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Harm to patients ‘normalised’ as ‘burned-out’ paramedics work without breaks, care watchdog warns

Harm to patients has become “normalised” as burned-out paramedics are working without breaks, the national care watchdog has warned.

Concerns over the pressures on staff at South East Coast Ambulance Service have been raised by the Care Quality Commission (CQC).

Senior staff told the CQC that patients were being adversely affected by ambulance delays but it was now being seen as “part of the culture”.

The CQC found pressures on staff within the South East Coast Ambulance Service, such as long waits outside of the emergency department, had led to low morale and staff feeling they were not valued.

It said: “Staff described feeling frustrated and burnout and that senior leaders did not understand or respond to the challenges or concerns they raised. Some local senior managers described that harm to patients, caused by delays in reaching them, had become normalised as a culture.”

“At times there were many outstanding category 3 [urgent] patients awaiting an ambulance or assessment by a paramedic practitioner. At busy times, these patients waited for extended lengths of time for crews and callbacks. Therefore, this group of patients were at risk of deterioration whilst they were waiting for a response.”

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Source: The Independent, 26 October 2022

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Seven in 10 NHS trusts in England failing to hit cancer referrals target

People with suspected cancer in England are facing a higher risk of “worrying” outcomes owing to unacceptable delays in being referred to hospital, experts have said, as figures show seven in 10 NHS trusts are failing to hit a key target.

The number of NHS trusts missing the national target for urgent cancer referrals is the highest it has been for at least three years, according to analysis of NHS data.

In England, the maximum waiting time for a hospital appointment for suspected cancer is two weeks from the day the hospital receives a referral letter from a GP. At least 93% of patients should be seen within 14 days, according to the NHS. But analysis by the PA news agency, using data from August 2019 to August 2022, shows this target is routinely being missed, putting patients at greater risk of poor outcomes.

Minesh Patel, head of policy at Macmillan Cancer Support, said: “There are huge pressures even at that early stage of the cancer pathway, let alone when you get to treatment, and it is really worrying for somebody’s prognosis. If somebody starts treatment later, the more worrying the outcome could be in terms of their ability to survive their cancer, to have minimal after-effects after a treatment. This is about survival and giving people the best chance and improving their quality of life, ultimately.”

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Source: The Guardian, 26 October 2022

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Public health cuts must be avoided, new PM told

Cuts to public health budgets will hit poorest communities the hardest, the new government is being warned.

Directors of public health say local authorities - which pay for initiatives such as smoking cessation services - are on a financial cliff edge.

Rising inflation means ventures will cost more to run. Any reduction in funding in next week's spending announcement will have a direct impact on the lives of the most vulnerable, they said.

David Finch, assistant director of healthy lives at The Health Foundation, said: "Public health interventions have been shown to be really cost effective. Investing in these preventative measures that help to keep people in good health in the first place means you're protecting against future costs to the economy and society by keeping people healthy and reducing poor health in the future."

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Source: BBC News, 26 October 2022

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Trust criticised over handling of 60-hour A&E waits

Senior staff have questioned why a major hospital did not seek support from neighbours when emergency patients were left waiting more than 60 hours to be admitted to a bed.

Cambridge University Hospitals Foundation Trust’s emergency department came under severe pressure last week, with patients being bedded down in corridors and facing very long waits to be admitted to a ward.

Senior sources told HSJ there were two cases where patients were waiting more than 60 hours last Monday, and the trust declared an internal incident.

But the sources felt the trust should have escalated its alert level to “Opel 4”, which prompts calls for external support when trusts are under the most severe levels of operational pressure. This can include diverting ambulances to other hospitals.

The trust apologised to patients who had been kept “waiting for a long time” but that the required threshold for Opel 4 had not been reached.

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Source: HSJ, 25 October 2022

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Aggressive breast cancer hits black women harder

Researchers in the US have found a genetic link between people with African ancestry and the aggressive type of breast cancer. They hope their findings will encourage more black people to get involved in clinical trials in a bid to improve survival rates for people with the disease.

Triple negative breast cancer (TNBC) is more common in women under 40 and disproportionately affects black women.

A study published in the journal JAMA Oncology found that black women diagnosed with TNBC are 28% more likely to die from it than white women with the same diagnosis.

Now a new study has confirmed a definitive genetic link between African ancestry and TNBC. Lisa Newman, of Weill Cornell Medicine, has been part of an international project studying breast cancer in women in different regions of Africa for 20 years.

She says representation of women with diverse backgrounds on clinical trials is absolutely critical.

"Unfortunately, African-American women are disproportionately under-represented in cancer clinical trials and we see this in the breast cancer clinical trials as well," says Dr Newman.

"If you don't have diverse representation, you don't understand how to apply these advances in treatment.

"Part of it is because there is some historic mistrust of the healthcare system.

"We do continue to see systemic racism in the healthcare delivery system where it has been documented, tragically, that many cancer care providers are less likely to offer clinical trials to their black patients compared with their white patients."

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Disturbing pattern in baby deaths, nurse's trial told

A medical expert has told the trial of nurse Lucy Letby how he noticed a "quite disturbing and quite unusual" pattern in the deaths of babies she is accused of murdering.

Ms Letby is charged with killing seven babies and attempting to murder 10 others at the Countess of Chester Hospital in 2015 and 2016.

Expert Dr Dewi Evans was approached by the National Crime Agency to review the case in 2017.

Giving evidence at Manchester Crown Court, Dr Evans said: "The concern was that there had been a number of deaths in the Countess of Chester that had been unusual.

"There were far more deaths than they would expect. There was collapses in babies that were otherwise quite stable, but in many of the cases resuscitation was not successful."

It is alleged Ms Letby injected air into the bloodstream of a baby referred to in court as Child A, shortly after she came on shift in June 2015, just over 24 hours after his premature birth.

The prosecution alleges she used the same method to attack his sister, Child B, on the following night shift.

Dr Evans told the court that a review of Child A's records showed that the baby boy was in a "stable condition" before his collapse.

He said: "He was as well as could be expected, all the markers of wellbeing were very satisfactory.

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Source: BBC News, 25 October 2022

 

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Winners of HSJ Patient Safety Awards 2022 revealed

More than 900 invitees converged on Manchester Central last night to find out which projects would emerge winners in the latest edition of our Patient Safety Awards.

The awards recognise and reward the hard-working teams and individuals who, in these times of austerity, pay restraints and workforce shortages, are striving to deliver improved patient care.

HSJ correspondent Annabelle Collins gave a welcome speech before comedian and writer Justin Moorhouse hosted the event, which was held at the end of the first day of the Patient Safety Congress.

Ms Collins said: “Not only are you treating more and more patients, in difficult circumstances, you’re treating them safely and innovating during a time when the health service is being told by the government to be more efficient. To do more, with less. I think this makes your work and achievements even more special.

This year, the awards were presented under four key areas:

  • Clinical and specialist excellence;
  • Enacting organisation-wide change;
  • Proactive prevention and harm avoidance; and
  • Service/system innovation.

Read about the winners

Source: HSJ, 25 October 2022

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Endometriosis surgery delay 'caused irreversible damage'

An endometriosis sufferer has said her reproductive organs are so damaged by a three-year delay for surgery, it has affected her ability to have children.

Claire Nicholls, 29, has been in pain for years with the condition - which involves tissue similar to the lining of the womb growing elsewhere.

Ms Nicholls said she was passed from "pillar to post" and for 10 years, medical professionals did not seem to believe how much pain she was actually in.

She has stage four endometriosis, which is the most severe and widespread.

"The pain can be excruciating, at times I can't get out of bed and I have also had to attend the emergency department," she said.

After opting to go private, her surgeon said he was unable to see many of her organs due to the amount of scarred tissue caused by the delay in surgery.

"He told me the scarred tissue and adhesions were all around my organs... they couldn't remove it all as it could have damaged other organs including my bladder - it was just too severe," she said.

Northern Ireland has the longest gynaecological waiting lists in the UK, according to a professional body. It is calling for two regional endometriosis centres.

The report from the Royal College of Obstetricians and Gynaecologists found 36,900 women in Northern Ireland are on a gynaecology waiting list - a 42% increase since the start of the pandemic.

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Source: BBC News, 25 October 2022

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Hospitals ‘desperate’ to discharge patients admit ambulance delays are a ‘threat to life’

Hospitals “desperate” to free up beds could be putting patients in danger, The Independent has been told.

NHS trusts are being forced into “risky behaviours” in the push to free up hospital beds and A&E departments, experts have warned.

It comes as new data reveals that waits for ambulance crews outside hospitals hit 26 hours in September, with more than 4,000 patients likely to have experienced severe harm due to delays.

In documents leaked to The Independent, hospital leaders in Cornwall warned staff that current pressures in its emergency care system combined with ambulance delays have “tragically resulted in deaths”.

Royal Cornwall Hospitals Trust and the Cornwall Partnership NHS Foundation Trust said in the document that ambulance delays and waits in A&E were causing a “risk to life”, and that as a result they were planning to begin discharging patients into the care of the voluntary sector.

The document said: “It is likely that the risk of such support not meeting all the patients’ individual requirements is less than the risk to life currently experienced in the community when there are significant handover delays at the hospital front doors.”

It comes as North West Ambulance Service launched an investigation after a patient died waiting in the back of an ambulance outside A&E, the Manchester Evening News reported.

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Source: The Independent, 24 October 2022

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Why is Britain still lagging behind on cancer care?

Cancer patients in this country should have the best survival chances in the world. With its universal healthcare system and world-leading researchers, the UK should be able to offer every patient the knowledge and reassurance that their disease will be picked up quickly and treated rapidly, with the best that science can throw at it.

Yet Britain languishes towards the bottom of developed nations’ league tables of cancer performance. On nearly every metric this is one of the worst places in the western world to get cancer — and some experts fear that survival rates are about to go backwards for the first time in a generation.

Britain is now operating a “late diagnosis service” for the disease, a former UK cancer tsar has said, while waiting times are creeping up and up and nearly half of patients are diagnosed when their tumours have already spread, slashing their survival chances.

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Source: The Times, 22 October 2022

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Wales NHS: Prioritise patients waiting longest

The NHS in Wales needs to "speed up the process" of treating people waiting over two years for hospital treatment, the health minister said.

Eluned Morgan said health boards need to prioritise the "longest waiters and they're not always doing that".

There are 59,350 people waiting over two years in Wales, although the number has fallen for a fifth month in a row.

The Welsh NHS Confederation, which represents NHS health organisations, has been asked to comment.

In Wales, there are 183,450 operations and procedures waiting more than a year.

Overall waits - from referral to treatment - have passed 750,000.

Scotland has 7,650 patients waiting more than two years, England has 2,646.

Asked on BBC Politics Wales why so many more people are waiting longer in Wales, Ms Morgan said: "Our health boards need to make sure that they're taking people from the longest waiters and they're not always doing that."

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Source: BBC News, 23 October 2022

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Medical device regulation challenges put children's surgeries at risk

Research led by Trinity College in Ireland has found that a regulation which came into effect in May 2021 with the aim of improving the oversight of medical devices in Ireland is leading to unintended consequences which may put some surgeries for children, and the treatment of rare diseases, at risk. The study has been published in the journal Pediatric Cardiology.

Medical devices include a great diversity of technologies, which are evaluated and approved in the European Union (EU) according to a revised law that came into effect on 26 May 2021, known as the Medical Device Regulation or MDR (EU 745/2017). It has a transition period that allows products that were approved under the previous rules (the EU Medical Device Directives) to continue to be marketed until 26 May 2024 at the latest. As a result of a series of unforeseen factors, there is a possibility that the MDR may result in products becoming unavailable, with the consequent risk of a loss of some interventions that are reliant upon those devices. Devices that are used for orphan or paediatric indications are particularly vulnerable to this.

The paper provides an example of one device, the Rashkind balloon catheter, first developed by Dr William Rashkind in 1966 to open the upper chambers in the heart in neonates with congenital heart disease. A number of these balloons were once available in Europe and now there is only one. This device may become unavailable next year. If this happens, it will not be possible to continue this procedure, and alternative surgeries or treatments are far less optimal. The paper also describes the timeline and cost of bringing the device to market in the EU, the US and Canada, and the cost and time needed to access the EU market has become much greater. 

Researchers believe there is now an urgent need for policy to be developed to protect essential medical devices for orphan indications and for use in children, to ensure that necessary interventions can continue, and to ensure a more sustainable system in Europe over the longer term.

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Source: Trinity College Dublin, 20 October 2022

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CEOs ‘risk becoming prisoners’ in trusts with poor culture

Trust chief executives risk becoming “prisoners” of organisations with poor cultures if they do not “step back and see the bigger picture”, a former chief inspector of hospitals has said.

Ted Baker said he was “tired” of people getting angry about cultural problems in the NHS while doing nothing to change it, amid an appeal for “less anger and more thoughtful interventions”.

He told HSJ’s Patient Safety Congress greater understanding was needed about what will change culture, and working to do so, rather than “rail against the culture in the way people do all the time”.

Professor Baker said: “One of my real concerns is that we often end up criticising individuals in organisations because they, if you like, embody the ‘wrong’ culture.

“But many individuals are often prisoners of the culture themselves, but we don’t see that.

“You put a chief executive into an organisation with a poor culture, if they don’t have the wisdom and the vision to step back and see the bigger picture, they could become trapped in the culture themselves.”

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Source: HSJ, 24 October 2022

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Infected blood scandal: Victims to get £100,000 by end of month

About 4,000 UK victims of the infected blood scandal are to receive interim compensation payments of £100,000 by the end of this month.

It is being paid to those whose health is failing after developing blood borne viruses like hepatitis and HIV. It is also being paid to partners of people who have died.

Conan McIlwrath, from Larne in County Antrim, who is among the 100 or so victims affected in Northern Ireland said it was "very much welcomed".

"This is the first compensation that's ever been paid - anything prior has been support," he told BBC News NI.

All victims have campaigned for actual 'compensation' as they have said only this would acknowledge decades of physical and social injury, as well as loss of earnings and the cost of care.

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Source: BBC News, 22 October 2022

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Nurse recruitment drive launched by NHS England amid acute shortages

The NHS is launching an effort to recruit tens of thousands of nurses to help fill the record number of vacancies that low pay, Covid and heavy workloads have created across the service.

A multimedia blitz will try to raise nursing’s profile as a worthwhile career by featuring patients who benefited from nurses’ skills and dedication.

NHS England’s “We are the NHS” campaign will use radio, social media and cinema advertisements to portray nursing as a varied and fulfilling role that can change people’s lives.

It comes soon after NHS figures showed that the number of empty posts in nursing across hospitals, mental health, community care and other services had reached 46,828 – the largest number ever. That means that more than one in 10 nursing roles (11.8%) are unfilled across the service overall.

While the NHS is short of almost every type of staff, service chiefs say the acute lack of nurses is a key reason why so many patients are waiting so long for A&E, cancer treatment and other care.

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Source: The Guardian, 24 October 2022

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Racism a ‘very serious problem’ at NHS agency

The troubled agency that supplies blood to the NHS has a ’very serious problem’ with racism, a staff survey has revealed.

Six hundred staff at NHS Blood and Transplant were surveyed and the results have been summarised in an internal memo, seen by HSJ. 

It said 55% of respondents felt the problem of racism at NHSBT is “extremely or very serious”, while half had little confidence in the organisation’s recent efforts to tackle racial inequality.

When contacted for comment, a NHSBT spokeswoman said the results were “difficult to read” and added that “we are deeply sorry to those who have experienced negative behaviour”.

The issues over race and leadership come at perhaps the most operationally challenging period in NHSBT’s history.  It is struggling to find enough staff for its donation clinics, which meant it issued its first-ever “amber alert” over blood supplies recently. 

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Source: HSJ, 21 October 2022

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Health of nation study calls on millions to sign up

Researchers are calling on five million UK adults to join what they hope will be one of the biggest studies in the world, to create the most detailed picture ever of the nation's health.

The aim is it to find better ways to prevent, spot and treat illnesses like cancer and dementia early on. It will involve collecting health and genetic data and creating a long-term repository of health information.

Our Future Health is part-funded by government, industry and charities. They hope to get their first set of results in the next few years.

Chairman of the programme, Prof Sir John Bell, said the ambition is to use the results to fundamentally shift the focus of healthcare systems to earlier diagnosis and prevention.

Invitations will go out this autumn to more than three million people in London, West Yorkshire, West Midlands and Greater Manchester. Over time it will be open to all UK adults.

Volunteers will:

  • fill in questionnaires about their lifestyles and any health problems
  • have blood tests for measurements such as blood sugar and cholesterol
  • have their height, weight and blood pressure measured
  • take genetic tests
  • consent to share their NHS records.

According to the plans the information will be used in a number of different ways.

Scientists will collate and combine this information and store it so that people cannot be identified, building up a bank of health and genetic data.

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Source: BBC News, 24 October 2022

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‘Uncomfortable’ A&E model could be rolled out nationally

A patient flow model which involves moving A&E patients to wards “irrespective” of whether there are beds available, is under review for wider rollout by NHS England and is being endorsed by senior clinicians, despite safety fears, HSJ has learned. 

The Royal College of Emergency Medicine has said it would be “unethical” for leaders not to at least consider implementing some form of “continuous flow” model for emergency patients.

The approach has been been trialled recently by North Bristol Trust and at several London trusts. HSJ understands NHS England is considering the wider implementation of the continuous flow model, although no final decision has yet been made.

The calls come despite patient safety concerns about the model being raised by the Nuffield Trust think tank, who said the evidence for the model is “poor” and could spread risk to other parts of the hospital.

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Source: HSJ, 21 October 2022

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‘My cancer patients took priority’ says doctor suspended for working while Covid positive

A Harley Street doctor suspended for working while testing positive for Covid at the height of the pandemic has said that his patient’s cancer treatment took priority.

Dr Andrew Gaya was found to have “blatantly disregarded” the rules by going to work at a centre for patients with brain tumours after he tested positive for the disease.

The “highly regarded” consultant oncologist “dishonestly” misled colleagues that he was safe to work by keeping his positive test secret, a tribunal found.

Dr Gaya, whose work is at the forefront of tumour care and has been described as “world class”, said he defied Covid-19 rules because he believed “the risk of harm to his patient” in delaying treatment was “greater than the risk he posed”.

Now, the doctor of 27 years has been suspended for three months at a Medical Practitioners’ Tribunal.

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Source: The Times, 20 Ocotober 2022

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Care homes ignore lifting of Covid curbs and shut out visitors

Sarah was only allowed to see her 78-year-old mother through a small, double-glazed window that opened 2in at the bottom. There had been a Covid outbreak in her care home and her family were barred from entry, contrary to government guidelines.

But this was not December 2020. It was two months ago.

“It was just horrific,” said Sarah. “Mum said, ‘I feel like I’m in prison.’ And it was hard for us to disagree.” Sarah and her sisters kept pushing for visitor rights, offering to wear full PPE, but the home, which charged £1,050 a week, instead issued a 28-day eviction notice, saying they “could not meet the family’s needs”.

In March this year, all restrictions on care homes were lifted. In a Covid outbreak — two or more positive tests — “visits should happen in all circumstances”. Each resident is allowed one visitor, and this does not need to be the same person throughout the outbreak. However, privately run homes are not following government guidelines. 

“We saw a massive, tragic loss of life at the beginning of the pandemic among this demographic,” said Helen Wildbore, director of Relatives and Residents Association. “But now care homes have swung dramatically to the other extreme and they have become medically risk averse at the cost of people’s mental health and quality of life. We know people in isolation who have just given up the will to live, who feel like they have been abandoned.”

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Source: The Times, 23 October 2022

You may also be interested to read these two original blogs posted on the hub:

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Thousands at risk as A&E queues stop NHS paramedics attending 999 calls

Paramedics in England cannot respond to 117,000 urgent 999 calls every month because they are stuck outside hospitals looking after patients, figures show.

The amount of time ambulance crews had to wait outside A&E units meant they were unavailable to attend almost one in six incidents.

Long delays in handing patients over to A&E staff meant 38,000 people may have been harmed last month alone – one in seven of the 292,000 who had to wait at least 15 minutes.

Of those left at risk of harm, 4,100 suffered potential “severe harm”, according to the bosses of England’s ambulance services.

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Source: The Guardian, 21 October 2022

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Urgent recall of contaminated antibiotic powder

Some batches of an antibiotic medicine called teicoplanin (brand name Targocid) are being urgently recalled in the UK because of possible contamination.

The two affected batches are labelled 0J25D1 and 0J25D2, say safety experts.

Patients and prescribers are being asked to check packs and stop using the medicine if it has either batch number.

Four patients so far have suffered high fevers just hours after being given a dose from these batches.

Other products containing teicoplanin are not affected by the recall.

The Medicines and Healthcare products Regulatory Agency (MHRA) says the two batches of Targocid 200mg powder for making a solution to take as an injection, by infusion or by mouth, were found to contain high levels of bacterial endotoxins - a toxic compound found in bacterial cell walls that can cause inflammation-related symptoms, high fever and, in very serious cases, septic shock.

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Source: BBC News, 21 October 2022

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Struggling hospices fear demand for beds will grow as dying patients can’t afford to heat homes

The cost of living crisis could force dying patients to move into hospice beds as they can no longer afford to heat their homes, it is claimed.

The stark warning comes as the care sector faces soaring energy bills of its own, with the industry predicting a huge hike in costs next year.

Speaking about the impact the cost of living crisis is having on patients, Paul Marriot, Chief Executive of North East hospice St Cuthbert’s, said: “Here in the North East, for example, many of our patients are already on low incomes and the fact that they are ill increases their costs. The key thing is that they are in a time in life when they’ve got less choice around what they do about [costs]. So it’s not an opportunity for them to switch off the heating, it’s not an option for them, just to wear more clothes, it’s not an option for them to see it out until the spring, because they may not be here in the spring."

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Source: The Independent, 17 October 2022

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Cough syrup banned in Indonesia after spate of child deaths

Indonesia has temporarily banned all syrup-based and liquid cough medicines after the death of nearly 100 children from acute kidney failure since the start of this year.

Most of those affected are said to be below the age of six.

Muhammad Syahril Mansyur, the country’s health ministry spokesman, said: “Until today, we have received 206 reported cases from 20 provinces with 99 deaths.”

He added: “As a precaution, the ministry has asked all health workers in health facilities not to prescribe liquid medicine or syrup temporarily … we also asked drug stores to temporarily stop non-prescription liquid medicine or syrup sales until the investigation is completed.”

The ban, announced by the health ministry on Wednesday, applies to prescription and over-the-counter medicines. It comes after nearly 70 children died of acute kidney failure this year in the Gambia, linked to four brands of paracetamol cough syrup manufactured by India’s Maiden Pharmaceuticals.

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Source: The Times, 20 October 2022

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Families accept damages over Nottingham NHS endoscopy deaths

The families of three patients who all died after undergoing the same specialised endoscopy procedure have accepted damages from an NHS trust.

The patients all died after a procedure called an endoscopic retrograde cholangiopancreatography (ERCP) at Nottingham University Hospitals NHS Trust.

Following their deaths, a coroner issued a report calling for changes. The trust said improvements had been made.

William - known as Bill - Doleman, 76, Anita Burkey, 85, Peter Sellars, 72, and Carol Cole, 53, died in the space of about six months after undergoing the procedures.

An inquest found they died as a result of complications of the ERCP - where a tube is passed through a patient's throat to examine and treat possible gallstones and other conditions.

The families said they had accepted undisclosed damages from the trust over the deaths.

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Source: BBC News, 21 October 2022

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