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Urgent call for help as ambulance trust faces relying on ‘first aiders’ during strikes

Medics and nurses have been urgently called upon to support London Ambulance Service during next week’s strike action, as it will otherwise have to rely on staff only able to provide ‘first aid’.

The North East London primary care team has sent out a request for clinical staff working for integrated care boards to be released from duties ahead of industrial action on 21 December.

Unison members are preparing to walk out, alongside thousands of other staff at nine other ambulance trusts across the country, in a dispute over pay.

The letter, seen by HSJ, was sent yesterday afternoon. It said: “LAS are keen to have experienced medics and nurses, who have current urgent and emergency clinical exposure, have knowledge of how to navigate the system and can operate as a senior clinical decision maker. Medical Practitioners would ideally be from general practice and emergency medicine.

“Advanced Paramedics and Advanced Care Practitioners with urgent care or IUC CAS experience are also required. A knowledge of ambulance services is preferred as it removes the need to learn very quickly the significant differences in ambulance services and LAS control rooms."

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Source: HSJ, 13 December 2022

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Strep A: Parents say son misdiagnosed before death

The family of a boy who died of an invasive form of strep A have said they sought medical help three times before he was admitted to hospital.

Jax Albert Jefferys, who attended Morelands Primary School in Waterlooville, Hampshire, died on 1 December, aged five.

His family said they were initially told he had flu.

Since September, UK Health Security Agency figures show 15 UK children have died after invasive strep A infections.

Paying tribute to their "darling son", Jax's family said they had sought medical advice on three occasions during the four days leading up to his death and were told that he was suffering with influenza A.

"We then followed the recommended course of action: to administer a proprietary paracetamol-based medication in the prescribed dosage," they said in a statement.

However, they said on the fourth day Jax's condition "deteriorated so much" they "rushed him to hospital" and he later died.

"Only after his death was it confirmed that the cause was [strep A]," the family said.

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Source: BBC News, 14 December 2022

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Every ambulance trust on highest alert level

All ambulance services have declared the highest level of alert due to ‘extreme pressures’ facing the urgent and emergency care system.

One senior ambulance chief told HSJ that ambulance response times have dropped dramatically in the last few days, while A&E handover delays have surged. They said: “The wheels are falling off [the emergency care system] now, we’re in a really awful situation.”

They said ambulance leaders have major concerns about the planned strike action by nurses on Thursday, fearing this will exacerbate discharge delays and have a knock-on effect on ambulance handover problems.

It also comes ahead of strike action planned by ambulance staff for next week.

HSJ has seen internal communications which confirm all ten ambulance trusts in England are now in level four of their “resource escalation action plan”, which means they can seek assistance from other nearby trusts or services. However, this is more difficult when an entire sector is under pressure, as is the case currently. 

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Source: HSJ, 13 December 2022

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Midwives will not strike, after ballot falls short

The Royal College of Midwives (RCM) has not met thresholds required to strike in its vote, it announced today, but physiotherapy staff are set to strike at more than 100 trusts in their first ever action ballot over pay.

The trade union announced this afternoon that its ballot had not reached the turnout required to take strike action. 88& of those who voted said they supported strike action, but only about 47% of eligible members voted. Law requires a turnout of at least 50%, the RCM said.

It comes as nurses prepare to take industrial action on 15 and 20 December, over pay and safety concerns, with ambulance staff across the GMB Union, Unison and Unite set to walk out on 21 December (and GMB also on 28 December).

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Source: HSJ, 13 December 2022

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NHSE estimates mortality rate for autistic people is 51% higher

Autistic people in England who do not also have a learning disability are approximately 51% more likely to die in a single year compared to the general population, according to a leaked document which estimates the mortality rate for the first time.

According to an internal NHS England document, seen by HSJ, the standardised mortality rate between April 2020 and March 2021 was 16.6 deaths per 10,000 for people with autism and no learning disability compared to 11 deaths per 10,000 for the general population. 

NHSE also determined life expectancy for this group to be 75 years – 5.4 years less than the general population.

Dominic Slowie, former national clinical director for learning disability, told HSJ that because of the different ways autism presents itself, it can be difficult to pinpoint causes of premature mortality. 

“In some cases, people with autism who are severely disabled and can’t communicate their needs in a conventional way are going to have premature mortality for the same reasons that people with a learning disability do, because people do not really understand the level of their need or do not investigate their need in a reasonably adjusted way,” he said.

“While, if someone is presenting atypically in their communication, we mustn’t make presumptions – we must make reasonable adjustments to ensure they are investigated and diagnosed in the same way.”

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Source: HSJ, 13 December 2022

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Lucy Letby trial: Nurse used syringe to force milk and air into baby, court is told

Lucy Letby used a plunger to force milk and air into one of the babies she is accused of attempting to murder, a medical expert has told a court.

The alleged attack caused the infant’s stomach to distend to such a degree that she then projectile vomited a “massive” amount of milk so violently that the material left her cot and splashed over a chair several feet away.

Staff at the Countess of Chester Hospital managed to save Baby G’s life but the incident was so catastrophic that it caused the child severe brain damage. Seven years later she still suffers from quadriplegic cerebral palsy.

Dr Dewi Evans, a consultant paediatrician called in by the prosecution, said the use of a plunger on the end of a syringe was the only explanation for the baby’s sudden collapse in the early hours of 7 September 7 2015.

Letby, 32, of Hereford, is accused of murdering seven children in the neonatal unit of the hospital in Cheshire, and of ten attempted murders, between June 2015 and June 2016. She denies all the charges.

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Source: The Times, 13 December 2022

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NHS operations cancelled in England due to staff shortages double in three years

The number of operations cancelled by the NHS in England because of staff shortages may have doubled in three years, with an estimated 30,000 not proceeding because no staff were available to perform them.

At least a third of cancelled operations were those that were deemed urgent, according to the analysis by Labour. It suggested at least 2,500 cancelled operations for cancer patients and 8,000 on children.

It found staff shortages were the most common reason given for cancellations by hospitals, accounting for one in five of all operations cancelled for non-clinical reasons last year.

The Department of Health and Social Care said it was “misleading” to extrapolate that figure from the data in the FOIs. “Thousands of elective appointments and procedures had to be cancelled during the pandemic to protect the NHS, and since then we’ve been focused on delivering the biggest catch-up programme in health history - virtually eliminating the longest 2-year waits for treatment,” a spokesman said.

In total, 158,000 operations were cancelled for issues including equipment failures, a shortage of beds, and 5,700 because of equipment failure, administrative errors, and theatre lists overrunning. Labour cited one case that involved a 72-year-old woman who had two operations to remove a brain tumour cancelled in September, blamed on a lack of available beds.

About 9,500 operations were cancelled because an emergency case took priority, and 250 due to adverse weather.

Separate figures from the NHS show record numbers of operations cancelled at the last minute are not rearranged to take place within a month, with one in five patients waiting longer.

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Source: The Guardian, 12 December 2022

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100 ambulances were left waiting outside hospitals with 600 patients stranded without help last night

Bosses at the North West Ambulance Service issued an urgent warning to members of the public on 999 calls and apologised for delays last night.

At 5pm on Monday (December 12), more than 600 patients were waiting for an ambulance across the North West, the service said. Another 100 emergency vehicles were parked outside of hospitals waiting to handover patients.

'Severe weather and hospital handover delays' had an impact on the service last night, as well as 'significant demand'. Ambulance chiefs said they had to 'maximise resources' by putting all clinically-trained staff on the frontline and increasing use of private providers.

In an urgent message issued on Monday night, medical director Dr Chris Grant said: "This is an urgent message for the public across the whole of the North West. Tonight, across both our 111 and 999 services, we're seeing a really significant demand and I apologise for the delay in getting care to you but I do need your help.

"We've called in all our operational and clinical resources to make sure we prioritise those who have the most life-threatening conditions. We need to keep our phone lines free so please only call us back if you no longer need our help or if your own condition has got significantly worse. Thanks for your support."

Ged Blezard, director of operations at NWAS said: "Please only call 999 if someone has a serious illness or injury, you think their life is at risk, and you cannot get them to hospital by any other means. We know there are patients waiting for our help and we are sorry that we are unable to respond as quickly as we would like.

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Source: Manchester Evening News, 13 December 2022

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Decade of neglect means NHS unable to tackle care backlog, report says

A “decade of neglect” by successive Conservative administrations has weakened the NHS to the point that it will not be able to tackle the 7 million-strong backlog of care, a government-commissioned report has concluded.

The paper by the King’s Fund says years of denying funding to the health service and failing to address its growing workforce crisis have left it with too few staff, too little equipment and too many outdated buildings to perform the amount of surgery needed.

The UK’s poor public finances, health service staff suffering from exhaustion, and a wave of NHS strikes this winter will also lead to ministers being unable to deliver key pledges on eradicating routinely long waits, the thinktank says.

“Though Covid certainly exacerbated the crisis in the NHS and social care, we are ultimately paying the price for a decade of neglect,” said the King’s Fund chief executive, Richard Murray.

“The sporadic injections of cash during the austerity years after 2010 were at best meant to cover [the service’s] day-to-day running costs. This dearth of long-term investment has led to a health and care system hamstrung by a lack of staff and equipment and crumbling buildings. These critical challenges have been obvious for years.

“The NHS in 2022 faces many of the same challenges it faced in 2000: unacceptably long waiting times and a service hobbled by staff shortages. To that is now added a cost of living crisis, industrial action by staff and a backdrop of a weak economy and weak public finances.”

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Source: The Guardian, 12 December 2022

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Man with broken hip taken to hospital tied to plank

A man who had broken his hip was taken to hospital strapped to a plank in the back of a van after his granddaughter was told no ambulances were available.

Nicole Lea found Melvyn Ryan behind the door of his home after he pressed an emergency call button around his neck.

When she got there she discovered the 89-year-old also had a broken shoulder.

She said she went to grandfather-of-eight Mr Ryan's home, in Cwmbran, Torfaen, after being contacted just after midnight on Friday.

She said: "I didn't waste any time in calling 999 and gave them my details. And they turned around and said they were unable to send anyone, there wasn't any help to send and that I'd have to find a way of getting him there myself."

The call handler advised her to call the out-of-hours GP before saying she had to go to deal with other calls.

She did not call the GP as she thought it would be a waste of time.

"With my partner and my mum's help we managed to come up with the idea of getting him onto a plank of wood and into the back of my partner's van to get him up to hospital," Ms Lea said. 

"Mr Ryan has had what sounds like the most appalling of experience," said Dr Iona Collins, chairwoman of the British Medical Association (BMA) Cymru.

"How must the ambulance service feel when they are getting calls like this? Obvious its an emergency and they need help and they are unable to help," she told Radio Wales Breakfast.

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Source: BBC News, 12 December 2022

 

 
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English hospitals make emergency plans amid winter power loss fears

English hospitals have increased emergency fuel supplies and put staff on standby to postpone operations and switch off X-ray scanners amid heightened concerns over energy provision this winter.

NHS hospital trusts across England have put their power plans under the microscope as they look to protect patients from potential outages for lifesaving equipment.

Responses to freedom of information requests to 63 NHS trusts revealed that 41 are re-examining their plans for a loss of power for this winter. A further 10 trusts said they conducted routine reviews of their business continuity plans this year, while 12 had not revised their strategies.

National Grid warned in October that, in extreme circumstances, it would be forced to enact planned three-hour power cuts with a days’ notice.

Major hospitals are exempt from this system, called rota disconnection, however businesses and the government have studied their plans for a complete power failure on the network.

Despite the pressure on the NHS budgets, the responses show that most hospitals have up-to-date plans and backup generators to ensure lives are not lost due to lack of power.

A quarter of hospital trusts said they were able to run indefinitely on backup diesel generator power, providing they had access to fuel supplies. Just over 10% said they could run on backup power for 10 days.

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Source: The Guardian, 12 December 2022

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USA: Surgeons concerned about impending cuts to surgical care

A new survey of more than 1,000 surgeons across the USA reiterates concerns that impending cuts to surgical care, set to take effect on 1 January 1 2023, will lead to a decrease in Medicare patient intake, increased delays to care, and longer wait times for patients in surgical practices. These survey results support the efforts of the over one million physician and non-physician healthcare providers joining together in urging congressional leadership to stop the full cut to Medicare payments through a Week of Action.

"Our survey results confirm that the impending cuts to Medicare payments will be disastrous for patients and their access to life-saving and life-altering care," said Patricia L. Turner, American College of Surgeons Executive Director and Chief Executive Officer. "As our population continues to age, more and more seniors depend on Medicare to receive the care they need. Congressional leadership must protect patients by stopping the full cut to Medicare payments so healthcare providers can focus on delivering high-quality care to patients."

The survey, conducted for the American College of Surgeons, a founding member of the Surgical Care Coalition, found:

  • Around two-thirds of members expect patients will be faced with delays to care (68%) or longer wait times (65%). These are up from 56% and 57%, respectively, in 2021.
  • One-in-three (33%) members say there will be a change in their Medicare patient intake if the cuts were to go into effect, up from 25% in 2021.
  • 20% say they expect to take on fewer new Medicare patients, but that they will keep all existing Medicare patients.
  • While members report feeling the impact from supply chain issues and inflation, surgeons are also sounding the siren around healthcare worker shortages.
  • Over nine-in-ten (93%) report healthcare worker shortages impacting their ability to provide high quality care over the last year. Over three-quarters (77%) report "a great deal of impact" from these shortages.

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Source: CISION PR Newswire, 9 December 2022

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Antibiotics in short supply across Australia as GPs call for fix to ‘increasing problem’

Medicine shortages are an “increasing problem” for Australia and antibiotics are among the commonly prescribed drugs currently in short supply, the peak body for general practitioners says.

The drugs regulator, the Therapeutic Goods Administration (TGA),  said the three most commonly prescribed antibiotics – amoxicillin, cefalexin and metronidazole – are scarce. They are used to treat a range of bacterial infections, including pneumonia and other chest infections, skin infections and urinary tract infections.

To see patients through the shortage, the TGA has authorised pharmacists to provide alternative antibiotics without approval from the prescribing doctor.

“Importantly, many of these medicines have alternatives available,” the TGA said. “Your pharmacist may be able to give you a different brand, or your doctor can prescribe a different strength or medicine with similar spectrum of activity.”

A TGA spokesperson said “most of the antibiotic shortages are caused by manufacturing issues or an unexpected increase in demand”.

Dr Nicole Higgins, the president of the Royal Australian College of General Practitioners, said the shortage of certain medicines was “becoming an increasing problem in Australia”.

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Source: The Guardian, 12 December 2022

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Mental health patients left in dilapidated wards amid £677m repairs backlog

Dilapidated mental health facilities across the country are in need of £677m worth of repairs to fix sewerage issues, collapsing roofs and wards that deprive patients of their dignity, The Independent has been told.

An NHS analysis of the government’s flagship programme to build 40 hospitals, seen by The Independent, shows ministers have failed in their promise of “parity” for mental health services as issues are not addressed.

NHS trust and psychiatry leaders warned that the out-of-date buildings are putting patients at risk and urged the government to include six mental health hospitals within its next round of improvements.

Data analysis by the Royal College of Psychiatrists, shared with The Independent, found that the cost of fixing “high and significant” risks in mental health and learning disability hospitals has rocketed from £92m in 2019-20 to £186m in 2021-22 – far higher than the 16 per cent increase in costs seen in acute hospitals. These are risks that must be fixed to avoid “catastrophic” failure or safety problems that could result in serious injury.

Saffron Cordery, interim chief executive at NHS Providers, said patients and staff are at risk because so many buildings aren’t fit for purpose, and warned that things will get worse until mental health trusts get the capital funding they need.

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Source: The Independent, 11 December 2022

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Strep A home-test kits sell out after spate of UK deaths sparks panic buying

Strep A home-testing kits have sold out online as parents rush to find ways to diagnose their children’s rashes and high temperatures.

The panic-buying follows the deaths of at least 16 children from invasive strep A infections in the UK.

As infections and deaths from strep A have risen over the past few weeks, parents have turned to tests that involve a long cotton swab that is lightly passed over the back of the throat. Solutions and a strip test are then used to display results.

These tests are now being sold online for more than £100, while some retailers have reported selling out after demand soared over the past few days. Other suppliers have warned customers that they will not be able to get hold of a test until after Christmas. One online retailer told customers that they would not be able to get the products until mid-January. Others said they were awaiting deliveries but “there may be delays beyond our control”.

Strep A tests are not sold in England through the NHS because the National Institute for Health and Care Excellence (NICE) – which approves and advises on clinical care – has said their accuracy is uncertain and likely to be “highly variable”. Scotland has not approved them either, though in Wales people can buy them over the counter for £7.50.

“We’re not advising using those [tests] for the time being,” Professor Kamila Hawthorne, chair of the Royal College of GPs, said on Friday. “It is a clinical diagnosis. It is not too difficult to make. So long as the parent watches their child and brings their child in, then we are more than happy to see them.”

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Source: The Guardian, 11 December 2022

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Six NHS workers reported ‘every week’ for sexually harassing patient or colleague

Six NHS staff workers are typically reported every week in England for sexually harassing a patient or colleague, the Telegraph can reveal.

Nearly a fifth of English trusts have recorded a rise in reports of sexual harassment within their services since 2017, while millions have been spent by the NHS on legal claims specific to sexual abuse over the same time period, according to newly obtained data.

Health secretary Steve Barclay described the findings as “worrying” and urged NHS leaders to take “robust action in response to any such incidents in their organisation”.

Patient Safety Learning said the Telegraph's “deeply troubling” revelations demonstrated an abuse of the “significant power imbalance” that exists between vulnerable patients and their care providers.

“Healthcare professionals need to recognise the power they hold over patients,” said chief executive Helen Hughes. “Inappropriate behaviours undermine trust in healthcare system and the ability to deliver safe care.”

“Clinicians, managers and healthcare leaders have both a professional and moral responsibility to patients to ensure that there is a safe culture in healthcare settings and that misconduct is not tolerated," said Ms Hughes.

As part of its investigation into sexual harassment within the NHS, the Telegraph uncovered the case of a mentally incapacitated patient who was raped by her healthcare worker and subsequently fell pregnant. The healthcare worker, who is in his 30s, was recently jailed for eight months after pleading guilty to sexual activity with a mentally disordered female. 

Joe Matchett, an expert lawyer at Irwin Mitchell who has secured settlements for survivors of abuse, said his firm continues to “represent a number of patients subjected to terrible abuse at the hands of hospital staff who have betrayed their position of trust in the worst imaginable way”.

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Source: The Telegraph, 11 December 2022

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Hospitals in England pay £5,200 for one agency doctor's shift

Hospitals in England have paid out as much as £5,200 for a shift by a doctor through an agency, according to figures obtained by Labour through Freedom of Information requests.

That is the latest in an intensifying debate over workforce shortages in the NHS in England.

Labour blamed the high agency fees on Conservatives, arguing they had failed to train enough doctors and nurses. A Conservative spokesperson said "record numbers" had been recruited.

The most expensive reported shift was £5,234 - paid by a trust in northern England. This covers the agency fee and other employer costs as well as the money going to the doctor.

The NHS Confederation said the "staffing crisis" was so "desperate" that NHS trusts were being forced to pay large fees to make sure rotas were "staffed safely".

Matthew Taylor, chief executive of the NHS Confederation, said: "Trusts are having to breach the caps on how much they pay for agency doctors because of the extremely high levels of demand they are facing for their services.

"The staffing crisis is so desperate that they either pay these fees or find that their rotas cannot be staffed safely, leading to reduced services for patients. This is particularly true in parts of the country where the NHS can struggle to recruit new staff."

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Source: BBC News, 12 December 2022

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Over 1000 'adverse events' in women and infants' care in Scotland

More than 1000 investigations have been launched in Scotland over the past decade into adverse events affecting women and infants' healthcare.

Figures obtained by the Herald show that at least 1,032 Significant Adverse Event Reviews (Saers) have been initiated by health boards since 2012 following "near misses" or instances of unexpected harm or death in relation to obstetrics, maternity, gynaecology or neonatal services.

The true figure will be higher as two health boards - Grampian and Orkney - have yet to respond to the freedom of information request, and a number of health boards reported the totals per year as "less than five" to protect patient confidentiality.

Saers are internal health board investigations which are carried out following events that could have, or did, result in major harm or death for a patient.

Major harm is generally classified as long-term disability or where medical intervention was required to save the patient's life. They are intended as learning exercises to establish what went wrong and whether it could have been avoided. Not all Saers find fault with the patient's care, but the objective is to improve safety.

NHS Lanarkshire was only able to provide data from April 2015 onwards, but this revealed a total of 194 Saers - of which 102 related to neonatal or maternity services, and 80 for obstetrics.

A Fatal Accident Inquiry involving NHS Lanarkshire has already been ordered into the deaths of three infants - Leo Lamont and Ellie McCormick in 2019, and Mirabelle Bosch in 2021 - because they had died in "circumstances giving rise to serious public concern".

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Source: The Herald, 10 December 2022

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Hospital apologises after hiding surgeon's error for seven years

A hospital trust has apologised to a woman for failing to admit a surgeon had been responsible for a massive haemorrhage that almost killed her after a Caesarean section.

For seven years, East Kent Hospitals Trust maintained the size of Louise Dempster's baby was to blame.

"It was just continuous lies," the 34-year-old told BBC News.

East Kent Hospitals chief executive Tracy Fletcher promised "to ensure lessons are learned".

Louise Dempster gave birth in May 2015 but the surgeon's error only emerged during an inquiry into poor maternity care at East Kent Hospitals Trust which reported this year.

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Source: BBC News, 9 December 2022

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Three investigations launched into trust beset by bullying and safety scandals

Three “major” reviews are being launched into a struggling teaching trust in response to growing concerns over bullying and poor workplace culture.

Birmingham and Solihull integrated care board has begun a series of investigations into University Hospitals Birmingham, whose chief executive announced he was standing down last month.

The first review will get under way immediately and will focus on specific allegations made recently on BBC Newsnight. These include patient safety concerns, the “bullying” of clinicians and the issues raised by a review of 12 patient deaths undertaken by former consultant Dr Manos Nikolousis in 2017.

It will be led by an “experienced senior independent clinician” from outside the local health system who is expected to report by the end of January. 

The second and third investigations will review the trust’s leadership and broader cultural issues respectively. The probes will be carried out with UHB and NHS England. Both are expected to report in the first half of 2023. 

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Source: HSJ, 9 December 2022

 

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USA: House Bill establishes Federal Agency dedicated to patient safety

Nanette Barragán, US representative for California’s 44th Congressional District, has announced the introduction of new legislation intended to establish a National Patient Safety Board (NPSB) as a non-punitive, collaborative, independent agency to address safety in healthcare. This landmark legislation is a critical step to improve safety for patients and healthcare providers by coordinating existing efforts within a single independent agency solely focused on addressing safety in health care through data-driven solutions.

Prior to the COVID-19 pandemic, medical error was the third leading cause of death in the United States, with conservative estimates of more than 250,000 patients dying annually from preventable medical harm and costs of more than $17 billion to the U.S. healthcare system. Recent data from the Centers for Medicare and Medicaid Services and Centers for Disease Control and Prevention indicate that patient safety worsened during the pandemic.

The NPSB’s solutions would focus on problems like medication errors, wrong-site surgeries, hospital-acquired infections, errors in pathology labs, and issues in transition from acute to long-term care. By leveraging interdisciplinary teams of researchers and new technology, including automated systems with AI algorithms, the NPSB’s solutions would help relieve the burden of data collection at the frontline, while also detecting precursors to harm.

A coalition of leaders in health care, technology, business, academia, and other industries has united to call for the establishment of an NPSB. 

“We have seen many valiant efforts to reduce the problem of preventable medical error, but most of these have relied on the frontline workforce to do the work or take extraordinary precautions,” said Karen Wolk Feinstein, PhD, president and CEO of the Pittsburgh Regional Health Initiative and spokesperson for the NPSB Advocacy Coalition. “The pandemic has now made things worse as weary, frustrated, and stressed nurses, doctors, and technicians leave clinical care, resulting in a cycle where harm becomes more prevalent. Many organizations have united to advance a national home for patient safety to promote substantive solutions, including those that deploy modern technologies to make safety as autonomous as possible.”

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Source: Business Wire, 8 December 2022

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Racism poses public health threat to millions worldwide, finds report

Racism is a “profound” and “insidious” driver of health inequalities worldwide and poses a public health threat to millions of people, according to a global review.

Racism, xenophobia and discrimination are “fundamental influences” on health globally but have been overlooked by health researchers, policymakers and practitioners, the series published in the Lancet suggests.

Inaccurate and unfounded assumptions about genetic differences between races also continue to shape health outcomes through research, policy and practice, the review of evidence and studies found.

“Racism and xenophobia exist in every modern society and have profound effects on the health of disadvantaged people,” said the lead author, Prof Delan Devakumar of University College London.

“Until racism and xenophobia are universally recognised as significant drivers of determinants of health, the root causes of discrimination will remain in the shadows and continue to cause and exacerbate health inequities.”

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Source: The Guardian, 8 December 2022

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Our job is to keep people out of A&E

As the pressures of winter and the Covid treatment backlog grow, the NHS is struggling. In Manchester, one organisation is pioneering a new way to care for people that tries to reduce the burden on the health service.

It's the first call-out of the day for nurse Manju and pharmacist Kara in north Manchester. They are on their way to see Steven, who has been diagnosed with Parkinson's disease and had a fall the previous night.

This might have led to a call-out for an ambulance crew and a visit to A&E. But instead the Manchester Local Care Organisation (LCO) stepped in.

Once at Steven's house, Manju makes sure he hasn't been harmed by his fall, while Kara checks his medication.

Manju notes that Steven's tablets could have contributed to his fall.

Manju asks Steven how he copes going up and down the stairs.

"I'm OK, just about," he says. But when he has a go at coming down the stairs, Manju spots he could use an extra grab rail and says she will sort one out.

This intervention by the team has not only avoided Steven ending up in A&E, but also ensures he can continue to live independently in his own home.

That's a key part of the LCO mission, according to Lana McEwan, one of the team leaders in north Manchester.

"We would consider ourselves to be an admission-avoidance service, so we're trying to prevent ambulances being called in the first instance.

"When an ambulance has been called, we're taking referrals directly from the ambulance service and responding within a one or two-hour response depending on need, and that's an alternative to A&E."

Local neighbourhood teams are made up of nurses, social workers, pharmacists and doctors, all working together to keep people out of hospital.

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Source: BBC News, 9 December 2022

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Stubborn cancer backlog at record high

The number of people waiting more than two months to start cancer treatment remained over 30,000 — double the pre-covid level — for three months to the end of October, according to new data published.

NHS England previously committed to bringing the number of people waiting longer than 62 days to be diagnosed and begin treatment, after referral for suspected cancer, to pre-pandemic levels – roughly 14,000 – by March 2023.

But the number has been generally growing since the spring, and remained above 30,000 from August through to the end of October, the latest figures available. September and October’s monthly totals were higher than the previous monthly peak in May 2020, after services were disrupted in the first covid wave.

The increase in waiters this year has been caused by diagnostic and treatment capacity falling short of an increased number of referrals. 

Matt Sample, policy development manager at Cancer Research UK, said: “While it’s good to see significant numbers of people coming forward with potential cancer symptoms, performance against key targets are among the worst on record, continuing a trend that existed long before the pandemic hit, with one target having been missed for almost seven years.”

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Source: HSJ, 8 December 2022

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Nurses bitten and screens smashed - life in A&E

Busy, noisy, highly stressful - and sometimes violent. This is the reality of A&E as the NHS gears up for what will be an incredibly difficult winter.

That much is clear from the experience of staff and patients at Royal Berkshire Hospital's emergency department.

Like all units, it is struggling to see patients quickly - more than a third of patients wait more than four hours.

The stress and frustration means tempers can easily boil over.

Receptionist Tahj Chrichlow says it can get so busy patients end up "packed like sardines".

"Sometimes people can be not as nice to us as we like," he adds, explaining how earlier this week the window of the reception office had been smashed by one angry person.

The Royal College of Emergency Medicine is warning delays are putting patients at risk.

Vice president Dr Ian Higginson says hospitals are "full to bursting".

"When our hospitals are full, we can't get patients out of our emergency departments.

"That means emergency departments become overcrowded and we see patients waiting for long periods on uncomfortable trollies in corridors or other rubbish places."

Dr Higginson says his colleagues are "very worried" and unable to deliver the care they would like to give to patients.

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Source: BBC News, 8 December 2022

 

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