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Keep up to date with the latest news, research and activity in patient safety.

Patients face “new normal” of medicines shortages as UK hampered by supply issues and impact of EU exit

Global supply problems have caused a “shock rise” in shortages of life-saving drugs like antibiotics and epilepsy medication, new research reveals. These shortages come at a cost to the patient and the taxpayer, and are happening despite the NHS spending hundreds of extra millions trying to mitigate the problem. The UK risks being left in the cold when it comes to co-ordinated EU attempts to tackle them. 
That’s according to a new report by the Nuffield Trust think tank and a group of academics, funded by the Health Foundation, which examined key indicators on drug shortages in the UK in the context of global problems with supply chains and the availability of key ingredients. It finds that the past two years have seen constantly elevated medicines shortages, in a "new normal" of frequent disruption to crucial products.  
Key findings on drugs shortages include: 
Price concessions (where the government gives extra funding because there are no drugs left at the NHS price) have risen sharply in recent months: prior to 2016 there were rarely more than 20 per month but in late 2022 they peaked at 199 and have remained high ever since.   The excess cost for medicines in months when they were subject to price concessions was £220m across the year to September 2023. There are now over double the number of notifications by drugs companies warning of impending shortages than there were three years ago: in 2023 there were 1,634 such alerts issued, compared to 648 in 2020 (a spike in 2021 was caused by concerns over supply fears in Northern Ireland following Brexit).    The UK has been slower to approve drugs than the EU for new drugs that are authorised centrally. Of drugs authorised in the year to December 2023, 56 drugs authorised in Europe were approved later in the UK and eight have not been approved. Four were approved faster. The report shows that the EU Exit has not caused the recent spike in medicine shortages, but it is likely to significantly weaken the UK’s ability to respond to them by splitting it from European supply chains, authorisations and collective efforts to respond to shortages. In particular, the research highlights the risks posed to the UK from being left out of key initiatives like the Critical Medicines Alliance and Voluntary Solidarity Mechanism, led by EU member states to work together to insulate themselves from the impact of medicines shortages.  
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Source: The Nuffield Trust, 18 April 2024
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NHS hospitals heavily reliant on locum doctors charging up to £850 per shift are 'undoubtedly' risking patient safety, study warns

Hospitals which rely heavily on locum doctors are 'undoubtedly' risking patient safety, a study of NHS practice found.
While temporary staff are a 'vital resource' to plug workforce gaps, issues such as unfamiliarity with protocols and procedures mean they 'pose significant patient safety challenges' for the NHS, experts say.
The report warned many were left feeling isolated and stigmatised by resident staff, creating a 'hostile environment'.
This has led to a 'defensive' culture over mistakes, hindering improvements to care, according to researchers.
Calling for greater monitoring by inspectors, NHS leaders must rethink how these professionals are supported and used, the authors said.
Writing in a linked editorial, Professor Richard Lilford, of the Institute of Applied Health Research at the University of Birmingham, said the findings suggested 'the life of the locum is a difficult and lonely one, opening up many pathways to unsafe practice.'
Likening it to airline pilots, he suggested staff would benefit from standardised practices – such as how the medicine cabinet is stocked – to minimise mistakes.
Agencies providing staff should be given routine feedback by employers and locum staff, to enhance patient safety, he said.
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Source: MailOnline, 16 April 2024
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GPs and patients invited to share views on legal ‘duty of candour’

The Government is inviting views on how well GP practices and other NHS organisations are complying with their legal duty of candour when things go wrong.
Patients and health professionals are being asked whether the statutory duty is well understood and adequately regulated by the CQC.
Under the statutory duty of candour, introduced for all CQC-registered providers in 2015, GP practices must be open and honest with their patients when something goes wrong and has caused harm. 
In December, the Department of Health and Social Care (DHSC) announced a review into whether healthcare providers are following the duty of candour rules.
This was in response to concerns that the duty is not always being met and that there is variation in how the rules are being applied. 
The DHSC has published its ‘call for evidence’ to gather views on how well the duty of candour obligation is working for both patients and health professionals. 
Patients have been asked whether GP practices and other providers ‘demonstrate meaningful and compassionate engagement’ with patients who have been affected by an incident. 
The call for evidence also asks for views on whether the criteria for triggering the duty are appropriate and well understood by staff.
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Source: Pulse, 16 April 2024
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Jammed 999 lines and not enough ambulances to go round

This is a sick country, getting sicker. NHS waits will take years to clear, if at all. While people wait, they get sicker. When more and more people slip into absolute poverty – a fifth of people now – they get even sicker. More sicken as they age, and that peak has not yet been reached. Every part of the NHS feels at the sharp end, coping mostly because, amazingly, they just do, even with no end in sight to the stress.
NHS data released last week on people waiting more than 18 weeks with serious heart problems suggests some will probably die before they get treatment. When waiting patients have heart attacks and strokes they call an ambulance – so there’s been an astonishing 7% rise in those category 1 calls.
At an ambulance dispatch centre in Kent, Polly Toynbee listens in to calls like this at the South East Coast Ambulance Service dispatch centre in Gillingham, north Kent, covering Surrey, Sussex and Kent. She sat with D, a seasoned and sympathetic emergency medical adviser, call handler and life-and-death decider.
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Source: The Guardian, 17 April 2024
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Concerns at Nottinghamshire hospital after baby's sepsis death

The parents of a baby who died from sepsis said their son deserved a "fighting chance" after concerns were raised over his care in hospital.
Ten-week-old Tommy Gillman was admitted to King's Mill hospital on 7 December 2022 but died the next day.
Tommy Gillman, from Coddington, Nottinghamshire, was "extremely unwell" with what proved to be Salmonella Brandenburg meningitis when admitted to the Sutton-in-Ashfield hospital at 12:35 GMT.
His assessment was delayed, and then the severity of his condition missed, meaning correct treatment with antibiotics and fluids did not start until 17:00.
A coroner's report identified a lack of experienced paediatric nurses and confusion in handovers between staff.
"I am not reassured that necessary actions to address these serious issues identified are in place," the coroner said.
Sherwood Forest Hospitals NHS Foundation Trust said it welcomed the review and a "rapid" programme of improvements was being worked on.
Tamzin Myers and Charlie Gillman said their son deserved "a fighting chance" by getting prompt treatment
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Source: BBC News, 17 April 2024
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Record 3.7m workers in England will have major illness by 2040, study finds

A record 3.7 million workers in England will have a major illness by 2040, according to research.
On current trends, 700,000 more working-age adults will be living with high healthcare needs or substantial risk of mortality by 2040 – up nearly 25% from 2019 levels, according to a report by the Health Foundation charity.
But the authors predicted no improvement in health inequalities for working-age adults by 2040, with 80% of the increase in major illness in more deprived areas.
Researchers at the Health Foundation’s research arm and the University of Liverpool examined 1.7m GP and hospital records, alongside mortality data, which was then linked to geographical data to estimate the difference in diagnosed illness by level of deprivation in England in 2019, the last year of health data before the pandemic.
They then projected how levels of ill health are predicted to change in England between 2019 and 2040 based on trends in risk factors such as smoking, alcohol use, obesity, diet and physical activity, as well as rates of illness, life expectancy and population changes.
Without action, the authors warn, people in the most deprived areas of England are likely to develop a major illness 10 years earlier than those in the least deprived areas and are also three times more likely to die by the age of 70.
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Source: The Guardian, 17 April 2024
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Can AI techniques help clinicians assess and treat patients with bone fractures?

Investigators have applied artificial intelligence (AI) techniques to gait analyses and medical records data to provide insights about individuals with leg fractures and aspects of their recovery.
The study, published in the Journal of Orthopaedic Research, uncovered a significant association between the rates of hospital readmission after fracture surgery and the presence of underlying medical conditions. Correlations were also found between underlying medical conditions and orthopedic complications, although these links were not significant.
It was also apparent that gait analyses in the early postinjury phase offer valuable insights into the injury’s impact on locomotion and recovery. For clinical professionals, these patterns were key to optimizing rehabilitation strategies.
"Our findings demonstrate the profound impact that integrating machine learning and gait analysis into orthopaedic practice can have, not only in improving the accuracy of post-injury complication predictions but also in tailoring rehabilitation strategies to individual patient needs," said corresponding author Mostafa Rezapour, PhD, of Wake Forest University School of Medicine. "This approach represents a pivotal shift towards more personalised, predictive, and ultimately more effective orthopaedic care."
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Source: Digital Health News, 12 April 2024
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Three in four NHS staff are struggling with mental health, as NHSE forced to reverse axing of support

Three in four NHS staff have struggled with a mental health condition in the last year, according to a new poll.
A survey of workers carried out by NHS Charities Together over medics’ mental health comes as healthcare leaders were forced to reverse cuts to NHS Practitioner Health, a service for medics.
A backlash from NHS staff over the proposed cuts forced health secretary Victoria Atkins to intervene.
In the new poll of more than 1,000 NHS staff, 76% said they have experienced a health condition in the last year with 52% reporting anxiety, 51% reporting low mood, while 42% of respondents also said they’d experienced exhaustion.
Meanwhile, the most recent NHS data shows the most common reasons for staff sickness are anxiety, stress, depression or other psychiatric conditions, with more than 586,600 working days lost over this in November 2023.
NHS Practitioner Health began as a mental health service for GPs but has since expanded to other specialities following funding from NHS England. However, last week the provider announced this national funding was due to end, so its service would be reduced.
NHS England said the decision was so it could review the services available for all NHS staff. However, it was forced to u-turn on the decision and agreed to provide funding for an additional year.
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Source: The Independent, 17 April 2024
Sam

Data regulator issues new guidance for healthcare sector on transparency

The UK’s data protection regulator has published new guidance for health and social care organisations it says will help them be more transparent about how personal information is being used.
The Information Commissioner’s Office (ICO) said the new guidance would provide regulatory certainty to organisations on how they should keep people properly informed as technology is increasingly used to deliver care and carry out research.
The regulator said focus on the issue was needed as the health and social care sector routinely handles sensitive information about the most intimate aspects of peoples’ health, and that under data protection law, people have a right to know what is happening to their personal information.
Being transparent is essential to building public trust in health and social care services
Anne Russell, head of regulatory policy projects at the ICO, said the ever-increasing use of technology meant personal data was more important than ever, and so therefore was more transparency.
“Being transparent is essential to building public trust in health and social care services,” she said.
“If people clearly understand how and why their personal information is being used, they are likely to feel empowered to share their health information to both access care and support initiatives such as medical research.
“As new technologies are developed and deployed in the health sector, our personal information is becoming more important than ever to boost the efficiency and public benefit of these systems.
“With this bespoke guidance, we want to support health and social care organisations by improving their understanding of effective transparency, ensuring that they are clear, open and honest with everyone whose personal information is being used.”
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Source: The Independent, 15 April 2024
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‘Disgraceful’ regulator’s 10-year case delay

A regulator overseeing 340,000 professionals breached a psychologist’s human rights by letting their fitness-to-practise case go on for a decade, amid widespread very long delays, it has emerged.
A judgment from the Health and Care Professions Tribunal said the “lamentable” situation for the registrant was down to the “disgraceful… manner in which the Healthcare Professions Council dealt with their case”.
The HCPC oversees professional standards for several groups including radiographers, paramedics, physiotherapists, occupational therapists, and operating department practitioners.
If a complaint is made about a registrant, it can investigate and refer them to the tribunal, which can strike them off.
The Society of Radiographers said the current speed of cases was “simply unacceptable” and its director of industrial strategy Dean Rogers added: “Our members spend too long working — and living — under the intense scrutiny of their regulator, often under the control of an interim order restricting or even preventing their practise while investigations drag on.”
Read full story (paywalled)
Source: HSJ, 17 April 2024
Sam

Report suggests people with breast cancer are being ‘systematically left behind’

Many people with breast cancer are being “systematically left behind” due to inaction on inequities and hidden suffering, experts have said.
A new global report suggests people with the condition are continuing to face glaring inequalities and significant adversity, much of which remains unacknowledged by wider society and policymakers.
The Lancet Breast Cancer Commission highlights a need for better communication between medical staff and patients, and stresses the importance of early detection.
It also highlights the need for improved awareness of breast cancer risk factors, with almost one in four cases (23%) of the disease estimated to be preventable.
The Lancet Commission’s lead author, Professor Charlotte Coles, department of oncology, University of Cambridge, said: “Recent improvements in breast cancer survival represent a great success of modern medicine.
“However, we can’t ignore how many patients are being systematically left behind.
“Our commission builds on previous evidence, presents new data and integrates patient voices to shed light on a large unseen burden.
“We hope that by highlighting these inequities and hidden costs and suffering in breast cancer, they can be better recognised and addressed by healthcare professionals and policymakers in partnership with patients and the public around the world.”
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Source: The Independent, 15 April 2024
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Why Mondays are the deadliest day to go to A&E

The number of people dying needlessly in A&E soars on a Monday as hospitals are stretched to the limit and failing to discharge patients at the weekend, new data shows.
Figures uncovered by The Independent show an average of 126 patients died every Monday between 2020-2023 – 25% higher than any other day. On a Saturday, the average number of deaths drops as low as 90.
Waiting times are also shown to spike massively at the start of the week, with an average of 9,300 patients spending more than 12 hours waiting on a Monday – up to 2,000 more than any other day.
Medical experts said the rise in A&E waits can be attributed to people staying away from hospitals during weekends and patients not being discharged from medical care, causing a bottleneck in an already buckling system.
The stark statistics also directly contradict repeated government efforts to make the NHS a seven-day service. Multiple coroners have warned the government and health leaders about delays to patients’ treatment and diagnosis due to variations in staffing and access to specialists – particularly over the weekend.
Adrian Boyle, president of the Royal College of Emergency Medicine, said the NHS England data clearly signposted an “increased risk” at the start of the week. Another expert said the sharp rise in deaths on Mondays showed an A&E “running constantly in the red zone”.
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Source: The Independent, 8 April 2024
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AI makes retinal imaging 100 times faster

Researchers at the National Institutes of Health applied artificial intelligence (AI) to a technique that produces high-resolution images of cells in the eye. They report that with AI, imaging is 100 times faster and improves image contrast 3.5-fold. The advance, they say, will provide researchers with a better tool to evaluate age-related macular degeneration (AMD) and other retinal diseases.
"Artificial intelligence helps overcome a key limitation of imaging cells in the retina, which is time," said Johnny Tam, Ph.D., who leads the Clinical and Translational Imaging Section at NIH's National Eye Institute.
Tam is developing a technology called adaptive optics (AO) to improve imaging devices based on optical coherence tomography (OCT). Like ultrasound, OCT is noninvasive, quick, painless, and standard equipment in most eye clinics.
"Our results suggest that AI can fundamentally change how images are captured," said Tam. "Our P-GAN artificial intelligence will make AO imaging more accessible for routine clinical applications and for studies aimed at understanding the structure, function, and pathophysiology of blinding retinal diseases. Thinking about AI as a part of the overall imaging system, as opposed to a tool that is only applied after images have been captured, is a paradigm shift for the field of AI."
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Source: Digital Health News, 11 April 2024
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Arm skin patch system could warn of organ rejection

Some people having a lung transplant on the NHS will receive a skin patch graft from their donor too as a way of spotting organ rejection sooner.
Rejection could show as a rash on the donated skin patch, say experts, allowing early treatment to stop problems escalating.
The trial, by University of Oxford and NHS Blood and Transplant, will enrol 152 patients in England.
It follows earlier success with some other transplant patients, including Adam Alderson, 44, who received a donor skin graft on his abdomen in 2015 when he had eight organs replaced – including a pancreas, stomach and spleen – after treatment for a rare cancer.
He says the graft has already helped guide his treatment a few times to prevent his body rejecting his many new organs.
He said: "It's a really comforting thing to have - I feel safer knowing that I have a tool available to tell if something is going wrong before it becomes too serious. It's almost like an oil warning light on your car. Plus, having that visible reminder of how lucky I am is really special."
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Source: BBC News, 16 April 2024
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Doctor exodus: tens of thousands planning to move abroad, NHS warned

Tens of thousands of doctors are hoping to quit the NHS and move abroad this year in search of better pay, the medical regulator has warned.
Half of the doctors planning to leave said they wanted to move to Australia, which has been the most popular destination for emigrating UK doctors for the past five years.
The General Medical Council surveyed 3,154 doctors about their attitudes towards leaving the UK, including 1,000 who had recently left to practise abroad. Some 13% of those working in the NHS said they were “very likely” to move in the next 12 months, while another 17% said they were “fairly likely” to move.
The GMC said this would amount to 96,000 doctors quitting over the next year if applied to the total number of doctors on the medical register, although it acknowledged that the actual rate of departures was likely to be much lower.
Read full story (paywalled)
Source: The Times, 12 April 2024
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Causes of death to be scrutinised in revamp of death certificates

Public protection and support for bereaved families are at the heart of a government overhaul of how deaths are certified.
From September, medical examiners will look at the cause of death in all cases that haven’t been referred to the coroner in a move designed to help strengthen safeguards and prevent criminal activity.
They will also consult with families or representatives of the deceased, providing an opportunity for them to raise questions or concerns with a senior doctor not involved in the care of the person who died.
The changes demonstrate the government’s commitment to providing greater transparency after a death and will ensure the right deaths are referred to coroners for further investigation.
Health Minister, Maria Caulfield said:
Reforming death certification is a highly complex and sensitive process, so it was important for us to make sure we got these changes right. At such a difficult time, it’s vital that bereaved families have full faith in how the death of their loved one is certified and have their voices heard if they are concerned in any way. The measures I’m introducing today will ensure all deaths are reviewed and the bereaved are fully informed, making the system safer by improving protections against rare abuses. From 9 September 2024 it will become a requirement that all deaths in any health setting that are not referred to the coroner in the first instance are subject to medical examiner scrutiny.
Welcoming the announcement today, Dr Suzy Lishman CBE, Senior Advisor on Medical Examiners for Royal College of Pathologists, said:
“As the lead college for medical examiners, the Royal College of Pathologists welcomes the announcement of the statutory implementation date for these important death certification reforms.
“Medical examiners are already scrutinising the majority of deaths in England and Wales, identifying concerns, improving care for patients and supporting bereaved people. The move to a statutory system in September will further strengthen those safeguards, ensuring that all deaths are reviewed and that the voices of all bereaved people are heard.”
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Source: Gov.UK, 15 April 2024
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