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

Secret NHS report reveals failure to protect trainee paramedics from sexual harassment and racism

A secret report has warned that the NHS is failing to protect trainee paramedics from widespread sexual harassment and racism at work, The Independent has revealed.
A confidential NHS England report uncovered by The Independent has found that “extremely alarming” conduct and undermining behaviour are rife in ambulance trusts across the country, with trainees subjected to derogatory comments about their age, ethnicity and appearance in front of patients.
There is a “worrying acceptance” that this is “part of the job”, with students hesitant to raise complaints about sexual behaviour by male colleagues in case it gives them a reputation as “annoying snowflakes”, the report says.
The revelations come after a recent NHS staff survey revealed that thousands of ambulance staff had reported unwanted sexual behaviour from colleagues and patients last year.
One healthcare leader described the findings as “harrowing”, warning that much more needs to be done to protect junior staff.
The national report, which is understood to have gone through several edited versions and is marked commercially sensitive, was not due to be released until The Independent obtained the document through a freedom of information request.
It found an “undercurrent” of bullying in some areas, with examples of students leaving their jobs as a result of inappropriate behaviour.
Trainees reported feeling undervalued and unwanted while on the job, with one apparently told: “Your concerns don’t matter – we have to meet patient demands.”
Ambulance handover delays have also led to student paramedics having less experience and training on the job, prompting fears that newly qualified paramedics do not have sufficient levels of experience in life-critical situations.
Read full story
Source: The Independent, 19 March 2024
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Questions raised over NHS deletion of thousands of emails during whistleblower tribunal

NHS doctor Chris Day has won the right to challenge a tribunal decision which raises questions about information governance in NHS hospital trusts and the use of digital evidence by employment tribunals.

Day blew the whistle on acute understaffing at a South London intensive care unit linked to two patient deaths in 2013. His decade-long legal campaign has since exposed the lack of statutory whistleblowing protections for nearly 50,000 doctors below consultant level in England.

An appeal tribunal in February refused Day the right to challenge key aspects of an earlier tribunal ruling that cleared Lewisham and Greenwich NHS Trust (LGT) of deliberately concealing evidence and perverting the course of justice when one of the trust’s directors “deliberately” deleted up to 90,000 emails midway through a tribunal hearing in July 2022.

Day’s high-profile case nevertheless continues to raise questions about information governance practices in NHS hospital trusts and the degree of scrutiny applied to digital evidence retention and disclosure practices at UK employment tribunals.
The 2022 tribunal heard that LGT communications director David Cocke had attempted to destroy up to 90,000 emails and other electronic archives that were potentially critical to the case as the hearing progressed.
However, any remaining documents among the tens of thousands of emails and electronic archives, which NHS trust lawyers told the tribunal had been “permanently” destroyed, are likely still to exist and be recoverable, according to an expert consulted by Computer Weekly.
Read full story
Source: Computer Weekly, 19 March 2024
Sam

Disputed medical terms used to explain dozens of deaths after police restraint in UK

A controversial unproven medical condition which is rooted in pseudoscience and disputed by doctors is routinely being used in Britain to explain deaths after police restraint, the Observer has found.
“Acute behavioural disturbance” (ABD) and “excited delirium” are used to describe people who are agitated or acting bizarrely, usually due to mental illness, drug use or both. Symptoms are said to include insensitivity to pain, aggression, “superhuman” strength and elevated heart rate.
Police and other emergency services say the labels, often used interchangeably, are a helpful shorthand used to identify when a person who might need medical help and restraint may be dangerous. But the terms are not recognised by the World Health Organization and have been condemned as “spurious” by campaigners who say they are used to “explain away” the police role in deaths.
The American Medical Association rejected “excited delirium” after it was used by police lawyers in the case of George Floyd. California lawmakers banned it as a diagnosis or cause of death in October, saying it had been “used for decades to explain away mysterious deaths of mostly black and brown people in police custody”.
The Royal College of Psychiatrists has also warned that the current definition of ABD, as it is now more commonly known in the UK, could be leading to people “being subjected to avoidable and potentially harmful interventions”. In 2017, a Home Office-commissioned review into deaths in police custody said the terms were “strongly disputed amongst medical professionals”.
The Royal College of Psychiatrists has also warned that the current definition of ABD, as it is now more commonly known in the UK, could be leading to people “being subjected to avoidable and potentially harmful interventions”. In 2017, a Home Office-commissioned review into deaths in police custody said the terms were “strongly disputed amongst medical professionals”.
Read full story
Source: The Guardian, 17 March 2024
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NHS ombudsman warns hospitals are cynically burying evidence of poor care

Hospitals are cynically burying evidence about poor care in a “cover-up culture” that leads to avoidable deaths, and families being denied the truth about their loved ones, the NHS ombudsman has warned.
Ministers, NHS leaders and hospital boards are doing too little to end the health service’s deeply ingrained “cover-up culture” and victimisation of staff who turn whistleblower, he added.
In an interview with the Guardian as he prepares to step down after seven years in the post, Rob Behrens claimed many parts of the NHS still put “reputation management” ahead of being open with relatives who have lost a loved one due to medical negligence.
The ombudsman for England said that although the NHS was staffed by “brilliant people” working under intense pressures, too often his investigations into patients’ complaints had revealed cover-ups, “including the altering of care plans and the disappearance of crucial documents after patients have died and robust denial in the face of documentary evidence”.
Read full story
Source: The Guardian, 17 March 2024
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£6bn deficit warning sparks ‘horrible’ demands for nationwide cuts

Local NHS organisations are facing intense “pressure” from NHS England’s national and regional teams to cut staffing numbers to improve the service’s financial outlook for 2024-25. 
Multiple sources have told HSJ that first draft financial returns submitted by the 42 integrated care systems indicate a combined deficit of around £6bn for the service.
The £6bn figure is likely to fall substantially as NHS England meets individually with integrated care systems with the worst numbers.
The need to reduce the number is prompting “horrible” conversations about service cuts, according to HSJ sources. One local leader in the South East region said the need to reduce staffing numbers constituted a “very significant part of the pushback on first-cut numbers”.
A senior source in the Midlands added: “We’ve got virtually no workforce growth in our plan now… and we’ve still got a deficit. To get to breakeven we’d have to be looking at quite a significant workforce reduction.”
Another leader in the South of the country said there was “big pressure” to get down to pre-pandemic staff numbers, “despite [the] increases in acuity, demand and backlogs as a consequence of covid”.
Read full story (paywalled)
Source: HSJ, 18 March 2024
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Endometriosis: Women in Wales waiting 10 years for diagnosis

The wait to be diagnosed with endometriosis has increased to almost ten years, a "devastating" milestone say women with the condition.
It now takes almost a year more than before 2020 to be diagnosed, according to research published by Endometriosis UK, which is setting up new volunteer-led support groups in Wales.
The wait in Wales is also the longest in the UK, the research found.
The Welsh government said it knew there was "room for improvement".
"Nobody listened to me, and to feel like women are still going through that 20 years after my diagnosis is horrific," said Michelle Bates. The 48-year old from Cardiff was diagnosed aged 25 after suffering with "harrowing" pain from age 13 onwards - a 12-year wait.
"I went back and forth to the GP with my mum, who was the only one who believed in my pain," she said.
The study by Endometriosis UK, which is based on a survey of 4,371 people who received a diagnosis of endometriosis, showed almost half of all respondents (47%) had visited their GP 10 or more times with symptoms prior to receiving a diagnosis, and 70% had visited five times or more.
It also found 78% of people who later went on to receive a diagnosis of endometriosis - up from 69% in 2020 - were told by doctors they were making a "fuss about nothing", or comments to that effect.
Read full story
Source: BBC News, 18 March 2024
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Nurse reveals sexual harassment and whistleblowing ‘nightmare’

A nurse has warned that she has been “crushed and silenced” over a battle with the NHS and the nursing regulator to investigate claims that she was sexually harassed by a colleague at work.
Michelle Russell told Nursing Times of the “eight-year nightmare” she has endured since coming forward about her experiences and that she said had recently led her nursing career to come to an end.
“Knowing what’s happened to me is not going to make it easier for anybody else to speak out"
She has argued that “speaking up is not encouraged” in the NHS and that her case would discourage other nurses from coming forward about sexual harassment.
Ms Russell said: “Anybody who has been around me would be able to see the emotional impact of all of this on me.
“I’ve lost my job for highlighting a public safety concern.”
The national guardian for the NHS told Nursing Times sexual harassment was a “patient safety issue” and warned that staff continued to face difficulties when speaking out.
It comes as the latest NHS Staff Survey this month revealed that almost 4% of nurses and midwives had been the target of unwanted sexual behaviour in the workplace by another member of staff in the last 12 months.
Read full story
Source: Nursing Times, 15 March 2024
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Clutching morphine and sheltering in a bus stop: the NHS patients sent from hospital to the street

Gripping a bag of morphine handed to him by hospital staff, Antonio sheltered at a bus stop, cold and shivering, as he tried to work out what to do.
It was three days after undergoing gruelling surgery to remove his testicular cancer and the 36-year-old had been discharged from NHS care with nowhere to go.
He was clutching a referral letter for the council’s housing team, given to him by hospital staff. When he arrived at the council office, he explained he had been homeless for the past few months – but was told they could not house him.
“They asked me: ‘If you are in so much pain and trouble, why did they send you here?’ and I didn’t know what to say,” Antonio, whose name has been changed, tells The Independent. He was given a piece of paper with a phone number on it and told to call the next day.
It was now late in the afternoon and the Salvation Army’s homeless day centre, where he would usually go for help, was closed. He had no option but to turn around and ready himself for a night on the streets.
Antonio’s story is, tragically, not unique. He is one of thousands of people across England who have been discharged from NHS hospitals into homelessness in recent years, many while still battling serious health conditions.
Data obtained by The Independent, in collaboration with the Salvation Army, shows at least 4,200 people were discharged from wards to “no fixed abode” in 2022/23.
Read full story
Source: The Independent, 17 March 2024
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Caving ceilings and plummeting lifts: inside our NHS hospitals

The ceiling of an intensive care ward collapsed onto a patient on life support and hours later a falling lift broke a doctor’s leg in a 24-hour snapshot of Britain’s crumbling NHS hospitals last week.
Staff rushed to evacuate the ten-bed unit at the Princess Alexandra Hospital, in Harlow, Essex, and the local trust declared a major incident on Thursday morning as engineers carried out urgent safety checks and patients were moved to other wards.
The next day, a surgeon was in a lift at the Royal London Hospital, in Whitechapel, east London, when the lift plummeted four floors. His leg was broken when the lift’s emergency brakes activated. Hospital managers shut down four other lifts pending a safety investigation. The day before, another lift in the hospital had also fallen.
The incidents signify that “chickens are coming home to roost” after years of underinvestment in NHS facilities, Dame Meg Hillier, chairwoman of the Commons public accounts committee, said.
“It’s a sign of the crumbling infrastructure, not just of our hospitals but of the whole country,” she said. “These are not conditions that patients or hospital staff should have to work in.”
Read full story (paywalled)
Source: The Times, 17 March 2024
Sam

Calls for public inquiry into 20,000 sexual abuse allegations on NHS wards

The government is facing calls for a public inquiry into the scandal of sexual abuse in mental health hospitals, following an investigation by The Independent.
Rape Crisis England and Wales has warned that the “alarming” scale of abuse within the UK’s psychiatric system requires “major intervention” from ministers.
It comes after an expose by the Independent and Sky News revealed that almost 20,000 reports of sexual incidents – involving both patients and staff – had been made in more than half of NHS mental health trusts in the past five years.
As well as a public inquiry, which would give survivors the chance to give evidence, Rape Crisis England and Wales wants the government to appoint a named minister with responsibility for addressing the problem.
Chief executive Ciara Bergman said: “That anyone in the already vulnerable position of needing or being detained for in-patient care because of their mental health needs should experience sexual violence and abuse whilst in the care of the state, is deeply concerning.
“We are concerned that without major intervention and leadership at the highest levels, this could lead to more incidents of sexual violence and abuse happening, and this behaviour being accepted as inevitable, when it is not, and is indeed absolutely preventable.”
Read full story
Source: The Independent, 15 March 2024
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Australian doctor suspended amid investigation into woman’s death after abortion

A doctor working at a women’s health clinic in Melbourne has been suspended as a regulator revealed it was aware of concerns about other practitioners there. The facility’s boss claims it is a “witch hunt”.
It follows the death of 30-year-old mother Harjit Kaur, who died in January at the Hampton Park Women’s Clinic after what was described as a “minor procedure”.
It was later identified as a pregnancy termination.
The Australian Health Practitioner Regulation Agency (Ahpra) has confirmed Dr Rudolph Lopes’ registration had been suspended but did not reveal the reason behind the decision.
His registration details show he was reprimanded in 2021 for failing to respond to the regulator’s inquiries.
“[The regulator] has received a range of concerns about a number of practitioners associated with the Hampton Park Women’s Clinic,” Ahpra said in a statement.
“[The regulator] has established a specialist team to lead a co-ordinated examination of these issues which involve multiple practitioners across a number of professions and across a number of practice locations.”
Ahpra chief executive, Martin Fletcher, said he was “gravely concerned by the picture that is emerging.”
“We have taken strong action to protect the public while our investigations continue,” Fletcher said.
“National boards stand ready to take any further regulatory action needed to keep patients safe.
“While the coroner continues to examine the tragic death of a patient, our inquiries are focusing on a wider range of issues that our investigations bring to light.”
Read more
Source: The Guardian, 15 March 2024
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‘Alarming’ rise in Americans with Long Covid symptoms

Some 6.8% of American adults are currently experiencing long Covid symptoms, according to a new survey from the US Centers for Disease Control and Prevention (CDC), revealing an “alarming” increase in recent months even as the health agency relaxes Covid isolation recommendations, experts say.
That means an estimated 17.6 million Americans could now be living with long Covid.
“This should be setting off alarms for many people,” said David Putrino, the Nash Family Director of the Cohen Center for Recovery From Complex Chronic Illness at Mount Sinai. “We’re really starting to see issues emerging faster than I expected.”
When the same survey was conducted in October, 5.3% of respondents were experiencing long Covid symptoms at the time.
The 1.5 percentage-point increase comes after the second-biggest surge of infections across the US this winter, as measured by available wastewater data.
More than three-quarters of the people with long Covid right now say the illness limits their day-to-day activity, and about one in five say it significantly affects their activities – an estimated 3.8 million Americans who are now experiencing debilitating illness after Covid infection.
Read full story
Source: The Guardian, 15 March 2024
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Parents watched 18 month old die after Shrewsbury hospital failings

Alice and Lewis Jones were forced to watch their 18-month-old baby die in front of them after a failure by a scandal-hit NHS trust left him with a “catastrophic brain injury” following his birth.
Their son Ronnie was one of hundreds of babies who have died following errors by Shrewsbury and Telford Hospital, where the largest NHS maternity scandal to date was previously uncovered by The Independent.
Two years later, Mr and Mrs Jones are calling for the Supreme Court to overturn a controversial decision in February which ruled bereaved relatives could not claim compensation over the psychological impact of seeing a loved one die, even if it was caused by medical negligence.
It comes after the trust admitted to failings in a letter to the parents’ lawyers.
Ronnie’s birth in 2020 fell outside of the Ockenden review and his parents have warned it showed failures were still occurring despite warnings made during the inquiry.
Within the Ockenden inquiry, multiple cases of staff failing to recognise and act upon CTG training were found, and the final report recommended all hospitals have systems to ensure staff are trained and up to date in CTG and emergency skills.
The report also said the NHS should make CTG training mandatory and that clinicians must not work in labour wards or provide childbirth care without it.
A CTG measures a baby’s heart and monitors conditions in the uterus and is an important measure before birth and during labour to observe the baby for any signs of distress.
Ms Jones said: “We knew about the Ockenden review, but everything at Telford was new and so I think we just assumed that lessons had been learned, the same thing wouldn’t happen to us.”
Ronnie’s parents are campaigning to reverse the Supreme Court which ruled that “secondary victims” – including parents who are not directly harmed by the birth – are not eligible to bring claims for psychiatric injury following medical negligence.
Read full story
Source: The Independent, 14 March 2024
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Trust ordered to make second £400k-plus payment to a whistleblower

A trust which last year was ordered to pay a whistleblowing nurse nearly £500,000 must now give a surgeon £430,000 to compensate him for the racial discrimination and harassment he faced after raising patient safety concerns.
Tribunal judges previously upheld complaints made by Manuf Kassem against North Tees and Hartlepool Foundation Trust and have published a remedy judgment this week setting out the levels of damages the NHS organisation must pay.
The judgment comes just over a year after a former senior nurse at the trust was awarded £472,600 for unfair dismissal after she warned high workloads had led to a patient’s death.
Mr Kassem raised 25 concerns regarding patients’ care during a grievance meeting in August 2017. He alleged patients had “suffered complications, negligence, delayed treatment and avoidable deaths”.
A trust review concluded appropriate processes were followed in the 25 cases. However, the tribunal ruled Mr Kassem was subjected to detriment after making the protected disclosure.
According to the judgment, Mr Kassem was subsequently removed from the on-call emergency rota and his identity as a whistleblower was revealed by clinical director Anil Agarwal.
In September 2018, he was the subject of a disciplinary investigation following several allegations against him made by colleagues and others, which concerned “unsafe working practices,” “excessive working hours,” and “potential fraudulent activity.”
The investigation lasted 17 months and none of the allegations against Mr Kassem were upheld or progressed to a disciplinary hearing. 
Read full story (paywalled)
Source: HSJ, 15 March 2024
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Oxford palliative care 'virtual ward' launched

A "virtual ward" enabling patients who want to die at home get the palliative care they need has launched.
Hospice Outreach provides a "specialised pathway" for patients identified by existing services who would benefit from support.
It is part of a project that supports people at the very end of their life.
Dr Victoria Bradley, of Oxford University Hospitals NHS Foundation Trust (OUH), said it was about giving people "control and agency".
OUH claims Hospice Outreach's virtual ward will mean more people will receive personalised care, including in their own homes if that is their choice.
It said specialist palliative care would be "provided virtually or in person, depending on what is best for the patient".
Amelia Foster, chief executive at Sobell House, said: "Being able to offer a virtual ward to those in a palliative crisis or at the end of their lives helping them to remain at home means more people can access our care in the way that they wish."
Dr Bradley, who is the clinical lead for palliative medicine at OUH, said: "We can support with discharge from hospital to people's homes if that is their wish, and by reducing people's time in hospital and caring for them at home, we can offer the right support in their chosen surroundings."
Read full story
Source: BBC News, 14 March 2024
Patient Safety Learning

‘Continuity risk’ to abortion services triggers national intervention

NHS England has told integrated care board (ICBs) leaders they must intervene over failures in abortion services in their patches amid “unprecedented demand” for such provision, HSJ has learned.
NICE guidance states people should be assessed within a week of requesting an abortion, while procedures should take place within a week of assessment.
However, NHSE said in a letter to ICBs today that “significant service pressures” have driven up waiting times for surgical abortions – approximately 13% of procedures – to three weeks or longer.
NHSE has told ICBs to work with providers to, by July 2024:
Respond to cases of “acute service disruption” and instances where rising waiting times risk limiting access to services; Establish referral pathways and procedures to ensure smooth transfers of care between independent and NHS providers when required; Ensure contracts for 2024-25 are sustainable and follow guidance in the NHS payment scheme; and Commission services in a more managed and collaborative way, including coordination of provision locally to bring waiting times in line with NICE standards. Read full story (paywalled)
Source: HSJ, 12 March 2024
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