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

Hospital boss claims unfair dismissal after chairman 'bullied' her

A former NHS chief executive is suing her employer, saying she was "bullied, harassed, intimidated and undermined" by the hospital trust's chairman.
In legal papers, seen by BBC News, Dr Susan Gilby alleges she was effectively unfairly dismissed by the Countess of Chester NHS Foundation Trust, after she made a formal complaint.
Dr Gilby claims the chairman was "highly aggressive and intimidatory" in meetings, that he banged his hand on a desk to emphasise his point, and oversaw a climate where "offensively sexist comments and ferocious and repetitive criticisms" were made by either him or his associates.
Dr Gilby's complaint accuses the chairman of putting finance above patient safety at the hospital trust
She made a formal whistle-blowing complaint against the chairman in July 2022, raising her concerns about his behaviour to both the trust and NHS England.
The trust responded to her concerns, Dr Gilby claims, by proposing that she be seconded to a senior advisory role within NHS England on the condition she withdrew her allegations.
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Source: BBC News, 12 May 2023
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Waiting list hits new record high as attention shifts to 65-week breaches

The NHS waiting list hit a record 7.3 million incomplete pathways in March, according to new official data, as trust bosses gear up to clear the circa 95,000 patients who have waited over 65 weeks.
NHS England also confirmed in its monthly statistical update that there remained around 10,000 patients on the waiting list who had breached 78 weeks despite a target to clear this cohort by April, as HSJ revealed would be the case in March. It instead hoped these will be cleared by June or July.
Ten trusts are responsible for around half of the 78-week breaches, with Manchester University Foundation Trust recording the most on 969, University Hospitals Leicester Trust reporting 837 and Royal Devon University Healthcare FT on 695.
NHSE chief executive Amanda Pritchard said the NHS “is making great strides on long waits… in the face of incredible pressure [and this] is testimony to the hard work, drive and innovation of frontline colleagues”.
Read full story (paywalled)
Source: HSJ, 11 May 2023
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Autistic teenager was stuck on general hospital ward for months

An autistic girl aged 16 spent nearly seven months in a busy general hospital due to a lack of suitable children's mental health services in England.
The teenager, called Molly, spent about 200 days living in a side-room of a children's ward at the Queen Alexandra Hospital in Portsmouth. It is not a mental health unit.
Experts say a general hospital was not the right place for her, but she had nowhere else to go because of a lack of help in the community.
Agency mental health nurses were brought in because she needed constant, three-to-one observations to keep her safe. Her family says security guards were also often stationed outside her room.
Like many autistic people, Molly finds dealing with noise difficult. The clamour of the hospital overloaded her senses and her behaviour sometimes became challenging. She was restrained numerous times.
A spokesperson for Hampshire and Isle of Wight Integrated Care System (ICS) said it was sorry Molly "did not receive care in an environment better suited to her needs", adding: "Molly's safety has always been our priority."
Campaigners describe the shortage of appropriate support for people with autism as a human rights crisis.
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Source: BBC News, 10 May 2023
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ICBs should set up ‘escalation routes’ after 25 daily GP contacts, says new BMA guidance

ICBs should ensure there are ‘formal escalation routes’ in place for GPs after 25 daily clinical contacts, the BMA has said in new guidance.
From next week (15 May), GP practices are contractually required to offer an ‘appropriate response’ to patients the first time they get in contact, by offering them an appointment or redirection, rather than asking them to call back at a different time.
While GP leaders warned this would lead to increased pressure on NHS 111 and A&E, NHS England attempted to clarify in this week’s recovery plan that GPs should only redirect patients in ‘exceptional circumstances’. It also said practices should inform their ICB on each such occasion.
However, conflicting BMA guidance has now been published, warning that practices attempting to adhere to the new requirement ‘may do so at the expense of clinician wellbeing and patient safety’.
It reiterates the GP Committee for England’s safe working guidance recommending that clinicians have no more than 25 clinical contacts per day because anything beyond this "can lead to decision fatigue, clinical errors and patient harm, and clinician burn out".
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Source: Pulse, 11 May 2023
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US recommends women start screening for breast cancer at 40

A leading health panel in the USA has recommended the age at which women are regularly screened for breast cancer should be cut from 50 to 40.
The US Preventive Services Task Force (USPSTF) said an extra 20 million women in their forties would benefit from a mammogram every two years.
The change would save 20% more lives, according to the USPSTF, which has drafted the proposal in response to rising rates among middle-aged women.
Currently, all women in the USA aged 50 to 74 are advised to get checked via a mammogram every two years.
The number of new breast cancer cases is rising roughly two percent every year, John Wong, an internist and professor of medicine at Tufts University School of Medicine, who is on the task force, told the Washington Post.
Dr Wong said: "It is now clear that screening every other year starting at age 40 has the potential to save about 20 percent more lives among all women, and there is even greater potential benefit for black women, who are much more likely to die from breast cancer."
Read full story
Source: Mail Online, 9 May 2023
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Simple intervention for severe blood loss after childbirth is found to save lives

A simple intervention to detect and treat postpartum haemorrhage could dramatically cut maternal mortality and morbidity worldwide, a large trial led by the University of Birmingham has shown.
Use of a special drape to measure blood loss during childbirth and rapid deployment of a “bundle” of existing treatments reduced severe bleeding, the need for laparotomy, or maternal death by 60% in a study done in 80 hospitals across Kenya, Nigeria, South Africa, and Tanzania.
Reporting the results in the New England Journal of Medicine, the researchers said that postpartum haemorrhage was detected in 93.1% of patients in the intervention and in 51.1% of those receiving usual care.
Read full story (paywalled)
Source: BMJ, 10 May 2023
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FDA panel backs first over-the-counter birth control pill in US

The first non-prescription birth control pill in the US is on the way to approval, after a thumbs-up from an advisory committee of drug regulators.
The Food and Drug Administration (FDA) panel's unanimous vote is not binding, but means the agency is likely to formally approve the drug this summer.
Opill has been available, but only by prescription, for the past 50 years.
The push for over-the-counter access in the US comes amid Republican-led efforts to restrict access to abortion and contraception at the national and state level.
Advisors on the panel said they were mostly confident women of all ages would use the drug as appropriate without first consulting a healthcare provider.
"In the balance between benefit and risk, we'd have a hard time justifying not taking this action," said chairwoman Maria Coyle, an Ohio State University pharmacist.
"The drug is incredibly effective, and I think it will be effective in the over-the-counter realm just as it is in the prescription realm."
Read full story
Source: BBC News, 10 May 2023
Patient Safety Learning

Figures show maternal death rate race disparity

Figures showing the risk of maternal death being almost four times higher among women from black ethnic minority backgrounds compared with white women in the UK have been published.
The figures, which relate to 2019 - 2021, have been released by MBRRACE-UK, a collaboration involving the University of Leicester.
The MBRRACE-UK collaboration (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries), led from Oxford Population Health's National Perinatal Epidemiology Unit, looked at data on women who died during, or up to six weeks after, pregnancy between 2019 and 2021 in the UK.
The report showed the risk of maternal death in 2019 - 2021 was almost four times higher among women from black ethnic minority backgrounds compared with white women.
Marian Knight, professor of Maternal and Child Population Health at Oxford Population Health and maternal reporting lead, said: "Persistent disparities in maternal health remain.
"It is critical that we are working towards more inclusive care where women are listened to, their voices are heard, and we are acting upon what they are telling us."
Read full story
Source: BBC News, 11 May 2023
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AI can predict pancreatic cancer three years before it occurs, major Harvard study finds

A breakthrough AI model can determine a person's risk of developing pancreatic cancer with staggering accuracy, research suggests.
Using medical records and information from previous scans, the AI was able to flag patients at a high risk of developing pancreatic cancer within the next three years with great accuracy.
There are currently no full-proof scans for pancreatic cancer, with doctors using a combination of CT scans, MRIs and other invasive procedures to diagnose it. This keeps many doctors away from recommending these screenings.
Over time, they also hope these AI models will help them develop a reliable way to screen for pancreatic cancer — which already exists for other types of the diseases.
"One of the most important decisions clinicians face day to day is who is at high risk for a disease, and who would benefit from further testing, which can also mean more invasive and more expensive procedures that carry their own risks," Dr Chris Sander, a biologist at Harvard who contributed to the study, said. 
"An AI tool that can zero in on those at highest risk for pancreatic cancer who stand to benefit most from further tests could go a long way toward improving clinical decision-making."
Read full story
Source: Mail Online, 9 May 2023
Sam

Staff shortages force pharmacies to close for 100,000 hours in a year amid plans to give them more work

Staff shortages forced pharmacies to shut for 100,000 hours in a year, new figures show, just as the government has unveiled plans to shift more GP work their way.
The data, shared exclusively with The Independent by the organisation which represents pharmacies in England, also showed that almost 1,000 establishments closed for good between October 2016 and November 2022.
The Pharmaceutical Services Negotiating Committee (PSNC) figures revealed that pharmacies in the most deprived areas were more likely to shut permanently due to lack of staff, with areas such as Birmingham and Manchester among the worst affected.
The figures come as the government announced plans on Tuesday to allow pharmacists to prescribe medicines for conditions including earache, sore throats and urinary tract infections without GP involvement.
However, experts have said the plans are unlikely to significantly reduce pressure on GP practices as prescriptions for these conditions make up just 3 per cent of all appointments.
And the King’s Fund health think tank warned of the potential for a postcode lottery – saying some pharmacies will not be able to offer the services because they may not have access to diagnostic tools, or sufficient staff and consultation rooms.
Read full story
Source: The Independent, 10 May 2023
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Online UK pharmacies prescribing weight loss jabs to people with healthy BMI

Online pharmacies operating in the UK are approving and dispatching prescriptions of controversial slimming jabs for people of a healthy weight, a Guardian investigation has found.
Some pharmacies appear to be issuing prescriptions of such medications to people who lie about their body mass index (BMI) on an online form. In one case a reporter was issued a prescription after accurately saying their BMI was about 20. A healthy BMI lies between 18.5 and 24.9.
The findings have raised alarm among eating disorder charities, which have warned that weight-loss medications should only be sold under the strictest conditions. Their concern has prompted calls for online pharmacies to employ stronger health checks and screening for eating disorders.
Read full story
Source: The Guardian, 10 May 2023
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Children with type 2 diabetes to be given sensors to replace finger-prick testing

Hundreds of children who manage their type 2 diabetes by regularly pricking their finger can now monitor their glucose levels using automated sensors, the government’s expert health advisers have announced.
Doctors and nurses in England, Wales and Northern Ireland have been advised they can now give glucose monitoring devices to children with type 2 diabetes who currently use the more intrusive finger-prick testing methods, the National Institute for Health and Care Excellence (NICE) said on Thursday.
The health minister Helen Whately said that offering children the devices would relieve a burden and “empower them to manage their condition more easily”.
She said: “Type 2 diabetes is increasingly being diagnosed in children, many of whom face the constant stress of needing to monitor their blood glucose levels by finger-prick testing – often multiple times a day – just to stay healthy and avoid complications.”
The NICE committee that reached the decision heard that children found finger pricking to check their glucose levels several times a day “burdensome”, “tiring” and “stressful”.
The devices, which give a continuous stream of real-time information on a smartphone, have already been recommended for children with type 1 diabetes, a less aggressive form of the disease.
Read full story
Source: The Guardian, 11 May 2023
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Pledge to reduce NHS backlog has been broken, Steve Barclay admits

A key government pledge to reduce the size of the NHS’s record-breaking care backlog has been broken, the health secretary has admitted.
Steve Barclay slipped out the news in a Commons statement on Tuesday about a totally unrelated area of NHS policy – his new plan to improve access to GP care.
He disclosed to MPs that the NHS in England had missed its target to ensure that all patients who had been waiting 18 months for an operation in hospital would be treated by April.
It is thought that about 10,000 people who had been waiting for at least 78 weeks were still languishing on the 7.2 million-strong waiting list at the end of April.
The failure to eradicate 18-month waits for care is embarrassing for Rishi Sunak, who made “cut waiting lists” one of his five key pledges and insisted as recently as January that the promise, which NHS England and the then health secretary Sajid Javid first made in the elective surgery recovery plan last year, would be honoured.
Read full story
Source: The Guardian, 9 May 2023
Sam

Seriously ill children put at risk by firm’s failure to deliver NHS medication

Children with serious health conditions are getting sicker as a result of persistent failings by Sciensus, a private company paid millions by the NHS to deliver essential medication, the Guardian can reveal.
Parents of sick children say they are repeatedly let down by botched, delayed or missed deliveries, while NHS paediatric clinicians warn some are suffering avoidable harm as a result.
Sciensus failed to send injections to Autumn Powell, an eight-year-old girl with Crohn’s disease, four times this year, according to her mother, Dallas Powell. As a result, she has suffered stomach cramping, pain and fatigue, and been off school sick.
“It makes me mad, frustrated, but mostly it’s heartbreaking seeing my child suffering – and feeling helpless,” Powell said. “I am not one to go and complain publicly, but this is serious.”
In a complaint to the Care Quality Commission (CQC), the care regulator, three NHS paediatric clinicians working at two of the UK’s largest children’s hospitals have raised multiple concerns about Sciensus.
Medicines ordered by the NHS to be sent urgently to sick children were delayed or never arrived, they said. Parents of those with serious health conditions also experienced difficulties with the company’s app. In some cases Sciensus did not respond to emails and calls about children’s missing medicines.
Read full story
Source: The Guardian, 9 May 2023
Sam

USA: Amid hospital 'chaos,' stick to standards to improve quality

Every time a mistake is made in a healthcare setting, there can be serious repercussions. Patients may suffer lifetime injuries or even pay the ultimate price for someone else's mistake. Hospitals may wind up paying the price literally — financially and legally — and suffer costly public reputation troubles in the aftermath. 
Increased patient loads combined with the workforce shortage and often decreasing financial resources have created "chaos" in hospitals, said Doug Salvador MD, chief quality officer at Baystate Health in Springfield, Mass. 
Safety watchdog organizations, including The Joint Commission and The Leapfrog Group, have reported the result of that chaos: soaring cases of preventable medical errors. 
The solution, he and several other sources who spoke with Becker's said, is to create standard operating procedures in every department, at every step of the patient journey. These SOPs are more than lists of guidelines; they require strict adherence and limited room for error thanks to built-in cross-check points. And, when instituted properly, they highlight system flaws in real time by creating what Dr. Salvador called "situational awareness." 
Situational awareness, he added, keeps front-line healthcare professionals on top of their safety game. 
Read full story
Source: Becker's Healthcare, 9 May 2023
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AI poses existential threat and risk to health of millions, experts warn

AI could harm the health of millions and pose an existential threat to humanity, doctors and public health experts have said as they called for a halt to the development of artificial general intelligence until it is regulated.
Artificial intelligence has the potential to revolutionise healthcare by improving diagnosis of diseases, finding better ways to treat patients and extending care to more people.
But the development of artificial intelligence also has the potential to produce negative health impacts, according to health professionals from the UK, US, Australia, Costa Rica and Malaysia writing in the journal BMJ Global Health.
The risks associated with medicine and healthcare “include the potential for AI errors to cause patient harm, issues with data privacy and security and the use of AI in ways that will worsen social and health inequalities”, they said.
One example of harm, they said, was the use of an AI-driven pulse oximeter that overestimated blood oxygen levels in patients with darker skin, resulting in the undertreatment of their hypoxia.
Read full story
Source: The Guardian, 10 May 2023
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