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Hospital recorded 50 times birth gas legal limit

Nitrous oxide levels on Watford General Hospital's maternity suite far exceeded legal limits during peak periods, a BBC investigation has found.

In February 2022, air monitoring showed levels of almost 5,000 parts per million (ppm) - 50 times what is safe.

The hospital's trust said it had since installed machines to remove the gas.

It was one of a number of nitrous oxide incidents reported by NHS trusts to the Health and Safety Executive (HSE), Freedom of Information data has shown.

The HSE disclosed the details following a request for its notifications under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR).

There were 11 notifications to the HSE between August 2018 and December 2022 from seven NHS trusts and one private hospital in relation to nitrous oxide - almost all relating to maternity units.

Monitoring has led to a string of NHS trusts suspending the use of Entonox - a mixture of nitrous oxide and air used to assist women in labour with pain relief.

NHS bosses acknowledge there is "limited research on the occupational exposure to Entonox, and the long-term health risks this may pose", though at least one expert has played down the risk.

But staff working in maternity units face uncertainty due to prolonged periods of time spent in affected areas, with particular concerns over Vitamin B deficiency due to exposure.

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Source: BBC News, 13 February 2023

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NHS A&E and cancer nurses set to join ‘most disruptive’ strikes yet

Nurses in England are preparing to escalate their dispute with the government by involving staff from NHS A&E departments, intensive care and cancer wards in a series of 48-hour strikes.

The Royal College of Nursing (RCN) is understood to be planning to announce walk outs for two consecutive days and nights, rather than limiting action from 8am to 8pm as they have done so far.

NHS leaders warned the looming strike could be the “biggest impact” on patients yet seen, with the union preparing to end a process where the RCN had agreed to exemptions with hospitals.

The RCN told NHS leaders on Friday it is preparing to step up its dispute by asking its members working in emergency departments, intensive care units and oncology to join the strike.

But the union, expected to announce the strike this week, will make a very limited set of provisions for the most urgent clinical situations as part of a legal obligation not to endanger life.

Saffron Cordery, deputy chief executive at NHS Providers said: “A continuous 48-hour strike that includes staff from emergency departments, intensive care units and cancer care services would likely have the biggest impact on patients we’ve seen.”

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Source: The Independent, 12 February 2023

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Health ombudsman issues unprecedented warning over safety and culture

A health watchdog has issued an unprecedented warning over patient safety, culture and leadership at a scandal-hit NHS trust,The Independent has learned.

The Parliamentary Health Service Ombudsman, the government body that investigates patients’ complaints, has used powers for the very first time to raise “serious concerns” about University Hospitals Birmingham Foundation Trust.

The body does not have its own powers to intervene but the warning has triggered an investigation by NHS England.

Ombudsman Rob Behrens said there needed to be “significant improvements” in culture and leadership at the trust. He also raised concerns that the trust had failed to “fully accept or acknowledge” the impact of findings from investigations on patient safety.

The decision to trigger the alert, known as the emerging concerns protocol, was “not taken lightly”, Mr Behrens said.

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Source: The Independent, 12 February 2023

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USA: Patients needing home IV nutrition fear dangerous shortages

CVS Health confirmed last year it was closing half its Coram home infusion branches and firing about 2,000 nurses, dietitians and pharmacists.

Their patients with life-threatening digestive disorders depend on parenteral nutrition, or PN — in which amino acids, sugars, fats, vitamins and electrolytes typically are pumped through a catheter into a large vein near the heart.

A day later Optum Rx, another big supplier, announced its own consolidation. Suddenly, thousands were scrambling for their complex essential drugs and nutrients.

“With this kind of disruption, patients can’t get through on the phones. They panic,” said Cynthia Reddick, a senior nutritionist laid off last summer in the CVS restructuring.

“It was very difficult. Many emails, many phone calls, acting as a liaison between my doctor and the company,” said Elizabeth Fisher Smith, a 32-year-old public health instructor in New York, whose Coram branch closed. A rare medical disorder has forced her to rely on PN for survival since 2017. “It added to my mental burden,” she said

Home and outpatient infusions in the USA are a growing business, as new drugs for chronic illness expand treatment options and enable patients, providers and insurers to avoid hospitalisation. 

But while reimbursement for expensive new drugs has attracted corporations and private equity, the industry is constrained by a lack of nurses and pharmacists. The less profitable parts of the business — and the vulnerable patients they serve — are at risk. This includes the 30,000-plus Americans who rely on parenteral nutrition — including premature infants, post-surgery patients and those with damaged bowels because of genetic defects.

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Source: The Washington Post, 6 February 2023

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Workers fighting America’s overdose crisis are ‘hanging by a thread’

President Biden has endorsed “harm reduction,” which aims to cut down on overdoses by encouraging safer drug use. But the organizations carrying out that strategy are severely underfunded.

In his State of the Union address on Tuesday, Mr Biden, the first president to endorse the strategy, highlighted the federal government’s attention to some of the core features of harm reduction work, including a provision in a recently enacted spending package that makes it easier for doctors to prescribe buprenorphine, an effective addiction medication that Ms Krauss works to get to drug users. During his speech, Mr Biden recognised the father of a 20-year-old from New Hampshire who died from a fentanyl overdose, citing the more than 70,000 Americans dying each year from the potent synthetic opioid.

But two years after Mr Biden took office, with the nation’s drug supply increasingly complex and deadly, the practice of harm reduction remains underfunded and partially outlawed in many states.

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Source: New York Times, 10 February 2023

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Children in mental health crisis spent more than 900,000 hours in A&E in England

Children suffering mental health crises spent more than 900,000 hours in A&E in England last year seeking urgent and potentially life-saving help, NHS figures reveal.

Experts said the huge amount of time under-18s with mental health issues were spending in A&E was “simply astounding” and showed that NHS services for that vulnerable age group were inadequate.

Children as young as three and four years old are among those ending up in emergency departments because of mental health problems, according to data obtained by Labour.

Dr Rosena Allin-Khan, the shadow mental health minister, who is also an A&E doctor, said: “With nowhere to turn, children with a mental illness are left to deteriorate and reach crisis point – at which time A&E is the only place left for them to go. Emergency departments are incredibly unsuitable settings for children in crisis, yet we’re witnessing increasingly younger children having to present to A&E in desperation.”

Young people who endured long A&E waits included those with depression, psychosis and eating disorders as well as some who had self-harmed or tried to kill themselves, doctors said.

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Source: The Guardian, 9 February 2023

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Ian Paterson victim calls for patient safety to be prioritised

A woman who underwent needless surgery at the hands of convicted surgeon Ian Paterson said patient safety was still not being prioritised.

Paterson was convicted of 17 counts of wounding with intent in 2017 and was jailed for 20 years.

Debbie Douglas, who now campaigns for his victims, said more still needed to be done following a damning report.

In December, the Department for Health said it was making "good progress" on changes.

The inquiry, published in 2020, made 15 recommendations and Ms Douglas called on health chiefs to "get on" with the improvements.

"It's three years and technically none of the recommendations are closed," she said.

"It's all around patient safety and it's not being given the priority it deserves."

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Source: BBC News, 9 February 2023

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Hip surgery could halve waiting times

Changes to hip and knee surgery could halve waiting lists at one hospital within a year, say doctors.

Tweaks to surgeries at the Princess of Wales hospital in Bridgend have allowed more patients to be sent home on the same day. Therefore, a shortage of hospital beds is not a barrier for them.

It comes as over 37,000 orthopaedic patients are waiting over one year for surgery in Wales.

Consultant orthopaedic surgeon Keshav Singhal said a number of "minor tweaks" were made to the procedure "but all of them add up to a huge effect".

He said the anaesthetic and pain medication given to patients is "fine-tuned" to reduce pain and nausea after the operation and extra time is spent pinpointing any potential area of bleeding and cauterising it to "prevent wound leakage".

"In day surgery we are not constrained by beds - there are no beds here," said Mr Singhal.

"Patients can come in, be very well cared for in a state of the art day-surgery unit, and go home in the evening, and that totally cuts down on the inpatient beds."

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Source: BBC News, 10 February 2023

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Ambulance waits down by nearly an hour in a month

Ambulance crews reached emergencies such as heart attacks and strokes one hour quicker in January than December in England, figures show.

They took 32 minutes on average, compared with more than 90 the month before.

The target is 18 minutes but January's average was the quickest for 19 months.

A&E waiting times also improved, with just over a quarter of patients waiting longer than four hours - down from more than a third in December.

But Society for Acute Medicine president Dr Tim Cooksley said wait times remained "intolerable".

And he highlighted the waits the sickest and most frail were facing for a bed on a ward.

Nearly four out of every 10 patients waited over four hours on trolleys and in corridors.

"The fundamental problem remains a significant shortage of workforce, leading to woefully inadequate inpatient bed and social-care capacity," Dr Cooksley added.

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Source: BBC News, 9 February 2023

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‘NHS factors’ lead to more than a third of delayed discharges

More than a third of delayed discharges for long-stay patients are being caused by factors generally associated with the NHS, according to new data obtained by HSJ.

Delayed discharges from hospital are often blamed on issues around social care, but figures for the nine months to January, for patients who have been in hospital for at least 21 days, suggest a significant proportion are due to NHS-related delays.

The most common reason is waiting for rehabilitation beds in a community hospital or similar facility, which accounts for 23% of total delayed discharges, based on daily averages.

Other reasons generally associated with NHS-related issues included delays around medical decisions (4%), therapist decisions (4 per cent), transfers to another acute site (2%), and diagnostic tests (1%).

On top of this, a further 12% of the causes were at least partly associated with the NHS, such as delays relating to transfer of care hubs, which are generally jointly run with councils.

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Source: HSJ, 9 February 2023

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Major law firm faces court over withheld contracts in landmark NHS whistleblowing case

A law firm that routinely advises health service bosses faces claims it withheld evidence in a landmark NHS whistleblowing case.

A judge has called for full evidence disclosure to assess claims that healthcare specialist firm Hill Dickinson acted fraudulently in a dispute over a lack of legal protection for NHS doctors in whistleblowing claims.

The firm will now have to account for its actions in litigation that saw more than 50,000 doctors below consultant level in England deprived of legal whistleblowing protections, according to the junior medic at the centre of it, Chris Day. The case also had implications for 865,000 agency workers across other sectors – including construction.

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Source: ByLine Times, 9 February 2023

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‘Underhand’ formula milk ads stop millions from breastfeeding, experts say

Exploitative and “underhand” marketing of formula milk is preventing millions of women from breastfeeding, according to a series of reports published in the Lancet.

The reports, by 25 experts from 12 countries, including paediatricians, public health specialists, scientists, economists and midwives, finds that the commercial milk formula companies “exploit parents’ emotions and manipulate scientific information to generate sales at the expense of the health and rights of families, women and children”.

Breastfeeding promotes brain development, protects infants against malnutrition, infectious diseases and death, while also reducing risks of obesity and chronic diseases in later life. It also helps protect mothers against breast and ovarian cancers. The World Health Organization (WHO) recommends exclusively breastfeeding babies for the first six months and giving breast milk alongside solid food until the age of two or beyond.

Over three reports, the series reveals how, more than 40 years since the World Health Assembly developed a voluntary international code prohibiting the marketing of infant formula, widespread violation of the code persists, with promotion of infant formula milk continuing in about 100 countries in every region of the world since the code was adopted.

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Source: The Guardian, 7 February 2023

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NHS to use test that prevents babies going deaf

A rapid test that can help preserve the hearing of newborn babies is set to be used by NHS hospitals.

For some babies, commonly used antibiotics can become toxic. The drugs damage sensory cells inside the ear leading to permanent hearing loss.

The test - which analyses babies' DNA - can quickly spot those who are vulnerable. It means they can be given a different type of antibiotic and avoid having a lifetime of damaged hearing.

Gentamicin is the first-choice antibiotic if a newborn develops a serious bacterial infection. It is life-saving and safe for the majority of people.

However, it has a rare side effect. About 1,250 babies in England and Wales are born with a subtle change in their genetic code that allows the antibiotic to bind more strongly to the hair cells in their ears, where it becomes toxic.

These tiny hairs help convert sounds into the electrical signals that are understood by the brain. If they are damaged, it results in hearing loss.

The side effect is well known, but until now there was no test that could get the results fast enough. It would be dangerous to delay treatment, and alternative antibiotics are not used as they have their own side effects and because of concerns about antibiotic resistance.

The new genedrive kit analyses a sample taken from inside the baby's cheek. Tests at two neonatal intensive care units in Manchester and Liverpool showed it could spot who was susceptible to hearing loss in 26 minutes, and using it did not delay treatment.

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Source: BBC News, 9 February 2023

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Mental health sick days for NHS staff surge – and cost more than £460m in a year

Mental health sick days cost the NHS almost half a million pounds as staff anxiety and stress levels haved skyrocketed.

Costs have almost doubled compared to before the pandemic from £279 million to £468 million.

The sickness data shared with The Independent by GoodShape, an employee well-being and performance analysis company, shows the number of staff sick days increased in 2022 to 12 million from 7.21 million in 2019. That is despite the overall number of people working in the NHS increasing from 1.2 to 1.3 million.

The overall cost to the NHS of absences for the five most common reasons – which includes mental health – increased to a “staggering” £1.85 billion from £1.01 billion between 2019 to 2022, according to figures from GoodShape.

Covid was still the most common reason for staff sickness last year, according to the analysis, accounting for 4.4 million lost days, while mental health was a close second driving 3 million days off due to illness.

Pat Cullen, chief executive and general secretary for the Royal College of Nursing said in response: “These figures are shocking but not surprising. With 47,000 vacant nurse posts in England alone, the pressures on staff are unrelenting.

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Source: The Independent, 8 February 2023

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Covid: Scientists reveal ‘perfect’ room layout to prevent spread of virus

The ‘optimal layout’ for an isolation room to contain the spread of Covid has been created following tests at a London hospital.

The room was designed by researchers at Imperial College London to reduce the risk of infection for health care staff as far as possible.

Researchers used a state-of-the-art fluid model to simulate the transmission of the virus within an isolation room at the Royal Brompton Hospital in Chelsea, west London.

They found that the area of highest risk of infection is above a patient’s bed at a height of 0.7 to two metres, where the highest concentration of Covid is found.

After the virus is expelled from a patient’s mouth, the research team explained that it gets driven vertically by wind forces within the room.

The research, published in the journal Physics of Fluids, is based on data collected from the room during a Covid patient’s stay.

The work centred on the location of the room’s air extractor and filtration rates, the location of the bed, and the health and safety of the hospital staff working within the area.

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Source: The Independent, 8 February 2023

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Millions with mental health needs not seeking NHS help, watchdog says

Millions of people in England with mental ill-health are not seeking NHS help, and many who get it face long delays and a “poor experience”, a report says.

Long waits for care will persist for years because soaring demand, exacerbated by Covid, will continue to outstrip the ability of severely understaffed mental health services to provide speedy treatment, the National Audit Office (NAO) found.

The report found that “NHS mental health services are under continued and increasing pressure and many people using services are reporting poor experiences”. Under-18s, the LGBT+ community, minority ethnic groups and people with more complex needs are most likely to find the system inadequate.

“While funding and the workforce for mental health services have increased and more people have been treated, many people still cannot access services or have lengthy waits for treatment,” the NAO said.

It found:

  • An estimated 8 million people with mental health needs are not in contact with NHS services.
  • There are 1.2 million people waiting for help from community-based mental health services.
  • While the mental health workforce grew by 22% between 2016-17 and 2021-22, the NHS recorded a 44% increase in referrals over the same period.
  • In 2021-22, 13% of mental health staff quit.

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Source: The Guardian, 9 February 2023

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Mental health patients at risk of sexual assault on mixed sex wards, watchdog warns

Vulnerable female patients have been sexually “exposed” on a mixed gender ward deemed not “fit for purpose”, the NHS watchdog has warned.

The Care Quality Commission found that sexual incidents had occured at Hill Crest, a 25-bed mixed gender mental health unit in Redditch, as male and female were being put at risk.

It found male patients are able to walk into female bathrooms and bedrooms, leading to risks of sexual assault and relationships. It found that sexual incidents had taken on the unit because of the risks.

The rate of assaults on mixed sex wards is significantly higher than on single-sex wards, data has shown.

According to the CQC, the trust graded sexual incidents between patients as “low harm” but did not fully consider them or follow up actions to keep patients safe.

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Source: The Independent, 8 February 2023

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NHSE must ‘demonstrate it is trustworthy’ on data, says watchdog

The independent data watchdog has called for greater clarity from NHS England on how it will ensure there are “as strong… if not stronger” safeguards on health and care data following its takeover of NHS Digital.

NHS Digital – whose role included controlling access to large amounts of NHS data – became part of NHS England on 1 February, and its teams and functions are due to merge in coming months.

In an interview with HSJ, national data guardian Nicola Byrne said the merger creates “an inherent tension in having one organisation be both data custodian and the organisation seeking to access the data”, although it “makes sense in terms of streamlining and efficiencies”.

Concerns have been raised about the merger’s information governance implications by campaign group medConfidential, the British Medical Association and politicians. These include that there would be less transparency over the handling of data, and that NHSE would be “marking its own homework” as both controller of, and a major user of, data.

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Source: HSJ, 8 February 2023

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Surgeon given warning over life-changing injuries

A Norfolk surgeon who left two patients with life-changing injuries has received a formal warning by a disciplinary panel.

Camilo Valero Valdivieso was found guilty of "serious misconduct" by an independent medical panel after two operations went wrong in six days.

One of his patients, Paul Tooth, 65, said his life was "a constant struggle" since his operation in January 2020.

However, the panel found the surgeon had "learned from these events".

The findings from the Medical Practitioners Service (MPTS) panel said that his actions had "risked damaging public confidence in the profession".

It heard that he twice "misinterpreted the anatomy" - on one occasion severing a patient's gallbladder.

The panel also concluded Mr Valero's fitness to practise was not currently impaired, allowing him to continue working.

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Source: BBC News, 7 February 2023

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Mother of suicidal girl held in locked hospital room ‘frightened’ for child’s life

A mother who has seen her suicidal 12-year-old daughter shuttled between placements and then held in a locked and windowless hospital room says she is frightened for her child’s life.

Since going into care in Staffordshire nine months ago, Becky (not her real name) has attempted to take her own life on several occasions. Her case throws fresh light on the chronic nationwide shortage of secure accommodation for vulnerable children.

“I am constantly told there is nowhere for her,” said her mother, who cannot be identified for legal reasons. “I fear I’ll soon be arranging her funeral due to the systemic failings in health and social care.”

Becky has been alone in a locked hospital room since 27 January. The room has no window or access to the outdoors, no furniture except for a bed, and she is permitted no belongings. All human contact is conducted through a hatch.

The child’s court-appointed guardian told the high court at a hearing to discuss Becky’s case that she considered “the risk to Becky’s life to be catastrophic”.

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Source: The Guardian, 7 February 2023

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NHS waiting lists in England unlikely to fall in 2023, research suggests

NHS waiting lists are unlikely to fall in 2023, and the backlog is unlikely to be significantly tackled until mid-2024 despite being one of Rishi Sunak’s priorities for this year, research suggests.

The NHS has struggled to increase the number of people it is treating from its waiting lists each month due to ongoing pressures from Covid-19, although there have been signs of improvement in the past month, analysis from the Institute for Fiscal Studies (IFS) has found.

Max Warner, an IFS economist and one of the report’s authors, said that although the NHS had made “real progress” to reduce the number of patients waiting a very long time for care, efforts to increase overall treatment volumes had “so far been considerably less successful”.

The NHS Providers’ chief executive, Julian Hartley, urged the government to introduce a fully funded workforce plan and to talk to unions about pay for this financial year as strikes were causing huge disruption to services, and risked undoing hard-won progress made on care backlogs.

“Mounting pressures on acute, ambulance, mental health and community services, such as chronic workforce shortages, could hamper efforts to cut the backlog further if left unchecked,” he said.

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Source: The Guardian, 8 February 2023

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Thousands of patients recalled over eye damage concerns

Thousands of patients are being recalled for urgent eye checks after regulators raised safety concerns related to a product used in cataract surgery.

It is thought around 20 trusts have suspended use of the EyeCee One lenses, after the Medicines and Healthcare Products Regulatory Agency warned of links to higher pressure in the eye, which can cause lost vision.

The MHRA has issued an alert ordering trusts to recall patients who have had surgery since October, and estimates between 2 and 4 per cent of patients could have complications. The watchdog stressed reduced vision would only occur if patients were not treated.

It is thought the complications could be down to the way the implant was being used in surgery, rather than the product itself.

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Source: HSJ, 7 February 2023

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More failings discovered at maternity scandal trust

East Kent Hospital University Foundation Trust has been criticised for failures in services by the Care Quality Commission, after an unannounced inspection last month, years after major problems began to come to light.

The Care Quality Commission has highlighted:

  • Issues with processes for fetal monitoring and escalation at the William Harvey Hospital, Ashford. There had been “incidents highlighting fetal heart monitoring” problems in September and October, and the trust’s measures to improve processes were not “embedded and understood by the clinical team”;
  • Slow maternity triage, due to staffing problems, and infection control problems at the William Harvey. The trust is reviewing how issues with infection prevention and control and cleanliness were not identified or escalated; and 
  • Fire safety issues at the Queen Elizabeth, the Queen Mother Hospital, in Thanet with problems linked to fire doors and an easily accessible secondary fire escape route.

Three years ago issues with reading and acting on fetal monitoring were highlighted at the inquest into baby Harry Richford, whose poor care by the trust led to an independent inquiry into widespread failings in its maternity services, led by Bill Kirkup.

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Source: HSJ, 6 February 2023

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Draft NHSE plans seek to ‘eradicate’ police role in SIM care model

A draft NHSE statement suggests mental trusts could be asked to eradicate features of the ‘serenity integrated mentoring’ (SIM) care model from clinical practice, following a whirlwind of concerns in 2021 and an investigation by national clinical director Tim Kendall.

A core feature of SIM is to place a police officer within a healthcare team charged with supporting patients who frequently attend emergency services in crisis, and creating crisis plans.

The draft position statement produced by NHSE, which the regulator said is not its final version and is subject to changes, says SIM should not be used.

It also proposes the eradication of the following practices from any equivalent care model:

  • Police involvement in delivery of therapeutic interventions in planned, non-emergency, community mental healthcare;
  • The use of coercion, sanctions (criminal or otherwise), withholding care and otherwise punitive approaches; and
  • Discriminatory practices and attitudes towards patients who express self-harm behaviours, suicidality and/or those who are deemed “high intensity users”.

The statement, which is the first indication of NHSE’s position on the SIM model but not its final stance, also suggests Professor Kendall will be seeking assurance from trust medical directors that SIM or similar models, and the above three features of concern, are no longer used. A full policy and public statement on the model is expected by the spring.

The StopSIM coalition, whose campaigning prompted the NHSE review, said: “Unless and until the full policy is freely available to service users and the public, service users are not equipped to protect themselves against the dangers of SIM and similar approaches".

Further reading on the hub:

The High Intensity Network (HIN) approach and SIM model for mental health care and 'high intensity users' – views and discussion

StopSIM: Mental health is not a crime

 

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The patients with treatable eating disorders who are dying before the NHS can help them

A record number of eating disorder patients are not getting the life-saving treatment they need due to lengthy waits, leaked NHS data shows.

More than 8,000 adults are waiting to be seen for therapy, according to internal figures from NHS England – the highest figure recorded since data collection began in 2019. In March 2021, there were around 6,000 adults waiting, while it was less than 2,000 in March 2019.

One leading doctor warned that delays were leading to avoidable deaths, while multiple coroners investigating the deaths of nine patients since 2021 have repeatedly called on the NHS and ministers to improve services to prevent more.

An investigation by The Independent can also reveal that long waits have led to a woman, 24, taking her own life while waiting two years for appropriate care, and patients being admitted to hospital because their conditions became so severe they developed life-threatening physical conditions.

Dr Agnes Ayton, the Royal College of Psychiatrists’ lead for adult eating disorders, said long waits meant patients were “dying avoidably” because under-resourced services were forced to turn them away or leave them waiting for years. Anorexia has the highest morality rate of any psychiatric disorder.

“One important thing is eating disorders are treatable, people can get better with time and treatment. We shouldn’t accept anorexia has the highest mortality rate because a lot of these deaths are avoidable and treatable. We should be aiming to provide high-quality care,” she said.

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Source: The Independent, 6 February 2023

Further reading on the hub:

 

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