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

Donor organs should be allocated by need, not geography, report recommends

Donor organs should no longer go to the nearest in-need patient, an official report has recommended. 
Instead, specialised organ centres across the country will be responsible for preserving, repairing and matching an organ with the most needy individual on the transplant register, irrespective of location.
An official report commissioned by the Department for Health and Social Care and headed up by Prof Stephen Powis, the national medical director for England, has recommended 12 changes to further improve donation. 
Among the recommendations – which have been backed by the Government and are expected to be implemented in the coming weeks – is equal access to organ donation services “irrespective of personal circumstances, including ethnicity, geography, socio-economic status or sex”.
Read full story (paywalled)
Source: The Telegraph, 21 February 2023
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NHSE set for £400m dentistry underspend despite ‘access crisis’

The national dentistry budget is set to be underspent by a record £400m this year, due to a shortage of dentists willing to take on NHS work, HSJ has learned.
The situation is understood to have prompted major concerns in the senior ranks of NHS England, and calls for a “fundamental rethink” of the much-maligned primary dental care contract.
The unspent funding is due to be used to plug budget deficits in other services and comes as patients in many areas struggle to access NHS dentistry. Healthwatch England described the estimated underspend as an “absolute scandal”.
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Source: HSJ, 21 February 2023
Sam

Striking staff drop cover for strokes and suspected heart attacks

Striking ambulance workers in two regions have said for the first time that they will only answer immediately life-threatening calls — abandoning previous agreements to cover some Category 2 incidents.
Agreed exemptions (derogations) from ambulance strike action so far this winter have varied regionally and across different unions; but all have so far included some Category 2 cover.
However, GMB told HSJ its members in the North East and North West today would cover only Category 1 calls – defined as “immediately life threatening” – during their action today.
Category 2 includes more than any other category, and covers a wide range of incidents including suspected heart attacks and strokes.
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Source: HSJ, 20 February 2023
Sam

WHO reveals one-third of prisoners in Europe suffer mental health disorders

One in three prisoners in Europe suffer from mental health disorders, the World Health Organization (WHO) has said in a new report.
While European prisons managed adequate COVID-19 pandemic responses for inmates, concerns remain about poor mental health services, overcrowding and suicide rates, the report stated.
“Prisons are embedded in communities and investments made in the health of people in prison becomes a community dividend,” said Dr. Hans Henri P. Kluge, regional director of the WHO regional office for Europe. “Incarceration should never become a sentence to poorer health. All citizens are entitled to good-quality health care regardless of their legal status.”
The second status report on prison health in the WHO European region provides an overview of the performance of prisons in the region based on survey data from 36 countries, where more than 600,000 people are incarcerated. Findings showed that the most prevalent condition among people in prison was mental health disorders, affecting 32.8% of the prison population.
The report drew attention to several areas of concern, including overcrowding and a lack of services for mental health, which represents the greatest health need among people in prison across the region.
The most common cause of death in prisons was suicide, with a much higher rate than in the wider community, the report found.
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Source: United Nations, 14 February 2023
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Covid-19: Evusheld is unlikely to prevent infection with current or future variants, NICE concludes

The National Institute for Health and Care Excellence (NICE) has decided not to recommend Evusheld for adults who are unlikely to have an adequate immune response or cannot have the vaccine against Covid-19, citing a lack of evidence that it is effective against circulating variants.
However, it is still reviewing whether the antibody drug could be used to prevent covid-19 infection in adults at the highest risk of severe illness, including people with immunodeficiency, people who have had a solid organ transplant, and people with cancer.
NICE’s director of medicines evaluation, Helen Knight, acknowledged that the decision would be “disappointing for the many thousands” of vulnerable people who “continue to significantly modify their behaviour to avoid infection.
Commenting on NICE’s decision, Lennard Lee, senior clinical research fellow at the University of Birmingham, said, “While it’s right for NICE to ensure that treatment options are based on the best possible evidence for their safety, efficacy, and cost effectiveness, it must be recognised that those who remain extremely vulnerable to covid need to be prioritised in trials akin to those early days of the pandemic to find treatments fit for them.
“Otherwise, we run the risk of consigning half a million people to continue to live in 2020, stuck in their homes, not able to see their families and friends for fear of infection with no protection.”
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Source: The BMJ, 16 February 2023
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Higher bills are leading Americans to delay medical care

While some people avoided seeking medical care during the worst of the pandemic, worried about the risk of infection or unable to get an appointment because hospitals and doctors were overwhelmed, now many in the USA are finding that inflation and the uncertain economy have thrown up another barrier.
“We are starting to see some individuals who are putting off some care, especially preventive care, due to the costs,” said Dr. Tochi Iroku-Malize, the president of the American Academy of Family Physicians and the chair of family medicine for Northwell Health in New York. Choosing between going to the doctor or paying for rent and food, “the health issue is no longer the priority,” she said.
With the prices of prescription drugs, hospital stays and other treatments expected to increase significantly this year and next, some doctors expect families to have an even harder time affording medical care. 
When Margaret Bell, 71, found that her cancer had returned four years ago, she hesitated to resume her chemotherapy because she could not afford it, and higher prices have made it even harder. She would regularly skip appointments.
About one-fourth of respondents in a recent Gallup poll said they put off care last year for what they considered a “serious” condition.
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Source: New York Times, 16 February 2023
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Pharma boss apologises for not disclosing sponsorship of anti-obesity training

The chief executive of pharma group Novo Nordisk has apologised for breaking the UK industry code by failing to disclose its sponsorship of obesity and weight management training courses for healthcare professionals that also promoted its weight loss drug.
The webinars, which were viewed by thousands of healthcare professionals, preferentially included positive information about Novo’s weight loss drug Saxenda, which the self-regulatory watchdog deemed a “disguised” large-scale promotional campaign. 
The industry self-regulatory body published a strongly worded reprimand last year, saying it was “concerned about the company’s compliance culture . . . internal governance systems and processes, and a perceived naivety and lack of accountability from Novo Nordisk”.
It also said it was concerned about “the potential impact on patient safety” because the webinars, which were run by a third-party provider but sponsored by Novo, showed a “lack of balance” in how they compared the side effects of Saxenda and its competitors.
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Source: The Financial Times, 12 February 2023
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Is Heatherwood Hospital a model for the future of the NHS?

Pradeep Gill can see very little of the intense activity around him. He is leaning back in a reclining chair inside one of Heatherwood Hospital's operating theatres.
Buzzing around him is the operating team, led by consultant orthopaedic surgeon Jeremy Granville-Chapman.
For the surgeon and his team, this procedure is the very definition of routine. They have carried out more than 1,000 joint operations in the past 10 months.
Heatherwood Hospital, part of the Frimley Health NHS Foundation Trust, is a specialist elective hub where patients can come in for routine but life-changing surgery at a super-charged pace with theatres working at full tilt, six days a week.
It is busy. But it is a good-busy, not the bad-busy we have come to associate with the NHS during this winter crisis.
The site opened in March last year and Frimley's hospital executives are keen to stress the impact it has made.
"As a specialist planned care facility, Heatherwood has been able to perform surgery six days a week with four out of its six state-of-the-art theatres dedicated to orthopaedic procedures," it said in a press release.
"The hospital has also successfully reduced the length of time patients stay in hospital, with 40% of patients safely discharged within 24 hours."
This is the practice the NHS wants to adopt as it battles a record seven-million-strong waiting list.
Heatherwood can do that because the hospital is ring-fenced from acute pressures that affect other hospitals, as one its most senior orthopaedic surgeons, Mr Rakesh Kucheira, explained.
"We have now realised that winter pressures are 12 months not just three months, which means the acute sites are not going to be able to do planned activity that they planned for, so we've got to create more space," he said.
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Source: Sky News, 9 March 2023
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Most health claims on formula milk ‘not backed by evidence’

Most health claims on formula milk products have little or no supporting evidence, researchers have said, prompting calls for stricter marketing rules to be introduced worldwide.
Millions of parents use formula milk in what has become a multibillion-dollar global industry. But a study published in the BMJ has found most health and nutritional claims about the products appear to be backed by little or no high-quality scientific evidence.
“The wide range of health and nutrition claims made by infant formula products are often not backed by scientific references,” said Dr Ka Yan Cheung and Loukia Petrou, the joint first co-authors of the study. “When they are, the evidence is often weak and biased.”
Dr Daniel Munblit and Dr Robert Boyle, senior co-authors for the study, added: “There is a clear need for greater regulation and oversight to ensure that these claims are supported by sound scientific evidence and to protect the health and wellbeing of our youngest and most vulnerable populations.”
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Source: The Guardian, 15 February 2023
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Ambulance waits putting disabled children's lives at risk, doctors warn

Thousands of severely disabled children's lives are at risk because of long waits for ambulances, doctors and other experts have warned.
Emergency care is a vital part of their everyday lives, the British Academy of Childhood Disability says. 
Almost 100,000 children have life-limiting conditions or need regular ventilator support in the UK. They often rely on ambulances as part of their healthcare plan, because their condition can become life-threatening in an instant.
Dr Toni Wolff, who chairs the British Academy of Childhood Disability, told BBC News some families with severely disabled children had "what are essentially high-dependency units" of medical equipment at home.
"As part of their healthcare plan, we would normally say, 'If the child starts to deteriorate, call for an ambulance and it will be there within 10 or 20 minutes,'" she said.
"Now, we can't give that reassurance."
Despite their child being classed as a priority, parents have told BBC News they face the difficult decision to wait for an ambulance or take them, often in a life-threatening condition, to hospital themselves - a risk because of the huge amounts of equipment needed to keep them alive,
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Source: BBC News, 16 February 2023
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USA: The number one problem keeping hospital CEOs up at night

Workforce problems in US hospitals are troublesome enough for the American College of Healthcare Executives to devote a new category to them in its annual survey on hospital CEOs' concerns. In the latest survey, executives identified "workforce challenges" as the number one concern for the second year in a row.
Although workforce challenges were not seen as the most pressing concern for 16 years, they rocketed to the top quickly and rather universally for US healthcare organisations in the past two years. Most CEOs (90%) ranked shortages of registered nurses as the most pressing within the category of workforce challenges, followed by shortages of technicians (83%) and burnout among non-physician staff (80%). 
Read full story
Source: Becker Hospital Review, 13 February 2023
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One in three women with female health conditions forced to wait three years for diagnosis

A third of those with a women’s health condition have been made to wait three years or longer for a diagnosis, damning new research has revealed.
The same study found half of those women took a year or more to be given their diagnosis.
Srdjan Saso, a consultant gynaecologist and surgeon who works with King Edward VII’s Hospital, told The Independent: “A delayed diagnosis can mean a severe impact on quality of life both professionally and personally.
“It can have a significant impact on a woman’s day-to-day life and hence needs to be addressed properly and seriously. From a more sinister perspective, in certain cases, it can be cancer and we are picking it up late.”
Source: Independent, 14 February 2023
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Now for sale: Data on your mental health (Washington Post)

Capitalizing on the pandemic explosion in telehealth and therapy apps that collect details of your mental health needs, data brokers are packaging that information for resale, a new study finds. There’s no law stopping them.
In a study published Monday, a research team at Duke University’s Sanford School of Public Policy outlines how expansive the market for people’s health data has become.
After contacting data brokers to ask what kinds of mental health information she could buy, researcher Joanne Kim reported that she ultimately found 11 companies willing to sell bundles of data that included information on what antidepressants people were taking, whether they struggled with insomnia or attention issues, and details on other medical ailments, including Alzheimer’s disease or bladder-control difficulties.
Justin Sherman, a senior fellow at Duke who ran the research team, says that mental health data should be treated especially carefully, given that it could pertain to people in vulnerable situations — and that, if shared publicly or rendered inaccurately, could lead to devastating results.
Source: Washington Post, 13 February 2023
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Chronic UTI sufferers face mental health crises after being ‘dismissed and gaslighted’ for years

Women suffering from chronic urinary tract infections (UTIs) are facing mental health crises after being “dismissed and gaslighted” by health professionals for years, according to a leading specialist.
Daily debilitating pain has left patients feeling suicidal, with those in recovery describing lingering mental health problems “akin to post-traumatic stress disorder (PTSD)”, said Dr Rajvinder Khasriya, an NHS consultant urogynaecologist at the Whittington Hospital in London.
Patients have said they feel crippling anxiety over planning ahead to ensure there is always a toilet around, even after their condition has been controlled with treatment. 
Vicky Matthews, who searched for a diagnosis for three years after a recurrent UTI became chronic, said the condition caused a “gradual decline” in her mental health as medical professionals were unable to pinpoint what was causing her pain.
"I questioned my pain. I questioned what was going on. I questioned whether it was actually real and that was a pretty awful thing to be dealing with on top of having physical pain,” the 43-year-old said, describing what she felt was “mental torture”.
Read full story
Source: I News, 12 February 
Further reading on the hub
The clinical implications of bacterial pathogenesis and mucosal immunity in chronic urinary track infection
Sam

Delayed discharges rise in 17 ICSs despite Barclay’s £250m fund

A high-profile £250m government intervention to free up hospital beds has so far failed to deliver any significant reduction in delayed discharges – with multiple systems instead reporting large increases.
Steve Barclay announced the fund, including £200m to buy step-down residential care beds to speed up discharges, on 9 January, following a “recovery forum” crisis summit at 10 Downing Street.
NHS England said in guidance on 13 January the funding must bring “immediate improvements”, and local leaders were again told to “maximise the impact of their areas’ allocation of the money in the run up to strikes on 6 February”. 
But according to official data, in the week the new money was announced, there was an average of 14,035 patients who did not meet the clinical “criteria to reside”, but were still waiting to leave hospital, equating to around one in seven occupied beds. The total numbers have barely changed since then, with an average of 13,975 cases reported in the week to 5 February, also representing one in seven occupied beds.
Read full story (paywalled)
Source: HSJ, 13 February 2023
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‘A growing threat to human health’: we are ill-equipped for the dangers of fungal infections

About 2 million people die a year as a result of a core group of fungi, and the WHO is concerned we are unprepared for the future.
In October, the World Health Organization released its fungal priority pathogens list, the first global effort to create a mycological “most wanted” list of the 19 fungi most dangerous to humans . “Despite posing a growing threat to human health, fungal infections receive very little attention and resources globally,” the report said. “This all makes it impossible to estimate the exact burden of fungal infections, and consequently difficult to galvanise policy and programmatic action.”
Fungi are the most populous life form on the planet, with an estimated 12 million species existing worldwide. Only a fraction of these species infect humans, but they are responsible for roughly a billion infections each year. “Most of those are superficial things like athlete’s foot, that no one’s particularly bothered about, but there is a core group that causes life-threatening infections, and particularly in susceptible populations such as the very old or young, and those with immune systems that don’t work properly,” says Mark Ramsdale, an associate professor of mycology at the MRC Centre for Medical Mycology in Exeter.
About 1.5 million people die a year as a result of these infections, says Ramsdale – although that may be an underestimation, because fungi predominantly infect people who already have major health problems. “The primary cause of death will probably be leukaemia or heart transplant, or whatever,” he says. “But the thing that actually kills the patient is a fungal infection, so there is a strong element of underreporting going on.”
Underestimating them would be a mistake.
Read full story
Source: The Guardian, 10 February 2023
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