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

ChatGPT could help reduce A&E wait times

ChatGPT could be used to diagnose patients in a bid to reduce waiting times in emergency departments, researchers have suggested.
It comes after a study found the language model, powered by artificial intelligence (AI), “performed well” in generating a list of diagnoses for patients and suggesting the most likely option.
Researchers in the Netherlands entered the records of 30 patients who visited an emergency department in 2022, as well as anonymous doctors’ notes, into ChatGPT versions 3.5 and 4.0.
The AI analysis was compared to two clinicians who made a diagnosis based on the same information, both with and without laboratory data.
When lab data was included, doctors had the correct answer in their top five differential diagnoses in 87% of cases, compared with 97% for ChatGPT 3.5 and 87% for ChatGPT 4.0.
There was a 60% overlap between the differential diagnoses by clinicians and ChatGPT.
The team said that while ChatGPT was “able to suggest medical diagnoses much like a human doctor would”, more work is needed before it is applied in the real world.
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Source: The Independent, 13 September 2023
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Sussex police widen inquiry into Brighton hospital deaths

A police investigation into allegations of cover-up and medical negligence over dozens of deaths at the Royal Sussex county hospital (RSCH) in Brighton has been expanded to include more recent cases, amid internal claims about dangerous surgery.
In June the Guardian revealed that Sussex police were investigating the deaths of about 40 patients in the general surgery and neurosurgery departments at the RSCH.
The force initially said the investigation, since named Operation Bramber, related to allegations of medical negligence in these departments between 2015 and 2020.
It has now extended the scope of the investigation to more recent cases, amid internal allegations that the departments continue to be unsafe and fail to properly review serious incidents.
An insider said the police should review what was considered to be an avoidable death after a procedure in July. The source said some of the surgeons remained a danger to the public. “You would not want your family members touched by these people,” they said.
They added: “This is not a historic issue, it is ongoing. The same surgeons that were involved in previous problems remain in place.” They cited a woman who lost the power of speech in April after an alleged mistake in surgery to remove a brain tumour led to a stroke, and a man who was left with a brain abscess in May after being operated on despite a heightened risk of infection.
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Source: The Guardian, 13 September 2023
Sam

Patients feel misled by pledge of cannabis on NHS

A high-profile government climbdown which legalised a type of cannabis medicine on the NHS five years ago misled patients, campaigners say.
It was thought the law change would mean the unlicensed drug, which treats a range of conditions, could be freely prescribed by specialist doctors.
But fewer than five NHS patients have been given the medicine, leaving others to either pay privately or miss out.
The government says safety needs to be proven before a wider rollout.
Legalisation of whole-cannabis medicine was hailed as a breakthrough for patients - giving either NHS or private specialist doctors the option to prescribe it if they believed their patients would benefit.
But patients are being turned away, say campaigners, because doctors often do not know about the medicine, which is not on NHS trusts' approved lists. Some specialists who do know about it say there is insufficient evidence of the drug's safety and benefits to support prescribing.
Senior paediatric consultant Dr David McCormick, from King's College Hospital in London, says it was "disingenuous" of the government to suggest in 2018 that NHS prescribing was ready to take place.
"Parents were clamouring at our door, or phoning all the time, as they believed we were able to prescribe and that was not the case.
"The message went out, 'doctors can now prescribe cannabis products' and that put us in a difficult position, because in truth we need to apply for that to be approved by NHS England."
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Source: BBC News, 13 September 2023
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BBL surgery: Woman who died in Turkey 'not told of risks'

A woman who died during an operation for a buttock enlargement in Turkey was not given enough information to make a safe decision about the procedure, a coroner has concluded.
Melissa Kerr, 31, from Gorleston, Norfolk, died at the private Medicana Haznedar Hospital in Istanbul, in 2019.
Ms Kerr had gone abroad to have what is commonly referred to as a Brazilian butt-lift or BBL, the Norwich inquest heard.
The inquest was told Brazilian butt-lift operations carried the highest risk of all cosmetic surgery procedures.
The UK has an agreed moratorium on carrying out such operations due to the dangers involved, expert witness and plastic surgeon Simon Withey said in a report for the inquest.
Mr Withey said if the risk of the procedure had been explained to Ms Kerr before she had financially committed to the procedure she would not "in all probability" have gone through with it.
Coroner Jaqueline Lake said she would be writing a report for the health secretary to try and prevent further deaths from this "risky" procedure. She said she was "concerned patients are not being made aware of the risks or the mortality rate associated with such surgery".
She added, while the UK government had no control over what happens in other countries, "the danger to citizens who continue to travel abroad for such procedures continues... and I'm of the view future deaths can be prevented by way of better information".
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Source: BBC News, 12 September 2023
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Trust ‘led with integrity’ in face of maternity scandal, says CQC

A trust facing a police investigation into one of the NHS’s largest ever maternity scandals is no longer rated ‘inadequate’ by the Care Quality Commission in its well-led and maternity domains.
Nottingham University Hospitals Trust was rated “inadequate” for its leadership and maternity services during inspections in 2021 and 2022, following serious care failings exposed by staff and patients during this period. The Nottinghamshire police confirmed last week they were opening an investigation.
But the regulator noted improvements after its well-led and maternity inspections which took place in April and June.
The well-led rating has gone up from “inadequate” to “requires improvement” and maternity services at both hospitals have also gone up to “requirements improvement”.
Greg Rielly, CQC deputy director of operations in the Midlands, said: “During this inspection, we saw a team that consistently led with integrity who were open and honest in their approach.”
However, he stressed that while the culture across the trust was improving, some staff still didn’t feel able to raise concerns without fear of retribution.
“Leaders were aware of this and were working to create a workplace that is free from bullying, harassment, racism, and discrimination so we hope to see an improved picture soon,” he said.
Read full story (paywalled)
Source: HSJ, 13 September 2023
Patient Safety Learning

You can pay for private healthcare — but can you trust it?

More than a quarter of million people dipped into their savings or took a loan to pay for a private hospital operation or appointment last year — a record high. This year could exceed that.
And who can blame them? With the NHS waiting list at a staggering 7.6 million and monthly strikes by doctors lengthening waiting times, patients are increasingly prepared to jump the queue and pay hard cash to do so.
In an effort to cut waits and expand choice for patients, Rishi Sunak is funnelling thousands more NHS patients into the private sector.
Yet private healthcare is not without risks, many of which are not fully understood. There is a difference between the NHS, which — for all its faults — has been a dependable, free at the point of use health service for more than 75 years, and the sometimes murky world of private doctors and hospital companies who use them.
Can you trust your private doctor? When you look under the bonnet of private healthcare, beyond the glossy adverts, things can get a little uncertain.
Read full story (paywalled)
Source: The Times, 10 September 2023
Sam

A grandad went into hospital with stomach problems and had to have both legs and a hand amputated

A grandfather who went into hospital with stomach problems needed both of his legs and his left hand amputating after contracting a life-threatening infection.
Stephen Hughes, from Edmondstown, had been admitted to the Royal Glamorgan Hospital in Llantrisant, in March 2022, with gallstones and aggressive stomach inflammation. This led to pancreatitis corroding a hole in the duodenum which caused a significant bleed into his gut. The 56-year-old's condition deteriorated and he was transferred to the ICU at the University Hospital of Wales as a patient in critical condition.
Whilst at UHW, his family said that the NHS staff worked tirelessly to stop the internal bleeding he was suffering. His gallbladder was removed on September 8th, 2022, and stents were placed along his arteries. Although these operations were successful, his family claims that Mr Hughes caught sepsis from the feeding tube in his neck on 11 September 2022 whilst recovering.
Stephen’s body prioritised sending blood to his vital organs which resulted in his outer limbs being deprived of blood and oxygen. Stephen then had to have life-altering operations, which resulted in both of his legs being amputated towards the end of September, and his left hand being amputated at the start of October. He was later discharged on 31 October.
A spokesperson for Cardiff and Vale University Health Board said: “As a Health Board we are unable to comment on individual patient cases, however we appreciate how life altering operations are particularly distressing for the individual and also their loved ones.
Read full story
Source: Wales Online, 9 September 2023
Sam

MPs to investigate sexual harassment of female surgeons

MPs will investigate the sexual harassment and sexual assault of female surgeons taking place within the NHS.
BBC News reported women being sexually assaulted even in the operating theatre, while surgery took place.
And the first major report into the problem found female trainees being abused by senior male surgeons.
The Health and Social Care Committee said it would look into the issue and its chair, Steve Brine, said the revelations were "shocking".
"The NHS has a duty to ensure that hospitals are safe spaces for all staff to work in and to hold managers to account to ensure that action is taken against those responsible," Mr Brine said.
"We expect to look into this when we consider leadership in the NHS in our future work."
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Source: BBC News, 13 September 2023
Patient Safety Learning

Martha's rule: Mother to press health secretary on patient rights

The mother of Martha Mills, whose preventable death in hospital has led to calls for extra patients' rights, has said she is to meet the health secretary to discuss "Martha's Rule".
If introduced, it would give families a statutory right to get a second opinion if they have concerns about care.
Merope Mills said patients needed more clarity and to feel empowered.
Her daughter, Martha, died two years ago after failures in treating her sepsis at King's College Hospital.
She had entered hospital with an injury to her pancreas after falling off her bike. The injury was serious but should never have been fatal. Within days she had died of sepsis.
In an interview on Radio 4's Today programme, Mrs Mills said she had raised concerns but doctors told her the extensive bleeding was "a normal side-effect of the infection, that her clotting abilities were slightly off".
The King's College Hospital Trust said it remained "deeply sorry that we failed Martha when she needed us most" and her parents should have been listened to.
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Source: BBC News, 12 September 2023
Sam

Trust heavily criticised by coroner for delays to death investigations

A coroner has strongly criticised a mental health trust for failing to investigate serious incidents promptly.
Tees Esk and Wear Valleys Foundation Trust has been told that delays in probing serious incidents may “compromise the quality” of these investigations and hence “their value in preventing deaths”.
The warnings, from Jeremy Chipperfield, senior coroner for County Durham and Darlington, come amid an ongoing inquest into the death of TEWV patient Ian Darwin. Mr Darwin died aged 42 in March, and the serious incident review into his death is still ongoing.
A recently published prevention of future deaths report relating to Mr Darwin’s death said TEWV’s serious incident death investigations, “at all levels of seriousness, are routinely (if not invariably) significantly delayed and I understand there is no expectation of immediate, or any timetable for eventual rectification”.
“In permitting delay of ‘serious incident’ investigations, TEWV may permit lethal hazard to persist for longer than necessary, and compromise the quality of such investigations and hence their value in preventing avoidable deaths.”
Patient Safety Learning

BMA writes to trust chiefs over ‘concerns about doctors’ safety’

The British Medical Association has written to trust chief executives warning of ‘concerns regarding the safety of our members and the patients they serve’ due to flawed concrete beams.
The BMA has written to trust chiefs, copying in their medical committee leads, in the wake of a wave of publicity around reinforced autoclaved aerated concrete in recent weeks.
The letter said: “The HSJ has reported that many NHS hospital buildings have been constructed with RAAC, which is in some cases reaching the end of safe use and causing danger to staff and patients.
“Unfortunately, your trust may be one of the affected hospitals. We have concerns regarding the safety of our members and the patients they serve, and would appreciate answers to the following.”
It also requested the trusts provide answers, under the Freedom of Information Act, to questions including whether they had identified RAAC, what assessments they had made, what mitigations were planned or in place, and emergency plans such as evacuation.
It is thought the letter was sent to all or most provider trusts.
Read full story (paywalled)
Source: HSJ, 12 September 2023
Patient Safety Learning

Female surgeons sexually assaulted while operating

Female surgeons say they are being sexually harassed, assaulted and in some cases raped by colleagues, a major analysis of NHS staff has found.
The Royal College of Surgeons said the findings were "truly shocking".
Sexual harassment, sexual assault and rape have been referred to as surgery's open secret.
There is an untold story of women being fondled inside their scrubs, of male surgeons wiping their brow on their breasts and men rubbing erections against female staff. Some have been offered career opportunities for sex.
Nearly two-thirds of women surgeons that responded to the researchers said they had been the target of sexual harassment and a third had been sexually assaulted by colleagues in the past five years.
Women say they fear reporting incidents will damage their careers and they lack confidence the NHS will take action.
It is widely accepted there is a culture of silence around such behaviour. Surgical training relies on learning from senior colleagues in the operating theatre and women have told us it is risky to speak out about those who have power and influence over their future careers.
Read full story
Source: BBC News, 12 September 2023
Related reading on the hub:
Breaking the silence: Addressing sexual misconduct in healthcare Calling out the sexist and misogynist culture within healthcare: a blog by Dr Chelcie Jewitt, co-founder of the Surviving in Scrubs campaign GMC's Good medical practice 2024
Patient Safety Learning

Bristol Spire Hospital widens investigation into mesh surgeon

A hospital review of mesh operations by a surgeon who left dozens of patients in agony is now looking into another type of procedure he carried out.
Tony Dixon, who used mesh surgery to treat bowel problems, has always maintained he did the operations in good faith.
Now it has emerged that other patients who had their rectum stapled are also being written to.
Spire Hospital Bristol said its "comprehensive" review remains ongoing.
Mr Dixon pioneered the use of artificial mesh to lift prolapsed bowels and a review of the care he gave patients receiving Laparoscopic ventral mesh rectopexy has already concluded.
Now the Spire has contacted patients who underwent a Stapled Transanal Rectal Resection (STARR operation) with Mr Dixon.
Many of the affected patients have told the BBC they did not give informed consent for the procedure and are in chronic pain.
Read full story
Source: 11 September 2023
Sam

Suicide prevention drive launched in England amid concern for young people

Ministers have vowed to reduce suicide rates in England with the launch of more than 100 new initiatives amid particular concerns over rising deaths and self-harm among children and young people.
The pledge to reverse the trends within two and a half years came as the government launched its first prevention strategy in more than a decade. In 2022, there were 5,275 suicides in England, equivalent to 10.6 suicides per 100,000 people, according to the Office for National Statistics.
“While overall the current suicide rate is not significantly higher than in 2012, the rate is not falling,” a new government document says. “We must do all we can to prevent more suicides, save many more lives and ultimately reduce suicide rates.”
It highlights how rates of suicide among children and young people have increased in recent years, despite being low overall, adding: “Urgent attention is needed to address and reverse these trends.”
The new measures being launched will also aid other specific groups at risk of suicide, including middle-aged men, autistic people, pregnant women and new mothers.
Steve Barclay, the health secretary, said: “Too many people are still affected by the tragedy of suicide, which is so often preventable. This national cross-government strategy details over 100 actions we’ll take to ensure anyone experiencing the turmoil of a crisis has access to the urgent support they need.”
Read full story
Source: The Guardian, 11 September 2023
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Wait-and-see policy on heart devices puts lives at risk, says UK charity

Patients are needlessly being put at risk of dying from heart problems because they have to wait months to be fitted with lifesaving implantable defibrillators, experts have said.
Two million people in the UK live with coronary heart disease, which is a leading cause of heart failure. Those at the highest risk of dying as a result of heart failure may be offered an implantable cardioverter defibrillator device (ICD). These can kickstart the heart and may save their life.
Patients have to wait at least 90 days before they can be fitted with an ICD while doctors wait to see if stents and medication might improve their health. However, a large study funded by the British Heart Foundation suggests there is little or no benefit to waiting, and the charity says lives are needlessly being put at risk as a result.
Dr Sonya Babu-Narayan, an associate medical director at the BHF, said the results had significant implications.
“The findings suggest that the current ‘wait and see’ approach to find out whether a patient’s heart function improves with medication and stents isn’t always best, and that an unnecessary wait could even be the difference between life and death,” she said.
“The results from this large UK-wide trial could lead to re-evaluation of how best to treat people living with severe heart failure due to coronary heart disease.”
Read full story
Source: The Guardian, 11 September 2023
Patient Safety Learning

Teaching trust reviewing decisions made under Letby CEO

A trust which hired the former chief executive of the Countess of Chester Hospital as an interim CEO has launched a review of decisions about safety and whistleblowing taken under his leadership.
Jacqui Smith, chair-in-common at Barts Health and Barking, Havering and Redbridge University Hospitals trusts, made the announcement at a board meeting, following the nurse Lucy Letby’s conviction for murdering seven babies, and attempting to murder six more, during a year-long period between June 2015 and June 2016.
Tony Chambers was Countess of Chester Hospital Foundation Trust CEO for six years from December 2012 to September 2018, and resigned shortly after Letby’s initial arrest. His role – and that of fellow senior managers in Chester – in responding to concerns raised by doctors, has come under intense scrutiny since the verdicts.
Mr Chambers served as BHRUT’s interim chief from January 2020 until August 2021, and Ms Smith told BHRUT’s board: “In the light of concerns, particularly around listening to staff and patients, and given the seriousness of the events, we will undertake a look at the periods of Tony Chambers’ tenure.
“To see whether there are, firstly, any significant decisions taken regarding quality and safety that we need to look at again, and [secondly], checking our log of whistleblowing cases and other concerns to make sure that they have been appropriately followed up."
Read full story
Source: HSJ, 8 September 2023
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