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Texas woman dies after receiving inadequate treatment for a miscarriage

A Texas woman has died after receiving inadequate medical treatment for a miscarriage, according to a new report from ProPublica – the fifth pregnant woman the publication has found to have died since the fall of Roe v Wade after receiving inadequate care or being denied a legal abortion.

Porsha Ngumezi, a 35-year-old mother of two, died in June 2023 after experiencing a miscarriage in Texas, where nearly all abortions are banned, ProPublica reported on Monday. Ten weeks into her pregnancy, Ngumezi started to bleed and went to Houston Methodist Sugar Land, which is part of the Houston Methodist hospital chain and located in the Houston metropolitan area. While at the hospital, Ngumezi continued to bleed for several hours. She underwent multiple blood transfusions.

Doctors who reviewed Ngumezi’s case told ProPublica that she should have been offered a dilation and curettage, or D&C, a common procedure that can be used for miscarriages and abortions to clear tissue from the uterus. However, some doctors in states with abortion bans have become hesitant to offer D&Cs, doctors said, because they are afraid of being punished for violating abortion bans – even in situations where women’s pregnancies have ended, as in Ngumezi’s case.

Rather than being offered a D&C, a doctor gave Ngumezi misoprostol, ProPublica reported. Although misoprostol is frequently used in miscarriages and abortions, it can be dangerous to give to women who are – like Ngumezi – bleeding heavily.

However, in states with abortion bans, doctors may feel more comfortable giving patients misoprostol than giving them D&Cs, because D&Cs can attract too much attention.

“You have to convince everyone that it is legal and won’t put them at risk,” Dr Alison Goulding, a Houston OB-GYN, told ProPublica of D&Cs. “Many people may be afraid and misinformed and refuse to participate – even if it’s for a miscarriage.”

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Source: The Guardian, 25 November 2024

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New AI tool offers insights to improve safety for mothers and babies in maternity care

Loughborough University researchers have developed an artificial intelligence (AI) tool that identifies the key human factors influencing maternity care outcomes, supporting ongoing efforts to improve safety for mothers and babies.

Developed by AI and data scientist Professor Georgina Cosma and human factors and complex systems expert Professor Patrick Waterson, the tool analyses maternity incident reports to highlight key human factors – such as communication, teamwork, and decision-making – that may have impacted care outcomes, providing insights into areas that could benefit from additional support.

When an adverse maternity incident occurs in England, detailed investigation reports are produced to identify opportunities for learning and enhancing safety.

Currently, experts must carry out manual reviews to extract human factor insights from incident reports. This process is resource-intensive, time-consuming, and relies on individual interpretation and expertise, which can lead to varying conclusions.

The AI tool addresses these challenges by identifying and categorising human factors in reports quickly and consistently. Its standardised approach allows it to analyse multiple reports and identify recurring factors, helping pinpoint areas that would benefit most from additional support.

The AI model was trained and tested on data from 188 real maternity incident reports. It successfully identified human factors in each report and analysed them collectively, providing insights into where extra support could improve outcomes.

"AI has transformed our analysis of maternity safety reports. We've uncovered crucial insights far quicker than manual methods," said Professor Cosma.

“This has enabled us to gather a comprehensive understanding of where there are areas for improvement in maternity care, and these insights can help identify ways to enhance patient safety and improve outcomes for mothers and babies."

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Source: Loughborough University, 20 November 2024

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Hospital covered up baby’s death, says senior coroner

A senior coroner has accused Chelsea and Westminster Hospital of a cover-up over the death of a baby who died when midwives failed to act on clear signs that his mother was in distress.

Elton Deutekom was pronounced dead 37 minutes after his birth in January 2022. During labour his mother had a placental abruption — when some or all of the placenta separates from the wall of the womb. This was not picked up by her care team, and Elton was starved of oxygen.

Doctors at the west London hospital did not refer the incident to the coroner and wrongly told the NHS’s healthcare safety investigation branch (HSIB) that Elton had been stillborn and no investigation was required, an inquest into his death was told.

It was not until his parents learnt of this anomaly in the records that an investigation was carried out by the HSIB, which uncovered serious failings in his care.

Professor Fiona Wilcox, the senior coroner, said: “I need to say this on the record and in public — this feels like there has been an attempt at a cover-up.” She later repeated: “I am concerned there is an element of cover-up in this death. I will say it categorically.”

Concluding that Elton had died from natural causes to which neglect contributed, the coroner said there had been “gross” failings in his care. She said that if the midwives had adequately monitored his heart rate, acknowledged his mother’s pain and recognised hypoxia — oxygen deficiency — he would have been delivered earlier and would have survived.

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Source: The Times, 21 November 2024

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Give me prescription or I'll kill you, nurse told

Staff at a GP surgery were left in tears and forced to call police after incidents in which angry patients threatened them and acted violently.

Nurse consultant Dr Jennifer Loke, who works at the practice in East Yorkshire, said she was forced to press a panic button when one patient started moving towards her, saying, "If you don't give me that prescription, I'm going to kill you".

Humberside Police has received 411 reports of abuse towards GP staff in the region since 2019. Although most were verbal, the force investigated assaults, a kidnapping and six death threats.

The British Medical Association (BMA) said it knew current pressures could make it harder for patients to get care, but no one should go to work fearing abuse.

Among the death threats was one made towards Dr Loke – an academic doctor who works as a nurse consultant.

Dr Loke said she was not frightened by the incident, but abuse took its toll.

"It's stressful enough to work in a surgery because you have to cope with a lot of complex issues and you need to maintain your cool with patients who are anxious and depressed," she said.

"And yet you have all this in the background, so it's quite distressing."

Most of the patients she saw were "good", but attitudes had changed because of an "on-demand" and consumer culture.

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Source: BBC News, 25 November 2024

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About 20 terminally ill people in UK die in unrelieved pain each day, research finds

An estimated 20 terminally ill people in the UK die in unrelieved pain each day, according to a study by the independent Office of Health Economics (OHE).

According to its research, to be presented to MPs on Tuesday, one in four people receiving palliative care in England have “unmet pain needs”. The OHE said it used “the most conservative of estimates [suggesting] the true number is likely to be much larger”.

It calculated that, even with the “highest possible standards of hospice-level palliative care”, more than 7,300 people across the UK died with unrelieved pain in the last three months of their lives in 2023. In 2019, the comparable figure was nearly 6,400 people a year – a 15% increase over four years.

It also said that fewer than 5% of terminally ill people in England who needed hospice care in 2023 received it.

The OHE’s findings will feed into an intensifying debate over the legalisation of assisted dying ahead of a historic vote by MPs on Friday. 

The OHE said that irrespective of the outcome of Friday’s vote, investment in high-quality end-of-life care should be a “crucial component of the conversation around assisted dying”.

Prof Graham Cookson, the organisation’s chief executive, said: “Our research finds that even assuming the highest standards of care, there remains a group for whom no amount of pain relief will ease their suffering in the last few months of their life.

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Source: The Guardian, 25 November 2024

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NHS bosses who silence whistleblowers face sack under government plans

NHS managers who silence whistleblowers or endanger patients through misconduct face being sacked and barred from working in the health service for life under radical government plans to regulate thousands of bosses for the first time.

Ministers will begin a public consultation on Tuesday seeking views on the proposals, which they say are designed to eradicate a “culture of cover-up” in the NHS. It follows a series of scandals over the last decade at trusts including Morecambe Bay, East Kent and Shrewsbury and Telford.

A statutory duty of candour making NHS managers legally accountable for responding to concerns about patient safety could also be introduced as part of the government’s plans.

Measures being considered include “statutory barring mechanisms”, similar to systems used for teachers, which could see health bosses who have been deemed to be unfit to practise appearing on a centrally held list.

Karin Smyth, a minister in the Department of Health and Social Care, said the proposals formed part of the government’s plans to end the “revolving door” that allows failing bosses to continue working in the NHS.

“To turn around our NHS we need the best and brightest managing the health service, a culture of transparency that keeps patients safe, and an end to the revolving door that allows failed managers to pick up in a new NHS organisation,” she said.

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Source: The Guardian, 24 November 2024

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A toxic staffing row is splitting the NHS

Julia’s first four years as a physician associate were everything she hoped they would be. After working in the NHS for the best part of a decade in a non-patient facing role, she was delighted to be on the wards supporting doctors and the wider healthcare teams.

“I loved the contact I had with patients, assessing them and playing a part in their care. I felt supported and part of a team.”

That all changed about a year ago.

“Suddenly we came under attack. Doctors in the radiology department started refusing to talk to me about scans and others have been saying we don’t deserve to get paid what we do.

“The atmosphere has totally changed. We’ve even stopped going into the canteen as we were being made to feel uncomfortable.”

Julia is far from alone. United Medical Associate Professionals (UMAPs), a body which represents physician (PAs) and anaesthesia associate (AAs), says there are countless examples like this with staff facing bullying and being sidelined.

The Academy of Medical Royal Colleges, which represents senior doctors in the NHS, has warned the whole situation has become so “destructive” that it is damaging teamwork across hospitals and GP surgeries where PAs and AAs work.

Dr Emma Runswick, of the British Medical Association, is worried about patient safety. She says: “We’re seeing PAs doing things, such as ordering scans they are not qualified to order and prescribing drugs that they aren't qualified to prescribe.

"And when they see patients it’s not always clear to the patient that they are not being seen by a doctor. It’s dangerous and has got to stop.”

But UMAPs chief Stephen Nash says: “It’s not about patient safety, but about protecting their interests. They want us to be subservient.”

He says the deaths like those reported are “absolute tragedies”, but he has concerns about how they are being used to attack a whole profession.

“There is meant to be a no-blame approach to learning the lessons from failures.”

He says when mistakes are made there are often multiple factors at play, but the campaign against PAs and AAs has meant their role has been singled out. “It misleads the public," he adds.

In the end it will be up to the independent review, which is being led by Royal Society of Medicine president Prof Gillian Leng, to establish the truth on this.

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Source: BBC News, 23 November 2024

Read our recent interview on the hub: Physician associates: What are the patient safety issues? An interview with Asif Qasim

 

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One in seven A&E patients are repeat visitors with unmet needs, study finds

One in seven A&E patients are repeat visitors with unmet medical needs who feel they have nowhere else to go, according to research that found most are over 70 with multiple conditions or under 50 with mental ill health.

Less than 2% of the population account for almost 14% of all A&E attendances, the British Red Cross study suggests. Across the UK, patients are turning to emergency departments five or more times a year due to “unresolved medical issues”, the charity said.

“Many of those frequently attending A&E had often tried to get other help but this had not met their needs,” its report says. “This meant that when they reached A&E, they were often in need of more urgent care.”

The research comes as NHS England’s top A&E doctor urged people to use 111 services this winter and suggested that as many as two in five people arriving at A&E could be better treated elsewhere.

Frontline emergency doctors have sounded the alarm over an approaching winter crisis that they say is already putting patients in overstretched A&E departments at risk.

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Source: The Guardian, 25 November 2024

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‘Deeply flawed’ watchdog fails to act in 182 cases

Bereaved parents have described maternity investigations carried out by a watchdog as “deeply flawed” after it failed to make recommendations to trusts in 182 cases of deaths and harm. 

The Maternity and Newborn Safety Investigations programme investigates certain cases of early neonatal deaths, stillbirths and severe brain injury in babies born at term following labour, alongside maternal deaths. Last year, it moved to the Care Quality Commission having previously been hosted by the Health Services Safety Investigation Branch.

Now a Freedom of Information request has revealed a third (182) of 556 MNSI reports completed between April 2023 and March 2024 did not contain recommendations.

Officials said in the 182 reports, none of the findings of the investigation contributed to the outcome for the mother or baby, and therefore no recommendations were made.

However, Emily Barley, whose daughter Beatrice died during labour in 2022, said it was “very concerning” to see that so many investigations result in no safety recommendations at all.

She added: “It is hard to believe that when a full-term baby dies or suffers a serious brain injury there is nothing for providers to learn. 

“I do not have any confidence in the MNSI, its investigations, or its conclusions. Having been through an MNSI investigation following the death of my daughter… it is clear to me the entire process is deeply flawed.”

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Source: HSJ, 25 November 2024

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Worst trusts on A&E experience revealed by CQC

A Care Quality Commission (CQC) survey has identified the trusts where the most patients report a bad experience in A&E.

The CQC surveyed more than 45,500 people who used NHS urgent and emergency care services in 2024.

It found that while many were broadly positive about their interactions with staff, there were often complaints of long waits for assessment, and some patients were not given enough help to manage their pain or control symptoms.

The survey, published this week, identified six acute providers that achieved “worse” or “much worse than expected” results when compared with all other trusts across the full range of survey questions. Even these did have more areas where patients were “positive” than those which were negative, however.

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Source: HSJ, 22 November 2024

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USA: Georgia axes maternal health panel after leak about abortion deaths

Georgia officials have dissolved a committee responsible for investigating deaths of pregnant women in the state, after one or more members leaked confidential information about deaths linked to the state's strict abortion laws.

In a letter sent to members of the Maternal Mortality Review Committee (MMRC), Georgia health commissioner Kathleen Toomey said an investigation failed to identify those responsible for the leak, so all current members would be removed.

The news comes two months after the outlet published stories on the deaths of two women, external the panel ruled were preventable and linked to the state's strict abortion ban.

The women's stories became a rallying call for reproductive rights advocates and was cited often by Democrats during the US election.

Since June 2022, Georgia has prohibited all abortions after six weeks of pregnancy, when many women might not know they are pregnant, except in cases of rape, incest or when necessary to prevent "irreversible physical impairment" or death of the mother.

Amber Thurman, 28, and Candi Miller, 41, both died that same year, following rare complications involving the FDA-approved abortion medications mifepristone and misoprostol prescribed from out of state.

Thurman waited 19 hours at a Georgia hospital before doctors performed a rare procedure - prohibited by the state abortion ban with few exceptions - needed to expel fetal tissue from the uterus that had not been fully cleared by the abortion pills.

By the time she was taken into surgery, Thurman had developed acute sepsis. She died on the surgery table.

Tasked with examining pregnancy-related deaths to improve maternal health, the panel of experts, which includes 10 doctors, deemed her death “preventable” and said the hospital’s delay in performing the critical procedure had a “large” impact on her fatal outcome.

“The fact that she felt that she had to make these decisions, that she didn’t have adequate choices here in Georgia, we felt that definitely influenced her case,” one committee member told ProPublica in September. “She’s absolutely responding to this legislation.”

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Source: BBC News, 22 November 2024

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UK Covid-19 Inquiry: Evidence shows a leadership culture that cares even less for science than it does for healthcare worker’s lives

A consortium of healthcare professional bodies, representing 65,000 healthcare workers, has drawn depressing conclusions from the evidence given during Module 3 of the UK Covid-19 Inquiry. 

The COVID-19 Airborne Transmission Alliance or CATA came together early in the pandemic to provide scientific evidence which challenge officials’ stated view that the virus was not capable of being spread by the airborne route, which would have required employers to provide respiratory protective equipment such as FFP3 masks. CATA has been a core participant in the Module 3 Inquiry and provided substantial evidence about the science, but also the bizarre behaviour of healthcare bureaucrats.

“Having followed the evidence in detail, it seems that those who had leadership roles during the pandemic, many of whom have been promoted to even more senior positions and rewarded with national honours, care less for science than they did for the lives of healthcare workers,” says Dr Barry Jones, Chair of CATA and an eminent medic. “They have taken the stand and asked the Inquiry to believe ideas that offend against common sense, let alone science.”

CATA has consistently pointed out the mass of scientific evidence that shows while diseases can be spread by a combination of inhaling airborne particles and being infected by droplets or contact with infected surfaces, Covid-19 has a significant dominant airborne component. CATA’s contentions have been supported by the experts commissioned by the Inquiry, are now no longer denied by the majority of healthcare leaders in the UK and are supported by international organisations including WHO and CDC.

Shockingly, evidence from the most senior health officials and experts in infection prevention and control confirm that they deem that protecting against droplets and aerosols is an either/or choice.

“It’s a bit like saying that your house can be damaged by fire or flood, but your insurance company saying that you can only pick one to be protected against,” commented Dr Barry Jones.

Rather than accepting that difficult decisions needed to be made because of lack of supply of PPE, senior healthcare leaders have taken the view that specially designed PPE might not have worked anyway, so it was not needed.

The Inquiry has heard evidence that there is no plan to stockpile PPE for future pandemics or to have a national supply, despite a global shortage costing the UK millions and resulting in illness and deaths for hundreds of healthcare workers, not to mention almost a quarter of a million UK citizens

The Inquiry has heard of continuing confusion about who was responsible for making critical decisions about how the scientific evidence was used to inform guidance for protecting healthcare workers and patients. 

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Source: British Occupational Hygiene Society, 21 November 2024

Related reading on the hub:

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Learning CPR on manikins without breasts puts women’s lives at risk, study finds

Most CPR manikins don’t have breasts, which contributes towards women being less likely to receive life-saving first aid from bystanders, a study has found.

The study led by Dr Rebecca Szabo, the lead of the Gandel Simulation Service at the Royal Women’s hospital in Melbourne, analysed all manikin models on the global market designed for adult cardiopulmonary resuscitation training.

Of the 20 different manikins, the researchers found all them had flat torsos, with only one model having a breast overlay. Eight were identified as male and seven had no gender specified.

The study, published in the journal Health Promotion International, highlights the findings as an equity issue with implications for the human right to health.

Australian research published in June found women are less likely to receive life-saving CPR after cardiac arrest and less likely to survive.

A survey by St John Ambulance in the UK, published in October, found women who go into cardiac arrest in public are less likely than men to receive chest compressions from bystanders as people “worry about touching their breasts”. The study suggested “unequal outcomes for women after cardiac arrest may start in CPR training and CPR manikin design related to implicit bias.”

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Source: The Guardian, 21 November 2024

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Streeting names and shames trust for ‘really poor’ care

The health and care secretary has singled out a trust for “really poor-quality care,” just moments after he said he was “not in the business of public humiliation.”

Wes Streeting said North East London Foundation Trust “continues to appear in the headlines for providing really poor quality care.”

Mr Streeting was responding to a question from the trust’s chair, Eileen Taylor, who had called on the minister to highlight the work being done by NELFT, which covers his Ilford North constituency.

NELFT is currently being prosecuted for manslaughter by gross negligence in the death of mental health inpatient Alice Figueiredo, for not removing suicide risks from the wards.

The organisation has also been criticised by a coroner for a “culture of impunity” and the falsification of patient records.

NELFT chair Eileen Taylor asked if Mr Streeting “could also reinforce that it’s not just the acute trust, but it’s the community and mental health care as well” after he had paid tribute to leadership at Barking, Havering and Redbridge University Hospitals Trust, which serves the same patch, prompting applause from the audience.

The health and care secretary responded: “I’m very aware of NELFT, not least because NELFT has and continues to appear in the headlines for providing really poor-quality care.

“So, if we want to name and shame, I’ll do the name and shame before the naming and praising… 

“I really don’t need lectures from NELFT about recognising the challenges and pressures there, because I read about them in the newspapers on a regular basis.”

Mr Streeting did say he agreed with Ms Taylor ”about the need for the left shift” which is “exactly what we want to deliver”.

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Source: HSJ, 13 November 2024

Related reading:

There are many better things Wes Streeting could focus on than picking rows with NHS managers, writes HSJ editor Alastair McLellan in Not having a row about failing managers

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‘Racist and misogynistic’ behaviour called out by regulator

A teaching trust has been warned it could see resident doctors removed unless it addresses a raft of concerns, including racist and misogynistic behaviour.

The General Medical Council has placed conditions on Norfolk and Norwich University Hospital Foundation Trust following a period of “enhanced monitoring”.

The concerns cover the trust’s medicine and surgical departments, and involve all grades of resident doctors (formerly known as junior doctors).

The trust said it was taking the issues “very seriously” and is “resolved to make this a great place to work, train and develop”.

The medical regulator’s director for education and standards Professor Colin Melville said: “Despite ongoing work with the trust for two years, doctors in training in these departments continue to report a range of concerns, including racist and misogynistic behaviours, which need to be addressed as a priority.

“There are also concerns around the clinical supervision of doctors in training, handover processes and access to educational opportunities.”

The trust was told to adequately cover rotas, and make sure trainees were not subjected to “behaviours including racist and misogynistic behaviours”. 

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Source: HSJ, 21 November 2024

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Emergency prescribing and ‘shared care’ withdrawn by GPs

Emergency prescribing and monitoring of patients with severe mental health conditions are among services being cancelled by GP practices as part of “collective action”.

Although the action, primarily over funding, began in the summer, growing numbers of practices are now cancelling local enhanced services, according to multiple board papers and other documents.

A common theme among those being “handed back” or cancelled is prescribing and monitoring for people who have severe mental health conditions, neurological conditions, and other long-term conditions.

Practices are often refusing “shared care” arrangements with secondary care, where patients with long-term conditions, including mental health illness, are meant to be monitored and supported by GPs, but also overseen by specialists. 

These are often funded and determined by integrated care boards locally, as “local enhanced services” or “locally commissioned services”, although they are often similar in different systems.

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Source: HSJ, 20 November 2024

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Women who have lost a baby prefer the term ‘pregnancy loss’ over ‘miscarriage’

Women who have lost a baby often dislike the language used by medical professionals and would prefer the term “pregnancy loss” over “miscarriage”, research has found.

More than six in 10 women (61%) who had lost a baby between 18 and 23 weeks of pregnancy said it was unacceptable for doctors, midwives and nurses to use the word “miscarriage”.

Only 22% thought that was an acceptable way to refer to the loss they had suffered, even though that is the medical and legal definition in the UK of a baby who dies before reaching 24 weeks’ gestation. Large majorities also disapprove of “intrapartum foetal death” and “intrauterine death”.

Four out of five (82%) women would prefer staff to use “pregnancy loss”, according to the research, which was led by Dr Beth Malory, a lecturer in English linguistics at University College London.

Malory began looking into how women felt about the clinical language used around baby loss after having a daughter born in the second trimester of pregnancy and seeing how often complaints were aired in online communities, such as the Facebook group of the baby charity Tommy’s.

“‘Pregnancy loss’ is much more broadly acceptable than ‘miscarriage’, which prompts really mixed feelings and which a lot of people actively dislike due to connotations of blame, failure and so on,” said Malory.

She and fellow researcher Dr Louise Nuttall found “widespread dissatisfaction” among women who had lost a baby, with “lots of words and phrases that trigger trauma”.

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Source: The Guardian, 21 November 2024

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Vapes '95% safer' than cigarettes messaging backfired

The message that vaping is 95% safer than smoking has backfired, encouraging some children to vape, says a top health expert.

Dr Mike McKean treats children with lung conditions and is vice-president for policy at the Royal College of Paediatrics and Child Health. He says the 2015 public messaging should have been clearer - vapes are only for adults addicted to cigarettes.

Evidence on the possible health risks of vaping is still being gathered.

In an exclusive interview with the BBC, Dr McKean said: "Vaping is not for children and young people. In fact it could be very bad for you," although he stresses that it is not making lots of children very sick, and serious complications are rare.

"Vaping is only a tool for adults who are addicted to cigarettes."

He says the 95% safe messaging was "a very unwise thing to have done and it's opened the door to significant chaos".

"There are many children, young people who have taken up vaping who never intended to smoke and are now likely addicted to vaping. And I think it's absolutely shocking that we've allowed that to happen."

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Source: BBC News, 26 September 2023

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Mental health patients harmed by being sent to units far from home, report finds

Mental health patients in England are being harmed by the rise in psychiatric unit placements far from their homes and families, a report indicates.

Some patients had experienced anxiety and post-traumatic stress disorder (PTSD), while others had died by suicide as a result of their distant placements, according to a Health Services Safety Investigations Body (HSSIB) report, which drew on interviews with patients and their families.

The participants said their experiences had resulted in anger, frustration and a loss of trust in the mental health system.

Neil Alexander, a senior safety investigator, said “urgent improvements” were needed to reduce harm to patients. “The reality is patients need to be treated and sometimes it is seen as safer to admit them to an inpatient ward or unit,” he said.

“However, as our investigation sadly showed, the harm caused to patients when moved far from home or moved back and forth between settings can be distressing, for them and for their families.

“The investigation emphasised that inappropriate out-of-area placements are a symptom of wider issues within health and social care: financial and resources pressures, long waiting lists for social housing and a lack of true integration between the two.”

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Source: The Guardian, 21 November 2024

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High staff turnover rates linked to patient deaths

More than 4,000 people could be dying per year because of high turnover rates of nurses and doctors in NHS hospitals, according to new research from the University of Surrey.

The university said the research had shown a clear association between high turnover rates of nurses and doctors in NHS hospitals and a "troubling" rise in patient mortality rates.

The study analysed nearly a decade of data from 148 NHS hospitals in England using anonymised patient and worker records.

The researchers found that a one standard deviation increase in nurse turnover is associated with 35 additional deaths per 100,000 hospital admissions within 30 days.

With an average of 8.2 million hospital admissions occurring annually, the turnover rates of hospital nurses and senior doctors could translate to nearly 335 additional deaths each month across the NHS.

Dr Giuseppe Moscelli, lead researcher of the study at the University of Surrey, said: "Our findings underscore the vital role that stable staffing plays in ensuring patient safety.

"High turnover rates are not simply an administrative issue; they have real, life-or-death implications for patients. It's time for healthcare leaders to focus on retention strategies that prioritise workforce stability."

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Source: BBC News, 21 November 2024

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GP ‘inconsistency’ compounding dangerous A&E crowding, says trust

A review into emergency care deaths at a struggling trust claims a “lack of consistency” in primary care referrals is a major factor causing A&E crowding.

Royal Cornwall Hospitals Trust, a national outlier for long accident and emergency waits and ambulance handover delays, carried out a review into potential harm to patients from crowding in its emergency departments, which has been obtained by HSJ.

The review found that several factors, both internal and external to the hospital, were leading to long A&E waits. Among them was a “lack of consistency in referrals from primary care”.

It said: “Too many GPs or their deputies send patients to ED when they could safely be referred to [inpatient] teams and bypass ED altogether.”

The review also found the ED was often being used by multiple specialties “as their receiving ‘ward’, bringing more patients to ED who do not need ED care”. This was particularly the case ”when [the specialty’s] own unit closes due to their opening hours, staffing or number of patients in department”.

Another factor was a “lack of provision of extended opening hours, staffing and radiology support for key [minor injury units and urgent treatment centres] meaning flow increases to ED in the evening”. The review also said there were “poor comms” when these services close.

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Source: HSJ, 21 November 2024

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Medics warn of dangers of freebirths

A concerning trend of women giving birth without qualified medics risks "reversing [care] to the middle ages," experts have said.

Figures show a rise in the number of women using doulas - a person who provides support to a pregnant woman before, during and after childbirth, and usually involves a home birth.

In some cases, doulas were persuading women to ignore medical advice, medically experts have said.

A senior consultant said mums-to-be were risking their child's life with medically unsupervised births, and their own health. She knew of a patient left with a colostomy bag after a doula advised them not to be stitched up following a fourth degree tear.

She is now calling on the government to introduce regulation for doulas.

Director of Doula UK Trudi Dawson told the BBC that they do not perform medical tasks and are only there for "advocacy and support".

She insisted members are not allowed to steer women towards making particular birth choices, adding: "We would signpost them to the evidence.

Mrs Dawson does not agree with calls from obstetricians for doulas to be regulated.

She added: "Obviously we can’t be the doula police but we are trying to make sure that there is kind of a gold standard by having a register of doulas who have done specific training, who've had a mentored period, and who stand by the philosophy and a code of conduct."

But a senior obstetrician and gynaecologist, who didn't want to be named, said she was "terrified" about women giving birth in medically unsupervised environments.

She said: "I just feel like freebirthing and allowing women to take that sort of risk with themselves, their bodies and their baby, is risking their baby dying and them potentially dying in that very unsupervised environment."

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Source: BBC News, 20 November 2024

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Women plan UK legal action over talc cancer claims

Hundreds of women in the UK are planning to take on one of the world's biggest pharmaceutical companies over alleged links between talc and cancer.

Diagnosed with ovarian cancer in 2021, Cassandra Wardle is one of the women launching a group action against the biggest seller of talcum powder, Johnson & Johnson (J&J).

Cassandra, who stumbled on a Facebook article linking cancer and talc following her diagnosis, said it was used on her as a baby and she continued to use it "for 20 years or more".

If it proceeds, the legal action would be the first of its kind brought against the pharmaceutical multinational in the UK.

With 1,900 potential claimants, including cancer patients, survivors and families, lawyers say it is set to be the largest pharmaceutical product group action in English and Welsh legal history.

The BBC has spoken to a number of women with gynaecological cancers - many are part of the group action - who believe their repeated use of talcum powder played a part in their diagnosis.

Their lawyers allege that for decades, talcum powder was contaminated with cancer-causing asbestos - something they claim J&J was aware of but sought to suppress.

J&J denies suppressing any information and denies any links between its baby powder, asbestos and cancer.

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Source: BBC News, 20 November 2024

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Mental health nurses on 999 calls reduce ED admissions

A new pilot project that sees mental health nurses speaking on 999 calls has seen a 40% reduction in the number of people in mental health crisis being admitted to emergency departments (EDs).

The project in the South Eastern Health Trust area, funded by the Public Health Agency (PHA), sees 12 mental health practitioners from the trust work with the Northern Ireland Ambulance Service (NIAS) in its control room in Belfast at the weekends.

It is aimed at people who call 999 in mental health distress.

In the scheme, a medical health practitioner will give a mental health assessment to de-escalate people from attending EDs, and prevent ambulances from going to people that are in mental health crisis.

The trust's project lead, Stephanie Patten, said the pilot has been proving successful so far.

"From April to September, there were 190 [mental health] calls," she told BBC News NI.

"40% of those calls were de-escalated which meant they did not require an emergency ambulance."

Ms Patten said this means people "have the right care and the right response at the right time" when they are in crisis, and don't have to wait on an ambulance or in a busy ED.

"An emergency department is not an appropriate place for someone who is depressed, anxious or distressed to be sitting waiting," she added.

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Source: BBC News, 20 November 2024

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