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The last acute trust deemed “inadequate” by the Care Quality Commission has had its rating improved to “requires improvement”, the regulator has announced today. Shrewsbury and Telford Hospitals Trust has been rated “inadequate” since November 2021. Until today, it was the only acute trust in England to have the lowest possible combined CQC rating. Inspectors said leaders were visible and approachable, but kept the trust’s leadership rating as “requires improvement.” This was unchanged from the previous inspection. Meanwhile, maternity services at Princess Royal Hospital in Telford, which for years have been under intense scrutiny over multiple instances of poor care and scores of baby deaths, have also been upgraded, this time from “requires improvement” to “good”. Inspectors visiting in October and November 2023 said there had been a “positive shift” in culture with staff saying they felt safer to speak up. The CQC’s report said that overall, people were receiving a higher standard of care with “staff now proud to work for the trust” and SaTH was “working hard to help rebuild people’s confidence” in its services. Read full story (paywalled) Source: HSJ, 15 May 2024

The Patient-Centered Outcomes Research Institute (PCORI) awarded Patients for Patient Safety US (PFPS US) a $100,000 Eugene Washington PCORI Engagement Award for a new project called “Patients Involved in deVeloping Outcomes Together” or “Project PIVOT.” Project PIVOT is a novel patient-led initiative to advance the integration of patient-centred patient-reported outcomes (PROs) and patient-reported experiences (PREs) into Patient-Centered Outcome Research (PCOR), Comparative Clinical Effectiveness Research (CER) and quality assessment measurement tools to improve patient safety, diagnostic quality, and equity. “This award will allow us to identify opportunities to capture—directly from patients and families—their care experiences and challenges, filling key gaps in the traditional data sources used to evaluate healthcare quality and safety,” stated Sue Sheridan, co-founder of PFPS US. In contrast to traditional tools, such as clinical outcome measures and hospital readmission rates, Project PIVOT’s long-term goal is to make healthcare safer and more equitable by capturing and learning from patients’ experiences related to patient safety, diagnostic quality and bias. Project PIVOT will have a special focus on historically underserved communities to help define which questions and outcomes are most important to capture. Priority areas of focus include maternal/newborn health in communities of colour, the physical, intellectual and developmental disability communities and older adults. Read full story Source: Newswire, 13 May 2024

The changes will allow pharmacists to spend more time with patients, levelling the playing field between smaller pharmacies and larger chains. The government has confirmed plans to make ‘hub and spoke’ dispensing models available to all local pharmacies. The change aims to make local pharmacies more efficient and free up time for more complex elements of dispensing and clinical care. The move is part of government’s drive to make patient access to medicines and treatment more efficient across the NHS. Patients stand to benefit thanks to an efficiency drive that will allow all local pharmacies to dispense medicines more efficiently. Currently, larger pharmacy chains can take advantage of the efficiencies and cost-savings that come with centralising the dispensing of medicines at a larger ‘hub’. But smaller independent pharmacies are unable to operate the same model due to legal restrictions on dispensing for pharmacies under different ownership, meaning they can face additional costs and workload. Under the changes announced today, the government will progress in making the ‘hub and spoke’ model universally available, allowing pharmacies belonging to different legal entities to use hubs belonging to other companies. This will level the playing field between smaller pharmacies and larger chains. The changes will enable pharmacists to dispense medicines more efficiently and spend more time dealing face to face with patients. Primary Care Minister, Andrea Leadsom said, “We’re continuing our drive to make access to medicines and care faster, simpler and fairer for all patients, including at local pharmacies. These proposals will level the playing field and enable our hard-working community pharmacies to benefit from centralised dispensing. It will also free up highly skilled pharmacists from back-office duties to deliver patient-facing services, including Pharmacy First and contraception consultations, supply medicines and provide advice.” Read full story Source: WiredGov, 13 May 2024

NHS England will begin monitoring and benchmarking systems on the extent to which patients are given the option to be treated by a private provider. The move follows the government today endorsing the recommendations of a review by the chair of the newly created Independent Patient Choice and Procurement Panel, which has highlighted how some local areas are restricting patient choice. It highlighted significant variation in choice between some systems, which it said was driven by factors including messaging from commissioners to GPs that discourages choice and/or encourages referrals to local NHS trusts, financial incentives for referrals to particular providers and difficulties in securing accreditation from commissioners. It cited one example where the operator of an independent sector hospital that is co-located with an NHS hospital was contractually prevented by the NHS trust from accepting certain referrals. Health and social care secretary Victoria Atkins said: “Empowering patients to take control of their own healthcare decisions is a key part of my missions to make the NHS faster, simpler and fairer for everyone that uses it.” Read full story (paywalled) Source: HSJ, 15 May 2024

A recent analysis found poor survival rates after bone fractures in older adults, with fewer than a third of men and half of women surviving five years after a fracture. Published in JBMR Plus, the study looked at a cohort of 98,474 Ontario residents age 66 and older who suffered fractures to parts of the body associated with osteoporosis between January 2011 and March 2015. The patients were grouped into sets based on the fracture site and matched to patients with a similar demographic profile but no bone breaks during the study period. The fracture cohort was mostly female (73 percent), and the median age at fracture was 80. In the year before the fracture, up to 45 percent of the women and 14 percent of the men had been treated for osteoporosis. The analysis revealed that those within a year of a hip, vertebral or proximal non-hip, non-vertebral fracture were at the highest risk of death. The survival probability was lower for the oldest patients. “Survival most dramatically declined within one month after most types of fracture, with a five-year survival being similar to or worse than some common cancers,” the paper’s lead author, Laval University department of medicine professor Jacques Brown, said Read full story (paywalled) Source: Washington Post, 12 May 2024

More and more UK hospitals are leaving patients in corridors due to a lack of bed space. NHS bosses say so-called corridor care is freeing up ambulances and saving lives, but BBC Newsnight has spoken to patients who say the growing practice is humiliating and degrading. Gregory Knowles counted 13 other patients alongside him on a corridor at the Norfolk and Norwich University Hospital (NNUH) in March. Complications after an operation put him back in hospital and on to a ward but at 04:00 one morning he was moved. The 68-year-old was wheeled in his bed to reception. "I was waking up with people around me. It was horrendous," he told the BBC. "I had no screens and no facilities for water or for really getting changed. My possessions were on the bottom of the bed. My daughter and partner were as horrified as I was," he said. His partner Alicia Goulty described how staff had been too rushed to attend to him. "One day when we got there his catheter had leaked in the bed when he was on the corridor. He was wet with no covers or any screens and I had to take him to the bathroom to get him cleaned". Ms Goulty said her partner's medication had been missed. "We had to ask for water for him. We had to ask sometimes for his meals because he got forgotten." Read full story Source: BBC News, 15 May 2024 You can read a nurse's first-hand account of a corridor care shift in this blog on the hub: A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift

An NHS trust has lost an employment tribunal case against a nurse who had his shifts cancelled after whistleblowing when a patient was put in seclusion because of staff shortages. A judgment published last week found that Mark Temperton, a mental health nurse, was “subjected to detriment” after having made a “protected disclosure” during his agency shift at Greater Manchester Mental Health Foundation Trust’s (GMMH) Atherleigh Park Hospital. Mr Temperton, who is also employed by the Priory Group as a regulatory inspector as well as doing ad-hoc work for the Care Quality Commission, worked as an agency mental health nurse for Blackstone Recruitment and was booked to work a night shift in a psychiatric intensive care unit (Priestners Unit) at Atherleigh Park on 14 October 2022. He raised concerns after a patient, brought in by the police, was put “immediately” into seclusion because of staff shortages. Mr Temperton subsequently raised it with the nurse in charge and with a locum consultant psychiatrist but the patient was kept in seclusion. According to the Mental Health Act’s Code of Practice, seclusion “should not be used as a punishment or a threat, or because of a shortage of staff”. Serious concerns were also raised about the trust’s Edenfield Centre in September 2022 by BBC Panorama, one of them being use of inappropriate seclusion. Paul Lewis-Grundy, associate director of corporate governance at GMMH, said: “It is absolutely vital that staff feel confident and safe to speak up, with no detrimental impact to themselves or their career and prospects. Over the past two years, we have invested significantly, and taken a number of steps, to support this across GMMH.” Read full story (paywalled) Source: HSJ, 15 May 2024

A weight loss injection could reduce the risk of heart attacks and benefit the cardiovascular health of millions of adults across the UK, in what could be the largest medical breakthrough since statins, according to a study. It found that participants taking the medication semaglutide, the active ingredient in brands including Wegovy and Ozempic, had a 20% lower risk of heart attack, stroke, or death due to cardiovascular disease. Read full story Source: Guardian, 14 May 2024

The government is spending £5.5bn less on health in England than it suggested it would be at this stage, the Institute for Fiscal Studies says. Plans set out in the 2019 election campaign indicated the budget would increase by 3.3% a year above inflation during this Parliament, the IFS said. But despite extra being put in to cover the high inflation seen, spending had risen by only 2.7% a year on average. Read full story Source. BBC News, 14 May 2024

An NHS England review has found the proportion of ‘low acuity’ patients attending emergency departments is far smaller than expected. During a trial of new acuity measures at 17 accident and emergency sites, NHSE found the proportion of patients with low acuity was just 4 per cent, when it had expected the figure to be between 20 and 40 per cent. Low acuity cases are those which could often be seen by less specialist services, such as urgent treatment centres. Read full story (paywalled) Source: HSJ, 13 May 2024

Patients in part of the East of England are choosing to begin palliative care over cancer treatment because of prohibitive travel times and costs to get to the nearest specialist centre, a local system leader has warned. The Bedfordshire, Luton and Milton Keynes Integrated Care Board CEO said delays to a proposed £400m project, which includes creating “satellite” treatment centres on its patch, was therefore putting lives at risk and widening inequalities. Read full story (paywalled) Source: HSJ, 13 May 2024

Before Sara Smythe began to disappear, she was thriving. The youngest of four sisters, Sara was born with Down syndrome and lived the life of an active teen. At 13, the Toledo student was heading to middle school and loved soccer and swim practice, took dance and karate classes, and was a Girl Scout. But in 2011, everything changed in a matter of weeks. Sara morphed from a sociable teen to a person who stopped talking and engaging with other people, and, at her worst, had full-blown catatonia. Sara’s doctors were at a loss, but her mother, Eileen Quinn, wasn’t giving up. She embarked on what would become a 13-year quest, harnessing the power of a mother’s love to push the scientific community to pay attention to the mysterious regressions that some young people with Down syndrome were experiencing. Read full story (paywalled) Source: Washington Post, 12 May 2024

An inquiry into traumatic childbirths has called for an overhaul of the UK's maternity and postnatal care after hearing "harrowing" stories from parents. The Birth Trauma Inquiry heard evidence from more than 1,300 women - some said they were left in blood-soaked sheets while others said their children had suffered life-changing injuries due to medical negligence. A new maternity commissioner who would report directly to the prime minister is a key recommendation in the group's report, along with ensuring safe levels of staffing. Read full story Source: BBC News, 13 May 2024

Dementia could cost the UK almost £91bn a year by 2040, as the number of people affected rises inexorably, a study has found. The “colossal” costs of the disease are likely to more than double from an already “staggering” £42.5bn today to £90.6bn, according to research undertaken for the Alzheimer’s Society. That projected rise will happen in line with an expected increase in the number of diagnosed cases from 981,575 to 1,402,010, related to an ageing and growing population. Read full story Source: Guardian, 13 May 2024

The chair of the major inquiry into rogue surgeon Ian Paterson has raised concerns over a separate patient recall process conducted by Salford Royal Hospital, and suggested NHS England should intervene. Leaders in Salford have been resisting pressure to expand a review of patients treated by the former head of its spinal division, John Williamson, over his 23-year career at the hospital. A review of his last five years established clear problems with his surgical techniques and found multiple cases of avoidable harm. Read full story Source: HSJ, 7 May 2024

A new vaccine could be effective against coronaviruses which have yet to emerge, with hopes it could be used to battle future pandemics, research suggests. Scientists at the University of Cambridge, the University of Oxford, and Caltech in the US are developing a novel approach called “proactive vaccinology”, which aims to train the body’s immune system to recognise several different coronaviruses. The vaccine used antigens – a substance that triggers an immune response in the body – found in eight different coronaviruses, including those circulating in bats. This trains the immune system to go after the parts of the antigens that are shared across the viruses and other similar ones, including those not included in the vaccine. “Our focus is to create a vaccine that will protect us against the next coronavirus pandemic, and have it ready before the pandemic has even started,” said Rory Hills, a graduate researcher in the University of Cambridge’s Department of Pharmacology and first author of the report. He added: “We’ve created a vaccine that provides protection against a broad range of different coronaviruses – including ones we don’t even know about yet.” Read full story Source: Independent, 7 May 2024

Integrated care boards and local authorities are cutting their voluntary contributions to the better care fund by more than £500m compared to a high point in 2021-22. It appears to be caused by the funding squeeze in both the NHS and local government; extra pressure on ICBs to focus on hospital admissions and discharge; a shift away from pooled budgets as a method of integration; and restructure, with ICBs taking over from clinical commissioning groups in 2022. Local BCF pooled budgets are made up of mandatory “minimum” funds from ICBs and local government – the largest share, which the government has generally ordered to grow steadily each year – and from the “additional” voluntary contributions. In the past government has said it wants the sum pooled across the NHS and councils to grow and to ultimately account for most NHS and adult social care spending, to help join up services and decision making. But figures published on Tuesday by NHS England show the voluntary income going backwards. At its high point in 2021-22, ICBs and councils planned a discretionary ”additional” contribution of £3bn, and the actual spend turned out to be £3.2bn – £2bn from the NHS and £1.2bn from councils. The newly published figures show the total was planned to fall to £2.8bn in 2023-24 and £2.7bn in 2024-25 – £500m less than the 2021-22 peak spend. Read full story (paywalled) Source: HSJ, 8 May 2024

Five babies have died from whooping cough as cases continue to rise in England, health officials have announced. The UK Health Security Agency (UKHSA) reported 1,319 cases in England in March, after just over 900 in February, making the 2024 total nearly 2,800. It fears it could be a bumper year for the bacterial infection. The last peak year, 2016, saw 5,949 cases in England. The infection can be particularly serious for babies and infants. Half of cases seen so far this year have been in the under-15s, with the highest rates in babies under three months of age. The five babies who died this year were all under three months old. Known as pertussis or "100-day cough", the infection is a cyclical disease with peaks seen every three to five years. UKHSA has said a steady decline in uptake of the vaccine in pregnant women and children and the very low numbers seen during the pandemic, as happened with other infections because of restrictions and public behaviour, were both factors. The agency said a peak year was therefore overdue and urged families to come forward to get vaccinated if they had not already. Read full story Source: BBC News, 9 May 2024

NHS England has found that one in five GP surgeries – and more than two-fifths in some regions – were built more than 75 years ago, and is concerned a lack of space will stop it meeting targets to train more GPs, HSJ has learned. An internal NHSE document seen by HSJ reveals a major audit it commissioned in 2019 – but has not made public – found 20 per cent of 8,900 buildings examined were built before 1948. The figure rises to more than 40 per cent of practices in London, HSJ understands. These practices are likely to be in converted houses, normally owned by GP partners, with very limited space and little scope for expansion. The NHSE slides which include the figure warn the “limited [GP] estate” means there is “strain on existing capacity and meeting current training needs is challenging”. HSJ understands officials are concerned poor estates and lack of space will restrict the big expansion of GP training planned under the NHS long-term workforce plan. Other fears relate to poor tech and the shortage of experienced staff to supervise trainees. NHSE said in a statement: “NHS England has asked every ICS to review their infrastructure to assess which buildings they need to expand and reconfigure to manage additional workforce over the next 10 years.” Read full story (paywalled) Source: HSJ, 9 May 2024

A piece of equipment known as a vein finder is being used for inpatients at Ysbyty Gwynedd in order to improve the experience for patients with hard-to-find veins. Anyone who has difficult veins will know the discomfort when there are failed attempts to locate a vein, such as when having bloods taken. Having noticed the need to improve the experience for patients with difficult veins, Junior Doctor Lois Williams secured a £3,000 grant from Health Education and Improvement Wales and around £600 from Menter Môn to purchase the equipment through the Trainees Transforming Training initiative. Dr Williams said: “We’ve been very lucky to obtain a grant to purchase a vein finder and we hope this will empower nurses, phlebotomists, medical students and junior doctors to take blood and cannulate from patients who are difficult to obtain access. It works by infrared, which can bounce back and show us visibility of the vein which you cannot do with the naked eye. It also helps to reduce the time we need to attempt cannulating patients and how often we might need to cannulate them because of failed attempts, which can be quite distressing for some patients. Our hope is that this will improve the quality of patient care in the future.” Read full story Source: NHS Wales, 30 April 2024

Bereaved families who lost loved ones in the contaminated blood scandal have claimed their relatives were being “used for research” after discovering historic notes in medical records. It is claimed that some patients being treated for the blood clotting disorder haemophilia in the 1970s and 1980s were given blood plasma treatment which doctors knew might be contaminated and infect them with hepatitis. They wanted to study the links between the haemophilia treatment Factor VIII and the risk of infection, but a number of families have claimed their loved ones were enrolled in these studies without their knowledge or consent. The Factor 8 campaign group alleges that instead of stopping treatment, clinicians lobbied to continue trials, even after identifying the association between hepatitis and the treatment. Jason Evans, director of the campaign group, found notes alluding to the research in his father’s medical records. He has since found other families who have discovered the same notes in the records of their loved ones. Mr Evans, whose father died in 1993 after being infected with both HIV and hepatitis C during the course of his treatment for haemophilia, said: “It is appalling that hundreds of people with haemophilia across the country were knowingly infected with lethal viruses under the guise of scientific research. These secret experiments, conducted without consent, show individuals were treated as mere test subjects, not human beings." Read full story Source: Independent, 9 May 2024

Drug shortages in England are now at such critical levels that patients are at risk of immediate harm and even death, pharmacists have warned. The situation is so serious that pharmacists increasingly have to issue “owings” to patients – telling someone that only part of their prescription can be dispensed and asking them to come back for the rest of it later, once the pharmacist has sourced the remainder. Hundreds of different drugs have become hard or impossible to obtain, according to Community Pharmacy England (CPE), which published the report. Widespread and often long-lasting shortages posed “immediate risks to patient health and wellbeing” and caused distress, it said. “The medicine supply challenges being faced by community pharmacies and their patients are beyond critical,” said Janet Morrison, CPE’s chief executive. “Patients with a wide range of clinical and therapeutic needs are being affected on a daily basis and this is going far beyond inconvenience, leading to frustration, anxiety and affecting their health. CPE, which represents England’s 10,500 community pharmacies, based its findings on a survey of the views of owners of 6,100 pharmacy premises and 2,000 of their staff. It found: 79% of pharmacy staff said that medicine shortages were putting patient health at risk. 91% of pharmacy owners had seen a “significant increase” in the problem since last year. 99% of pharmacy workers found a drug was unavailable at least weekly, and 72% encountered that several times a day. Pharmacists are finding themselves on the receiving end of abuse and hostility from patients who are frustrated and angered by not being able to get the drugs they have been prescribed. Read full story Source: Guardian, 9 May 2024

An agency providing last-minute freelance nurses to NHS hospitals is routinely charging up to £2,000 a shift, BBC News has discovered. Glen Burley, chief executive of an NHS trust, said that Thornbury Nursing Services is targeting areas in England where nurses are in short supply. He says it is "profiteering" from an overstretched NHS, but Thornbury says it offers a valuable, flexible service. The government says new measures will end the use of expensive agencies. However, Labour has said the high costs are a result of the "Conservatives' failure to train enough nurses over the past 14 years". Under NHS rules, hospital managers are obliged to use staffing agencies that work within an agreed framework, with a limit or cap on how much should be paid. But when last-minute essential cover is needed, trusts may use off-framework agencies, such as Thornbury. These are not legally obliged to abide by pre-agreed pay scales. Workload pressures in the NHS and a desire for more flexibility over shifts are thought to be driving more nurses to work for such agencies, which tend to pay the people on their books more while also taking a payment for themselves. BBC News has discovered Thornbury charges almost £2,000 for a 12-hour bank holiday shift by a specialist paediatric nurse - an area of expertise where there are known staff shortages. Of that, BBC News calculates the nurse receives about £1,050 - meaning nearly £800 goes to the agency.  Read full story Source: BBC News, 8 May 2024

NHS staff do not correctly monitor a baby’s heart rate during labour in almost half of cases where serious failings lead to tragedy, a review of maternity care has found. The Care Quality Commission identified that inadequate foetal monitoring occurred in 45 of 92 cases (49%) in which a baby died or suffered serious brain damage while being born in a midwife-led unit in England. The findings show that correct monitoring is “critically important” to ensure care is safe in all maternity units, said Sandy Lewis, the director of the CQC’s maternity and newborn safety investigations (MNSI) programme. It analysed four common failings in the 92 births in a report that is intended to help midwives and doctors improve the quality and safety of care. In one case the investigation team found that “there were likely to have been abnormalities in the baby’s heart rate which were ongoing for a prolonged period of time, which were not identified during intermittent auscultation [monitoring]”. In another, midwives were so busy dealing with a separate emergency on the unit that they failed to monitor the baby at the correct recommended intervals and the woman was left unattended. The 92 incidents involved 62 cases in which the newborn suffered a severe brain injury, 19 in which it was alive at the start of labour but was stillborn and 11 when it died within its first six days of life. Read full story Source: Guardian, 8 May 2024

Hospitals in the UK are facing shortages of almost 2,000 anaesthetists, leading the NHS to miss 1.4 million operations a year, doctors have warned. The government has been urged to increase funding for the number of newly qualified doctors who can train as anaesthetists as more than 2,000 miss out on places each year. The Royal College of Anaesthetists has said the NHS will not be able to tackle waiting lists without more of these specialist doctors. Their warning comes amid fears hospitals are substituting doctors for staff without sufficient training, called anaesthesia associates. This week the NHS will publish new waiting list figures. They stood at 7.6 million in March. Dr Fiona Donald, president of the Royal College of Anaesthetists warned: “The shortage of anaesthetists has reached crisis levels and is preventing patients from getting the operations they so desperately need. During the election campaign, I’m sure we’ll see all parties pledge to reduce NHS waiting lists but unless their policies include plans for more anaesthetists they will have limited impact.” According to the college, each year 2,600 doctors apply for anaesthetist training however only 550 places are funded. For more advanced training there are around 650 applicants a year yet only 400 are funded. Read full story Source: Independent, 8 May 2024