales leaving job due to stress, report says

Morale among community nurses is low and many are leaving the service due to stress and an increased workload, a report has claimed.

The report from a Welsh assembly committee said the changing nature of healthcare, in particular the move to provide more help in the home and the ageing population, made the role of community nurses increasingly important. But it said many community nurses feel they do not get the support they need and some see themselves as the “invisible service”.

One of the biggest issues raised by nurses in Wales during a committee inquiry was their inability to access to technology to enable them to do their job effectively.

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Source: The Guardian, 21 August 2019

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West Lane Hospital patients 'at high risk of avoidable harm'

A mental health unit for young people where two girls died in two months is not safe. The Care Quality Commission (CQC) rated West Lane Hospital in Middlesbrough inadequate and said patients were at high risk of "avoidable harm". It found staff did not store medicines safely, out-of-date medicines were still in use, and staff used non-approved restraint techniques.

Tees, Esk and Wear Valleys NHS Trust said it was taking "urgent action".

The inspection in June uncovered a catalogue of failings, including "substantial and frequent staff shortages" and employees not always "adequately assessing, monitoring or managing risks to patients".

The report said staff did not feel supported or valued, with morale low, and some told inspectors not all incidents were reported.

CQC report

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Source: BBC News, 21 August 2019

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Two million Britons are taking seven different prescription drugs

Two million pensioners are taking at least seven types of prescription drugs - putting them at risk of potentially lethal side-effects, a major report warns. 

Age UK said the rise of “polypharmacy” was putting lives at risk, with three quarters likely to suffer adverse reactions to at least one of their drugs. The research found that the number of emergency hospital admissions linked to such side-effects has risen by 53 per cent in seven years, with some cases proving fatal.

Experts said GPs were doling out too many drugs because they were too busy to properly consider complex health problems, and the risk of side-effects, and interactions between different drugs. 

Caroline Abrahams, Charity Director at Age UK, said: "We are incredibly fortunate to live at a time when there are so many effective drugs available to treat older people’s health conditions, but it’s a big potential problem if singly or in combination these drugs produce side effects that ultimately do an older person more harm than good.”

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Source: The Telegraph, 22 August 2019

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Brexit: Health leaders issue new no-deal warning

Health leaders have written to Boris Johnson issuing new warnings on the impact of a no-deal Brexit. In a letter to the Prime Minister, the heads of 17 royal colleges and health charities across the UK say clinicians are "unable to reassure patients" their health and care will not be affected. 

They go on to say they have "significant concerns about shortages of medical supplies". Government said it was working with the health sector on "robust preparations". 

The letter, co-ordinated by the Royal College of Physicians, is signed by the heads of organisations including the British Dental Association, the Royal Pharmaceutical Society, Kidney Care UK and the Royal College of Emergency Medicine. It calls for the Health and Social Care Secretary Matt Hancock to be put on the EU exit strategy committee chaired by Michael Gove, who is in charge of no-deal planning.

The signatories argue that - given the scale of the NHS - without sufficient planning, even the smallest of problems could have "huge consequences on the lives of millions of people".

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Source: BBC News, 21 August 2019

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Cardiologist who fitted wrong pacemaker and destroyed patient notes is struck off

A cardiologist has been struck off the UK medical register after he failed to check a patient’s medical notes before surgery, implanted the wrong type of pacemaker, and then destroyed the notes specifying the correct type.

Amer Chit, a locum consultant cardiologist at Royal Cornwall Hospitals NHS Trust, admitted to a trust investigation that, before implanting the pacemaker, he had looked at the operating list but not at the patient’s medical notes.

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Source: BMJ, 23 August 2019

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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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Hospital deep clean as baby skin infection detected

A small number of babies at a Belfast hospital have been found to have pseudomonas on their skin. The infants involved were being treated in the neonatal unit of the Royal Jubilee Maternity Service. Although the bacteria was found on their skin, it does not mean the babies were infected. Staff have put in place infection prevention measures and carried out a deep clean of the unit.

A spokesperson for the Belfast Health Trust said while the issue was unfortunate it wanted to reassure patients, their families and the public that the situation was being managed appropriately.

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Source: BBC News, 29 August 2019

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NHS faces legal action from ‘abandoned’ IV feed patients

The NHS and the national medical regulator could face legal action over the shortage of intravenous feed supplies for hundreds of UK patients, HSJ has learned. 

The law firm acting for more than a dozen patients affected by the shortage of feed supplies has confirmed to HSJ it has been instructed to take action against NHS England, the Department of Health and Social Care, the Medicines and Healthcare products Regulatory Agency and the company responsible for producing the feed, Calea. 

Since June, hundreds of patients who rely on IV feed known as total parenteral nutrition have gone without deliveries of their bespoke feed. More than 40 people have been admitted to hospital as a result.

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Source: HSJ, 29 August 2019

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Crumbling hospitals putting lives at risk, say NHS chiefs

Hospital patients’ safety is being put at risk by fires, floods and crumbling, overcrowded buildings caused by a £4 billion government squeeze on capital funding, NHS bosses are warning.

Hospitals say they do not have the funding to replace outdated scanners, fix leaking roofs and boilers, or remove ligature points that suicidal patients may attempt to use to try to end their lives.

Four out of five (82%) chief executives and chief finance officers at NHS trusts in England fear the lack of capital funding poses a medium or high risk to patient safety.

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Source: Guardian, 30 August 2019

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Addenbrooke's surgeon suspended after performing wrong operation

An orthopaedic surgeon falsified records and lied to a patient after he performed the wrong operation on her. 

Alan Norrish admitted performing the wrong type of partial knee replacement on his patient in January 2018 at the Nuffield Hospital in Cambridge. Having realised his mistake the former Addenbrooke's consultant tried to cover it up by falsifying records and doing "revision" surgery six days later.

Mr Norrish has been suspended for a year following a medical tribunal. He told the hearing of the Medical Practitioners Tribunal Service (MPTS) he was "shocked" and "upset" when he realised his mistake. It was found he had lied in a letter to a hospital matron about the reason for the second operation, which was carried out on 25 January 2018.

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Source: BBC News, 30 August 2019

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Girl died after sepsis guidelines ignored

A five-year-old girl who died due to sepsis complications could have been saved if clinical guidelines had been followed, an inquest heard.

Ava Macfarlane died of toxic shock caused by a bacterial infection on 15 December 2017. She had presented with symptoms when she first went to hospital two days earlier but they were not picked up. Nottingham Coroner's Court heard she was given Calpol and ibuprofen before doctors allowed her to go home.

Dr Shearn admitted Ava had been showing at least two "red flags" of sepsis and if he had followed guidelines from the National Institute for Health Care and Excellence and the Sepsis Trust, then the infection would have been picked up earlier. When asked by Assistant Coroner Laurinda Bower whether the "failure to follow the Sepsis 6 Pathway contributed to her death", he replied "it probably did".

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Source: BBC News, 2 September 2019

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High street heart checks on the NHS

Pharmacists are set to offer rapid detection and help for killer conditions like heart disease as part of a major revamp of high street pharmacy services. The high street heart checks are part of an ambitious target the NHS in England has set itself as part of its Long Term Plan to prevent tens of thousands of strokes and heart attacks over the next ten years.

Plans are underway for both GPs and community pharmacists to lead the fight against common conditions that cause cardiovascular disease (CVD) and stroke, building on successful pilots which have reduced strokes by a quarter.

From 1 October 2019, as part of their new £13 billion five-year contract, community pharmacists will start to develop and test an early detection service to identify people who may have undiagnosed high-risk conditions like high blood pressure for referral for further testing and treatment. If successful this could be rolled out to all community pharmacies in 2021-22.

Professor Stephen Powis, NHS national medical director, said: “Heart disease and strokes dramatically cut short lives, and leave thousands of people disabled every year, so rapid detection of killer conditions through High street heart checks will be a game-changer."

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Source: NHS England, 2 September 2019

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Almost half of consultant anaesthetists have had a car accident or near miss on their commute home because of fatigue

A survey of consultants in anaesthesia and paediatric intensive care working in the UK and Ireland found that most had experienced work related fatigue.

The survey, published in Anaesthesia, received 3847 responses from consultants working in the UK and the Republic of Ireland. Most (91%) said that they had experienced work related fatigue and 72% said that this had a moderate or significant negative impact on their social and family life.

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Source: BMJ, 3 September 2019

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First ‘digital’ baby born at West Cumberland Hospital

The first baby born using entirely digital maternity notes in north Cumbria has been born at West Cumberland Hospital in Whitehaven. The new digital system replaces the traditional paper-based system with notes being held digitally for staff and linking to a phone app so women no longer need to carry their notes to appointments.

The app which expectant and new mothers can use is called ‘Maternity Notes’. It helps women track their pregnancy journey and contains lots of information about the baby’s development as they move through their pregnancy, and up to six weeks post-birth. The new system is safer too, with women no longer needing to carry paper maternity notes.

Since going live on 1 April, 100% of women registering a new pregnancy have signed up to the app.

North Cumbria University Hospitals NHS Trust is one of only 14 Trusts across the country to implement electronic maternity notes.

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Source: Health Tech Digital, 2 September 2019

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Isle of Wight NHS Trust 'no longer inadequate or unsafe'

An NHS Trust, rated inadequate for more than two years, has been awarded an improved grade by inspectors.

Isle of Wight NHS Trust has made "improvements in most areas" and is no longer unsafe overall, the Care Quality Commission (CQC) said. Although it recommended the trust should remain in special measures, the CQC gave the trust a rating of "requires improvement".

The trust said it welcomed the change and was committed to improving further.

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Source: BBC News, 4 September 2019

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An open letter to MPs on the impact of a no deal Brexit on health and care

In an open letter to MPs, The King's Fund, the Health Foundation and Nuffield Trust have summarised the four major areas where the impact of a no deal Brexit could be felt most sharply in health and care. 

There is a very real risk that leaving the EU without an agreement could exacerbate the workforce crisis in health and care, drive up demand for already hard-pressed services, hinder the supply of medicines and other vital supplies, and stretch the public finances which pay for healthcare.

They conclude that a no deal Brexit could cause significant harm to health and social care services and the people who rely on them.

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Source: The King's Fund, 3 September 2019

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Nottingham's Queen's Medical Centre failings led to girl's sepsis death

A series of hospital failings contributed to the death of a five-year-old girl who died from toxic shock syndrome, an inquest jury has found. Ava Macfarlane died on 15 December 2017 after being treated at Nottingham's Queen's Medical Centre.  

Prescribing antibiotics earlier could have "given her chances of survival", Nottingham Coroner's Court heard. Returning a narrative conclusion the jury said there had been "missed opportunities" to diagnose sepsis.

Dr Keith Girling, medical director at Nottingham University Hospitals NHS Trust, apologised for the "significant shortcomings" in its care.

He said a number of changes had been made following Ava's death and greater awareness of sepsis, in relation to children with complex medical conditions, had been raised.

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Source: BBC News, 4 September

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Significant failings in care by Great Ormond Street Hospital

The coroner looking into the death of Scottish teenager Amy Allan has found significant failings in her care by Great Ormond Street Hospital.

Amy, from Dalry in North Ayrshire, was 14 when she died in September last year following surgery on her spine. Coroner Edwyn Buckett outlined poor planning and support from the hospital. But he said he "was not able to make a firm conclusion" that those omissions "had caused or materially contributed to her death." The coroner is however likely to issue a prevention of future deaths report.

Great Ormond Street Hospital admitted Amy's care "fell short of the high standards" it should be meeting but said it had made changes to the way it worked.

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Source: BBC News, 5 September 2019

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Postnatal checks for new mothers need to be properly funded, charity tells government

Almost half (47%) of new mothers get less than three minutes or no time to discuss their mental and physical health at the routine six week postnatal check-up, according to a survey by the National Childbirth Trust (NCT).

The charity is calling on the government to provide funding for a full postnatal check-up so that GPs have sufficient time to talk to a new mother about her health and wellbeing.

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Source: BMJ, 5 September 2019

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