A key element in the new covid-19 response service run by NHS 111 urgently needs more doctors, NHS England has said.
The national covid-19 clinical assessment service, or CCAS, serves a cohort of patients with coronavirus symptoms deemed by 111 as needing a clinical assessment over the phone or online.
An email to GPs from NHSE’s primary care directors on Friday evening said: “We urgently need more GPs help to staff this service, especially as covid-19 cases increase over coming days, because of your expertise and experience.”
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Source: HSJ, 6 April 2020
The toxicity of a commonly prescribed beta blocker needs better recognition across the NHS to prevent deaths from overdose, a new report warns today.
The Healthcare and Safety Investigation Branch (HSIB) report focuses on propranolol, a cardiac drug that is now predominately used to treat migraine and anxiety symptoms. It is highly toxic when taken in large quantities and patients deteriorate quickly, making it difficult to treat. The investigation highlighted that these risks aren’t known widely enough by medical staff across the health service, whether issuing prescriptions to at risk patients, responding to overdose calls or carrying out emergency treatment.
Dr Stephen Drage, ICU consultant and HSIB’s Director of Investigations, said: “Propranolol is a powerful and safe drug, benefitting patients across the country. However, what our investigation has highlighted is just how potent it can be in overdose. This safety risk spans every area of healthcare – from the GPs that initially prescribe the drug, to ambulance staff who respond to those urgent calls and the clinicians that administer emergency treatment."
The report also emphasises that there is a link between anxiety, depression and migraine, and that more research is needed to understand the interactions between antidepressants and propranolol in overdose.
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Source: HSIB, 6 February 2020
A shortage of contraception is causing chaos and risks unplanned pregnancies and abortions, doctors are warning.
Leading sexual health experts have written to ministers warning that the supply shortage of contraceptives is beginning to lead to serious problems across the UK.
A number of daily pills and a long-acting injectable contraceptive are thought to be affected, including Noriday, Norimin and Synphase. The problem follows a shortage of hormone replacement therapy for menopausal women last year.
It is unclear how many women use these types of contraception - overall around three million women take daily pills, and more than 500,000 use long-acting contraception, such as coils, implants and injections.
The Royal College of GPs said its members were doing their best to help women find alternatives - there are many different types of daily pill available.
Faculty president Dr Asha Kasliwal said; "We are aware that women are sent away with prescriptions for unavailable products and end up lost in a system. This is causing utter chaos."
The faculty has teamed up with the Royal College of Obstetricians and Gynaecologists and the British Menopause Society to write to ministers, asking them to set up a working group to address the problems. The letter warns women are becoming distressed by having to find alternative products that might not necessarily suit them or go without contraception altogether.
It said this was affecting the "physical and mental wellbeing of girls and women" and could lead to a "rise in unplanned pregnancies and abortions".
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Source: BBC News, 7 February 2020
Dozens of women who thought they were having a "complete mesh removal" have discovered material has been left behind, the BBC's Victoria Derbyshire programme has been told.
Some women have been left unable to walk, work or have sex after having the initial vaginal-mesh implants.
Specialist surgeons say in some cases total or partial mesh removal can be beneficial. But some women said their symptoms had become worse. One was left suicidal.
Vaginal-mesh implants remain available on the NHS in England but only when certain conditions are met. In Scotland, the use of mesh was halted in 2018.
One paitent said her surgeon had promised her a "full mesh removal", but she has now been told more than 10cm (4in) could have been left behind. She had the mesh implanted several years ago to treat urinary incontinence and said she had woken after the surgery with "chronic pain in my legs, my groin and my hips". It is believed she suffered nerve damage.
A year later – after being told by one expert a mesh removal would be unlikely to resolve her pain – she found a surgeon who told her the implant could be completely removed. She had two operations, each taking her half a year to recover from, and was told there had been a full removal. But "within a few months" the pain began to return and her health deteriorated and she found out that only 5–8cm had been removed.
"My whole world turned upside down," she said, breaking into tears.
She has since been told by a separate specialist her form of mesh was one of the most difficult to remove and could cause significant nerve damage if not removed properly. She said she had never been told this by her surgeon.
The number of women affected is unknown but the Victoria Derbyshire programme understands there are at least dozens of such cases.
The Royal College of Obstetricians and Gynaecologists said in a statement that it took "each and every complication caused by mesh very seriously". It said: "Women must be informed of all options available and the benefits and risks of each so they can make the best decision about their care."
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Source: BBC News, 6 February 2020
Patients were harmed at a Midlands trust because of delays in receiving outpatients and diagnostics appointments, the Care Quality Commission (CQC) has warned.
Following the inspection at Northern Lincolnshire and Goole Foundation Trust in September and October last year, the CQC has lowered the trust’s rating in its safety domain from “requires improvement” to “inadequate”. It warned there were insufficient numbers of staff with the right skills, qualifications and experience to “keep patients safe from avoidable harm”.
The report noted the trust had identified incidents in 2018 and 2019 where patients had come to harm due to delays in receiving appointments in outpatients, particularly in ophthalmology. Ten patients were found to have come to low harm, one patient moderate harm and two patients severe harm.
The CQC also issued a Section 31 letter of intent to seek further clarification in relation to incidents where patients had come to harm because of delays to receiving appointments in outpatients and diagnostic imaging, although it has confirmed the trust has provided details on how it is going to manage the issues raised. The watchdog said it would continue to monitor the issue.
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Source: HSJ, 7 February 2020
A GP has been given three life sentences for 90 sex assaults on female patients.
Manish Shah assaulted 23 women and a 15-year-old girl while working in London - carrying out invasive examinations for his own gratification. The Old Bailey heard he used Angelina Jolie and Jade Goody as examples to frighten patients about their health.
Judge Anne Molyneux described him as a "master of deception who abused his position of power". "You made up stories which got into heads and caused panic," she said.
Shah, from Romford, convinced his victims to have unnecessary checks between May 2009 and June 2013.
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Source: BBC News, 7 February 2020
A police investigation has been launched into an alleged assault against an elderly patient with Alzheimer’s by NHS staff at the troubled East Kent Hospitals University NHS Foundation Trust.
The Independent can reveal nurses and carers at the William Harvey Hospital have been suspended after being filmed by hospital security staff for eight minutes allegedly holding down the man’s arms and legs as well as his face while they inserted a catheter.
The trust has confirmed it has launched an investigation and alerted police after the incident on 15 December on the Cambridge J ward at the William Harvey Hospital in Ashford. A spokesperson “apologised unreservedly” for the incident and said it was being treated with the “utmost seriousness”.
A whistleblower spoke out to The Independent about the incident, fearing it was being covered up by the trust after staff were told “don’t discuss it, don’t refer to it at all”.
The senior clinician said they had decided to go public after the “horrific” incident because of the trust’s toxic culture and concerns for the welfare of other patients on wards.
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Source: The Independent, 7 February 2020
The ghosts of medical errors haunt Dr. Peter Pronovost. Two deaths, both caused by mistakes. First, his father’s, who died as the result of a cancer misdiagnosis. Then a little girl, a burn victim who succumbed to infection and diagnostic missteps at the hospital where Pronovost worked early in his career.
Those deaths led Pronovost to pursue a medical career dedicated to patient safety, and to create the medical checklist he has become known for worldwide.
Now, he’s implementing his second act, at University Hospitals in the USA, as its Chief Transformation Officer, a job he has held since late 2018. His goal: To transform a $4 billion health care system by reducing shortcomings in medical care and increasing the quality of treatment.
The challenge fits Pronovost, says one of his former Johns Hopkins University professors, Dr. Albert Wu. “He’s one of the few people for whom the title might be appropriate, because his work has led to significant changes and innovations in how we deliver health care in the United States.
“He’s a once-in-a-generation guy.”
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Source: Cleveland.com, 9 February 2020
It has been revealed that three patients a day are dying from starvation or thirst or choking on NHS wards.
In 2017, 936 hospital deaths were attributed to one of those factors, with starvation the primary cause of death in 74 cases.The Office for National Statistics data reveals malnutrition deaths are 34% higher than in 2013.
Over-stretched nurses are simply too busy to check if the sick and elderly are getting nourishment.
However, Myer Glickman from the ONS says the data is not conclusive proof of poor NHS care. He said:“There has been an increase over time in the number of patients admitted to hospital while already malnourished. This may suggest that malnutrition is increasingly prevalent in the community, possibly associated with the ageing of the population and an increase in long-term chronic diseases.”
Yet campaigners say too many vulnerable people are being “forgotten to death” in NHS hospitals and urgent action is needed to identify and treat malnutrition.
In a recent pilot scheme the number of deaths among elderly patients with a fractured hip was halved by simply having someone to feed them. Six NHS trusts employed a junior staff member for each ward tasked with getting 500 extra calories a day into them. More survived and the patients spent an average five days less in hospital, unblocking beds and saving more than £1,400 each.
It wasn’t just the calories though – it helped keep their morale up.
Because, as one consultant said: “Food is a very, very cheap drug that’s extremely powerful.”
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Source: Mirror, 4 February 2020
Concerns have been raised that NHS ambulance staff are being "silenced" over bullying allegations.
Hundreds of East of England Ambulance Service (EEAS) employees reported bullying in 2018, while 28 non-disclosure agreements (NDAs) have been issued since 2016. The GMB union said the figures showed a "heavy-handed culture".
The service said it took bullying and harassment "extremely seriously" and had policies to prevent such behaviour.
EEAS faced scrutiny in November when it emerged three members of staff died in 11 days. One, Luke Wright, 24, is believed to have taken his own life. An independent investigation, which dealt in part with bullying claims, has been carried out with the results reported to the trust in January.
The 28 NDAs had been made in cases where bullying, harassment or abuse by colleagues had been reported, according to figures obtained under the Freedom of Information Act. These involved an individual agreement, often with a payment, which prevented the person speaking about their case.
In the latest staff survey from 2018, 23% of staff reported bullying, up from 21% in the previous year.
The GMB said NDAs were seen as a "method of silencing rather than resolving" and called on the trust to discuss more meaningful ways of dealing with problems.
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Source: BBC News, 10 February 2020
Reports of illegal teeth-whitening that could leave patients at risk of health problems including burns or lost teeth have increased, the BBC has found.
General Dental Council (GDC) figures showed a 26% rise in reports last year.
Teeth-whitening can only be performed legally in the UK by professionals registered with the GDC. One beauty school claimed to have provided "thousands" of candidates with illegitimate qualifications, an undercover investigation found. Failure to comply with the requirement to be registered can result in a criminal record and an unlimited fine.
Untrained beauticians using teeth-whitening kits have been known to cause tooth loss, burns and blisters.
Dr Ben Atkins, president of the Oral Health Foundation, said: "When things go wrong in dentistry, they can really go wrong. I've been that dentist with the full back up service when the patient's had that heart attack. It would be catastrophic for the patient and the person who's been trained and told it's legal to do it."
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Source: BBC News, 10 February 2020
A doctor and mother of two with just months left to live has warned of a “hidden epidemic” of asbestos-related cancers among NHS staff and patients because hospitals have failed to properly handle the toxic material.
Kate Richmond, 44, has spoken out to raise awareness after she won a legal case against the NHS for negligently exposing her to asbestos while she was working as a medical student and junior doctor.
An investigation by The Independent has learnt there have been 13 prosecutions linked to NHS breaches of regulations for the handling of asbestos since 2010, while 381 compensation claims have been made by NHS staff for work-related diseases, including exposure to asbestos, since 2013, costing the health service more than £26m.
According to data from the Health and Safety Executive, between 2011 and 2017, a total of 128 people working in health and social care roles died from mesothelioma, the same asbestos-related cancer which is killing Kate Richmond.
She described how maintenance staff removed asbestos ceiling tiles with no protective measures, allowing dust and debris to fall on to wards where patients were in their beds and staff were working. Managers at the Walsgrave Hospital in Coventry failed to heed warnings by workers that they were putting people at risk.
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Source: The Independent, 9 February 2020
One in three trainee doctors in Australia have experienced or witnessed bullying, harassment or discrimination in the past 12 months, but just a third have reported it.
That's according to a national survey of almost 10,000 trainee doctors released today by the Australian Health Practitioner Regulation Agency (AHPRA).
The results of the survey, co-developed by the Medical Board of Australia (MBA), send a "loud message" about bullying and harassment to those in the medical profession, said MBA chair Anne Tonkin.
"It is incumbent on all of us to heed it," Dr Tonkin said. "We must do this if we are serious about improving the culture of medicine."
"Bullying, harassment and discrimination are not good for patient safety, constructive learning or the culture of medicine," Dr Tonkin continued. "We must all redouble our efforts to strengthen professional behaviour and deal effectively with unacceptable behaviour."
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Source: ABC News, 10 February 2020
On January 2020, Patient Safety will be on the G20 agenda (among other five health key priorities), but Abdulelah M. Alhawsawi, Saudi Patient Safety Center, asks "what is patient safety doing on an economic forum like the G20?"
Patient harm is estimated to be the 14th leading cause of the global disease burden. This is comparable to medical conditions such as tuberculosis and malaria. In both US and Canada, patient safety adverse events represent the 3rd leading cause of death, preceded only by cancer and heart disease. In the US alone, 440,000 patients die annually from healthcare associated infections. In Canada, there are more than 28,000 deaths a year due to patient safety adverse events. In low-middle income countries, 134 million adverse events take place every year, resulting in 2.6 million deaths annually.
In addition to lives lost and harm inflicted, unsafe medical practice results in money loss. Nearly, 15 % of the health expenditure across Organization of Economic Cooperative Development countries is attributed to patient safety failures each year, but if we add the indirect and opportunity cost (economic and social), the cost of harm could amount to trillions of dollars globally.
When a patient is harmed, the country loses twice. The individual will be lost as a revenue generating source for society and the individual will become a burden on the healthcare system because he or she will require more treatment. Unless we do something different about patient safety, we would risk the sustainability of healthcare systems and the overall economies.
Alhawsaw proposed establishing a G20 Patient Safety Network (Group) that will combine Safety experts from healthcare and other leading industries (like aviation, nuclear, oil and gas, other), and economy and fFinancial experts
This will function as a platform to prioritise and come up with innovative patient safety solutions to solve global challenges while highlighting the return on investment (ROI) aspects.
This multidisciplinary group of experts can work with each state that adopts the addressed global challenge to ensure correct implementation of proposed solution.
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Source: The G20 Health & Development Partnersip, 10 February 2020
A woman described as a "high risk" anorexia patient faced delays in treatment after moving to university, an inquest has heard.
Madeline Wallace, 18, from Cambridgeshire, was told there could be a six-week delay in her seeing a specialist after moving to Edinburgh.
The student "struggled" while at university and a coroner said there appeared to be a "gap" in her care. Ms Wallace died on 9 January 2018 due to complications from sepsis.
A parliamentary health service ombudsman report into her death was being written at the time of Ms Wallace's treatment in 2017 and issues raised included moving from one provider to another and higher education.
Coroner Sean Horstead said Ms Wallace only had one dietician meeting in three months, despite meal preparation and planning being an area of anxiety she had raised.
Dr Hazel said she had tried to make arrangements with the Cullen Centre in Edinburgh in April 2017 but had been told to call back in August. The Cullen Centre said it could only accept her as a patient after she registered with a GP and that an appointment could take up to six weeks from that point.
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Source: BBC News, 10 February 2020
A BBC News investigation has uncovered more preventable baby deaths at an NHS trust that has already been criticised for its maternity services.
Four families said their babies would have survived had East Kent Hospitals NHS Trust provided better care. The NHS's Healthcare Safety Branch is investigating 25 maternity cases at the hospitals in Margate and Ashford.
The trust has apologised for the care provided in two of the cases and said they were investigating a third. It has denied any wrongdoing in the fourth case.
The government is due to receive the Healthcare Safety Branch's report into the 25 cases later, as well as a Care Quality Commission report from an inspection carried out in January.
Last month, the BBC discovered at least seven preventable deaths may have occurred at the trust since 2016. Four further families have now spoken out, saying their babies would not have died if medics had provided better care. In two of the cases, the mothers said the actions of the trust left them feeling they were to blame for their babies' deaths.
In a statement, East Kent Hospitals Trust it had set up a board sub-committee "to ensure we are complying with national safety standards and ensure we are implementing the coroner's recommendations fully and swiftly".
"We are deeply saddened by the stories of families who have suffered the death of a much-loved baby, and we are extremely sorry for their loss," it added.
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Source: BBC News, 10 February 2020
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