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

Ministers must fix ‘vicious cycle’ of short staffing in NHS mental health care, MPs warn

NHS mental health services are stuck in a “vicious cycle” of short staffing and overwhelming pressures, a government committee has warned.
Rising demand for mental health services has “outstripped” the number of staff working within NHS organisations, according to the public accounts committee.
A report from the committee warned that ministers must act to get services out of a “doom loop” in which staff shortages is hitting morale and leading people to quit the already-stretched services.
It found staffing across mental health services has increased by 22% between 2016 and 17 and 2021 and 22 while referrals for care have increased by 44% over the same period.
Healthcare leaders warned there are 1.8 million people on the waiting list for NHS mental health care with hospital bosses “deeply concerned”.
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Source: The Independent, 21 July 2023
Sam

Trust chiefs sacked ‘only in extreme circumstances’, says government

The government has admitted that many ‘vulnerable’ hospitals ‘suffer with a lack of permanence of leadership’, but said that chiefs are only sacked by NHS England ‘in extreme and exceptional circumstances’.
The comments were included in the government’s response to the independent investigation into major maternity care failures at East Kent Hospitals University Foundation Trust, which highlighted how the practice of repeatedly hiring and firing leaders  had contributed to its problems.
The investigation said successive chairs and CEOs at the FT were “wrong” to believe it provided adequate care, and urged that they be held accountable. But it said senior management churn had been “wholly counterproductive”, and that it had “found at chief executive, chair and other levels a pattern of hiring and firing, initiated by NHS England” which would “never have been an explicit policy, but [had] become institutionalised”.
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Source: HSJ, 21 July 2023
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More than 250,000 dementia patients in England could miss new treatments

More than 250,000 dementia patients could miss out on new treatments for the disease because they do not have a formal diagnosis, according to government figures.
NHS data published for the first time shows the prevalence of different types of dementia with which people in England have been diagnosed.
Dementia is an umbrella term for many different conditions, affecting more than 55 million people worldwide.
This week, health regulators were urged to approve two new game-changing dementia drugs, after a landmark study confirmed that donanemab slowed cognitive decline in Alzheimer’s patients by 35%, while last year, a second drug, lecanemab, was found to reduce the rate by 27%.
The NHS primary care dementia figures estimate that there are about 708,000 people over 65 with dementia in England, but only about 450,000 have a recorded diagnosis. That means that more than 250,000 are missing out on these potential new treatments. 
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Source: The Guardian, 20 July 2023
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Only one in five staff at care scandal trust confident in execs

Just one-fifth of staff at a trust engulfed in an abuse scandal expressed confidence in the executive team, according to the Care Quality Commission (CQC), which has downgraded the trust and its leadership team to ‘inadequate’.
The CQC inspected Greater Manchester Mental Health Trust following NHS England launching a review into the trust in November 2022 after BBC Panorama exposed abuse and care failings at the medium-secure Edenfield Centre.
The two inspections, made between January and March 2023, which assessed inpatient services and whether the organisation was well-led, also saw the trust served with a warning notice due to continued concerns over safety and quality of care, including failure to manage ligature risks on inpatient wards.
Inspectors identified more than 1,000 ligature incidents on adult acute and psychiatric intensive care wards in a six-month period. In the year to January, four deaths had occurred by use of ligature on wards which the CQC said “demonstrated that actions to mitigate ligature risks and incidents by clinical and operational management had not been effective”.
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Source: HSJ, 21 July 2023
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Patients 'waiting for days' in Emergency Department

The Royal College of Nursing (RCN) has said patients are waiting for days in corridors at Belfast's Royal Victoria Hospital's Emergency Department.
Rita Devlin, NI director of the RCN, visited the unit on Thursday after getting calls from nursing staff.
She described the situation as "scandalous".
Speaking to Radio Ulster's Evening Extra programme, Ms Devlin said while it was the Royal Hospital on Thursday, the situation is "bad right across the EDs".
She said talking to nurses at the Royal, she was struck by "the absolute despair" some are feeling.
"I spoke to some young, newly qualified nurses who are leaving because they just can't take the stress and the pressure any more," she said.
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Source: BBC News, 20 July 2023
Patient Safety Learning

ADHD and autism campaigners plan legal action against NHS over referral limits

Campaigners are planning to launch legal action after NHS chiefs in North Yorkshire placed limits on which adults can get referrals for autism and attention deficit hyperactivity disorder (ADHD) assessments.
North Yorkshire and York Health and Care Partnerships introduced a pilot programme in March in which adults seeking an NHS assessment for autism or ADHD are triaged via an online screening tool.
NHS chiefs say this screening process prioritises those with the most severe needs, rather than processing referrals in chronological order.
These priority needs reportedly include the patient being at risk of immediate self-harm or harming others, at risk of being unable to have lifesaving hospital treatment or care placement, or an imminent risk of family court decisions being determined on diagnosis.
Those who do not meet the criteria are given guidance and signposted to other support networks.
But campaigners say that in practise that means that most people cannot get a referral for an assessment – GPs can no longer make referrals themselves.
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Source: The Big Issue, 19 July 2023
Related reading on the hub:
Long waits for ADHD diagnosis and treatment are a patient safety issue  
Patient Safety Learning

Modernisation Agency chief returns to lead improvement drive

The director of the Modernisation Agency in the early 2000s is returning to lead a new national service improvement drive, NHS England has announced, while asking systems and providers to “baseline” their improvement needs and capability.
NHSE is establishing a “national improvement board” to oversee a new improvement programme called NHS Impact, as recommended by a review last year of the current infrastructure.
NHSE announced the board will be chaired by David Fillingham, who was director of the NHS Modernisation Agency from 2001-2004 where, NHSE said, “he focused on developing new practices and fostering leadership development”. 
The national improvement board will choose a small number of improvement priorities to be followed across national bodies and the wider health service. It will “set the direction of system wide improvement” through “collaboration and co-design,” NHSE said.
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Source: HSJ, 19 July 2023
Patient Safety Learning

System admits 10-year diagnostic waits

Adults across an integrated care system area are facing ‘unacceptable’ 10-year waits for an NHS assessment for attention deficit hyperactivity disorder, the longest known wait for such services in England.
Herefordshire and Worcestershire integrated care board has warned in board papers of “exceptionally high waiting times for ADHD assessment and treatment for Worcestershire patients (10 years+), with workforce challenges and service fragility compromising service delivery”.
HSJ understands the long waits for ADHD diagnosis, which is a national problem, is predominately affecting adults with approximately 2,000 people on Herefordshire and Worcestershire’s ADHD list alone.
Local provider Herefordshire and Worcestershire Health and Care Trust also warned on its website that its paediatric services were also “experiencing unprecedented demand”.
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Source: HSJ, 19 July 2023
Patient Safety Learning

Adoption of AI in the NHS should be faster, experts say

The adoption of artificial intelligence (AI) by the NHS should be faster, and more frameworks should be in place to get emerging technologies to as many patients as possible, experts have told MPs.
A number of senior figures from medicine and biotechnology gave evidence to the Health and Social Care Committee as part of its inquiry into cancer technology.
Stephen Duffy, a professor of cancer screening at the Wolfson Institute of Population Health at Queen Mary University of London, told MPs there is “strong potential” for AI, particularly in areas such as reading mammograms for the breast screening programme.
However, he warned that there will be “staff issues in terms of the number of staff needed to double-read mammograms”.
He added: “Those issues aren’t going away. It seems to me that AI systems have already been shown to be very good in terms of detection of cancer on from mammograms, so they’re safe in that respect.
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Source: The Independent, 19 July 2023
Sam

Service ‘collapses’ after department left with ‘no doctors’

A trust has been accused of presiding over the deterioration of a key service amid communication problems between senior leaders and a ‘worrying series of resignations’ which has left the department with ‘no doctors’.
The British Association of Dermatologists wrote to Worcestershire Acute Hospitals Trust on 13 July to request an urgent meeting with the provider’s management to discuss the matter.
The letter, seen by HSJ, outlines fundamental patient safety and staffing concerns about the trust’s dermatology service and accuses the trust of putting “continued communication barriers” between clinicians and management.
The letter, signed by BAD president Mabs Chowdhury, says there are now “no doctors in the department” after two consultants and a locum consultant resigned “due to apparent unhappiness with the running of services [and in] a continuation of a worrying series of resignations”.
Read full story (paywalled)
Source: HSJ, 19 July 2023
Sam

Regulatory ‘burden’ has increased despite promises, say trust leaders

The majority of trust leaders have reported an increase in the ‘burden’ put on them by regulators, citing more demanding ‘ad hoc’ requests during heightened operational pressure.
In NHS Providers’ latest survey of NHS trust leaders’ experiences of regulation, a little over half of respondents – 52% – said the burden from NHS England and the Care Quality Commission had increased in the past year.
The percentage was higher among acute/community and community trusts, and all ambulance and specialist trust respondents said the burden had increased. 
An even higher overall share of trusts – 59% – said “ad hoc requests” from regulators had increased during the same time period. This includes requests for information or meetings at short notice, diverting staff from day-to-day operational duties.
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Source: HSJ, 20 July 2023
Sam

Covid Inquiry: Bodies were treated like toxic waste, says daughter

The bodies of people who died with Covid were treated like "toxic waste" and families were left in shock, a bereaved woman has told the inquiry.
Anna-Louise Marsh-Rees said her father Ian died "gasping for breath" after catching the virus while in hospital.
Ms Marsh-Rees, who leads Covid-19 Bereaved Families for Justice Cymru, said he was "zipped away", and his belongings put in a Tesco carrier bag.
Ian Marsh-Rees died after catching the virus while in hospital, aged 85. His daughter said finding information regarding his care in hospital and how he became infected was "almost like an Agatha Christie mystery".
She said no GP ever suggested he might have Covid, although she now knows his discharge notes said he had been exposed to Covid.
"It wasn't until we saw his notes some months later that we saw the DNA CPR (do not attempt CPR) placed on him, and this was without consultation with us," she said.
"It kind of haunts us all that… people used to say 'well they're in the right place' when they go to hospital. I'm not sure they would say that any more," Ms Marsh-Rees said.
She now wants to change the way deaths are handled by health boards. She said it was important to prepare families before and support them after the death of a loved one, from palliative care to dignity in death.
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Source: BBC News, 18 July 2023
Patient Safety Learning

Just one-fifth of staff speak up in trust’s internal inquiry

Just one in five staff who were approached in a trust’s internal inquiry – prompted by an undercover broadcast raising serious care concerns – engaged with the process, a report has revealed. 
Essex Partnership University Foundation Trust said it took “immediate action” to investigate issues highlighted in a Channel 4 Dispatches programme into two acute mental health wards last year. This included speaking to staff identified as a high priority in the investigation. 
However, a new Care Quality Commission report has revealed, of the 61 staff members the trust approached, only 12 engaged with the process. 
Read full story (paywalled)
Source: HSJ, 19 July 2023
Patient Safety Learning

NHS is ‘tech averse healthcare system’, says ex-government adviser

A cut to the NHS tech budget, revealed by HSJ, has been described as “pretty outrageous” by a former government adviser and eminent medical leader.
Sir John Bell, an immunologist and geneticist and regius chair of medicine at Oxford University, made the comments in a talk at the Tony Blair Institute’s Future of Britain conference.
NHSE’s cut to its tech budget was attributed to having to divert the money to fund spending growth, and some other inflationary costs, without receiving extra from government. At the time, NHSE said the service “remains firmly committed to our digital strategy from supporting hospitals to adopt electronic patient record systems to transforming how patients access NHS services through the NHS App”.
But Sir John said: “The NHS is a technology averse healthcare system.”
He said NHS spending on medicines was “much lower than peers and if you look at our access to technology – like MRI and CR scanners – we’re right at the back. We just don’t do it.”
He added that rapid tech development and adoption was needed particularly to enable mass early diagnosis of diseases, and new treatment therapies.
Read full story (paywalled)
Source: HSJ, 18 July 2023
Patient Safety Learning

Children waiting over a year in pain for NHS tooth removal

Children in some areas of England are waiting up to 18 months on average for dental general-anaesthetic treatment and teeth extractions, an investigation reveals.
Some have been left with prolonged dental pain, according to information shared with BBC News.
The parents of one girl who has waited three years for extractions say the pain keeps her up at night.
At the start of this year, more than 12,000 under-18s were on waiting lists for assessment or treatment at community dental service (CDS) providers, data obtained by the Liberal Democrats from the NHS Business Services Authority and shared with BBC News earlier this year reveals.
Children are referred to a CDS provider when they have tooth decay too severe to be treated in general practice.
They also treat those with physical or learning disabilities when general practice is not a practical option.
The longest average wait faced by children for general-anaesthetic treatment at a CDS provider is 80 weeks, at Harrogate and District NHS Foundation Trust.
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Source: BBC News, 19 July 2023
Patient Safety Learning

Maternity unit refutes suggestion it breached safety standards

The trust at the centre of a maternity scandal insists it has been providing immediate anaesthetic cover for obstetric emergencies, contrary to an NHS England report suggesting it had not and had been potentially breaching safety standards.
Health Education England – now part of NHSE – visited William Harvey Hospital in March and was told senior doctors in training who were covering obstetrics could also be covering the cath lab – which deals with patients who have had a heart attack, and could receive trauma, paediatric emergency and cardiac arrest calls. This suggested the trust was in conflict with Royal College guidelines which state an anaesthetist should always be “immediately available” for obstetrics. 
East Kent Hospitals University Foundation Trust, which runs the hospital, originally told HSJ its rota had very recently been changed and that an anaesthetist with primary responsibility for maternity could leave any other work to attend to a maternity emergency immediately. However, it has since said it has been the case for a long time that an anaesthetist is available to return to maternity in case of an emergency. 
Read full story (paywalled)
Source: HSJ, 17 June 2023
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