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

Cervical cancer: 17,500 women to have smear tests re-checked

About 17,500 women in Northern Ireland are to have their smear tests re-checked as part of a major review of cervical screening dating back to 2008.
Some of these women will be recalled to have new smear tests carried out, BBC News NI can reveal.
The Southern Trust said that the women affected should receive letters by post from Tuesday.
It follows a highly critical report commissioned by the Royal College of Pathologists (RCPath).
It found:
Several cytology staff were "significantly underperforming". Mechanisms to check their work were flawed. Action taken by management was inadequate over many years. While a majority of negative results issued by the laboratory were correct, a "significant number" of these would likely have been identified as "potentially abnormal" by other laboratories. Read full story
Source: BBC News, 9 October 2023
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Mental healthcare in England is a national emergency, say hospital bosses

Mental healthcare in England has become “a national emergency”, with “overwhelmed” services unable to cope with a big post-Covid surge in people needing help, NHS bosses say.
Care is so stretched that thousands of people undergoing a mental health crisis are having to be admitted every year to acute hospitals, even though they are not set up to deal with them.
Hospital bosses claim mental health in England has been “forgotten” by ministers who are giving priority to tackling the record 7.7m-strong care backlog, access to GPs and ongoing NHS strikes.
“Mental health has slipped down the government’s set of priorities and patients and services are being forgotten. This is a national emergency which is now having serious consequences across the board, not least for those patients in crisis,” said Matthew Taylor, the chief executive of the NHS Confederation.
Read full story
Source: The Guardian, 9 October 2023
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Physician associates told they must not call themselves doctors

Staff without medical training who fill gaps in the NHS workforce must tell patients they are “not a doctor” when introducing themselves, under new guidance.
The advice has been issued to “physician associates” (PAs), a type of clinical role that requires less training than doctors receive, amid a row over their use in the NHS.
PAs complete a two-year postgraduate qualification, but no medical degree, and can diagnose and treat patients. They can work in A&E or GP surgeries.
NHS England has set out plans to expand the number of PAs to deal with staff shortages, with a workforce of 10,000 PAs wanted over the next decade. The plan has been met with opposition from doctors’ leaders, who say the growing use of PAs instead of fully qualified doctors is leading to missed diagnoses and deaths.
Guidance published by the Faculty of Physician Associates, a part of the Royal College of Physicians, said that PAs must not mislead patients into thinking they are doctors.
Read full story (paywalled)
Source: The Times, 6 October 2023
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NHS trust and ward manager appear in court charged with manslaughter of mental health patient

An NHS trust and ward manager have appeared in court charged with the manslaughter of a 22-year-old mental health patient who died in hospital in July 2015.
Alice Figueiredo was found dead at Goodmayes Hospital in east London, and an investigation into her death was opened in April 2016. 
The Crown Prosecution Service (CPS) authorised the Met Police to charge North East London NHS Foundation Trust (NELFT) with corporate manslaughter last month following a five-year investigation.
It is just the second NHS Trust to face manslaughter charges. The Trust is additionally charged with an offence under section three of the Health and Safety at Work Act in connection with mental health patient Ms Figueiredo's death.
Ward manager Benjamin Aninakwa also faces a charge of gross negligence manslaughter and an offence under section seven of the Health and Safety at Work act.
NELFT is just the second ever NHS Trust believed to have been charged with corporate manslaughter, after Maidstone and Tunbridge Wells Trust was charged over the death of a woman who underwent an emergency Caesarean in 2015.
Read full story
Source: Mail Online, 6 October 2023
Sam

How is the ADHD medication shortage in the UK affecting people?

ADHD patients around the UK are finding they can't get hold of medication since a national shortage was announced.
Three different medicines are affected, and the government says some supply issues could last until December.
The Department for Health and Social Care (DHSC) says "increased global demand and manufacturing issues" are behind the shortages.
Medication helps to manage symptoms, which can include difficulty concentrating and focusing, hyperactivity and impulsiveness.
Dr Saadia Arshad, a consultant psychiatrist, who specialises in diagnosing and treating people with ADHD.
She says the shortage of medication is "not a new issue, but it's a recurring one".
Dr Saadia says suddenly stopping meds can lead to patients "feeling jittery, finding it difficult to pay attention, staying focused and feeling restless".
Even though she understands the shortage can be worrying, Dr Saadia says it's important that people don't take measures into their own hands.
"These medicines can be quite potent and the response to medication for two individuals is not the same," she says.
"So please do not take any action without discussing it with your clinician."
Read full story
Source: BBC News, 6 October 2023
Sam

Seven trusts relegated to NHSE’s poorest performers group

Seven trusts have been added to NHS England’s list of providers with the worst elective and cancer problems, putting the number of organisations in the ‘tier 1’ group back into double figures – and five leaving it, HSJ has learned.
Since last summer, NHS England has put trusts considered most “at risk” of missing recovery trajectories into “tiers” for either elective or cancer performance, or both.
The list has changed significantly for quarter three of this year, despite only a few months passing since the last rankings were revealed in August.
HSJ understands this is due to system-level agreements and some national factors, including the impact of ongoing industrial action on elective activity.
The number of trusts in the most challenged “tier 1” group for both elective and cancer performance has increased from eight to 11, with seven new providers entering this tier and five leaving.
Read full storySource: HSJ, 9 October 2023 
Sam

Trust boss accuses private provider of ‘overpromising and underdelivering’

The boss of a large acute trust has accused a private provider of ‘overpromising and underdelivering’ after significant problems emerged with a local arrangement which have piled further pressure on its waiting list.
Mid and South Essex Foundation Trust recently discovered at least 1,000 cases were being returned to the trust from independent provider Omnes Healthcare following “complications” with a pathway for ear, nose and throat patients.
CEO Matthew Hopkins told a board meeting last Thursday: “I think other parts of the country, like us, are seeing independent sector providers in some cases overpromising and underdelivering. The consequence of that is what we’ve seen in the ENT example.”
The contract is managed by Mid and South Essex Integrated Care Board, which told HSJ it was “very sorry that some patients may have been waiting longer than they should have been” because of the problems.
Read full story (paywalled)
Source: HSJ, 6 October 2023
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Concern over severe food allergy prescriptions

Only 60% of patients who have had hospital treatment for food anaphylaxis were prescribed medicine to tackle another reaction, a study has found.
The study of some 130,000 NHS records where food allergy was mentioned showed 3,589 patients received "unplanned hospital treatment" for anaphylaxis.
Of those, only 2,152 were prescribed adrenaline auto-injectors (AAI) at least once.
Two leading allergy specialists have produced guidance to raise awareness.
Clinical scientist Dr Paul Turner from the National Heart & Lung Institute at Imperial College London, who carried out the study, and Prof Adam Fox, consultant paediatric allergist at Evelina London Children's Hospital, said they hoped the leaflet they have produced would save lives.
It is designed to help patients, parents, families, grandparents, friends and nannies so they feel empowered and more confident when looking after a person with food allergies.
Read full story
Source: BBC News, 6 October 2023
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Messages revealed healthcare workers were drugging patients

Two healthcare workers who exchanged vile texts while needless drugging sick people to ‘keep them quiet’ have been found guilty of ill-treating patients.
Senior nurse Catherine Hudson, 54, was found to have regularly tranquillised patients unnecessarily for her own amusement and to have an ‘easy’ shift.
While Charlotte Wilmot, 48, an assistant practitioner, wrote vile texts encouraging her to carry out the dangerous acts, with complete disregard for the consequences.
Preston Crown Court heard the pair worked on the stroke unit at Blackpool Victoria Hospital and had carried out needless sedations between 2017 and 2018.
Restrictions on prescription drugs were so lax in the stroke unit that staff would help themselves and self-medicate or steal drugs to supply to others, the court heard.
Drugs such as Zopiclone, a powerful medicine used to treat insomnia, were often stolen and used to drug multiple patients.
Police launched an investigation in November 2018 after a student nurse raised concerns about the treatment of patients in the stroke unit.
A number of staff members were arrested during the course of the investigation and their mobile devices were seized.
Read full story
Source: The Independent, 6 October 2023
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NHS ombudsman calls on trust chief to withdraw ‘not accurate’ remarks

The NHS ombudsman has told a health trust chief to withdraw “not accurate” remarks about him amid an alleged attempt to play down up to 1,000 avoidable patient deaths.
Rob Behrens wrote to Stuart Richardson, the head of the Norfolk and Suffolk mental health NHS trust, over remarks he made about him to Norfolk county council’s health scrutiny committee.
The councillors on the committee were questioning Richardson over claims reported by the BBC’s Newsnight programme that his trust had “watered down” a report into what are thought to be the avoidable deaths of up to 1,000 patients.
The changes between different versions of the document toned down criticism of the trust’s leadership, a move that drew criticism from Behrens and bereaved relatives.
For example, the auditors, Grant Thornton, removed references included in the first version to the trust’s governance being “poor, … weak [and] inadequate”, after discussions with trust bosses. The trust and Grant Thornton said the changes were part of a normal factchecking process.
Referring to the changes, Behrens had told Newsnight that “the differences in the texts at key points are so huge that this is not just a bureaucratic drafting issue”.
Read full story
Source: The Guardian, 5 October 2023
Patient Safety Learning

Ambulance sector vows to improve sexual safety

The ambulance sector has signed up to a consensus statement in a bid to tackle misogyny and improve sexual safety for its staff and patients.
The statement – which chief allied health professions officer for England Suzanne Rastrick launched at this week’s Ambulance Leadership Forum – commits the service to a “cultural transformation”.
Several ambulance trusts have been criticised for a culture which includes “highly sexualised banter” in recent years, with reports highlighting sexual harassment, often of younger female staff.
The statement’s guiding principles include: a focus on protecting staff from misogyny and inappropriate sexual behaviour; removing barriers to speaking up and supporting those affected; and working towards an inclusive culture where staff understand misogyny and come to work feeling “sexually safe”.
Read full story (paywalled)
Source: HSJ, 5 October 2023
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Doctors urged to ask patients about gambling in new NHS mental health guidance

People who seek help for mental health issues should be asked about problem gambling in the same way they are asked about drugs, smoking and alcohol, new guidance has suggested.
According to the National Institute for Health and Care Excellence (NICE), those who visit an NHS health professional in England for depression, anxiety or thoughts about self-harm or suicide because of a possible addiction, such as alcohol or drugs, could be at a greater risk of harm from gambling.
NICE said questions should be asked about patients’ gambling habits to ensure they could cope with their thoughts and urges. In new draft guidance, it suggested patients should be encouraged to assess the severity of their gambling by using a questionnaire available on the NHS website. Those who scored eight or higher should seek support and treatment from gambling services.
Read full story
Source: The Guardian, 5 October 2023
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Women at greater risk of heart attack death due to medical sexism

Women are a third less likely to receive lifesaving treatment for heart attacks due to sexism in medicine, research shows.
Research led by the University of Leeds and the British Heart Foundation (BHF) pooled NHS data from previous studies looking at common heart conditions over the past two decades.
It investigated how care varied according to age and sex, finding that women were significantly less likely to receive treatment for heart attacks and heart failure.
Following the most severe type of heart attack — a Stemi — women were one third less likely to receive a potentially lifesaving diagnostic procedure called a coronary angiogram.

Women were significantly more likely to die after being admitted to hospital with a severe heart attack. They were also less likely to be prescribed preventative drugs that can help to protect against future heart attacks, such as statins or beta-blockers.
Dr Sonya Babu-Narayan, associate medical director at the BHF and a consultant cardiologist said: “This review adds to existing evidence showing that the odds are stacked against women when it comes to their heart care. Deep-rooted inequalities mean women are underdiagnosed, undertreated, and underserved by today’s healthcare system."
“The underrepresentation of women in research could jeopardise the effectiveness of new tests and treatment, posing a threat to women’s health in the long-term,” she added.
Read full story (paywalled)
Source: The Times, 5 October 2023
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Reliance on physician associates risks patient safety, doctors say

The use of non-medics in clinical roles is leading to deaths and missed diagnoses, senior doctors have warned.
Hundreds of doctors have signed an open letter to the leadership of the Royal College of Physicians (RCP), urging them to take a stand over the rollout of physician associates (PAs).
PAs are a newer type of medical role that involves significantly less training than doctors receive. The NHS has used PAs since 2003 but concerns have emerged in recent months about them taking on more advanced work than is appropriate.
NHS England set out plans earlier this year to expand their numbers significantly amid ongoing staff shortages.
Now an open letter to the RCP’s council, to date signed by 46 fellows of the college and 194 other doctors, sets out concerns ranging from patient safety and liability to the fact that newly qualified PAs can earn more than newly qualified doctors.
They say: “There have been several high-profile incidents in which serious illness was missed by a PA when undertaking a role that would normally be filled by a doctor. In some cases, avoidable deaths have resulted.
“Given that some of these conditions required more advanced training than the PA had received, the implication is that rare avoidable deaths are a price society must pay for the replacement of medical staff with non-medical staff. We believe this trade-off must be debated widely not just by doctors but also by the lay public.”
Read full story (paywalled)
Source: The Times, 5 October 2023
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GP burnout: 'I was left feeling like a husk of a human'

The number of doctors seeking help for mental health issues has risen by more than three quarters within two years, according to figures from a specialist treatment service for NHS staff. For one GP, the relentless stress of the job led to him taking three months off work with burnout.
David Triska is no stranger to high-pressure situations. As an army medic, he served two tours of Afghanistan.
But mounting workloads at his village GP surgery left him feeling "hollowed out and spent". Simple tasks, like unlocking his car or making a meal, became a challenge - an experience he describes as leaving him feeling "like a husk of a human".
"At that extreme point, I couldn't see why I needed to be here anymore," Dr Triska said.
He is not alone. Since the year ending March 2021, there has been a 77% rise in the number of doctors seeking help for mental health issues, according to figures shared with the BBC by a confidential support service for NHS staff.
More than 5,600 doctors used the NHS Practitioner Health programme in England in 2022/23, with about a third having thought about taking their own lives.
Read full story
Source: BBC News, 5 October 2023
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Lucy Letby: Corporate manslaughter probe at Chester hospital

Police are investigating possible corporate manslaughter at the hospital where serial killer Lucy Letby worked.
The former nurse, 33, was jailed in August for murdering seven babies and attempting to kill six others at the Countess of Chester Hospital.
Cheshire Police said the latest investigation was in its early stages.
Lawyers representing some of the victims' families said they were "reassured" steps were being taken to consider the actions of management.
Organisations and companies can be found guilty of corporate manslaughter as a result of serious management failures resulting in a gross breach of a duty of care under The Corporate Manslaughter and Corporate Homicide Act 2007.
Det Supt Simon Blackwell, of Cheshire Police, said the inquiry would focus on the indictment period of the charges for Letby from June 2015 to June 2016.
He said the investigation would consider areas "including senior leadership and decision making to determine whether any criminality has taken place".
"At this stage we are not investigating any individuals in relation to gross negligence manslaughter," he added.

Read full story
Source: BBC News, 4 October 2023
Sam
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