Skip to content

News

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

We need to be ‘really thoughtful’ about intervening with ICSs

NHS England needs to be ‘really thoughtful’ about how and when it intervenes as powers are devolved from the centre to integrated care systems, NHSE’s chief executive has said.  
Following her keynote speech at NHS ConfedExpo in Manchester today, Amanda Pritchard was asked about “her vision for the future” devolving powers to Integrated Care Systems (ICSs) as part of the NHS reforms and if “it changes the way leaders should behave”.
Ms Pritchard admitted “earned autonomy” in relation to ICSs – a phrase she has previously used but has jarred with many local leaders – was “not quite the right phrase”.
“It feels like we’re using yesterday’s language for today’s ways of working. I know it’s not quite the right word, but I can’t think of a better one at the moment,” she said.
“What I am asking my own organisation to do, is make sure that we are really thoughtful about all of those different things that we do, and we are increasingly really intentional about which of those [tools] you can use in different circumstances [in regards to performance and accountability].”
Read full story
Source: HSJ, 14 June 2023
Patient Safety Learning

‘Many, many’ Australian doctors advertising as general physicians without required qualifications

Some doctors in Australia are using the title “specialist general physician” despite not having completed the training required by law, potentially misleading patients with complex and chronic health conditions that require specialised care, physicians say.
After completing a medical degree and postgraduate work experience, graduates can apply to the Royal Australasian College of Physicians (RACP) fellowship training program. All RACP trainees complete similar foundational training before choosing areas of advanced training to specialise in such as geriatrics, cardiology, general medicine or other areas.
General physicians are different from general practitioners (also known as GPs). General physicians care for patients with unusual or complex conditions and see patients either in hospital or those who are referred to them, usually by the patient’s GP.
Medical practitioners can only use titles such as “specialist general physician”, “specialist geriatrician” or “specialist cardiologist” if they have completed the advanced specialist RACP training in the corresponding field of practice and have registered with the Australian Health Practitioner Regulation Agency (Ahpra).
But Dr Jenna Paterson, a specialist general physician working in Victoria and South Australia, said there are “many, many” doctors who advertise their services to patients as a “general physician” without the qualifications to do so.
Read full story
Source: The Guardian, 13 June 2023
Patient Safety Learning

Antidepressants can cause 'chemical castration'

Antidepressants can cause severe, sometimes irreversible, sexual dysfunction that persists even after discontinuing the medication. 
Sufferers have described it as ‘chemical castration’ – a type of genital mutilation caused by antidepressants, mainly selective serotonin reuptake inhibitors (SSRIs).
The condition is known as post-SSRI sexual dysfunction (PSSD), a condition largely unrecognised, and the true incidence of which is unknown.
David Healy, psychiatrist and founder of RxISK.org said, “I saw my first patient with PSSD in 2000, a 35-year-old lady who told me that three months after stopping treatment, she could rub a hard-bristled brush across her genitals and feel nothing.”
David Healy, psychiatrist and founder of RxISK.org said, “I saw my first patient with PSSD in 2000, a 35-year-old lady who told me that three months after stopping treatment, she could rub a hard-bristled brush across her genitals and feel nothing.”
Josef Witt-Doerring, psychiatrist and former FDA medical officer said, “This condition is so devastating that it will cause serious changes to your life and to those around you.”
Read full story
Source: Maryanne Demasi, 13 June 2023
Sam

New triage policy implicated in 44-year-old’s death

An ambulance service says it has sped up clinical review of lower-priority calls, after a coroner said the new triage process — introduced in response to recent waiting time pressures — ‘will lead to further deaths’.
The coroner raised concerns with West Midlands Ambulance Service after a type 1 diabetic patient died following a long delay in deciding whether to send an ambulance.
Following a pilot in July 2021, all category 3 and 4 incidents at WMAS, except for a predefined list of exceptions, are sent directly to the trust’s “clinical validation team” to triage patients, with the aim of reducing the need for ambulance call-outs. It is thought a similar approach has been introduced across England since covid, as there have been huge pressures on ambulance capacity.
But coroner Emma Serrano has raised concerns about the process in a prevention of future deaths report published this week.
The inquest was told that Ms Finch waited 10 hours for her call to be “clinically assessed” and an ambulance call-out approved as the validation team was “under-staffed”. The PFD report also said that there was “no time limit” for assessments to take place, and no prioritisation system.
Read full story (paywalled)
Source: HSJ, 14 June 2023
Patient Safety Learning

Lords to investigate private health firms used to deliver NHS drugs

Peers are launching an inquiry into private health companies paid millions of pounds to courier NHS medicines in England, after the Guardian exposed how sick children and adults were being harmed by botched, delayed or missed deliveries.
The House of Lords public services committee will examine “the extent of the problems in homecare medicine services”, and the impact on patients, clinicians and the wider health service. More than 500,000 patients and their families rely on private companies contracted by the NHS to deliver essential medical supplies and care to their homes.
A Guardian investigation revealed how Sciensus, Britain’s biggest provider of homecare medicines services, has struggled to provide a safe or reliable service. Seriously ill children as young as four have been let down, with some becoming sicker because of failings by the company.
Patients and medics have complained to Sciensus and to regulators, but little has changed.
Read full story
Source: The Guardian, 13 June 2023
Patient Safety Learning

Trust insists ‘our data is correct’ despite waiting list ‘grip’ concerns

An external review of waiting list management at a large acute trust has found several serious problems – including ‘pop-up’ patients and thousands of cancelled appointments each week – but concluded they were no worse than would be found at ‘most NHS trusts’.
The review appears to have been triggered after University Hospitals of the North Midlands declared unexpected increases in the number of 78-week and 104-week waiters earlier this year, while the government and NHS England have been intensively performance managing these measures.
The independent report by independent consultant Wendy Baines states: “The review found no evidence of deliberate irregularities in the management of waiting times.
“Although as the case for most NHS trusts, the capacity to misrepresent the ‘true’ volume of waiters at a certain point in time is significant.
“Managing this risk by minimising the capacity for errors through training, the right pathway administration systems and tools, and the ability to monitor data quality through a defined set of process assurance measures is key. Whilst UHNM possesses these components, they are not necessarily working in cohesion to provide the assurance and oversight needed to manage patient waiting times.”
Read full story (paywalled)
Source: HSJ, 13 June 2023
Patient Safety Learning

Many more women now beating early breast cancer

Most women with early breast cancer now beat the disease thanks to huge improvements in treatments in recent years, a BMJ analysis has found.
Their risk of dying within five years of diagnosis is estimated to be around 5% - down from 14% in the 1990s.
The BMJ analysis tracked more than half a million women with early, invasive breast cancer - mostly stage one and two - diagnosed in the 1990s, 2000s and between 2010 and 2015.
It found the prognosis for nearly all women "has improved substantially since the 1990s", with most becoming long-term cancer survivors.
And based on those trends, the researchers behind the Oxford University-led study say women diagnosed today also have a much lower risk.
"That's good news - and reassuring for clinicians and patients," oncologist and lead researcher Prof Carolyn Taylor says.
Cancer Research UK says this offers "reassurance" to many women but warns more highly-trained staff are needed to meet rising demand.
Read full story
Source: BMJ, 14 June 2023
Patient Safety Learning

Whistleblowing surgeon quits profession over fear of being “hunted” by NHS

A campaigning whistleblowing surgeon who wrote two books about his experiences has decided to leave the medical profession out of fear that he is being “hunted” by the NHS.
Peter Duffy, a consultant urologist, is quitting work several years earlier than planned and intends to remove his name from the medical register. After a two year investigation the General Medical Council has decided to take no action against him. But he told The BMJ that he is worried that, after several investigations into his conduct, he remains vulnerable as long as he stays on the register.
Duffy, 61, who blew the whistle on patient safety issues at University Hospitals of Morecambe Bay NHS Foundation Trust’s urology department, left the NHS nearly seven years ago. He claimed he was forced to resign from the trust for his own protection and won a claim for unfair constructive dismissal in 2018, when the trust was ordered to pay him £102 000 in compensation.
Read full story (paywalled)
Source: BMJ, 12 June 2023
Patient Safety Learning

Health officials ‘ignored evidence of non-Covid deaths’ during lockdown

The Covid inquiry is being urged to investigate if health officials dismissed evidence of collateral deaths during lockdown after a whistleblower claimed that pathologists’ concerns were shut down.
As the inquiry prepares to hold its first full public hearing this week, Prof Sebastian Lucas, who worked as a consultant pathologist at St Thomas’ Hospital in London, claimed that PHE was not interested in what he described as “collateral deaths”.
Prof Lucas wrote to Prof Kevin Fenton, the director of PHE London, on behalf of the London Inner South Jurisdiction Pathology Advisory Group. 
He approached the agency in January 2021 as the UK entered its third lockdown, warning that collateral deaths as a result of the pandemic had not been recorded properly.
The group, which was headed up by a coroner, had identified several deaths that would not have happened had the NHS been functioning as normal. This included people who did not want to bother the doctor or who took their own lives because of lockdowns.
Read full story (paywalled)
Source: The Telegraph, 10 June 2023
Patient Safety Learning

How chatbots are helping doctors be more human and empathetic

Despite the drawbacks of turning to artificial intelligence in medicine, some US physicians find that ChatGPT improves their ability to communicate with patients.
Last year, Microsoft and OpenAI released the first free version of ChatGPT. Within 72 hours, doctors were using the artificial intelligence-powered chatbot.
Experts expected that ChatGPT and other A.I.-driven large language models could take over mundane tasks that eat up hours of doctors’ time and contribute to burnout, like writing appeals to health insurers or summarising patient notes. However, they found that doctors were asking ChatGPT to help them communicate with patients in a more compassionate way.
Dr Michael Pignone, the chairman of the department of internal medicine at the University of Texas at Austin, has no qualms about the help he and other doctors on his staff got from ChatGPT to communicate regularly with patients.
However, skeptics like Dr Dev Dash, who is part of the data science team at Stanford Health Care, are so far underwhelmed about the prospect of large language models like ChatGPT helping doctors. In tests performed by Dr Dash and his colleagues, they received replies that occasionally were wrong but, he said, more often were not useful or were inconsistent. If a doctor is using a chatbot to help communicate with a patient, errors could make a difficult situation worse.
Read full story (paywalled)
Source: New York Times, 12 June 2023
Patient Safety Learning

World's Best Hospitals 2023

These are challenging times for hospitals. Covid-19 put unprecedented stress on health systems, as have inflation and global financial uncertainty. In the USA and around the world, leading hospitals are dealing with rising costs, aging populations and a medical workforce exhausted from battling a global pandemic.
Among the hallmarks of great hospitals, however, are not just first-class care, first-class research and first-class innovation. The very best institutions also share another quality: consistency. The world's best hospitals consistently attract the best people and provide the best outcomes for patients as well as the most important new therapies and research. Of all the hospitals in the world, relatively few can do all those things year in and year out. 
To recognise them, Newsweek and global data firm Statista have put together their fifth annual listing of the World's Best Hospitals 2023. This year, they have ranked over 2,300 hospitals in 28 countries, including one that is new to the list, Taiwan. For the first time, they have ranked all top 250 global hospitals. They have listed the best hospitals by country; each country list also includes a listing of top specialty hospitals.
Read full story
Source: News Week
Patient Safety Learning

Maternity failures behind most big NHS payouts

More than three quarters of all multimillion-pound NHS medical negligence payouts are the consequences of failures in maternity care, new figures show.
In total, 364 patients or families received the highest-value compensation payments of at least £3.5 million after suing the NHS last year. Of those, 279 (77%) were maternity-related damages, according to figures from NHS Resolution. The large payouts have been offered to parents whose babies were stillborn or suffered avoidable life-changing disabilities or brain injuries.
Maternity makes up the bulk of NHS compensation payments. There were more than 10,000 clinical negligence claims brought against the NHS in 2021-22, with a total value of more than £6 billion. Maternity accounted for 62% of payments, or £3.74 billion.
When taking into account all cost of harm, including future periodic payments and legal costs, the cost of compensating mothers and their families rises to £8.2 billion a year. Analysis by The Times Health Commission found that this is more than twice the £3 billion spent by the NHS annually on maternity and neonatal services. Maternity claims have increased during the past decade amid a string of high-profile scandals and a shortage of midwives.
Read full story (paywalled)
Source: The Times, 12 June 2023
Patient Safety Learning

Covid inquiry prepares for first hearing after 220,000 deaths

More than three years after Boris Johnson announced a nationwide lockdown, the Covid investigation will cover every aspect of the UK’s pandemic response.
More than three years after the first lockdown began, two years after the last one ended, the public hearings are at last starting. Over the months that come the inquiry will have many questions to answer. Should we have locked down earlier? Should we have not locked down at all? Did we eat out to help restaurants out, or eat out to help the virus out? Could more have been done to protect care homes from infection? Should more have been done to protect residents from loneliness?
Baroness Hallett, the judge presiding, said her chief role is “to determine whether [the] level of loss,” in the broadest sense of the word, “was inevitable or whether things could have been done better”.
Read full story (paywalled)
Source: The Times, 13 June 2023
Patient Safety Learning

Three-day strike by doctors in England expected to have ‘enormous impact’

Almost all routine NHS care in England will be disrupted for three days this week when junior doctors strike in their latest attempt to force ministers to increase their pay.
Prof Stephen Powis, NHS England’s national medical director, said the stoppage would have an enormous impact and lead to huge numbers of patients missing out on planned care.
Many thousands of junior doctors are due to stage a 72-hour walkout starting at 7am on Wednesday and continuing until 7am on Saturday.
“The NHS has been preparing extensively for this next set of strikes,” said Powis. “But we know that – with the sheer number of appointments that need to be rescheduled – it will have an enormous impact on routine care for patients and on the waiting list, as procedures can take time to rearrange with multiple teams involved.”
Read full story
Source: The Guardian, 13 June 2023
Patient Safety Learning

Twenty-four UK doctors in five years censured over medical record breaches

Twenty-four doctors have been disciplined by the UK medical regulator in the last five years after accessing and using information from patients’ treatment records without good reason.
The General Medical Council (GMC) said it had struck off two of the 24 doctors it had sanctioned after finding that they had undertaken “inappropriate use” of medical records.
Another 10 were suspended, 10 were warned about their future conduct, one had a condition imposed on their licence to practise medicine and the other had to undertake not to repeat their behaviour.
The 24 cases were among 194 incidents of doctors allegedly accessing medical records without a clinical justification that prompted a complaint to the regulator between 2017 and 2022.
Privacy campaigners said it was shocking that almost 200 people had made complaints to the GMC accusing doctors of violating patients’ confidentiality in that way.
Read full story
Source: The Guardian, 13 June 2023
Patient Safety Learning

Hitting elective target ‘not in NHS’s control’, Sunak warned

The NHS Confederation chief says he will this week demand clarity about Rishi Sunak’s flagship waiting list reduction target, warning it may not be ‘the most sensible target [or] within the service’s control’.
Matthew Taylor also reflected in an exclusive interview with HSJ about a “pretty bruising” recent planning round for 2023-24.
Speaking ahead of the conference, which starts this week, he said he would ask Steve Barclay for “clarity” about “what exactly the government means when it talks about reducing waiting lists”.
The prime minister’s waiting list pledge is one of his frequently-referenced five priorities, which when he set them out in January stated: “NHS waiting lists will fall and people will get the care they need more quickly.”
But Mr Taylor said yesterday: “It’s a bit unclear to me… Does it mean the overall waiting list? Does it mean long waiters? And what about the other waiting lists that we don’t talk about [like psychiatric care for children]?”
Read full story (paywalled)
Source: HSJ, 13 June 2023
Patient Safety Learning
Registered address: Patient Safety Learning, China Works SB203, 100 Black Prince Road Vauxhall, London, SE1 7SJ

Account

Navigation

Search

Search

Configure browser push notifications
Chrome (Android)
  1. Tap the lock icon next to the address bar.
  2. Tap Permissions → Notifications.
  3. Adjust your preference.
Chrome (Desktop)
  1. Click the padlock icon in the address bar.
  2. Select Site settings.
  3. Find Notifications and adjust your preference.