The UK had a shortage of around 176 000 doctors, nurses, and midwives in 2022 and has become over-reliant on international recruitment, warns a report by the Organisation for Economic Co-operation and Development (OECD).
The report, which looked at the state of health in the EU, found that in total EU countries had an estimated shortage of 1.2 million doctors, nurses, and midwives. It cited multiple factors, including ageing populations, difficult working conditions, staff burnout, and challenges presented by the covid pandemic.
Significant inequalities also continue to exist between EU member states.
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Source: BMJ, 21 November 2024
Thousands of children with attention deficit hyperactivity disorder (ADHD) are having to go without medication as a result of shortages, with some missing school as a result.
There has been a national shortage of ADHD medications for more than a year, with the worst affected drug currently methylphenidate, which is commonly used for children and sold under the brand names Concerta and Ritalin.
Two thirds of parents said they faced problems getting their child’s medication at the beginning of this school year, according to a survey by the charity ADHD UK, with some saying their children are unable to concentrate in lessons or having to take days off.
Campaigners and pharmacists have urged the Department of Health and NHS to loosen bureaucracy that means patients cannot switch to alternative drugs that are in stock.
Henry Shelford, chief executive of ADHD UK, said: “We were under the impression it would be solved by now but it’s absolutely not. There are huge challenges across the country. The problem in the UK is much worse than almost anywhere else in the world.
“It is absolutely destroying lives. It is devastating for children. Removing medication from a child with ADHD is akin to removing a wheelchair from a disabled person. They can’t live their normal lives.
“I know people whose entire careers are being unravelled because of problems with their medication. For many people medication is life-changing, and so to have it removed is equally life-changing.”
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Source: The Times, 24 November 2024
Further reading on the hub:
Medicines Shortages Policy: Solutions for empty shelves
Medication supply issues: Mast cell activation syndrome (MCAS) - Medication including labelling - Patient Safety Learning - the hub
Medication supply issues: A pharmacist’s perspective
A Texas woman has died after receiving inadequate medical treatment for a miscarriage, according to a new report from ProPublica – the fifth pregnant woman the publication has found to have died since the fall of Roe v Wade after receiving inadequate care or being denied a legal abortion.
Porsha Ngumezi, a 35-year-old mother of two, died in June 2023 after experiencing a miscarriage in Texas, where nearly all abortions are banned, ProPublica reported on Monday. Ten weeks into her pregnancy, Ngumezi started to bleed and went to Houston Methodist Sugar Land, which is part of the Houston Methodist hospital chain and located in the Houston metropolitan area. While at the hospital, Ngumezi continued to bleed for several hours. She underwent multiple blood transfusions.
Doctors who reviewed Ngumezi’s case told ProPublica that she should have been offered a dilation and curettage, or D&C, a common procedure that can be used for miscarriages and abortions to clear tissue from the uterus. However, some doctors in states with abortion bans have become hesitant to offer D&Cs, doctors said, because they are afraid of being punished for violating abortion bans – even in situations where women’s pregnancies have ended, as in Ngumezi’s case.
Rather than being offered a D&C, a doctor gave Ngumezi misoprostol, ProPublica reported. Although misoprostol is frequently used in miscarriages and abortions, it can be dangerous to give to women who are – like Ngumezi – bleeding heavily.
However, in states with abortion bans, doctors may feel more comfortable giving patients misoprostol than giving them D&Cs, because D&Cs can attract too much attention.
“You have to convince everyone that it is legal and won’t put them at risk,” Dr Alison Goulding, a Houston OB-GYN, told ProPublica of D&Cs. “Many people may be afraid and misinformed and refuse to participate – even if it’s for a miscarriage.”
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Source: The Guardian, 25 November 2024
A major incident has been declared at a hospital "for cyber security reasons".
In a statement on their website, Wirral University Teaching Hospital said the ongoing incident at the Trust is likely to impact performance at Arrowe Park Hospital in Wirral.
The hospital has asked people to only attend the hospital if they have "a genuine emergency".
“The Trust business continuity processes are in place and our focus remains on maintaining patient safety," a hospital spokesperson said.
The statement added: “However, this issue is likely to result in longer waits in the emergency department and assessment areas.
“Please only attend the emergency department if you have a genuine emergency.
“If it’s not an emergency, please visit 111, use a walk-in centre, an urgent treatment centre, a GP or pharmacist."
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Source: BBC News, 26 November 2024
A senior coroner has accused Chelsea and Westminster Hospital of a cover-up over the death of a baby who died when midwives failed to act on clear signs that his mother was in distress.
Elton Deutekom was pronounced dead 37 minutes after his birth in January 2022. During labour his mother had a placental abruption — when some or all of the placenta separates from the wall of the womb. This was not picked up by her care team, and Elton was starved of oxygen.
Doctors at the west London hospital did not refer the incident to the coroner and wrongly told the NHS’s healthcare safety investigation branch (HSIB) that Elton had been stillborn and no investigation was required, an inquest into his death was told.
It was not until his parents learnt of this anomaly in the records that an investigation was carried out by the HSIB, which uncovered serious failings in his care.
Professor Fiona Wilcox, the senior coroner, said: “I need to say this on the record and in public — this feels like there has been an attempt at a cover-up.” She later repeated: “I am concerned there is an element of cover-up in this death. I will say it categorically.”
Concluding that Elton had died from natural causes to which neglect contributed, the coroner said there had been “gross” failings in his care. She said that if the midwives had adequately monitored his heart rate, acknowledged his mother’s pain and recognised hypoxia — oxygen deficiency — he would have been delivered earlier and would have survived.
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Source: The Times, 21 November 2024
Staff at a GP surgery were left in tears and forced to call police after incidents in which angry patients threatened them and acted violently.
Nurse consultant Dr Jennifer Loke, who works at the practice in East Yorkshire, said she was forced to press a panic button when one patient started moving towards her, saying, "If you don't give me that prescription, I'm going to kill you".
Humberside Police has received 411 reports of abuse towards GP staff in the region since 2019. Although most were verbal, the force investigated assaults, a kidnapping and six death threats.
The British Medical Association (BMA) said it knew current pressures could make it harder for patients to get care, but no one should go to work fearing abuse.
Among the death threats was one made towards Dr Loke – an academic doctor who works as a nurse consultant.
Dr Loke said she was not frightened by the incident, but abuse took its toll.
"It's stressful enough to work in a surgery because you have to cope with a lot of complex issues and you need to maintain your cool with patients who are anxious and depressed," she said.
"And yet you have all this in the background, so it's quite distressing."
Most of the patients she saw were "good", but attitudes had changed because of an "on-demand" and consumer culture.
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Source: BBC News, 25 November 2024
An estimated 20 terminally ill people in the UK die in unrelieved pain each day, according to a study by the independent Office of Health Economics (OHE).
According to its research, to be presented to MPs on Tuesday, one in four people receiving palliative care in England have “unmet pain needs”. The OHE said it used “the most conservative of estimates [suggesting] the true number is likely to be much larger”.
It calculated that, even with the “highest possible standards of hospice-level palliative care”, more than 7,300 people across the UK died with unrelieved pain in the last three months of their lives in 2023. In 2019, the comparable figure was nearly 6,400 people a year – a 15% increase over four years.
It also said that fewer than 5% of terminally ill people in England who needed hospice care in 2023 received it.
The OHE’s findings will feed into an intensifying debate over the legalisation of assisted dying ahead of a historic vote by MPs on Friday.
The OHE said that irrespective of the outcome of Friday’s vote, investment in high-quality end-of-life care should be a “crucial component of the conversation around assisted dying”.
Prof Graham Cookson, the organisation’s chief executive, said: “Our research finds that even assuming the highest standards of care, there remains a group for whom no amount of pain relief will ease their suffering in the last few months of their life.
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Source: The Guardian, 25 November 2024
Julia’s first four years as a physician associate were everything she hoped they would be. After working in the NHS for the best part of a decade in a non-patient facing role, she was delighted to be on the wards supporting doctors and the wider healthcare teams.
“I loved the contact I had with patients, assessing them and playing a part in their care. I felt supported and part of a team.”
That all changed about a year ago.
“Suddenly we came under attack. Doctors in the radiology department started refusing to talk to me about scans and others have been saying we don’t deserve to get paid what we do.
“The atmosphere has totally changed. We’ve even stopped going into the canteen as we were being made to feel uncomfortable.”
Julia is far from alone. United Medical Associate Professionals (UMAPs), a body which represents physician (PAs) and anaesthesia associate (AAs), says there are countless examples like this with staff facing bullying and being sidelined.
The Academy of Medical Royal Colleges, which represents senior doctors in the NHS, has warned the whole situation has become so “destructive” that it is damaging teamwork across hospitals and GP surgeries where PAs and AAs work.
Dr Emma Runswick, of the British Medical Association, is worried about patient safety. She says: “We’re seeing PAs doing things, such as ordering scans they are not qualified to order and prescribing drugs that they aren't qualified to prescribe.
"And when they see patients it’s not always clear to the patient that they are not being seen by a doctor. It’s dangerous and has got to stop.”
But UMAPs chief Stephen Nash says: “It’s not about patient safety, but about protecting their interests. They want us to be subservient.”
He says the deaths like those reported are “absolute tragedies”, but he has concerns about how they are being used to attack a whole profession.
“There is meant to be a no-blame approach to learning the lessons from failures.”
He says when mistakes are made there are often multiple factors at play, but the campaign against PAs and AAs has meant their role has been singled out. “It misleads the public," he adds.
In the end it will be up to the independent review, which is being led by Royal Society of Medicine president Prof Gillian Leng, to establish the truth on this.
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Source: BBC News, 23 November 2024
Read our recent interview on the hub: Physician associates: What are the patient safety issues? An interview with Asif Qasim
One in seven A&E patients are repeat visitors with unmet medical needs who feel they have nowhere else to go, according to research that found most are over 70 with multiple conditions or under 50 with mental ill health.
Less than 2% of the population account for almost 14% of all A&E attendances, the British Red Cross study suggests. Across the UK, patients are turning to emergency departments five or more times a year due to “unresolved medical issues”, the charity said.
“Many of those frequently attending A&E had often tried to get other help but this had not met their needs,” its report says. “This meant that when they reached A&E, they were often in need of more urgent care.”
The research comes as NHS England’s top A&E doctor urged people to use 111 services this winter and suggested that as many as two in five people arriving at A&E could be better treated elsewhere.
Frontline emergency doctors have sounded the alarm over an approaching winter crisis that they say is already putting patients in overstretched A&E departments at risk.
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Source: The Guardian, 25 November 2024
NHS managers who silence whistleblowers or endanger patients through misconduct face being sacked and barred from working in the health service for life under radical government plans to regulate thousands of bosses for the first time.
Ministers will begin a public consultation on Tuesday seeking views on the proposals, which they say are designed to eradicate a “culture of cover-up” in the NHS. It follows a series of scandals over the last decade at trusts including Morecambe Bay, East Kent and Shrewsbury and Telford.
A statutory duty of candour making NHS managers legally accountable for responding to concerns about patient safety could also be introduced as part of the government’s plans.
Measures being considered include “statutory barring mechanisms”, similar to systems used for teachers, which could see health bosses who have been deemed to be unfit to practise appearing on a centrally held list.
Karin Smyth, a minister in the Department of Health and Social Care, said the proposals formed part of the government’s plans to end the “revolving door” that allows failing bosses to continue working in the NHS.
“To turn around our NHS we need the best and brightest managing the health service, a culture of transparency that keeps patients safe, and an end to the revolving door that allows failed managers to pick up in a new NHS organisation,” she said.
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Source: The Guardian, 24 November 2024
Bereaved parents have described maternity investigations carried out by a watchdog as “deeply flawed” after it failed to make recommendations to trusts in 182 cases of deaths and harm.
The Maternity and Newborn Safety Investigations programme investigates certain cases of early neonatal deaths, stillbirths and severe brain injury in babies born at term following labour, alongside maternal deaths. Last year, it moved to the Care Quality Commission having previously been hosted by the Health Services Safety Investigation Branch.
Now a Freedom of Information request has revealed a third (182) of 556 MNSI reports completed between April 2023 and March 2024 did not contain recommendations.
Officials said in the 182 reports, none of the findings of the investigation contributed to the outcome for the mother or baby, and therefore no recommendations were made.
However, Emily Barley, whose daughter Beatrice died during labour in 2022, said it was “very concerning” to see that so many investigations result in no safety recommendations at all.
She added: “It is hard to believe that when a full-term baby dies or suffers a serious brain injury there is nothing for providers to learn.
“I do not have any confidence in the MNSI, its investigations, or its conclusions. Having been through an MNSI investigation following the death of my daughter… it is clear to me the entire process is deeply flawed.”
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Source: HSJ, 25 November 2024
Loughborough University researchers have developed an artificial intelligence (AI) tool that identifies the key human factors influencing maternity care outcomes, supporting ongoing efforts to improve safety for mothers and babies.
Developed by AI and data scientist Professor Georgina Cosma and human factors and complex systems expert Professor Patrick Waterson, the tool analyses maternity incident reports to highlight key human factors – such as communication, teamwork, and decision-making – that may have impacted care outcomes, providing insights into areas that could benefit from additional support.
When an adverse maternity incident occurs in England, detailed investigation reports are produced to identify opportunities for learning and enhancing safety.
Currently, experts must carry out manual reviews to extract human factor insights from incident reports. This process is resource-intensive, time-consuming, and relies on individual interpretation and expertise, which can lead to varying conclusions.
The AI tool addresses these challenges by identifying and categorising human factors in reports quickly and consistently. Its standardised approach allows it to analyse multiple reports and identify recurring factors, helping pinpoint areas that would benefit most from additional support.
The AI model was trained and tested on data from 188 real maternity incident reports. It successfully identified human factors in each report and analysed them collectively, providing insights into where extra support could improve outcomes.
"AI has transformed our analysis of maternity safety reports. We've uncovered crucial insights far quicker than manual methods," said Professor Cosma.
“This has enabled us to gather a comprehensive understanding of where there are areas for improvement in maternity care, and these insights can help identify ways to enhance patient safety and improve outcomes for mothers and babies."
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Source: Loughborough University, 20 November 2024
As the government promises NHS reform, there's a drive to get more people treated at home or in the community.
But what happens when that falls short?
Sky’s Nick Martin uncovers the bizarre story of the fake carer and what it says about the UK's multi-million-pound care industry.
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Source: Sky News, 21 November 2024
A Care Quality Commission (CQC) survey has identified the trusts where the most patients report a bad experience in A&E.
The CQC surveyed more than 45,500 people who used NHS urgent and emergency care services in 2024.
It found that while many were broadly positive about their interactions with staff, there were often complaints of long waits for assessment, and some patients were not given enough help to manage their pain or control symptoms.
The survey, published this week, identified six acute providers that achieved “worse” or “much worse than expected” results when compared with all other trusts across the full range of survey questions. Even these did have more areas where patients were “positive” than those which were negative, however.
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Source: HSJ, 22 November 2024
Georgia officials have dissolved a committee responsible for investigating deaths of pregnant women in the state, after one or more members leaked confidential information about deaths linked to the state's strict abortion laws.
In a letter sent to members of the Maternal Mortality Review Committee (MMRC), Georgia health commissioner Kathleen Toomey said an investigation failed to identify those responsible for the leak, so all current members would be removed.
The news comes two months after the outlet published stories on the deaths of two women, external the panel ruled were preventable and linked to the state's strict abortion ban.
The women's stories became a rallying call for reproductive rights advocates and was cited often by Democrats during the US election.
Since June 2022, Georgia has prohibited all abortions after six weeks of pregnancy, when many women might not know they are pregnant, except in cases of rape, incest or when necessary to prevent "irreversible physical impairment" or death of the mother.
Amber Thurman, 28, and Candi Miller, 41, both died that same year, following rare complications involving the FDA-approved abortion medications mifepristone and misoprostol prescribed from out of state.
Thurman waited 19 hours at a Georgia hospital before doctors performed a rare procedure - prohibited by the state abortion ban with few exceptions - needed to expel fetal tissue from the uterus that had not been fully cleared by the abortion pills.
By the time she was taken into surgery, Thurman had developed acute sepsis. She died on the surgery table.
Tasked with examining pregnancy-related deaths to improve maternal health, the panel of experts, which includes 10 doctors, deemed her death “preventable” and said the hospital’s delay in performing the critical procedure had a “large” impact on her fatal outcome.
“The fact that she felt that she had to make these decisions, that she didn’t have adequate choices here in Georgia, we felt that definitely influenced her case,” one committee member told ProPublica in September. “She’s absolutely responding to this legislation.”
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Source: BBC News, 22 November 2024
A consortium of healthcare professional bodies, representing 65,000 healthcare workers, has drawn depressing conclusions from the evidence given during Module 3 of the UK Covid-19 Inquiry.
The COVID-19 Airborne Transmission Alliance or CATA came together early in the pandemic to provide scientific evidence which challenge officials’ stated view that the virus was not capable of being spread by the airborne route, which would have required employers to provide respiratory protective equipment such as FFP3 masks. CATA has been a core participant in the Module 3 Inquiry and provided substantial evidence about the science, but also the bizarre behaviour of healthcare bureaucrats.
“Having followed the evidence in detail, it seems that those who had leadership roles during the pandemic, many of whom have been promoted to even more senior positions and rewarded with national honours, care less for science than they did for the lives of healthcare workers,” says Dr Barry Jones, Chair of CATA and an eminent medic. “They have taken the stand and asked the Inquiry to believe ideas that offend against common sense, let alone science.”
CATA has consistently pointed out the mass of scientific evidence that shows while diseases can be spread by a combination of inhaling airborne particles and being infected by droplets or contact with infected surfaces, Covid-19 has a significant dominant airborne component. CATA’s contentions have been supported by the experts commissioned by the Inquiry, are now no longer denied by the majority of healthcare leaders in the UK and are supported by international organisations including WHO and CDC.
Shockingly, evidence from the most senior health officials and experts in infection prevention and control confirm that they deem that protecting against droplets and aerosols is an either/or choice.
“It’s a bit like saying that your house can be damaged by fire or flood, but your insurance company saying that you can only pick one to be protected against,” commented Dr Barry Jones.
Rather than accepting that difficult decisions needed to be made because of lack of supply of PPE, senior healthcare leaders have taken the view that specially designed PPE might not have worked anyway, so it was not needed.
The Inquiry has heard evidence that there is no plan to stockpile PPE for future pandemics or to have a national supply, despite a global shortage costing the UK millions and resulting in illness and deaths for hundreds of healthcare workers, not to mention almost a quarter of a million UK citizens
The Inquiry has heard of continuing confusion about who was responsible for making critical decisions about how the scientific evidence was used to inform guidance for protecting healthcare workers and patients.
Read full story
Source: British Occupational Hygiene Society, 21 November 2024
Related reading on the hub:
Covid-19 : A risk assessment too far? A blog by David Osborn
Respiratory protective equipment: An unequal solution for healthcare workers? A blog by David Osborn
The pandemic – questions around Government governance: a blog from David Osborn
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