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

Global partners cheer progress towards eliminating cervical cancer and underline challenges

World leaders, cervical cancer survivors, advocates, partners, and civil society came together last week to mark the third Cervical Cancer Elimination Day of Action. The Initiative, which marked the first time Member States adopted a resolution to eliminate a noncommunicable disease, has continued to gain momentum, and this year's commemoration promises to be a beacon of hope, progress, and renewed commitment from nations around the world.
“In the last three years, we have witnessed significant progress, but women in poorer countries and poor and marginalized women in richer countries still suffer disproportionately from cervical cancer,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “With enhanced strategies to increase access to vaccination, screening and treatment, strong political and financial commitment from countries, and increased support from partners, we can realize our vision for eliminating cervical cancer.”
Australia is on target to be among the first countries in the world to eliminate cervical cancer, which the country anticipates to achieve in the next 10 years. 
In Norway, researchers have recently reported finding no cases of cervical cancer caused by the human papillomavirus (HPV) in 25-year-olds, the first cohort of women who were offered the vaccine as children through the national vaccination programme.
Indonesia announced this week a declaration committing to reach the 90-70-90 targets for cervical cancer elimination through the national cervical cancer elimination plan (2023 to 2030).
In the United Kingdom, England’s National Health Service (NHS) pledged this week to eliminate cervical cancer by 2040.
Read full story
Source: WHO, 17 November 2023
Sam

Two-year waits for community mental health services revealed for the first time

HSJ analysis of the NHS England data also found that 19,000 adults with a serious mental illness are waiting for longer than 18 months for a second contact with community mental health services. This is seen as a more meaningful metric for adults than the first contact.
In total, almost 240,000 children and young people were waiting for treatment from community mental health services in August 2023, as well as more than 192,000 adults.
The data revealed the median, or typical, waiting time for children and young people from referral to first contact was 178 days. The median wait time for adults from referral to “second contact” was 120 days.
The NHS long-term plan set out proposals for a four-week waiting time standard for children and adults to access community mental health services. This approach was piloted and a consultation published, but the new standards are yet to be implemented.
Sean Duggan, chief executive of the mental health network at the NHS Confederation, said leaders would be concerned – although “not surprised” – that patients were waiting so long for community services.
He added: “We need access and waiting times standards for all mental health services, to help us improve national data and to direct and allocate resources effectively.”
Sam

Toxic doctors put patients at risk, says NHS watchdog

Patient safety is being put at risk by the “toxic” behaviour of doctors in the NHS, the health ombudsman has said.
Rob Behrens, who investigates complaints about the NHS in England, warned that the hierarchical and high-handed attitude of clinicians was undermining the quality of care in some hospitals.
He called for medical training to be redesigned to encourage a more empathetic and collaborative approach from doctors.
Pointing to failings in the treatment of sepsis and the problems in maternity services, Behrens said he was “shocked on a daily basis” by what he saw as ombudsman. Too often, “organisational reputation has been put above patient safety”, he told The Times Health Commission.
The ombudsman warned of a “Balkanisation” of health professionals, with rivalries between doctors and nurses or midwives and obstetricians harming patient care. “For all the brilliance of clinicians quite often they’re not very good at working together,” he said. “Time and again, the handover from one clinician to another, from one shift to another, or the inability to raise the issue at a senior level has been a key factor in what has gone wrong.”
Read full story (paywalled)
Source: The Times, 18 November 2023
Sam

Patients ‘neglected and confused’ after leaving hospital, says NHS watchdog

Patients are being left feeling “confused and neglected” by not being told who to contact about their future care when they are discharged from hospital, an NHS watchdog has said.
Research by Healthwatch England has found that 51% of people are not being given details when they leave of which services they can turn to for help and advice while they are recovering.
The NHS was risking patients having to be readmitted as medical emergencies and hospital beds becoming even more scarce by failing to adhere to its own guidelines on discharge, it said.
“While our findings show some positive examples, it’s alarming that guidance on safe discharge from the hospital is routinely not being followed,” said Louise Ansari, the patient champion’s chief executive. Healthwatch asked 583 people and their carers how their discharge had gone.
Read full story
Source: The Guardian, 19 November 2023
Patient Safety Learning

Autistic patient trapped in hospital ward for four months due to system failures

Two young people facing mental health crises were left on paediatric wards for months while different agencies across a health system struggled to find appropriate placements. 
The patients – who were both autistic and had learning disabilities, with special educational needs – were admitted to Maidstone and Tunbridge Wells Trust (MTW) last year after attending emergency departments more than 10 times within a two-month period.
They were left on a paediatric ward – one of the patients for four months – as this was the “only available place of safety as opposed to the optimum setting to meet their needs,” according to Kent and Medway Integrated Care Board’s “learning review” of children and young people with complex needs, which the two cases prompted. 
The review, which HSJ obtained under a Freedom of Information request, revealed several problems with joint working, despite a multidisciplinary team meeting regularly to discuss the young patients’ needs.
Since the review, a new escalation process has been introduced, urgent mental health risk assessments in the community have been enhanced and a three-month pilot of a self-harm service has been implemented at Tunbridge Wells Hospital, part of MTW.
Read full story (paywalled)
Source: HSJ, 17 November 2023
Sam

BMA calls for immediate pause on recruitment of physician associates

The BMA has called for an immediate halt to the recruitment of Medical Associate Professionals (MAPs) in the UK including Physician Associates (PAs) and Anaesthetic Associates (AAs).
Doctors from across the UK who make up the BMA’s UK Council have passed a Motion which calls for the moratorium on the grounds of patient safety. They want the pause to last until the government and NHS put guarantees in place to make sure that MAPs are properly regulated and supervised. The move follows a number of recent cases in which patients have not always known they were being treated by a physician associate and tragically have come to harm.
Professor Phil Banfield, BMA chair of council, said:
“Doctors across the UK are getting more and more worried about the relentless expansion of the medical associate professions, brought into sharp focus by terrible cases of patients suffering serious harm after getting the wrong care from MAPs. Now is the time for the Government to listen before it is too late. We are clear: until there is clarity and material assurances about the role of MAPs, they should not be recruited in the NHS.  
“We have always been clear that MAPs can play an important part in NHS teams, and doctors will continue to value, respect and support individual staff they work with. But MAPs roles and responsibilities are not clearly defined. We are seeing increased instances of MAPs encroaching on the role of doctors; they are not doctors, do not have a medical degree and do not have the extensive training and depth of knowledge that doctors do. As doctors, we are worried that patients and public do not understand what this could mean in respect of the level of experience and expertise in care they receive.
“The General Medical Council is the exclusive regulator of doctors in the UK. Adding staff who are not doctors and do not have a medical degree to the GMC register brings into question the competence and qualification of the whole medical profession. The Government may view this as a price worth paying for a shortcut to solving the workforce crisis they have presided over. We know otherwise. GMC regulation of MAPs will only add to the confusion and uncertainty that patients face.
“Ministers may hope that by using secondary legislation, which may not even require the vote of MPs, they can avoid raising the alarm. But patients want doctors to remain doctors, regulated by a dedicated body, and they have a right to have confidence in the expert medical care they receive. There must be no doubt that when a patient goes to see a doctor, they are going to see a doctor. This blurring of roles and the confusion caused to patients must stop now.”
Source: BMA, 16 November 2023
Patient Safety Learning

NHS failing to prioritise those in most need, says departing ICB chief

The NHS should better track patients with the greatest clinical need so they can move to the front of the queue for treatment, a former government waiting list tsar has said.
Anthony “Mac” McKeever told HSJ the health service could improve how it works through its elective backlog by using a system introduced during the covid pandemic to prioritise the most pressing cases.
He said a “large chunk” of cases were still not given a code to say how long they are considered to be able to wait for surgery, which is at the heart of this process.
Mr McKeever retired as Mid and South Essex Integrated Care Board  chief executive this month following nearly five decades in the health service, including as a trust leader. 
Although Mr McKeever said he only knew the regional situation for the East of England, he would be “very surprised” if the national picture was any different. Waiting list expert Rob Findlay agreed this was a reasonable assumption.
Read full story (paywalled)
Source: HSJ, 17 November 2023
Patient Safety Learning

NHSE tells GPs they’re ‘breaching contract’ by denying record access

NHS England has taken the unusual move of warning multiple GP practices they are breaching their contract by refusing to give people automatic access to future entries in their record.
Under the current national GP contract, practices were ordered to give people on their list automatic access to prospective (future) medical records, via the NHS App, by 31 October. 
However, the British Medical Association GP committee has urged GPs to instead adopt an “opt in” model, saying it is concerned that giving automatic access could endanger some people.
The BMA gave practices a template letter to use to tell their integrated care boards they cannot move ahead with automatic access “due to several risks that cannot be sufficiently mitigated”.
NHS England’s own template letter for ICBs to use in response, seen by HSJ, states: “Based on your letter we interpret that the required changes were not implemented by 31 October 2023, thereby putting you in breach of your contractual obligations. We would therefore like to discuss with you your plan, including the timeline to become compliant.”
It is an unusual warning from NHSE which could potentially apply to hundreds or thousands of practices.
Read full story (paywalled)
Source: HSJ, 16 November 2023
Patient Safety Learning

Nursing watchdog to miss target to cut soaring complaints backlog

The nursing watchdog will miss its target to tackle a 5,500-case backlog of complaints as referrals hit a record high.
The Nursing and Midwifery Council NMC has admitted it won’t hit its pledge to cut the number of unresolved complaints against nurses and midwives to 4,000 by March 2024.
The news comes as it faces questions over the way it handles complaints after The Independent revealed a number of serious allegations, including poor investigations that have led to fears of rouge nursing going unchecked. The newspaper exposes have prompted two independent reviews.
Details of the first two reviews have been revealed for the first time and will look at:
The NMC’s response to whistleblower concerns, including whether they were treated fairly and whether it acted fairly and reasonably. Any evidence of cultural issues which may have impacted the NMC’s response to whistleblowing. Whether concerns raised are substantiated and indicate a decision-making process by the NMC which is insufficient in protecting the public. Evidence of shortcomings in guidance and training. The senior whistleblower whose evidence prompted the review said: “The NMC has refused to change its approach to the investigations into my whistleblowing concerns to allow me to share and explain my evidence without fear of reprisal. I don’t think it is possible to draw safe conclusions about either how I have been treated or the impact of our culture on case work from reviewing only 13 of our current 5,500 open cases, and 6 closed cases and a selection of my emails.”
Read full story
Source: The Independent, 16 November 2023
Patient Safety Learning

Forcing medical staff to work during strikes could harm care, NHS Providers says

Forcing some medical staff to work through industrial action under new anti-strike laws could end up harming patient care, hospital trust leaders have said, as ministers claimed their new measures would keep public services running over Christmas.
NHS Providers, which represents hospital, mental health and ambulance trusts, said there was a significant risk it would damage relationships between staff and employers that are already very challenged, in a way that could affect patients.
In a submission to the consultation on minimum service levels in hospitals, it said: “Our key concern is that rather than strengthening services as intended, the legislation proposed would worsen relationships between employers and staff, and between trusts and local union representatives to the longer-term detriment of patient care.”
Read full story
Source: The Guardian, 17 November 2023
Patient Safety Learning

Therapy could be offered to women suffering menopause symptoms

Women experiencing hot flushes, night sweats, depression and sleep problems could be offered therapy to help reduce their menopause symptoms, under new guidelines.
But menopause champions warned that those suffering with symptoms could have long waits for mental health support and stressed that the new draft guidance to GPs from the National Institute for Health and Care Excellence (NICE) must not distract from “ongoing challenges” of getting HRT.
A NICE evidence review found that cognitive behavioural therapy (CBT) can help make night-time sweats less severe and frequent and should be considered “alongside or as an alternative to HRT”.
The guidance is not mandatory but GPs will be expected to take the new guidance “fully into account”, said Nice.
Caroline Nokes, chair of the Commons’ women and equalities committee, welcomed the new guidance saying there was no “one size fits all” to help women going through the menopause, but said it must not be used to fob off women, some of whom were still facing drug shortages.
A major HRT drug shortage last year resulted in 22 restrictions being put in place, pushing some women to turn to the hidden market or meet up with other women to buy, swap or share medicines.
Read full story
Source: The Guardian, 17 November 2023
Patient Safety Learning

Loughborough University to deliver course to NHS professionals in a bid to improve patient safety

Loughborough University is collaborating with NHS England to deliver learning to hundreds of healthcare professionals in a bid to improve patient safety.
Human factors and ergonomics experts in the School of Design and Creative Arts will deliver Levels 3 and 4 of the NHS Patient Safety Syllabus and Curriculum after winning a competitive tender process.
Under the leadership of Dr Mike Fray, supported by Professor Sue Hignett and Professor Thomas Jun, the Loughborough University team will craft and deliver educational content to 820 patient safety specialists across various NHS Trusts in England from 2023 to 2024.
In 2021, the NHS Patient Safety Syllabus was created by drawing upon best practice from a number of safety-critical industries. It has as a core aim of changing how staff think about improving patient safety. The key to this is switching the focus to proactive prevention of safety incidents, and away from the current largely retrospective analyses.
Dr Fray believes Loughborough University’s world-leading reputation in the delivery of human factors and ergonomics education will help the NHS achieve its goals.
Dr Fray said: “No healthcare worker goes to work thinking they will do harm, but the systems, processes and complexity of the work can lead to errors, omissions, or reductions in quality of care.  “With this new course we will be able to support patient safety specialists in each Trust to lead safety improvement work and provide safety science expertise to their organisations so that patients across the NHS can benefit.”
Aidan Fowler, National Director of Patient Safety said: ‘’Training and education is at the centre of the NHS Patient Safety Strategy so that we can empower people with the latest skills and knowledge in patient safety science.
“The launch of this training for our patient safety specialists is the latest development in this work, using the syllabus created with the Academy of Medical Royal Colleges and adding to the training already available to all staff in the NHS.”
Read full story
Source: Loughborough University, 15 November 2023
Patient Safety Learning

More women to get contraceptive pill from chemists in England

Almost half a million women will be able to get the contraceptive pill from pharmacies in England, from next month, without the need for a GP appointment.
Treatments for urinary infections and other common conditions will also be on offer under the Pharmacy First scheme.
NHS England said it was a safe and common-sense way of making NHS services easier for patients to use.
New Health and Social Care Secretary Victoria Atkins said the changes meant "more options for women when making a choice about their preferred contraception" and would free up GP appointments.
From February, pharmacists who successfully apply to join the scheme will be able to offer advice and treatment, including antibiotics, for seven common conditions:
sinusitis sore throat earache infected insect bites impetigo shingles urinary tract infection in women. Read full story
Source: BBC News, 16 November 2023
Patient Safety Learning

Private firms harming NHS patients by failing to deliver medicines, Lords report warns

Private healthcare companies are harming NHS patients in their own homes by failing to deliver vital medicines, and then escaping censure amid an alarming lack of oversight by ministers and regulators, members of the House of Lords have warned.
More than 500,000 patients and their families rely on private companies paid by the NHS to deliver essential medical supplies, drugs and healthcare to their homes. The homecare medicines services sector is estimated to be worth billions of pounds.
A report by the Lords public services committee says patients are being harmed due to “real and serious problems” with the services provided by for-profit companies. The absence of a single person or organisation with overall control or oversight of the sector means poor performance is going unchecked, it says.
“There are serious problems with the way services are provided,” the Lords report says. “Some patients are experiencing delays, receiving the wrong medicine or not being taught how to administer their medicine. [This] can have serious impacts on patients’ health, sometimes requiring hospital care. This leaves NHS staff either firefighting the problems caused by problems in homecare medicines services, or working on the assumption that those services will fail.”
Read full story
Source: The Guardian, 16 November 2023
Patient Safety Learning

Most NHS maternity units not safe enough, says regulator

England's healthcare regulator has told BBC News that maternity units currently have the poorest safety ratings of any hospital service it inspects.
BBC analysis of Care Quality Commission (CQC) records showed it deemed two-thirds (67%) of them not to be safe enough, up from 55% last autumn.
The "deterioration" follows efforts to improve NHS maternity care, and is blamed partly on a midwife shortage.
The Department for Heath and Social Care (DHSC) said £165m a year was being invested in boosting the maternity workforce, but said "we know there is more to do".
The BBC's analysis also revealed the proportion of maternity units with the poorest safety ranking of "inadequate" - meaning that there is a high risk of avoidable harm to mother or baby - has more than doubled from 7% to 15% since September 2022.
The CQC, which also inspects core services such as emergency care and critical care, said the situation was "unacceptable" and "disappointing".
"We've seen this deterioration, and action needs to happen now, so that women can have the assurance they need that they're going to get that high-quality care in any maternity setting across England," said Kate Terroni, the CQC's deputy chief executive.
The regulator has been conducting focused inspections because of concerns about maternity care. These findings are "the poorest they have been" since it started recording the data in this way in 2018, Ms Terroni said.
Read full story
Source: BBC News, 16 November 2023
Patient Safety Learning

UK cancer care in crisis and patients will die due to lack of strategy, experts warn

UK cancer care is in crisis and patients will die because of ministers’ decision to axe a dedicated plan to tackle the disease, leading cancer experts have warned.
Waiting times for NHS cancer treatment are at a record high and it is expected there will be 2,000 extra cancer patients a week by 2040. In January, the government scrapped its longstanding cancer plan and instead merged it into a wider “major conditions strategy” that also covers a range of other major diseases.
In a report published in the Lancet Oncology, 12 cancer experts said the decision could cause more people to die.
Prof Pat Price, an oncologist and visiting professor at Imperial College London and joint senior author of the report, said: “The dangerous reality is that cancer care in this country is fast becoming a monumental crisis and there appears to be no realistic plan. A cancer plan is not just a strategy, it is a lifeline for the one in two of us that will get cancer.”
Mark Lawler, a professor of digital health at Queen’s University Belfast, the chair of the International Cancer Benchmarking Partnership and a co-author of the paper, said: “Getting rid of a dedicated cancer strategy will cost lives. Abandoning a dedicated national cancer control plan in favour of a major conditions strategy is an incomprehensible decision not in the best interests of people with cancer.”
Read full story
Source: The Guardian, 15 November 2023
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