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

NHS across UK spends a ‘staggering’ £10bn on temporary staff

Ministers are facing calls to tackle the NHS’s chronic lack of staff as figures reveal that the bill for hiring temporary frontline workers has soared to more than £10bn a year.
Hospitals and GP surgeries across the UK are paying a record £4.6bn for agency personnel and another £5.8bn for doctors and nurses on staff to do extra “bank” shifts to plug gaps in rotas.
Widespread short staffing has increasingly forced the service in all four home nations to hand colossal sums to employment agencies to hire stand-in workers. In England alone, the bill for agency staff, particularly nurses and GPs, has risen from £3bn to £3.5bn over the past year – a 16% rise.
Wes Streeting, the shadow health secretary, said years of neglect of the growing NHS staffing crisis by Conservative governments had obliged “desperate” hospitals to spend “huge” sums on agency staff, including doctors who can cost more than £5,000 to hire for a single shift.
The Royal College of Nursing said the levels of agency spending were “staggering”. It would be cheaper to employ more nurses as staff instead of having tens of thousands of vacancies, the general secretary Pat Cullen said. The NHS in England currently has 42,306 vacant nursing posts.
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Source: The Guardian, 16 January 2024
Patient Safety Learning

Covid jab skipped by 44%, entire UK study finds

More than 7,000 Covid-related hospital admissions could have been prevented in the UK in the summer of 2022 if the population had received the full number of jabs recommended, according to research in The Lancet.
Some 44% of the UK population was under-vaccinated, with younger people among the most likely to skip doses.
In a first, health records for everyone over five in the UK were analysed. The same approach could now be used to understand other diseases.
The entire population of the UK is 67 million, and all those over the age of five had their anonymised electronic health data analysed for The Lancet study.
With about 40,000 severe hospital admissions related to Covid during that summer, the research estimates that more than 7,000 - 17% - would have been avoided if everyone had taken up the offer of the vaccine and booster doses for which they were eligible.
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Source: BBC News, 16 January 2024
Patient Safety Learning

Record 420,000 patients in England had ‘more than 12 hour wait’ in A&E last year

A record 420,000 patients had to wait more than 12 hours in A&E last year, analysis has shown.
The latest NHS England figures revealed a 20% increase on 2022 in people facing lengthy delays after a decision to admit them to hospital from the emergency department.
In 2023, 419,560 people – or one in 15 A&E patients – faced “trolley waits” of 12 hours or more, according to the Liberal Democrats, who compiled the analysis. It marks by far the highest number since records began in 2011, and amounts to an average of 1,150 patients a day.
Ed Davey, the party leader, criticised the “appalling delays” and accused Rishi Sunak’s government of “ignoring the suffering of patients and driving our health service into the ground”.
Significant waits in A&E have been linked to excess deaths and increased harm to patients, as their condition could deteriorate before they are admitted or given a bed on a ward.
Davey said: “Every year A&E delays are getting worse and worse under this Conservative government as hospitals are starved of the resources and staff they need. These appalling delays are leaving often vulnerable and elderly patients waiting for hours on end in overcrowded A&Es."
Read full story
Source: The Guardian, 14 January 2024
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Social care crisis laid bare as quarter of NHS beds occupied by dementia patients

The scale of the crisis in social care is laid bare as figures show that dementia patients occupy a quarter of all beds in the NHS. People living with the disease often go into hospital after falls or infections as well as for acute medical or surgical problems.
Dementia patients often experience longer hospital stays than the average patient and can be delayed leaving wards due to a shortage of care in the community.
At any one time in the NHS, one in four hospital beds are occupied by people living with dementia, according to the National Institute for Health and Care Excellence, which says stays on wards can trigger distress, confusion and delirium for patients.
Doctors must carry out a discharge assessment of patients to ensure they are healthy before they can leave hospital. Medics assess a dementia patient’s care needs outside of hospital and discharge can be delayed if these are deemed not adequate.
Demand for social care continues to rise as the population grows older but there is a shortage of workers in the sector. Skills for Care estimated that, in 2022/23 an average of 9.9 per cent - or 152,000 - roles in adult social care in England went unfilled.
This was the equivalent to 152,000 vacancies - down by 11,000 from the previous year, although vacancies remain high compared to the wider UK economy.
Services are so overstretched that people are left struggling without vital support to carry out everyday tasks in their own homes, and lives are being blighted.
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Source: The Independent, 14 January 2024
Patient Safety Learning

Virtual wards ‘not a silver bullet’ for NHS as occupancy levels grow

More than 8,500 patients in England were being treated on virtual wards in the run-up to Christmas, figures have revealed, as the NHS moves to ease pressures on hospital capacity.
However, experts said the so-called hospitals at home are not a “silver bullet to solve the crisis in health and social care”.
Figures published by NHS Digital revealed some 8,586 patients were treated virtually in December 2023, up from 7,886 in November.
The snapshot was taken on 21 December 2023, meaning it is likely those patients spent Christmas on a virtual ward rather than an actual hospital.
Virtual wards allow patients to receive care in their own homes, with clinical staff using apps or wearable technology to monitor them remotely.
Professor Sir Stephen Powis, NHS national medical director, said the “rapid expansion” of virtual wards beds and patients “is a real NHS success story”.
He added: “This not only frees up vital hospital beds for those who need them most but ensures patients can recover in the place they are most comfortable with support from families, carers and friends, and while occupancy has been growing rapidly as NHS teams make the most of all bed capacity available, we want to see continued growth right across the country so as many patients as possible can benefit."
However, Wendy Preston, the head of nursing practice at the Royal College of Nursing (RCN), said “virtual wards aren’t a silver bullet to solve the crisis in health and social care”.
“Whether they’re in a physical bed or on a virtual ward, patients still need to be able to see a nurse,” she added.
“But there are over 40,000 nursing vacancies across the NHS, and social care is chronically understaffed. Run effectively, virtual wards can relieve pressure, but on every single shift nursing staff are fighting an uphill battle to care for too many patients.
“If the UK government wants to turn around the state of the NHS and deliver the ‘hospital level’ care at home that patients expect, nursing staff need to see game-changing investment in the workforce.”
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Source: The Independent, 15 January 2024
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‘A real gift to women’s health’: The Pap smear era is over. Enter the DIY test

Thousands of Australian women who had previously feared uncomfortable Pap smears and speculum examinations have now had cervical screening tests for the first time because of a new option to take their own swab in private.
The federal government expanded eligibility for a new self-collected cervical screening test in July 2022, resulting in a 25-fold increase in people doing their own tests.
In the past, some people have avoided a potentially life-saving cervical screening test with a doctor because they had suffered sexual violence or trauma, had cultural objections, or had a bad experience with a test in the past.
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Source: The Sydney Morning Herald
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NHS medicines shortage putting lives at risk, pharmacists warn

An unprecedented medicines shortage in the NHS is endangering lives, pharmacists have said, as unpublished figures reveal that the number of products in short supply has doubled in two years.
A treatment for controlling epileptic seizures was the latest to be added on Wednesday to a UK drugs shortage list that includes treatments for conditions ranging from cancer to schizophrenia and type 2 diabetes.
Causes of the crisis are thought to include the plummeting purchasing value of the pound since the Brexit referendum, which reduces the NHS’s ability to source medicines abroad, and a government policy of taxing manufacturers.
According to Department of Health and Social Care (DHSC) figures provided to the British Generic Manufacturers Association, there were 111 drugs on a shortages list on 30 October last year and 96 on 18 December, with supply notifications issued for a further 10 treatments to NHS providers in the UK since then.
It amounts to a 100% increase in shortages compared with January 2022, with pharmacists and health charities claiming the conditions of some patients were deteriorating as a result.
Delyth Morgan, the chief executive of Breast Cancer Now, said her organisation had been contacted over the past 12 months by several patients unable to source the medicines they needed to control the spread of their disease.
She said: “Last year many people shared with us, via Breast Cancer Now’s helpline, that they’d been facing difficulties accessing their hormone treatment including letrozole, anastrozole and tamoxifen, causing them huge worry and anxiety. Trying to track down a treatment by travelling to a number of different pharmacies is an added burden for patients at an already difficult time.
“It may also sometimes be that certain brands of drugs are out of stock and people may have to switch to another brand or different drug. In the worst case someone may have a period of time without the medication, a drug which could help reduce the risk of their breast cancer coming back or spreading.”
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Source: The Guardian, 14 January 2024
Patient Safety Learning

Bariatric tourism care costs NHS more than actual surgery

People who go abroad for weight-loss surgery, and then need urgent medical care back in the UK, cost the NHS more than it costs to carry out the operation itself, according to new research.
A study featuring five London hospitals recorded the details of 35 people who had suffered complications after travelling abroad for gastric surgery during 2022.
The data, shared with the BBC's Disclosure programme, shows the patients suffered from a range of symptoms including severe malnutrition, vomiting, sepsis, hernias and haemorrhaging. Five of them needed feeding tubes inserted, while the average stay in hospital was 22 days.
The interventions at the five hospitals for the 35 patients cost the NHS a total of £560,234, or £16,006 per patient, in 2022.
The equivalent amount would have covered the cost of about 110 bariatric surgeries in UK hospitals.
Consultant bariatric surgeon Omar Khan, one of the lead authors of the study, said the paper was intended "to try and quantify" the effect on the NHS of increasing numbers of people going abroad for weight-loss surgery - sometimes known as bariatric tourism.
"We know that the waiting lists in the NHS are unfortunately long. We also know that there are new units, particularly in Turkey, which have been set up to cater for an international market," he explained.
"We focused on patients with major complications, patients who were severely ill. They had leaks from the stomach, they had bleeding, they had infections. A significant portion required further surgery and some required revisional surgery."
Read full story
Source: BBC News, 15 January 2024
Patient Safety Learning

Widespread failings discovered in EPR launch linked to patient death

“Better upfront planning, training and testing” were needed in a tech launch which was tied to patient harm and service disruption, an NHS England review has found. 
Royal Surrey and Ashford and St Peter’s Hospitals foundation trusts went live with Oracle Cerner’s electronic patient record in May 2022 – under a programme called Surrey Safe Care – but the implementation has since been linked to incidents of patient harm, including one death, and significant disruption to trust services.
Now, a lessons learned review, carried out by NHSE’s frontline digitisation team and obtained by HSJ via a Freedom of Information request, has identified 24 areas of improvement.
The key lessons cited by the review are “better upfront planning, roles and responsibilities, training and testing”. 
It recommended that, in future implementations, trust boards should be supported by others experienced with implementing EPRs within the NHS to “aid board level decisions and ‘what questions to ask when’”, while clearer responsibilities should also be agreed upon for programme leads and EPR suppliers.
The review also found the content of training must be evaluated thoroughly, while the EPR supplier should provide “upfront and continuous training”. It added the “full end-to-end testing [by] representatives from all end user groups” should be completed before go-live.
It also said EPR readiness needs to incorporate “data readiness, such as data quality, and mapping how data has originally been captured [which] may impact reporting and organisational readiness”.
Read full story (paywalled)
Source: HSJ, 15 January 2024
Related reading on the hub:
NHS England warns electronic patient record could pose ‘serious risks to patient safety’: what can we learn?
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Thousands of mental health patients readmitted within a month in England

Thousands of patients are being readmitted to NHS mental health units in England every year soon after being discharged, raising concerns about poor care, bed shortages and increased risk of suicide.
Experts say being discharged prematurely can be upsetting, set back the patient’s chances of making a full recovery and be “disastrous” for their health.
Figures from NHS mental health trusts in England show that last year almost 5,000 people – children and adults – were readmitted to a mental health facility within a month of leaving.
The Labour MP Dr Rosena Allin-Khan said the “alarming” data, which she obtained under freedom of information laws, showed too many patients were not receiving enough help to recover.
Allin-Khan said: “With record waiting lists and mental health beds in short supply, it is alarming that many patients are being discharged only to be readmitted within days. Every patient expects to receive full and appropriate mental health support, so it is concerning that in many cases patients are being discharged prematurely.
“Being discharged too soon can have a disastrous impact, stunting progress towards a full recovery, ultimately causing further damage to a patient’s mental health.”
Read full story
Source: The Guardian, 12 January 2024
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NHS must treat 10% more non-urgent cases a month to reduce backlog

The NHS must treat at least 10% more non-emergency hospital cases a month if it wants to reduce the hefty backlog caused by the pandemic, according to new analysis.
From February 2020 to October 2022, the waiting list for non-urgent care in England grew by 2.6m cases – a projected 1.8m more than if the pandemic had not hit.
NHS England’s recovery plan aims to increase capacity by 30% by 2025 compared with pre-pandemic levels, but figures published on Thursday showed that the waiting list in England stood at 7.6m, down just 1.3% from the previous month.
Researchers at the Universities of Edinburgh and Strathclyde examined the number of referrals awaiting treatment between January 2012 and October 2022.
They calculated that an estimated 10.2m fewer referrals were made to elective care from the beginning of the pandemic to 31 October 2022. They then modelled how many of these missing patients might return for care to estimate the potential impact on waiting lists.
NHS trusts would have to treat more than 10% to reverse the increasing trend in waiting lists, the authors conclude. “Even if the ambitious target of 30% increase in capacity is achieved during the next three years, several years (beyond the end of 2025) will be needed for the backlog to clear.”
The research comes as NHS England monthly data published on Thursday revealed the health service is going backwards on some key targets.
Read full story
Source: The Guardian, 11 January 2024
Patient Safety Learning

Long Covid GP consultations 'cost £23m'

Long Covid costs the UK at least an extra £23m in GP and other primary care consultations each year, according to estimates in a new study.
The University of Birmingham said extra appointments cost between £23m and £60m a year.
The study examined more than 950,000 electronic healthcare records since the start of the global pandemic.
People with Long Covid report symptoms including persistent coughs and brain fog. The condition is defined as having symptoms three months after the initial infection, which last for two months or more.
Factors found to increase primary care costs included being older, female, white, obese or someone with long-term health conditions.
Co-lead author Dr Shamil Haroon, from the university, said: "We might expect that patients who are older or who have long-term health conditions will need additional primary care support, but we have also seen additional costs associated with being white and female."
Read full story
Source: BBC, 11 January 2024
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Why are so many women dying during pregnancy and what can be done?

The number of women dying during pregnancy or soon after childbirth has reached its highest level in almost 20 years, according to new data. Experts have described the figures as “very worrying”.
Between 2020 and 2022, 293 women in the UK died during pregnancy or within 42 days of the end of their pregnancy. With 21 deaths classified as coincidental, 272 in 2,028,543 pregnancies resulted in a maternal death rate of 13.41 per 100,000.
This is a steep rise from the 8.79 deaths per 100,000 pregnancies in 2017 to 2019, the most recent three-year period with complete data. The death rate has increased to levels not seen since 2003 to 2005.
The data comes from MBRRACE-UK, which conducts surveillance and investigates the causes of maternal deaths, stillbirths and infant deaths as part of the national Maternal, Newborn and Infant Clinical Outcome Review Programme (MNI-CORP).
Urgent action is needed to bolster the quality of maternal healthcare, ensure it is accessible to all, and repair the damage inflicted by the pandemic on women’s healthcare services more generally.
Clea Harmer, the chief executive of bereavement charity Sands, said improving maternity safety also needs to be at the top of the UK’s agenda.
The government said it was committed to ensuring all women received safe and compassionate care from maternity services, regardless of their ethnicity, location or economic status.
Anneliese Dodds, the shadow women and equalities secretary, said Labour would seek to reverse the “deeply concerning” maternal mortality figures by training thousands more midwives and health visitors and incentivising continuity of care for women during pregnancy.
Read full story
Source: The Guardian, 11 January 2024
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Pregnant women with depression twice as likely to die as those without, researchers warn

Women who experience depression during pregnancy or in the year after giving birth are at a higher risk of suicide and attempting suicide, researchers have warned.
The British Medical Journal study warned that women who develop perinatal depression are twice as likely to die compared to those who don’t experience depression.
Suicide was the leading cause of death for women in the UK in 2022 between six weeks and one year after birth, while deaths from psychiatric causes accounted for almost 40 per cent of maternal deaths overall, according to a Perinatal Mortality Surveillance report.
Last year an analysis by Labour revealed 30,000 women who were pregnant were on waiting lists for specialist mental health support. The number of women waiting rose by 40 per cent between August 2022 and March 2023.
The most recent NHS data shows in September 2023, 61,000 women accessed perinatal mental health services. For 2023-24, the health service must hit a target to have 66,000 women accessing care.
In August 2023, the Royal College of Midwives published a research warning half of anxiety and depression cases among new and expectant mothers were being missed amid NHS staff shortages in maternity care.
Read full story
Source: The Independent, 11 January 2024
Patient Safety Learning

British mother, 26, dies in taxi hours after Brazilian bum lift operation in Turkey

A British mother-of-three has died just days after undergoing a Brazilian bum-lift operation in Turkey.
Demi Agoglia, 26, of Salford, Greater Manchester, died from a heart attack caused by the operation just hours before she was due to return to Manchester from Istanbul where she had the operation, her family said.
Ms Agoglia, who had a seven-month-old baby boy, went back to the clinic in Istanbul for a check-up but had a heart attack in a taxi on the way to the hospital as her partner, Bradley Jones, gave her CPR in a desperate bid to save her life.
Her brother Carl, 37, said Ms Agoglia’s family and partner had tried to convince her not to go through with the bum-lift as they were concerned for her safety.
Last year, a British surgeon warned of the dangers faced by Brits who fly to countries like Turkey for cheaper cosmetic surgery.
“Many people fail to do their research and focus too much on money, rather than the quality or safety of the clinic,” Dr Ahmed Alsayed, who is lead surgeon and medical director at plastic surgery specialists Signature Clinic told HullLive.
“Clinics in the UK have to adhere to the strictest levels of expertise, safety and cleanliness. You just can’t be sure you’ll get that from a cheaper option abroad,” Dr Alsayed said.
Read full story
Source: The Independent, 10 January 2023
Patient Safety Learning

UK has some of worst cancer survival rates in developed world

The UK has some of the worst cancer survival rates in the developed world, according to new research.
Analysis of international data by the Less Survivable Cancers Taskforce found that five-year survival rates for lung, liver, brain, oesophageal, pancreatic and stomach cancers in the UK are worse than in most comparable countries. On average, just 16% of UK patients live for five years with these cancers.
Out of 33 countries of comparable wealth and income levels, the UK ranks as low as 28th for five-year survival of both stomach and lung cancer, 26th for pancreatic cancer, 25th for brain cancer and 21st and 16th for liver and oesophageal cancers respectively.
The six cancers account for nearly half of all common cancer deaths in the UK and more than 90,000 people are diagnosed with one of them in Britain every year.
The taskforce calculated that if people with these cancers in the UK had the same prognosis as patients living in countries with the highest five-year survival rates – Korea, Belgium, the US, Australia and China – then more than 8,000 lives could be saved a year.
Anna Jewell, the chair of the Less Survivable Cancers Taskforce, said: “People diagnosed with a less survivable cancer are already fighting against the odds for survival. If we could bring the survivability of these cancers on level with the best-performing countries in the world then we could give valuable years to thousands of patients.
“If we’re going to see positive and meaningful change then all of the UK governments must commit to proactively investing in research and putting processes in place so we can speed up diagnosis and improve treatment options.”
Read full story
Source: The Guardian, 11 January 2023
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