Skip to content

News

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

Warning as baby dies and seven more fall critically ill with ‘usually mild virus’

A baby has died and seven others were left requiring intensive care after a “usually mild” virus appeared to trigger a serious heart condition, health officials have said.
The World Health Organization (WHO) said it had been notified of an “unusual” increase in myocarditis –inflammation of the heart – among newborns in south Wales infected with an enterovirus over the past year.
While enteroviruses are common and often asymptomatic, they are known to cause “occasional outbreaks in which an unusually high proportion of patients develop clinical disease, sometimes with serious and fatal consequences – in this instance myocarditis”, the UN health agency said.
While prior to the recent cluster of cases, south Wales had experienced only two similar cases in six years, the 10 months to April saw 10 cases of myocarditis in babies under the age of 28 days who tested positive for enterovirus, according to WHO.
Read full story
Source: The Independent, 19 May 2023
Patient Safety Learning

Inquiry into major UK maternity scandal slams NHS for failure to consult Black and Asian families

An inquiry into maternity care failings at an NHS trust that left dozens of babies dead or brain-damaged is “wholly insufficient” because only a fraction of Black and Asian women have come forward, its chair has warned.
Donna Ockenden, who is leading a review into Nottingham University Hospitals NHS Trust, suggested the health service must do more to increase the number of responses from ethnic minorities if the trust is to learn from the scandal.
Less than 20 families from Black and Asian communities are currently involved in the inquiry, compared to more than 250 white families, The Independent understands.
It is understood letters have only been sent out in English, while Ms Ockenden pointed to examples of women being unable to access translation services and expectant Muslim mothers being turned away if they objected to male sonographers.
She said the communities’ “mistrust” towards the trust had “deepened”, leaving the review team “climbing a mountain” to engage with them.
Read full story
Source: The Independent, 18 May 2023
Patient Safety Learning

Male GPs in England less likely to refer patients for IVF, report finds

Male GPs are less likely to refer eligible patients for IVF, research by a fertility charity suggests, raising concerns about access to NHS-funded treatment.
The Progress Educational Trust’s (PET) report highlights “utter confusion” and a lack of knowledge among GPs about eligibility criteria for NHS-funded treatment, which it says is exacerbating the so-called IVF postcode lottery. GPs typically make the initial referral to fertility clinics, meaning that they play a crucial role in access.
“For NHS treatment, GPs are the main initial gatekeeper. If you’re not getting pregnant, that’s who you go to for advice and support,” said Sarah Norcross, the director of PET. “It struck me that, when people have a known cause of infertility, male GPs still weren’t passing them on.”
The report is based on a survey of 200 GPs and commissioners across England, carried out by an independent research company, which investigated knowledge of national fertility guidelines and criteria they use for referral decisions.
Read full story
Source: The Guardian, 19 May 2023
Patient Safety Learning

150 ‘sexual safety incidents’ reported at ‘inadequate’ service in six months

A mental health trust’s acute and intensive care wards have been downgraded to “inadequate”, following a series of incidents including sexual assaults, fire setting, and patients taking their own lives while on leave.
The Care Quality Commission (CQC) inspection was prompted by reports of several serious incidents involving patients in these services. These included three occasions where patients had taken their own lives while on leave from wards, and four incidents where fires had been set at the Redwoods Centre in Shrewsbury.
Inspectors also identified a steep rise in mixed accommodation breaches, with just one ward out of the four inspected at St George’s Hospital in Stafford and none of the three inspected at Redwoods providing single sex units. 
The CQC report added “there were concerns about the implications of mixed sex ward environments contributing to sexual safety incidents”, with 158 such incidents recorded in a six-month period leading up to the inspection. These included assaults, verbal threats of sexual assault, and sexual orientation related abuse, with 126 recorded at Redwoods and 32 at St George’s.
Read full story (paywalled)
Source: HSJ, 19 May 2023
Patient Safety Learning

Use private sector more for NHS patients, says Labour

The government in England should increase its use of the private sector to tackle the NHS backlog, Labour says.
It said as many as 300,000 patients have missed out on treatment since it called for greater use of private clinics in January 2022.
And the party said it was unjust that the lack of action meant only those who could afford to pay for treatment themselves were being seen on time.
The government said it was delivering by cutting long waits. However, data published by NHS England last week showed key targets to tackle the backlogs in cancer care and routine treatment had been missed.
Overall, there are now a record 7.3 million people on a hospital waiting list, which is nearly three million higher than it was before the pandemic started.
Read full story
Source: BBC News, 19 May 2023
Patient Safety Learning

'Multiple systemic failures' found at Royal Infirmary of Edinburgh A&E

Patients spent up to 25 hours on trolleys in corridors waiting for treatment and in some cases were left lying on "urine-soaked sheets" and in another on a "blood-stained pillow for several hours" at the Royal Infirmary of Edinburgh.
Healthcare Improvement Scotland (HIS) inspectors also raised concerns over fire safety in the overcrowded A&E after two visits to the hospital - the first of which was carried out between February 20 to 22 and a further unannounced follow-up in March.
The watchdog found "multiple systemic failures" in a report published on Thursday but NHS Lothian said a major improvement drive was already underway.
The health board added that the hospital was had just endured its busiest winter on record ahead of the inspections.
At the time of the inspection, the emergency department was on some days operating at over three times its capacity.
The report described this as unsafe and a "fire safety risk" with the evacuation plan in place at the time not reflecting the "significant" impact of overcrowding. 
Read full story
Source: The Herald, 18 May 2023
Patient Safety Learning

Call for national guidelines on discussing past trauma in maternity appointments

National guidelines are needed to help maternity care professionals navigate discussions with pregnant women about past traumas, experts have said.
Their study, published in the journal Plos One, also found that while talking about previously experienced traumas can be valuable, they can also trigger painful memories if not approached sensitively.
The authors also raised concerns about the support available for professionals who may not feel equipped to explore challenging topics such as domestic or sexual abuse, childhood trauma and birth trauma without adequate guidelines or referral pathways.
Joanne Cull, a midwife and PhD student at the University of Central Lancashire’s School of Community Health and Midwifery, who is corresponding author on the study, said: “As awareness of the long-term effects of trauma on health and wellbeing has grown, there has been a move toward asking pregnant women about previous trauma, usually at the first appointment.
“No national guidance on this has been published in the UK so NHS Trusts have implemented this on a piecemeal approach.”
Read full story
Source: The Independent, 17 May 2023
Patient Safety Learning

USA: Drug shortages near an all-time high, leading to rationing

Thousands of patients are facing delays in getting treatments for cancer and other life-threatening diseases, with drug shortages in the United States approaching record levels.
Hundreds of drugs are on the list of medications in short supply in the United States, as officials grapple with an opaque and sometimes interrupted supply chain, quality and financial issues that are leading to manufacturing shutdowns.
The shortages are so acute that they are commanding the attention of the White House and Congress.
The Biden administration has assembled a team to find long-term solutions for shoring up the pharmaceutical supply chain, at a time when the United States remains heavily reliant on medicines and drug ingredients from India and China. And in recent weeks, generic drug makers, supply-chain experts and patient advocates have appeared before lawmakers to discuss the problems.
The scarcity of generic forms of chemotherapy to treat lung, breast, bladder and ovarian cancers has only heightened concerns.
“This is, in my opinion, a public health emergency,” said Dr. Amanda Fader, a professor at the Johns Hopkins School of Medicine and a president-elect of the Society of Gynecologic Oncology, “because of the breadth of the individuals it affects and the number of chemotherapy agents that are in shortage right now.”
Read full story (paywalled)
Source: New York Times, 17 May 2023
Patient Safety Learning

Staff suspended after ‘sleeping in patient’s bed’

Staff were suspended by their trust after they were found to have been sleeping in a patient’s bed, a Care Quality Commission (CQC) report has revealed.
The regulator inspected acute wards for adults and psychiatric intensive care units at Black Country Healthcare Foundation Trust in February, after safeguarding concerns were raised.
As HSJ revealed earlier this year, inspectors investigated a series of incidents, while a referral was also made to the police. As well as reports of staff using a mental health inpatient’s bed, there were complaints involving alleged inappropriate sexual behaviour and a governance breach. The concerns were said to relate to Hallam Street hospital in West Bromwich and Penn Hospital in Wolverhampton. 
The CQC inspection report said it inspected the service following allegations that “abuse had occurred” and a “multi-agency safeguarding meeting was convened to discuss the investigations of these”.
Read full story (paywalled)
Source: HSJ, 18 May 2023
Patient Safety Learning

Obese patients cost NHS double the amount of healthy people

Obese patients cost the NHS double the amount that people who are a healthy weight do, a landmark new study has revealed.
One million patients who were a healthy weight cost the NHS £638 on average in 2019, the research found. Meanwhile, £1,375 was spent per year on morbidly obese patients with a body mass index (BMI) of more than 40.
Experts warned the future viability of the NHS relies on combatting increasing obesity as it was leading to record levels of long-term sickness.
The research, presented at the European Congress of Obesity in Dublin, is the first to show how NHS spending varies depending on a patient’s weight.
The findings showed a staggering rise in spending on heavier patients because they develop obesity-related conditions like type 2 diabetes and heart disease.
Read full story
Source: The Independent, 18 May 2023
Patient Safety Learning

Quick blood tests to spot cancer: will they help or harm patients?

Investors are pouring billions into companies claiming they can analyse DNA to find the disease early. But some scientists question if they really work.
A pioneering group of people in the US and UK who have elected to take part in a new form of cancer screening known as multi-cancer early detection tests (MCED). The tests use gene sequencing or other novel technologies to detect fragments of DNA expelled by cancerous cells which circulate in people’s blood, allowing the identification of multiple types of cancer from a single blood draw. They have been hailed as “revolutionary” and “cutting edge” by British and US health chiefs.
Health bodies in both nations have set up MCED clinical trials in the hope that the tests can be rolled out to the population at large. The UK’s NHS is participating in a clinical trial of the Galleri test involving 140,000 patients. 
But not everyone is convinced the tests live up to the hype. Several health experts and scientists told the Financial Times that the tests could harm rather than help some patients due to risks associated with misdiagnosis, over-diagnosis and over-treatment.
Read full story (paywalled)
Source: The Financial Times, 17 May 2023
Patient Safety Learning

Anti-abortion laws harm patients facing dangerous and life-threatening complications, report finds

Healthcare providers caring for pregnant patients in the months after the US Supreme Court’s decision to strike down Roe v Wade have been unable to provide standard medical care in states where abortion is effectively outlawed, leading to delays and worsening and dangerous health outcomes for patients, according to an expansive new report.
In the wake of the Supreme Court’s ruling last year, individual reports from patients and providers have shed some light on the wide range of harm facing pregnant women in states where access to abortion care is restricted or outright banned.
But a first-of-its-kind report from the University of California San Francisco captures examples from across the country, documenting 50 cases in more than a dozen states that enacted abortion bans within the last 10 months, painting a “stark picture of how the fall of Roe is impacting healthcare in states that restrict abortion,” according to the report’s author Dr Daniel Grossman.
“Banning abortion and tying providers’ hands impacts every aspect of care and will do so for years to come,” he said in a statement accompanying the report. “Pregnant people deserve better than regressive policies that put their health and lives at risk.”
Read full story
Source: The Independent, 16 May 2023
Patient Safety Learning

‘Pathetic and dishonest’: trust’s deputy CEO blasts NHSE approach to cancer

NHS England’s approach to recovering cancer services has been described as ‘pathetic and dishonest’ by the deputy chief executive of a major trust.
Andy Welch, deputy chief executive and medical director of Newcastle Hospitals Foundation Trust, has publicly criticised comments made in November by NHSE’s national cancer director Dame Cally Palmer, who said “we have our foot on the gas” towards reaching cancer waiting time targets.
Mr Welch is an outspoken figure who has also slammed NHSE for “destroying” the morale of midwives through its “failed ‘continuity of care’ concept”, and described the potential “toppling” of the government as “brilliant” within the last three weeks alone.
The Newcastle medic is the chair of the Northern Cancer Alliance. His criticism of Dame Cally comes as performance against the flagship cancer target remains largely unchanged since last year.  
Read full story (paywalled)
Source: HSJ, 18 May 2023
Patient Safety Learning

Poverty and clinical need both key when prioritising patients for treatment says NHSE lead

Factors like deprivation should be considered in prioritising waiting lists, NHS England’s inequalities director has said, but in a ‘very sophisticated, thoughtful way’ alongside clinical need and waiting times.
NHSE said in summer 2020 the service would “restore services inclusively”, and some systems and trusts have developed tools they say could allow them to consider factors such as deprivation, race, employment, and lifestyle risk factors, such as smoking.
But the issue has been controversial. Research for University Hospitals Coventry and Warwickshire Trust, which has developed a new prioritisation system, found many members of the public are opposed to taking these factors into account.
NHSE standard contract guidance for 2023-24, seemingly cautioning against such moves, said: “[The Department of Health and Social Care] asked us to make clear that providers are ‘recommended to prioritise waiting lists according to clinical need and then in chronological order from the longest waiting patient.’” 
Read full story (paywalled)
Source: HSJ, 18 May 2023
Patient Safety Learning

Gosport hospital drug deaths: Police identify 19 suspects

Nineteen suspects have been identified by police as part of a new inquiry into hundreds of deaths at a hospital.
An independent panel found 456 patients died after being given opiates inappropriately at Gosport War Memorial Hospital between 1987 and 2001.
The new criminal investigation is being led by Kent Police after three previous ones by Hampshire Constabulary resulted in no prosecutions.
Police said interviews with the suspects under caution were ongoing.
Detectives are examining more than 750 patient records as part of Operation Magenta after families, who have also campaigned for judge-led "Hillsborough-style" inquests, repeatedly called for justice.
Read full story
Source: BBC, 17 May 2023
Patient Safety Learning

NHS clinic to offer depression magnet therapy

A therapy using magnets to treat severe depression is available on the NHS in the West for the first time.
Wellsprings clinic in Taunton can now deliver the repetitive Transcranial Magnetic Stimulation treatment (rTMS) to NHS patients through a referral.
During a session, a strong magnetic field is used to stimulate or inhibit different parts of the brain.
The National Institute for Health and Care Excellence (NICE) said it had "no major safety concerns" for the therapy.
Mark Rickman, 60, from Dartmoor deals with bipolar and depression and said rTMS has had a positive impact on him.
Mr Rickman previously tried Electroconvulsive Therapy (ECT), where electric shocks cause a brief surge of electrical activity in the brain, but said it was "debilitating" compared to rTMS.
NICE cleared rTMS for use in 2015, for people who had not responded well to antidepressants, and had "no major concerns" about the therapy.
The main side effects were said to be headaches, and patients at risk of seizures are screened.
Read full story
Source: BBC News, 18 May 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.