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Huge cyber attack caused minimal patient harm, ICB claims

A cyber attack which crippled a region’s pathology system for three months caused only five cases of “moderate” harm and no significant harm, the NHS has claimed.

The Synnovis cyber attack in June left GPs across six boroughs in London unable to order blood tests, and more than 1,000 inpatient procedures were cancelled at two large hospital trusts.

But South East London Integrated Care Board said this week 498 incidents linked to the attack had been assessed, and all of them were judged to have done either “no harm” or “low harm” — except for five at Guy’s and St Thomas’ hospitals, which were assessed as “moderate” harm.

The NHS’s incident response process judges “moderate” harm as where a patient “did not need immediate life-saving intervention” but needed or is likely to need other follow-up care. It is also triggered by them limiting a patient’s independence for less than six months or “affect[ing] the success of treatment, but without meeting the criteria for reduced life expectancy or accelerated disability.”

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Source: HSJ, 30 October 2024

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Canada: Alberta doctor sounds alarm after 7 patients contract infection from organ transplants

A disease that is more commonly associated with the trenches of the First World War, and can sometimes be found in refugee camps, has been detected in several patients in Alberta who received organ transplants.

Bartonella quintana, an infection caused by body lice, has been found in seven organ transplant recipients in Alberta since 2022, according to Dr. Dima Kabbani, a transplant infectious disease physician who treated the patients.

"It was quite alarming to us, especially that we know that this bacteria can cause a more serious type of infection because sometimes it can affect your heart valve or it can affect some of the major organs," Kabbani said.

"We were surprised to see that type of infection in Alberta."

The disease, which presents as skin lesions, was transferred to organ recipients from their deceased donors, all of whom were people who had been living with homelessness and who had been infected themselves.

"It signals that the bacteria is actually around individuals who are unhoused. So it tells you about a bigger public health problem," Kabbani said.

"If these individuals had access to just water to wash their clothes, or to shower, then we should not have been seeing this type of infection in people who are unhoused in Alberta."

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Source: CBC, 26 October 2024

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This mother made six attempts to raise the alarm about her sick toddler. Doctors told her he’d be fine. They were fatally wrong

On the morning of 30 November 2022, Keri-Sue McManus sat down with her three-year-old son, Micah, to watch the TV series Daniel Tiger’s Neighborhood. 

She was sensitive to his mood because it wasn’t the first time Micah had visited the emergency room in recent weeks. In fact, it was the third time Keri-Sue had taken her toddler to hospital, and the sixth time that month she had contacted various doctors about his deterioration: he had a lack of appetite, weakness, fatigue and severe dizziness, and these symptoms were getting worse.

Each time, she was reassured he would get better. One medic even implied that their frequent visits to the hospital were giving her son anxiety. It was suggested the mother should think twice about taking him in again, for his own sake – hence the cartoon.

In the Daniel Tiger episode, the cub, nervously approaching his appointment, is told: “The hospital is a place where doctors and nurses work together to help you get better.” But that’s not the way it worked out for Micah, who died just hours after he arrived on this third visit, after a series of clinicians failed to take his condition seriously.

I’ve relived all those moments a thousand times. What if I’d gone to this doctor; what if I’d said it this way instead of that way

“Daniel goes to hospital and the doctors fix him and everybody’s so nice. And then he gets to go home,” Keri-Sue remembers of the cartoon. “It’s like a fairytale that we didn’t get to live out.”

Micah’s story casts light on how parents, especially mothers, are frequently patronised and dismissed by the medical profession. “I can’t think of any other way to describe it besides gaslighting,” Keri-Sue says when we speak. “It’s your own child, so you get a feeling or you notice something. You know your child’s normal state better than anybody else and you’re paying attention more than anybody else. I’ve relived all those moments a thousand times. What if I’d gone to this doctor; what if I’d said it this way instead of that way. But the reality is that they weren’t paying attention and doing their job.

“Part of my grief has been trying to wrap my head around how it all happened.”

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Source: The Guardian, 26 October 2024

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‘I thought a vaginal mesh would help - instead it left me sobbing in agony’

Women suffering complications from vaginal mesh implants, including after removal, are calling on the Government to overhaul the compensation process.

Sharon Marchant, 61, from Bedfordshire, is one of thousands of women living with life-changing complications from a vaginal mesh implant.

Vaginal mesh, which is made from the same material used to make drinks bottles, is an implant used to treat pelvic organ prolapse and stress urinary incontinence.

For years it was viewed as the gold standard treatment for incontinence and prolapse in many women, but was later found to cause debilitating side effects including infection, pelvic and leg pain, difficulty urinating, pain during sex, and incontinence.

Earlier this week it was revealed that propylene, the material used commonly used in vaginal mesh implants starts to degrade within 60 days of being implanted in the pelvis.

Ms Marchant told i of the severe physical and mental pain she suffered due to her vaginal mesh implant.

In 2014, she was recommended for a mesh implant after being diagnosed with stress-caused urinary incontinence.

At the time, Ms Marchant did not know much about the vaginal mesh. “I hadn’t heard anything about it – good, bad or indifferent.

“Having been a nurse in my younger years, I just thought, well, if they’re doing this, they must know what they’re doing,” she said.

Within weeks she noticed something was wrong.

“I could feel something that was uncomfortable. And so I had to do a self examination, and then I very quickly realised with the use of a mirror, there was a very large lump of blue mesh exposed.”

She opted for a complete removal of the mesh and is relieved it is now gone. But as a result her stress incontinence worsened, requiring her to take new medication and does not feel comfortable enough to start a new relationship.

“It’s just taken away a huge portion of my life,” she said.

Some women are so desperate for the procedure they are travelling to the US and paying up to £30,000 for the procedure, i was told.

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Source: iNews, 26 October 2024

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Integrated care ICS told it’s ‘top down’ and ‘lacks effective leadership’

An under-pressure integrated care system has been told it lacks “effective leadership” and is “too centralised and top-down” in a survey of partner organisations.

Only 10% of senior leaders said Greater Manchester ICS had the necessary leadership and skills to deliver on its priorities. And only 7% agreed it had “clear roles, effective leadership and efficient processes”, in a survey carried out over the summer.

The work commissioned by the ICB received responses from 156 senior leaders in the ICB, its providers, local authorities, place teams, primary care, social care and voluntary and community services in the patch.

Several described the system’s leadership as “too centralised and top-down”, with “the tension between centralised control at the GM level and local autonomy” sparking “the most significant numbers of qualitative feedback” to the work, according to an ICB board paper this month.

Some also described “bullying by senior leaders and smaller organisations being treated inequitably”.

“Recent restructures and upheavals” have “weakened” a “history of great partnership working in Greater Manchester”, the survey feedback summary adds.

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Source: HSJ, 29 October 2024

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Northern Ireland women face 'foetal scan discrimination'

Pregnant women in Northern Ireland face discrimination over not being offered early scans for foetal abnormalities, according to gynaecology experts.

Early scans are routine in the rest of the UK.

Several patients, who contacted BBC News NI, described the trauma they experienced after their "non-viable" pregnancies were not detected until about 20 weeks.

In Scotland, Wales and England antenatal screening which tests for anomalies is offered to all pregnant women in the first trimester – between 11 and 13 weeks.

The Royal College of Obstetrics and Gynaecology (RCOG) said women in Northern Ireland have foetal abnormalities diagnosed "too late" and should not have to wait until their 20-week scan.

Dr Caitriona Monaghan, a consultant in maternal foetal medicine, said the late diagnosis can limit access to care.

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Source: BBC News, 3 October 2024

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WHO says 2023 saw the highest number of tuberculosis cases on record

More than eight million people were diagnosed with tuberculosis (TB) last year, the World Health Organization said Tuesday, the highest number recorded since the U.N. health agency began keeping track.

About 1.25 million people died of TB last year, the new report said, adding that TB likely returned to being the world’s top infectious disease killer after being replaced by COVID-19 during the pandemic. The deaths are almost double the number of people killed by HIV in 2023.

WHO said TB continues to mostly affect people in Southeast Asia, Africa and the Western Pacific; India, Indonesia, China, the Philippines and Pakistan account for more than half of the world's cases.

“The fact that TB still kills and sickens so many people is an outrage, when we have the tools to prevent it, detect it and treat it,” WHO Director-General Tedros Adhanom Ghebreyesus said in a statement.

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Source: The Independent, 29 October 2024

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Cancer patients’ scans will be cancelled over ‘severe’ supply shortages of vital chemical, minister warns

Cancer scans will be delayed and cancelled due to a “severe” shortage of a chemical which has left hospitals with “no supply at all”, a government minister has warned.

The Department of Health and Social Care issued a critical alert on Friday over the “severe shortage” of a radioactive chemical needed for the diagnosis of thousands of cancers, including prostate and breast cancer.

The fresh alert comes after The Independent revealed warnings from doctors and specialists in August that cancer care had been hit by a “perfect” storm in shortages of radioisotopes. Experts at the British Nuclear Medicine Society told The Independent at the time hundreds of cancer scans were being cancelled due to worsening shortages.

Now minister Karin Smyth has admitted the fresh shortage will lead to delays in access to care and cancellations as officials have been unable to mitigate the impact of the shortages.

The shortage comes after pharmaceutical supplier, Curium, was forced to stop production of a nuclear product that is needed to create Technetium-99m, a radioactive chemcial used in diagnostic imaging.

As a result of the shortage, clinicians are having to prioritise patients needing the most urgent scans, while hospitals have been called on to aid one another.

The shortage is expected to last for at least four weeks.

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Trusts rejecting GP referrals risk contract breach, LMCs warn

GP leaders are pushing back against hospital trusts rejecting referrals, with LMCs issuing warnings of potential contract breaches.

A number of LMCs have encouraged GPs to send warnings back to providers who reject their referrals, stating that there are no valid grounds for the rejection. 

Some template letters produced by LMCs to help GPs do this are badged as part of collective action efforts, since the BMA’s ‘menu’ of actions encourages GPs to ‘stop rationing referrals’.

It comes after Pulse revealed that GPs are concerned about a rise in rejected referrals and particularly from ‘anonymous’ clinicians, with referrals coming back to general practice unsigned, and patients being put at risk when secondary care and other providers do not accept GP referrals.

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Source: Pulse, 28 October 2024

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NHS facing ‘real problems this winter’ and Budget cash will not prevent avoidable deaths, Streeting warns

The NHS faces “real problems this winter”, the health secretary has admitted as he refused to rule out the prospect of people waiting on trolleys and in corridors over the coming months.

Speaking on a joint visit to St George’s Hospital with chancellor Rachel Reeves, Wes Streeting said the extra money the health service is set to receive in Wednesday’s Budget might not prevent avoidable deaths and another winter crisis over the coming months.

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Source: Independent, 29 October 2024

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Deadly new drugs found in fake medicines in the UK

Super-strength drugs linked to hundreds of deaths have been found in samples of fake medicines bought across the UK, the BBC can reveal.

We found more than 100 examples of people trying to buy prescription medicines such as diazepam - commonly used to treat anxiety, muscle spasms and seizures - and instead receiving products containing nitazenes.

The synthetic opioid drugs have been connected to 278 deaths across the country in a year, according to the National Crime Agency (NCA). Nitazenes can be stronger than both heroin and fentanyl, a prolific killer in the US.

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Source: BBC News, 29 October 2024

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Teenager’s death linked to national IT system, review suggests

The 999 assessment and triage system is being reviewed after the death of a young footballer, which may have highlighted a recurring flaw in the tool.

Adam Ankers collapsed as he came off the pitch after playing for Wycombe Wanderers’ under-19s team in January. He was airlifted to the Harefield Hospital in London but was brain dead and a few days later his family agreed to his life support being turned off.

The talented youngster was found to have an inherited heart condition, arrhythmogenic right ventricular cardiomyopathy. This and other inherited heart conditions are thought to be responsible for at least 600 sudden deaths a year in teenagers and young adults.

But a serious incident investigation into Adam’s death by South Central Ambulance Service Foundation Trust, shared with HSJ by Adam’s dad, revealed there was a potential missed opportunity to start life support earlier because “agonal breathing” — which is indicative of a cardiac arrest — was not identified.

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Source: HSJ, 28 October 2024

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‘Deeply concerning’ backlog of thousands of cancer patients waiting months for treatment revealed

Thousands of patients with suspected cancer have been left waiting more than two months for treatment, according to new data that exposes the “deeply concerning” state of NHS urology cancer care.

Almost half of the patients urgently referred for suspected urology cancer, such as kidney or bladder, have been left waiting too long, with leaked figures obtained by The Independent showing an “urgent backlog” of 4,237 patients who have waited more than the 62-day national target as of August.

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Source: Independent, 26 October 2024

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How close were hospitals to collapse in Covid?

Jim Reed, health reporter for the BBC reports on the impact of Covid at it's peak. 

"We’ve long been told that hospitals were struggling to cope during the pandemic. In January 2021, then prime minister Boris Johnson warned the NHS was “under unprecedented pressure But now many hours of testimony to the Covid inquiry this autumn is offering our clearest understanding yet of what was really going on at the height of the pandemic."

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Source: BBC Online, 28 October 2024

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UK regulator tells doctors to watch out for obesity injection misuse

The UK's drug safety regulator is asking doctors to be alert for patients who may be misusing obesity injections, such as Wegovy.

It follows reports of some people who are not obese becoming sick, after using the jabs for weight loss.

The Medicines and Healthcare products Regulatory Agency (MHRA) stresses that the drugs are only meant for treating obesity and diabetes.

Health Secretary Wes Streeting has backed the call, saying the drugs are "serious medicines" and not "for people to get a body beautiful picture for Instagram".

While most side-effects are mild, some can be serious, says the MHRA.

It adds that the drugs should only be prescribed by a registered healthcare professional.

When appropriately used, in line with the product licence, the benefits of these medications outweigh the risks for patients, says the regulator.

But this benefit-risk balance is positive only for those patients within the approved indications for weight management or type 2 diabetes, as described in the product information.

Dr Alison Cave, MHRA Chief Safety Officer, said all medicines carry a risk of potential side-effects: “We encourage healthcare professionals to ensure patients being treated with these medicines are aware of the common side-effects and how to minimise risk."

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Source: BBC News, 24 October 2024

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New data laws will allow patient data to be shared across the NHS

A new bill which will allow patients’ data to be easily transferable across the NHS has been introduced to Parliament.

Delivered by the Department for Science, Innovation, and Technology (DSIT), the bill will require IT suppliers for the health and care sector to ensure their systems meet common standards to enable data sharing across platforms.

The Data Use and Access Bill will enable healthcare information to be easily accessed in real time across all NHS trusts, GP surgeries and ambulance services, whichever IT system they are using.

A press release, published by DSIT on 24 October 2024, said that the measure “will free up 140,000 hours in NHS staff time every year, providing quicker care for patients and potentially saving lives”.

Government launches online platform to shape 10 year health plan 

The government has launched an online engagement platform for members of the public, NHS staff and experts to share their ideas to shape its forthcoming 10 year health plan.

Change.NHS.uk will be live until the start of 2025, and available via the NHS App.

The public engagement exercise will help shape the government’s 10 year health plan which will be published in spring 2025 and will be underlined by three big shifts in healthcare – hospital to community, analogue to digital, and sickness to prevention.

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Source: Digital Health, 24 October 2024

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NHS hospital and manager to stand trial for manslaughter of 22-year-old woman

An NHS trust will become the first ever to be tried for the corporate manslaughter of a mental health patient after being charged over the death of a 22-year-old woman.

Alice Figueiredo died at Goodmayes hospital, run by North East London NHS Foundation Trust (NELFT), in July 2015.

Last year the Crown Prosecution Service announced it was charging NELFT with corporate manslaughter as well as a health and safety breach.

The ward manager at the time, Benjamin Aninakwa, will also stand trial for manslaughter by gross negligence and health and safety breaches for actions related to her death.

The trial opens on 29 October and is expected to last for nine weeks.

NEFLT will be the second ever NHS trust to be charged with corporate manslaughter after Maidstone and Tunbridge Wells Trust was charged following the death of a woman who underwent an emergency Caesarean in 2015.

However, it is the first mental health trust to be charged over the death of a patient in a psychiatric unit.

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Source: The Independent, 24 October 2024

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Trust CEOs warn ‘generation of children’ at risk from failing services

A new report concludes that health services are “failing” children as young people face average waits of a year for an autism diagnosis.

The Care Quality Commission’s annual State of Care report, published today, warned of poor care and specialist staff shortages within providers, alongside “far too long” waits for treatment.

NHS Providers’ deputy CEO Saffron Cordery said trust leaders were “deeply concerned” about meeting demand, particularly in mental health services.

But she added: “Their ability to do so comes against a backdrop of soaring demand, resource pressures and the poor condition of the mental health estate, much of which isn’t fit for purpose.

“A cross-government approach to improving health and wellbeing is vital to protect a whole generation of children and young people at risk of being left behind.”

The CQC has faced two damning reviews of its own, as well as fundamental questions about the quality of its inspections, but NHS Providers and others have said it “echoed what NHS trust leaders tell us.”

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Source: HSJ, 25 October 2024

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USA: Limits on testing for bird flu in humans could pose difficulty for containing spread

As the number of people infected with bird flu rises in the US, continued limits on testing may pose a problem as these cases crop up.

Commercial labs are now developing tests that will be available by prescription, but the tests will still be recommended only for people in close contact with animals and animal products – even as cases in Missouri remain a mystery and wild bird migration and extreme heat may increase spillover opportunities, officials say.

Blood tests have revealed a second person in Missouri exposed to bird flu with no known animal contact, officials with the US Centers for Disease Control and Prevention (CDC) told reporters on Thursday.

Quest Diagnostics announced on Wednesday that its test for H5N1 will soon be available with a prescription from a medical provider, and other commercial labs are also developing tests for the public. But the tests will only be recommended for people with close contact to animals or animal products like raw meat or milk.

In “the lion’s share of situations”, most people with flu symptoms do not need an H5N1 specific test, said Nirav Shah, principal deputy director at the CDC. “It’s really when there’s an epidemiological exposure history that is suggestive of H5, where the H5 test would be warranted.”

Neither of the Missouri cases would’ve been detected with limitations like these. However, the CDC still recommends that states regularly check positive flu A tests for H5N1, which is how the first Missouri case was found.

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Source: The Guardian, 24 October 2024

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Private healthcare boom fuelled by NHS waiting lists

The value of the UK’s private healthcare market rose to a record £12.4bn last year as long NHS waiting lists fuelled demand from individuals and the health service paid for nearly £3.5bn of procedures to help ease the care backlog.

As private medical insurance boomed, total revenues generated in the independent healthcare sector hit an all-time high in real terms pegged to 2003 prices, research revealed.

The total value of work done in hospitals, clinics and by privately practising doctors, including cataract removals, knee surgery and MRI scans, was £1bn higher than in 2022, according to the latest report by the health data provider LaingBuisson.

More patients went private last year as the NHS waiting list peaked at 7.77 million in September, up sharply from 4.57 million at the end of 2019. Increasing numbers took out private medical insurance to fund their treatment, while there has been a decline in those paying out of their own pockets, LaingBuisson said.

Tim Read, the co-author of the report, said: “Increasingly we are seeing people willing to find alternatives rather than waiting to be seen on the NHS. Independent hospitals are seeing a continued boom in people claiming against health insurance entitlements, whilst independent clinics offering lower cost treatments – whether it’s cataract surgery or a diagnostic scan – are becoming an increasingly common sight on high streets across England, not just in more affluent areas traditionally associated with private healthcare.”

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Source: The Guardian, 25 October 2024

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College chiefs demand NHS workforce plan inquiry is reopened

Royal college chiefs have called for an inquiry into the NHS long-term workforce plan to be reopened amid “significant concerns” over its projections.

Seven colleges led by the Royal College of GPs have written to the Commons’ public accounts committee asking it to restart its probe into the workforce plan’s modelling, which began earlier this year but then halted ahead of July’s general election.

It comes after the National Audit Office found “significant weaknesses” in the workforce plan’s projections, such as the number of fully qualified GPs. HSJ has previously revealed GP numbers will barely increase under the national workforce plan.

NHSE has previously said the long-term workforce plan “is based on credible and robust modelling”, which was independently assessed by the Health Foundation think tank.

A letter to new PAC chair Sir Geoffrey Clifton-Brown, which has been signed by the Royal College of Nursing and the Royal College of Physicians among other bodies, said: “During the inquiry, written evidence submissions reflected significant concerns and recommendations regarding certain aspects of the LTWP.

“However, the general election halted this process, and the inquiry was closed before it was concluded. We are therefore calling on the committee to re-open its inquiry into the LTWP.”

The letter, shared with HSJ, called for the findings of the reopened inquiry to be published ahead of the workforce plan’s next iteration in summer 2025.

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Source: HSJ, 25 October 2024

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‘Bullying and racism’ provider faces NHSE investigation

A community services provider at the centre of bullying and racism allegations is being formally investigated by NHS England over its governance arrangements, HSJ can reveal.

The investigation will look into the governance of Sirona Care and Health, an NHS and council-funded social enterprise which is the main provider of community health services for the Bristol, North Somerset, and South Gloucestershire Integrated Care System.

HSJ last month reported that Sirona had launched an internal investigation into its staff culture following allegations of “unacceptable behaviours”, including racism and bullying.

In an internal staff message sent this month, seen by HSJ, Sirona interim chief executive Julie Sharma said NHSE “has a duty to make sure our governance is working well” and is therefore “undertaking a formal investigation” into how the provider is run, and its decision-making processes.

Ms Sharma said: “We know that some things could be better. For instance, too many of our executive directors are on interim contracts and our board is short of non-executive directors. We are addressing both of these.”

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Source: HSJ, 24 October 2024

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Patients ‘traumatised’ by mental health hospitals as major investigation reveals litany of failings

Vulnerable mental health patients are being traumatised, sexually assaulted and physically harmed in UK hospitals – and have even managed to escape, the safety watchdog has warned in its first major national investigation.

The report by the Health Services Safety Investigation Body (HSSIB), launched by former health secretary Steve Barclay after The Independent exposed a series of failings in the sector, warns the government and healthcare leaders that cash starved “oppressive” mental health hospitals are causing harm to patients.

Inpatient mental health services across England are failing to keep highly vulnerable patients safe and are even re-traumatising them, according to the HSSIB.

It highlights a litany of concerns over safety, much of it driven by national shortages of mental health staff and warns the flagship NHS long-term workforce plan ambitions may be “unattainable”.

Other failings highlighted by the safety watchdog include:

  • Short-staffed mental health wards are failing to protect patients from sexual harm as staff also “normalise” sexualised behaviour.
  • Female patients are still regularly housed in mixed-sex wards despite national rules banning this, as hospitals lack funding to change wards.
  • Patients are self-harming, subjected to violence and able to escape as hospitals lack the number of staff to prevent this.
  • Mental health patients are not getting therapeutic care in mental health wards.
  • “Oppressive” and “grim” hospital buildings are re-traumatising patients.

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Source: The Independent, 24 October 2024

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Safety watchdog urges Streeting to expand her role

The patient safety commissioner is urging the health and social care secretary to remove “constraints” limiting her role amid a government review of national watchdogs.

Henrietta Hughes was named the country’s first patient safety commissioner in 2022 by the Department of Health and Social Care, which restricted her role to “championing patients” and improving the safety of medical devices and medicines.

Two years on, her office still only has five staff, which the former NHS England regional medical director says is not enough to do “this enormous task”. She wants her remit to be expanded to cover “everything to do with keeping patients safe… and listening to patients’ voices”.

Her call comes as Wes Streeting last week announced a review of the six main patient safety organisations, including the commissioner’s office and her former employer the National Guardians’ Office, among others. Many expect it to lead to some of them being merged and scrapped.

She told HSJ: “We [all of the patient safety organisations] each have a narrow set of regulations… and I often have to signpost patients somewhere else.

“That’s a real disappointment to me – because I think the whole point of my role is to try and create a coherence to this disjoined, fragmented system.”

Dr Hughes added: “There’s a mismatch between what my role title is and what my remit is, and that’s really confusing for patients. So I would like to see those constraints removed so that my role is not just about medicines and medical devices.”

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Source: HSJ, 24 October 2024

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