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

Hundreds died on same day as being discharged, trust review finds

An independent review has raised concerns about a mental health trust’s reporting systems and has highlighted a significant number of patient deaths shortly after leaving the trust’s care, including almost 300 who died on the same day they were discharged. 
However, the review into how Norfolk and Suffolk Foundation Trust collects, processes and reports mortality data made no conclusions on the number of avoidable deaths – the issue which had originally prompted the probe. 
Local NHS leaders argued the review’s purpose was focused on auditing the trust’s processes, and this had been delivered. But a local MP, Clive Lewis, accused it of “explicitly dodg[ing] the big questions”. 
The report, which looked at data from between April 2019 and October 2022, has however raised concerns about the number of patients dying soon after being discharged.
Read full story (paywalled)
Source: HSJ, 28 June 2023
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NI’s £800m use of prescribed medicines higher than anywhere else in UK

Northern Ireland’s chief pharmaceutical officer has said that the use of prescribed medicines and the associated costs remains too high, exceeding £800m a year.
In a blog to reflect on the 75th anniversary of the NHS, Professor Cathy Harrison added that medicine costs in NI are the second largest single investment made in the health service, after staff.
“The average number of prescription items a year is 21 per person, at a cost of £227. This cost is the highest in the UK and the volume of prescription items is still rising each year,” she said.
“There is an uncomfortable truth that manifests in the prescribing data for medicines. In Northern Ireland, we continue to use more of almost every type of medicine than other parts of the UK.
“That includes more antibiotics, more painkillers, more baby milks, more nutritional supplements, even more oxygen.”
Read full story
Source: Belfast Telegraph, 27 June 2023
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UK risks becoming reliant on overseas care workers, report warns

The UK risks becoming highly reliant on overseas care workers after nearly 58,000 visas were issued for the sector last year, a report says.
Analysis by the Migration Observatory at the University of Oxford found that the demand for foreign staff had left the NHS and care homes open to “vulnerabilities” including “exposure to international competition for health workers and risks of exploitation”.
The study, commissioned by the employment group ReWAGE, also examined where care workers were coming from. In 2022, 99% of care workers sponsored for work visas in the UK were from non-EU countries. The top countries were India (33%), Zimbabwe (16%), Nigeria (15%) and the Philippines (11%).
Dr Madeleine Sumption, the director of the Migration Observatory, said: “Health and care employers have benefited a lot from international recruitment.
“But relying this much on overseas recruits also brings risks. For example, care workers on temporary visas are vulnerable to exploitation and the rapid growth in overseas recruitments makes monitoring pay and conditions a real challenge.”
Read full story
Source: The Guardian, 27 June 2023
Patient Safety Learning

USA: Number of health systems allegedly denying care to indebted patients grows

Recently Minneapolis-based Allina Health was highlighted by The New York Times for pulling back from its policy of denying nonemergency care to some indebted patients. However, a recent investigation showed it is not the only health system to allegedly have engaged in the practice.
According to KFF Health News, about 20% of US nationwide hospitals in a random sample pursued similar policies of care denial.
The Lown Institute went further, naming major health systems including Rochester, Minn.-based  Mayo Clinic, St. Louis-based Ascension, Indianapolis-based Indiana University Health, Livonia, Mich.-based Trinity Health and Los Angeles-based Cedars-Sinai as operating facilities where the practice is followed.
IU Health, Ascension, Trinity Health and Cedars-Sinai denied they have such practices.
"We do not restrict medically necessary non-emergency care for patients with unpaid bills," an Ascension spokesperson said.
Read full story
Source: Becker Hospital Review, 26 June 2023
Patient Safety Learning

The stubborn regional variation in early cancer detection

The gap between the areas with the best and worst records on the early detection of cancer has remained almost unchanged over the past five years, new NHS England data indicates.
The proportion of cancers detected at stages one and two – when they are more curable – has improved by 2.7 percentage points to 58.1% nationally, but this masks significant regional variation.
In the 12 months to February 2019, the percentage point difference between the top performing cancer alliance – Thames Valley (63.1%t) – and the worst performing – Lancashire and South Cumbria (51.6%) – was 11.5.
Read full story (paywalled)
Source: HSJ, 27 June 2023
 
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U.S. News & World Report's best children's hospitals 2023-24 honor roll

U.S. News & World Report's Best Children's Hospital list for 2023-2024, released 21 June, said 11 children's hospitals are at the top of their game when it comes to 10 pediatric specialties. This year, 11 children's hospitals are included on this list due to a tie in the diabetes and endocrinology category.
U.S. News gathered subjective data from more than 15,000 pediatric specialists and clinical data from close to 200 children's hospitals to develop its Best Children's Hospitals 2023-2024 listings. 
For the first time, Cincinnati Children's Hospital Medical Center took the top spot on the list. The hospital has the only level 4 neonatal intensive care unit, which offers care to infants at all level 3 NICUs in the area. The hospital discovered a "super antibody" it believes will inform new vaccines and offered a specialized approach to reduce stays in the NICU for opioid-exposed newborns.
Steve Davis, MD, president and CEO: "This distinction only confirms what we have always known — that we have outstanding, talented team members who are unmatched in their dedication to ensuring that all children have access to exceptional care."
Read full story
Source: Becker's Hospital Review, 23 June 2023
Patient Safety Learning

Bereaved call for body to enforce coroners’ advice

Relatives of a teenage rape survivor who died after failures by mental health services are joining other families to demand a new body to enforce coroners’ recommendations to prevent future deaths.
Campaigners claim the failure to act on hundreds of coroners’ recommendations every year, and to learn from the findings of often expensive inquiries into disasters, means the same mistakes are being repeated.
Gaia Pope, 19, was diagnosed with post-traumatic stress disorder after revealing that she had been drugged and raped when she was 16. She was found dead in undergrowth on a cliff 11 days after disappearing in Swanage, Dorset, in 2017.
After one of the longest inquests in legal history, the coroner, Rachael Griffin, made multiple reports last year to authorities including the NHS and police to prevent future deaths, but Pope’s family says most have not been acted upon.
The Inquest campaign, which works with families bereaved by state-related deaths, is calling for a “national oversight mechanism” to collate recommendations and responses in a new national database, analyse responses from public bodies, follow up on progress and share common findings.
Read full story (paywalled)
Source: The Times, 27 June 2023
Patient Safety Learning

Health service chief critical of Covid-19 ‘Protect the NHS’ slogan

The head of NHS England was critical of the government’s slogan urging people to “protect the NHS” at the start of the Covid pandemic, amid concerns it would stop people coming forward for much-needed treatment.
Simon Stevens, who led the NHS until July 2021, was one of the slogan’s “greatest critics” and was not involved in the government discussion that led to the phrase being deployed.
“It was a tremendously powerful slogan,” writes journalist Isabel Hardman in Fighting for Life: The Twelve Battles That Made Our NHS, and the Struggle for Its Future.
“It was popular in government – but not universally so. In fact, one of its greatest critics was Simon Stevens. Stevens wasn’t on the calls where [government advisers] came up with ‘Protect the NHS’, and initially he complained in private that it gave the impression that the public was there for the health service – not the health service being there for the public.
“Either way, the focus quickly became about the importance of ‘protecting the NHS’. But there was never a clear definition of what it was being protected from.”
Later in 2020, Lord Stevens referred to his concerns about the slogan, writing: “Rather than say ‘Protect the NHS’, health service staff prefer to say: ‘Help us help you’.”
Senior NHS figures also attempted to battle against the slogan from the spring of 2020, urging patients to come forward as normal.
Read full story
Source: The Guardian, 25 June 2023
Patient Safety Learning

AI cuts treatment time for cancer radiotherapy

A new type of artificial-intelligence technology that cuts the time cancer patients must wait before starting radiotherapy is to be offered at cost price to all NHS trusts in England.
It helps doctors calculate where to direct the therapeutic radiation beams, to kill cancerous cells while sparing as many healthy ones as possible.
Researchers at Addenbrooke's Hospital trained the AI program with Microsoft.
For each patient, doctors typically spend between 25 minutes and two hours working through about 100 scan cross-sections, carefully "contouring" or outlining bones and organs. But the AI program works two and a half times quicker, the researchers say.
When treating the prostate gland, for example, medics want to avoid damage to the nearby bladder or rectum, which could leave patients with lifelong continence issues.
Read full story
Source: BBC News, 27 June 2023
Patient Safety Learning

Black patients worst affected by 2016 junior doctors’ strike

Black patients at trusts most affected by 2016’s junior doctors’ strike suffered significantly more than their white or Asian counterparts, a new analysis has suggested.
Research by the Institute for Fiscal Studies analysed 30-day readmission rates after the 48-hour junior doctors’ strike in April 2016.
The co-authors of the research, George Stoye and Max Warner, said: “We find that patients treated in hospitals that were more exposed to the strike did not, on average, experience worse outcomes.”
However, they added that black patients were “more negatively affected by exposure to the strikes than white patients in the same hospitals”. The April 2016 strike affected both elective and emergency care and was the last before the dispute ended. 
The current junior doctors’ strike has been ongoing since March. It also affects emergency and elective care but stoppages have been longer, with a five-day strike planned in July.
Read full story (paywalled)
Source: HSJ, 27 June 2023
Patient Safety Learning

NHS may have missed thousands of deaf children in ‘huge national failure’

NHS trusts across England are scrambling to trace thousands of children for urgent hearing tests amid fears that cases of infant deafness may have been missed for years.
An internal NHS report has exposed poor-quality testing within paediatric audiology departments at five hospitals and warned of systemic failings. At another NHS trust, almost 1,500 children were found to have missed out on appointments dating back to 2012. 
Vital quality inspections of departments checking infants for hearing loss were stopped ten years ago. Whistleblowers who previously worked for the NHS’s newborn hearing screening programme have revealed that concerns were raised shortly before they were told to stop carrying out checks.
They say that thousands of children may have been mistreated for deafness and hearing loss in the past decade.
Read full story (paywalled)
Source: The Times, 25 June 2023
Sam

NHS not ministers should decide future ‘new hospitals’, says DHSC chief

A permanent change in approach is needed for deciding which hospitals are built and  when, and should be led by the NHS not politicians, the government’s ‘new hospitals programme’ boss has told HSJ.
Natalie Forrest, who is leading the government’s drive to build “40 new hospitals” by 2030, said the service must move beyond political targets, and towards the NHS having more autonomy to work through a list of rebuilds needed. 
Ms Forrest, who has led the programme since 2021, said: “There shouldn’t be a special group that are getting rebuilt, and everyone else has to watch from the sidelines.” 
The former Chase Farm Hospital chief said she believed this was now the direction of travel, and that a commitment from ministers for a “rolling programme” beyond 2030 represented the “biggest success [for the NHP] so far”. 
Read full story (paywalled)
Source: HSJ, 26 June 2023
Patient Safety Learning

All people in England who have smoked to be offered middle-age lung screening

Everyone who has ever smoked in England is to be offered lung screening in middle age under plans to detect and treat cancer earlier.
Lung cancer kills about 35,000 people every year, and is the most common cause of cancer death in the UK, accounting for one in five. It also has one of the worst cancer survival rates, which is largely attributed to diagnoses at a late stage when treatment is less likely to be effective.
Millions of people will be invited for lung checks in an effort to improve survival rates. About a million screenings of people aged 55 to 74 will be carried out every year under the programme.
It follows a successful pilot of the scheme in deprived areas of the country where people are four times more likely to smoke. It resulted in more than 2,000 people being detected as having cancer, 76% of them at an earlier stage compared with 29% outside the programme in 2019.
“Identifying lung cancer early saves lives, and the expansion of the NHS’s targeted lung health check programme is another landmark step forward in our drive to find and treat more people living with this devastating disease at the earliest stage,” said the chief executive of NHS England, Amanda Pritchard.
Read full story
Source: The Guardian, 26 June 2023
Patient Safety Learning

NHS plans: Sunak says expansion means 'more doctors, nurses, and GPs'

The NHS is set to undergo the "largest expansion in training and workforce" in its history, Rishi Sunak has said.
Speaking to the BBC, the prime minister said the plans would reduce "reliance on foreign-trained healthcare professionals".
It comes at a time of record-high waiting lists in the NHS and junior doctors set to stage a five-day strike next month.
The full plans are expected to be published next week.
Pressed about the length of time it would take to see the results of the changes, Mr Sunak accepted it could take "five, ten, fifteen years for these things to come through", but that did not mean it was not the right thing to do.
Read full story
Source: BBC News, 25 June 2023
Patient Safety Learning

NHS’s mounting failures and political neglect laid bare in sobering report

What would the NHS see if it looked in a mirror, asks Siva Anandaciva, author of the King’s Fund’s study comparing the health service with those of 18 other rich countries, in the introduction to his timely and sobering 118-page report.
The answer, he says, is “a service that has seen better days”.
Britons die sooner from cancer and heart disease than people in many other rich countries, partly because of the NHS’s lack of beds, staff and scanners, a study has found.
The UK “underperforms significantly” on tackling its biggest killer diseases, in part because the NHS has been weakened by years of underinvestment, according to the report from the King’s Fund health thinktank. It “performs poorly” as judged by the number of avoidable deaths resulting from disease and injury and also by fatalities that could have been prevented had patients received better or quicker treatment.
The comparative study of 19 well-off nations concluded that Britain achieves only “below average” health outcomes because it spends a “below average” amount for every person on healthcare.
Read full story
Source: The Guardian, 26 June 2023
Patient Safety Learning

Major study will use philosophical expertise to highlight patient voices in healthcare research and practice

A new six-year study, which aims to prevent the ‘silencing’ of patient voices and improve patient trust in the healthcare system, is due to begin thanks to a major funding award
Researchers at the University of Nottingham, University of Bristol and University of Birmingham have received a £2.6M Wellcome Discovery Grant for the 'Epistemic Injustice in Healthcare (EPIC)’ project. The study will use philosophical expertise to explore forms of 'silencing'.
Patients regularly report that their testimonies and perspectives are ignored, dismissed or explained away by the healthcare profession. These experiences are injustices because they are unfair and harmful - and philosophers call them ‘epistemic injustices’ because they jeopardise patient care and undermine trust in healthcare staff and systems.
By studying these epistemic injustices, EPIC will find ways to correct them and improve the relationship between patients and healthcare practitioners.
"Patients have long reported feeling ignored, dismissed, or silenced in ways that jeopardise their care and intensify their suffering. The challenge is to understand how this silencing happens and what can be done about it, in ways that can help patients and healthcare practitioners alike. The NHS is right to seek 'patient perspectives' and listen to 'patient voices'. Project EPIC will help them to do that better by fully diagnosing the causes of that silencing." Dr Ian James Kidd, EPIC Co-Investigator & Assistant Professor in the Department of Philosophy.
Read more
Source: University of Nottingham
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