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

Pictured: Doctor shows army of ‘pointless’ forms burying NHS hospitals

“Pointless” bureaucracy is helping hospitals grind to a halt, a leading doctor has warned.
Dr Gordon Caldwell, who has just retired after 40 years as an NHS hospital consultant, said “horribly inefficient” paperwork around patients moving in and out of wards is fuelling record delays.
The senior doctor took a photograph of all the forms required for one medical admission to an NHS hospital, laid against his 5ft 10in frame.
Dr Caldwell said promises by the NHS to “digitise” the health service had simply seen needless bureaucracy transferred on to poor computer systems that were often incompatible with each other.
The specialist in general medicine and diabetes endocrinology said: “A few years ago there were estimates that nurses were spending around 50 per cent of their time on paperwork;  now I’d say it’s closer to 70 per cent.”
“It’s bureaucratic and it’s very slow and horribly inefficient,” he said.
Read full story (paywalled)
Source: The Times, 21 January 2023
Sam

Over two million patients have to visit GP four times for referral

More than two million patients each year have to make four or more repeat visits to their GP before they get a referral, a patient watchdog has warned.
Patient safety campaigners said people faced waits of “weeks, months or even years” before officially joining NHS waiting lists, and that their health and wellbeing was suffering as a result. They warned it would also add to pressure on other services such as A&E departments.
Research by Healthwatch England revealed what the patient watchdog called a “hidden waiting list”.
“People wait for a GP appointment; they wait for their GP to tell them they will be referred; they wait for the hospital to confirm that referral; and then they join a hospital waiting list,” it said.
“NHS statistics monitor only the hospital waiting list, leaving the steps between getting a GP referral and a letter confirming a hospital appointment as a dangerous ‘blind spot’ for the NHS and patients.”
Read full story (paywalled)
Source: The Times, 11 April 2023
Patient Safety Learning

Covid no longer the leading cause of death in England and Wales

Covid-19 has dropped out of the top five leading causes of death in England and Wales for the first time since the start of the pandemic, figures show.
Coronavirus was recorded as the main cause of death for 22,454 people in 2022, or 3.9% of all deaths registered, making it the sixth leading cause overall.
In both 2020 and 2021 Covid-19 was the leading cause of death, with 73,766 deaths (12.1% of the total) and 67,350 (11.5%) respectively.
By contrast, dementia and Alzheimer’s disease was the leading cause in England and Wales in 2022, with 65,967 deaths registered (11.4% of the total), up from 61,250 (10.4%) in 2021.
The other causes in the top five were ischaemic heart diseases (59,356 deaths and 10.3% of the total); chronic lower respiratory diseases (29,815 deaths, 5.2%); cerebrovascular diseases such as strokes and aneurysms (29,274 deaths, 5.1%); and trachea, bronchus and lung cancer (28,571 deaths, 5.0%).
Read full story
Source: The Independent, 11 April 2023
Patient Safety Learning

Junior doctors’ strike: hospitals ‘worried about overnight patient safety’

Hospital bosses are worried about keeping patients safe overnight this week because of a shortage of consultants available to cover for striking junior doctors.
When junior doctors in England staged their first strike in mid-March in their pay dispute with the government, their consultant colleagues covered for them for the three days involved.
However, fewer consultants are available to do the same during this week’s four-day stoppage because it coincides with Easter, Passover and Ramadan and many are off.
NHS Providers, which represents health service trusts, highlighted the difficulty hospital bosses are facing in trying to ensure nightshift medical rotas are fully staffed this week. T
“Getting through today is just the start. Trust leaders are worried about securing adequate cover for the night shifts ahead. This is going to be a very long, difficult week for the NHS,” said Miriam Deakin, the head of policy at NHS Providers. “Keeping patients as safe as possible, trusts’ No 1 priority, will be even harder than in previous strikes so it’s all hands on deck.”
Other health professionals, including GPs, paramedics and pharmacists, were helping hospitals ensure patients received good care, Deakin added.
Read full story
Source: The Guardian, 11 April 2023
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NHS drop-out rate an accident waiting to happen, says surgeon

A leading surgeon says a major drop-out rate of trainee doctors is "an accident waiting to happen" for the NHS.
Nigel Mercer was tasked with prioritising surgery across the NHS during the pandemic when services were under intense pressure.
His biggest fear with what he sees as an up to 40% drop-out rate is whether there will be enough doctors to replace his generation of medics.
The government said the majority of trainees go on to work in the NHS.
"[But] at the moment everyone is so fed up with the system," Mr Mercer said
Concerns over pay and conditions are leading many trainees to consider moving to other countries, he said.
"You can get much more pay over in Australia and New Zealand and we reckon it's now 40% of medical graduates who are going to leave after their training and that's criminal," he continued.
"That's an accident waiting to happen, but if we don't produce high-quality paramedical staff there won't be the ability to train anybody.
Read full story
Source: BBC News, 12 April 2023
Sam

Tory ‘neglect’ blamed for 3.6m abandoned calls to NHS 111 in England

Patients contacting NHS 111 in England are having to wait so long for medical help that they are abandoning millions of calls, with 3.6m ditched in the past 12 months, official figures reveal.
The national helpline service is supposed to make it quicker and easier for patients to get the right advice or treatment they need, either for their physical or mental health. It is billed as being open 24 hours a day, seven days a week.
However, analysis by the House of Commons Library, commissioned by the Liberal Democrats, shows callers are waiting so long to speak to someone that nearly one in five give up. In 2022, 3,682,516 calls to NHS 111 were abandoned.
MPs said the “dire” figures exposed how the NHS had reached “breaking point” after years of “neglect and underfunding” by the government.
The data suggests that, on average, more than 10,000 callers hang up every day without receiving medical advice or treatment.
As well as being distressing for those who are unwell, abandoned NHS 111 calls pose a risk to patient safety. The problem also increases pressure on other urgent care services as people seek care elsewhere.
Read full story
Source: The Guardian, 10 April 2023
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USA: For uninsured people with cancer, access to care can be "very random"

Eighteen months after April Adcox learned she had skin cancer, she finally returned to Charleston's Medical University of South Carolina last May to seek treatment.
Adcox had first met with physicians at the academic medical center in late 2020, after a biopsy diagnosed basal cell carcinoma. The operation to remove the cancer would require several physicians, she was told, including a neurosurgeon, because of how close it was to her brain.
But Adcox was uninsured. She had lost her automotive plant job in the early days of the pandemic, and at the time of her diagnosis was equally panicked about the complex surgery and the prospect of a hefty bill. Instead of proceeding with treatment, she attempted to camouflage the expanding cancerous area for more than a year with hats and long bangs.
If Adcox had developed breast or cervical cancer, she likely would have qualified for insurance coverage under a federal law that extends Medicaid eligibility to lower-income patients diagnosed with those two malignancies. For female patients with other types of cancer, as well as pretty much all male patients, the options are scant, especially in South Carolina and the 11 other states that haven't yet implemented Medicaid expansion, according to cancer physicians and health policy experts who study access to care.
In the face of potentially daunting bills, uninsured adults sometimes delay care, which can result in worse survival outcomes, research shows. The odds of patients getting insurance to help cover the cost of treatment play out a bit like a game of roulette, depending upon where they live and what type of cancer they have.
"It is very random — that's, I think, the heartbreaking part about it," said Dr. Evan Graboyes, a head and neck surgeon and one of Adcox's physicians. "Whether you live or die from cancer shouldn't really be related to what state you live in."
Read full story
Source: CBS News, 7 April 2023
 
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'Ticking time bomb' – here's how many NHS staff actually want to quit

More than three quarters of NHS workers are seriously considering leaving their jobs amid the ongoing strain on the health service.
According to research from the worker-led network Organise – which surveyed 2,546 NHS staff in March – 78.5% are thinking about packing it all in.
Only a fifth (21.5%) said they had no plan to give up their NHS job any time soon.
And the survey shows this sentiment is shared across a range of professions within the health service – with nurses, healthcare assistants, paramedics, doctors, health visitors and more all struggling with their jobs right now.
This comes after years of public concerns about the longevity of the health service, amid funding cuts, staff shortages and burnout – not to mention the additional strain from the Covid pandemic.
The findings also show that in the last three years:
79% of respondents experienced stress 62% reported anxiety 55% reported burnout. More than half (55%) of respondents said they needed to take time off from their jobs as a result, with a quarter saying this meant a month or more away from work.
Read full story
Source: Huffington Post, 29 March 2023
Patient Safety Learning

Third scan could greatly reduce UK breech birth numbers, study suggests

Giving women a third scan at the end of their pregnancy could dramatically reduce the number of unexpected breech births and the risk of babies being born with severe health problems, research suggests.
Pregnant women in the UK have routine scans at 12 and 20 weeks only, with no further scan offered in the third trimester unless they are considered at risk of a complicated pregnancy. The researchers hope their findings could lead to a change in guidance for clinicians that will improve maternity care.
Prof Asma Khalil, who led the study at St George’s, University of London, said: “For the first time we’ve shown that just one extra scan could save mothers-to-be from trauma, an emergency C-section, and their babies from having severe health complications which could otherwise have been prevented.”
She said the two routine scans were “far too early” to establish how the baby would be positioned during labour. “That’s why a third scan at 36-37 weeks could be a gamechanger to pregnancy and birth care.”
Read full story
Source: The Guardian, 7 April 2023
Patient Safety Learning

Trust CEOs’ strike warning: ‘If anyone gets sick, we’re stuffed’

The leaders of acute trusts across England have told HSJ the second junior doctor’s strike ‘feels very different’ from the first stoppage, and services are much more vulnerable because of ‘thinner’ consultant coverage.
They also reported that the instruction from NHS England not to proactively cancel elective procedures and apppointments has been largely ignored by trusts.
The chief executive of a large trust in the east of England said they were “more concerned about clinical safety than at any time during covid surges”.
A trust CEO in the North West told HSJ this week’s stoppage “feels much more risky than the previous strike. We have managed to cover rotas but we are very stretched and concerned about short notice cancellation from agencies and short term sickness after bank holiday.”
Read full story (paywalled)
Source: HSJ, 11 April 2023
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Sexual assault, crude banter — what it’s like to be a female surgeon

Mehdian-Staffell, 37, is part of a new generation of female surgeons who are challenging the male-dominated culture in the profession.
It is clear that she loves her job. “My aim is not just to be a surgeon – it is to be a damn good one. I didn’t go into it to be average,” she says. But she is also exhausted and demoralised. “The sexism comes from patients as well as other members of staff. People will assume you’re a nurse. I’ve previously worked in departments where the guys all went off to golf and men were prioritised for opportunities over women. Sometimes, as female surgeons, we feel as if we have to work twice as hard.”
She says many of her more recent male colleagues have been supportive, but there is a systemic problem. Even the surgical instruments are made for male hands. Traditionally, surgeons are known as “Mr” rather than “Dr”, but women often get called by their first name.
There have been darker moments. “I’ve been sexually harassed lots of times,” she says.
 In 2021 the Royal College commissioned the human rights lawyer Helena Kennedy to do a review of diversity and inclusion in surgery. “The evidence I had from women was that the culture was very male and the chat in and around the operating theatre for surgeons was often inappropriate. It’s really not a very conducive environment for women.” She made a raft of recommendations to improve the situation but says she is “disappointed” at how slowly they are being implemented.
Read full story (paywalled)
Source: The Times, 8 April 2023
Related reading on the hub:
Calling out the sexist and misogynist culture within healthcare: a blog by Dr Chelcie Jewitt, co-founder of the Surviving in Scrubs campaign  
Patient Safety Learning

‘He tarnished my reputation’: whistleblower demands action against CQC accuser

A former adviser for the Care Quality Commission (CQC) has called on the regulator to explain what action it has taken against the officials responsible for wrongly dismissing him after he raised whistleblowing concerns.
Shyam Kumar, a surgeon who was part of inspection teams in the North West, told HSJ that he had to live with question marks over his reputation for several years. He is furious that a senior CQC official sought to question his honesty and integrity in evidence submitted to the employment tribunal examing his dismisal.
The tribunal heard Mr Kumar had raised a number of whistleblowing disclosures to the CQC, including concerns about the lack of appropriate expertise on inspection teams.
After a wide-ranging review around its handling of whistleblowing concerns, CQC chief executive Ian Trenholm last week apologised to Mr Kumar for “unacceptably poor treatment” by his organisation, and thanked him for contributing to the review.
However, Mr Kumar told HSJ: “I’m glad the CQC has looked at this and finally acknowledged what they did to me was wrong. But I want to know what has happened to the individuals that were responsible.”
Read full story (paywalled)
Source: HSJ, 6 April 2023
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1,643 ‘sexual safety incidents’ in a single 59-bed children’s unit

A single children’s mental health hospital with just 59 beds reported more than 1,600 “sexual safety incidents” in four years, shocking NHS figures reveal.
Huntercombe Hospital in Maidenhead was responsible for more than half of the sex investigations reported in the 209 children’s mental health units across the country.
Despite warnings at a rate of more than one a day to the health service since 2019, no action was taken to stop vulnerable NHS patients being sent to the scandal-hit unit as a result of the 1,643 sexual incident reports.
The private unit is now finally due to be closed after an investigation by The Independent revealed allegations of verbal and physical abuse, prompting the NHS to withdraw patients. The hospital since said it plans to reopen as an adult unit.
Figures obtained from the NHS show Huntercombe’s Maidenhead unit, Taplow Manor, was behind 57% of the 2,875 reported sexual incidents and assaults reported at England’s child and adolescent mental health services (CAMHS) over the past four years. Reported incidents can range from sexually inappropriate language to serious sexual assault and rape.
Read full story
Source: The Independent, 11 April 2023
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NHS patient 'stuck in hospital with months to live'

A woman who may only have months to live has told the BBC she is "angry and frustrated" at being in hospital five months after being cleared to go home.
Charlotte Mills-Murray, 34, said attempts to organise care at her family home had been repeatedly delayed.
Charlotte lives with intestinal failure caused by a severe form of Ehlers-Danlos syndrome, which weakens her body's connective tissue.
She was admitted to St James's Hospital in Leeds in June 2022 following an infection, and a new Hickman line - a tube that allows feeding and the administering of pain relief - was inserted.
By November, Charlotte was told she was well enough to be cared for at home, but she remains in hospital following delays in the hiring and training of staff able to support her.
With limited access to a hoist which would enable her to use her wheelchair, Charlotte said she had spent 10 months "stuck in bed".
Because of the complexity of her condition, Charlotte only has months to live. She believes her situation merits greater urgency because of the increased risk of infection in hospital.
Charlotte qualifies for 24-hour home care support through the NHS Continuing Healthcare scheme, but she said decisions over how this would be put in place had been slow and unclear.
The BBC has found a 16% rise over the past year in the number of patients in England who are in hospital despite being well enough to leave.
The Department of Health and Social Care said it was "fully committed to speeding up the safe discharge of patients who no longer need to be in hospital" and was making £1.6bn available in England over the next two years to support this, on top of £700m of extra funding in 2022 to ease NHS pressures over the winter.
Read full story
Source: BBC News, 9 April 2023
Patient Safety Learning

Junior doctors’ strike will have ‘catastrophic impact’ on waiting lists

The four-day strike by junior doctors in England will have a “catastrophic impact” on NHS waiting lists, with up to 350,000 appointments and operations likely to be cancelled, the chief executive of the NHS Confederation has said.
Matthew Taylor said the industrial action this week posed risks to patient safety and called on the public to avoid “risky behaviour”.
“These strikes are going to have a catastrophic impact on the capacity of the NHS to recover services,” he told Sky News. “The health service has to meet high levels of demand at the same time as making inroads into that huge backlog that built up before Covid, but then built up much more during Covid."
He said he hoped everyone who needed urgent care would get it, but added: “There’s no point hiding the fact that there will be risks to patients – risks to patient safety, risks to patient dignity – as we’re not able to provide the kind of care that we want to.”
He called on the public to use NHS services responsibly.
Read full story
Source; The Guardian, 10 April 2023
Patient Safety Learning

NHS workers betrayed: 'Cover up' allegations as most NHS Trusts say no staff died of Covid on their watch

NHS leaders and ministers face allegations of a “cover up”, as Byline Times reveals that almost two-thirds of NHS employers did not make a single, legally-required report of Covid being caught by staff working during the first 18 months of the pandemic.
And four-fifths (82%) of NHS employers have not reported a single death of a worker from Covid caught while working in those first two waves.
The Reporting of Injuries, Diseases & Dangerous Occurrences (RIDDOR) rules mean that employers have a legal duty to report certain serious workplace accidents and occupational diseases – including Covid. 
The lack of acceptance of responsibility from NHS employers has left some families in limbo – and angry at what they consider to be deliberate “denial” of the experiences of those who died serving the public.  
David Osborn, a health and safety consultant and member of the Covid-19 Airborne Transmission Alliance (CATA), co-wrote the research. He said: “One wonders how many bereaved families who have been denied this payment did not have the benefit of [these reports] to support their case.”
Osborn wrote to Sarah Albon, Chief Executive of the Health and Safety Executive, to raise his concerns after speaking with family members of NHS workers who had died of Covid, saying the reports of zero NHS worker deaths from Covid caught in the workplace are “difficult, nigh impossible, to believe.” 
Read full story
Source: Byline Times, 6 April 2023
Sam
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