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

NHS told to expect ‘huge number’ of legal challenges after pandemic

The NHS should expect a “huge number” of legal challenges relating to decisions made during the coronavirus pandemic, healthcare lawyers have warned.
The specialists said legal challenges against clinical commissioning groups and NHS providers would be inevitable, around issues such as breaches of human rights and clinical negligence claims.
Francesca Burfield, a barrister specialising in children’s health and social care, told HSJ’s Healthcheck podcast: “I think there is going to be huge number of challenges. If and when we move through this there will not only be a public enquiry, [but] I anticipate judicial reviews, civil actions in relation to negligence claims and breach[es] of human rights….”
She said criminal proceedings by the Care Quality Commission or Crown Prosecution Service would also be a possibility, around issues such as deprivation of liberty, neglect, safeguarding, and potential gross negligence manslaughter.
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Source: HSJ, 20 April 2020
Patient Safety Learning

Ventilator manufacturers form ventilator training alliance, create App to help front-line medical workers during COVID-19 pandemic

According to an Allego press release, several of the world’s ventilator manufacturers have formed a Ventilator Training Alliance (VTA) and partnered with Allego to create a mobile app that front-line medical providers can use to access a centralised repository of ventilator training resources.
Dräger, GE Healthcare, Getinge, Hamilton Medical, Medtronic, Nihon Kohden, and Philips have joined this humanitarian training coalition.
The VTA app – powered by learning and readiness platform provider Allego – connects respiratory therapists, nurses and other medical professionals with ventilator training resources from alliance member companies, including instructional how-to videos, manuals, troubleshooting guides, and other ventilator-operation expertise critical to helping responders treat patients suffering from COVID-19-related respiratory distress.
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Source: American Association for Respiratory Care, 16 April 2020
Patient Safety Learning

Masks for public 'could put NHS supplies at risk'

NHS supplies of face masks could be put at risk if the government starts advising the public to wear them, hospital bosses have warned.
The government's scientific advisers are to meet later to discuss whether the public should be urged to wear masks in a bid to combat coronavirus, but Chris Hopson, chief executive of NHS Providers, warned there should be "clear evidence" to justify their use.
He said securing supplies for NHS staff amid huge global demand was "crucial".
The World Health Organization (WHO) has said there is no evidence to support the use of face masks by the general population. It says people who are not in health and care facilities should only wear masks if they are sick or caring for those who are ill.
But the debate around their use in the UK has been gaining momentum in recent weeks, with proponents arguing they can help reduce the risk of people with the virus passing it on to others.
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Source: BBC News, 21 April 2020
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Coronavirus disproportionately affecting BAME communities in UK, new figures show

More than 16% of people who had tested positive for coronavirus when they died were from black, Asian and minority ethnic (BAME) communities, new data shows.
On Monday, NHS England released data showing the ethnic breakdown of people who have died with coronavirus for the first time.
The statistics come days after a review was announced to examine what appears to be a disproportionate number of BAME people who have been affected by Covid-19.
Last week Downing Street confirmed the NHS and Public Health England will lead the review of evidence, following pressure on ministers to launch an investigation.
Discussing the review, Professor Chris Whitty, the chief medical officer for England, said ethnicity is "less clear" than three others factors in determining who is most at risk from coronavirus.
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Source: The Independent, 21 April 2020
Patient Safety Learning

COVID-19: ibuprofen can be used for symptoms, says UK agency, but reasons for change in advice are unclear

UK medicines agencies have changed their advice on ibuprofen to say that the drug can be used to treat patients with symptoms of COVID-19, although the evidence that prompted the revision has not been made public.
The change follows a review by the Commission on Human Medicines’ expert working group on COVID-19 which, along with previous reviews of evidence, concluded that there is currently insufficient evidence to establish a link between use of ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs), and contracting or worsening of COVID-19.
The group’s review has not been published, but prompted the Medicines and Healthcare Products Regulatory Agency (MHRA), NHS England, and the National Institute for Health and Care Excellence (NICE) to update their advice to say that patients can take paracetamol or ibuprofen for symptoms of COVID-19, such as fever and headache.
This is a change to NICE’s recommendation on 3 April that paracetamol should be used in preference to NSAIDs for managing fever in patients with suspected COVID-19 until more evidence is available.
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Source: BMJ, 17 April 2020
Patient Safety Learning

COVID-19: increasing demand for dialysis sparks fears of supply shortage

More than a quarter of patients with COVID-19 on ventilators also need renal support in the form of dialysis, raising concerns that there could be significant supply problems as countries attempt to stock up on the required fluid and plastic consumables.
Nephrology consultant Graham Lipkin told The BMJ, “This is an under-recognised challenge. While the original focus has been on whether we have enough ventilators and intensive care beds, it has become apparent that there is a high incidence of acute kidney injury (AKI) requiring some form of renal replacement therapy (RRT) through dialysis. With the volume of people coming into intensive care, there are increasing challenges to capacity across the system.”
Lipkin, who is president of the Renal Association, has been working with NHS England to develop new clinical guidelines for the prevention and optimal management of AKI in hospital. The guidance aims to reduce the incidence of AKI and therefore the demand for dialysis.
Read full story
Source: BMJ, 21 April 2020
Patient Safety Learning

NHS staff given flawed coronavirus tests

Coronavirus tests given to thousands of NHS staff so they could return to work have been found to be flawed and should no longer be relied on, a leaked document reveals. 
The memo from Public Health England (PHE), sent earlier this month, warns of "degraded" performance, meaning the results are less reliable than first thought. 
Almost 100,000 NHS and social care workers and their relatives have now undergone tests in an effort to get as many staff back to the frontline as possible. 
But the memo, dated April 11, reveals that "discordant results" have been identified in the tests, run by PHE and NHS laboratories, requiring ambiguous samples to be re-checked.
Read full story
Source: The Telegraph, 22 April 2020
Patient Safety Learning

Hancock: Staff should be free to speak out over coronavirus concerns

NHS staff should “feel free” to speak out about problems like protective equipment shortages, Matt Hancock has said, despite many having been warned not to do so.
The health and social care secretary told the daily coronavirus briefing on 21 April that it’s “totally normal” for NHS staff to raise concerns about personal protective equipment shortages in their areas and said “transparency is important”.
HSJ has heard from multiple senior local NHS leaders that they have been given strong warnings not to communicate externally about the COVID-19 response, with national officials seeking to closely grip information given to the media.
There have been several reports of healthcare professionals having been “gagged” by hospitals and NHS bodies, with some reports of threats of disciplinary action if they raise concerns on social media or speak to journalists. 
Read full story
Source: HSJ, 21 April 2020
Patient Safety Learning

Shrewsbury maternity scandal: Hundreds of families sent letters as inquiry cases near 1,200

An independent investigation into one of the worst maternity safety scandals in NHS history has written to 400 families today as the number of cases under investigation swell to almost 1,200.
Despite the coronavirus crisis the review, chaired by midwifery expert Donna Ockenden, is continuing its work investigating poor maternity care at the Shrewsbury and Telford Hospitals Trust where dozens of babies died or suffered brain damage as a result of poor care over several decades.
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Source: The Independent, 21 April 2020
Patient Safety Learning

Nurse shortage causes Nightingale hospital to turn away patients

Dozens of patients with Covid-19 have been turned away from the NHS Nightingale hospital in London because it has too few nurses to treat them, the Guardian can reveal.
The hospital has been unable to admit about 50 people with the disease and needing “life or death” care since its first patient arrived at the site, in the ExCeL exhibition centre, in London’s Docklands, on 7 April. Thirty of these people were rejected because of a lack of staff.
The planned transfer of more than 30 patients from established London hospitals to the Nightingale was “cancelled due to staffing issues”, according to NHS documents seen by the Guardian.
The revelation raises questions about the role and future of the hospital, which up until Monday had only treated 41 patients, despite being designed to include almost 4,000 beds.
One member of staff said: “There are plenty of people working here, including plenty of doctors. But there aren’t enough critical care nurses. They’re already working in other hospitals and being run ragged there. There aren’t spare people [specialist nurses] around to do this. That’s the problem. That leads to patients having to be rejected, because there aren’t enough critical care nurses.”
Read full story
Source: The Guardian. 21 April 2020
Patient Safety Learning

NHS data sharing failure ‘exasperating and could cause error’

Significant concerns about the NHS’ refusal to share data with councils have emerged in a letter from a leading council chief executive and clinical commissioning group accountable officer. 
Steven Pleasant, chief executive of Tameside Metropolitan Borough Council and accountable officer of Tameside and Glossop CCG, said the failures are “becoming increasingly exasperating”, in a letter intended for the Ministry of Housing, Communities and Local Government’s shielding sounding board.
Steven said he understands NHS Digital has decided the most recent version of the list cannot be shared with councils even though it is being shared with police, fire, voluntary organisations and companies offering logistical support.
“I am sure that you will appreciate that this is counterproductive and frustrating given that local authorities are leading and coordinating the response to the most vulnerable in communities,” he wrote.
He also raised concerns about how the NHS’ shielded patients team is passing on to councils information about people needing additional support — for instance, if the recipient’s food parcel stock is running low, requiring the council to step in. Welfare concerns and medication information could also need to be passed on. Mr Pleasant said although his council had asked for this information to be provided via email, staff “have been told by the NHS shielding team that they do not have permission to do this and that details can only be provided verbally over the phone”.
“We believe this significantly increases the chances of error and presents significant risk… around incorrect information being captured,” he wrote.
Read full story
Source: HSJ, 21 April 2020
Patient Safety Learning

Coronavirus death toll in UK twice as high as official figure

The coronavirus pandemic has already caused as many as 41,000 deaths in the UK, according to a Financial Times analysis of the latest data from the Office for National Statistics.
The estimate is more than double the official figure of 17,337 released by ministers on Tuesday, which is updated daily and only counts those who have died in hospitals after testing positive for the virus. The FT extrapolation, based on figures from the ONS that were also published on Tuesday, includes deaths that occurred outside hospitals updated to reflect recent mortality trends.
The ONS data also showed that deaths at home and in care homes had also jumped sharply during the pandemic. In the week ending 10 April, deaths in care homes reached 4,927, almost double the figure of 2,471 a month earlier.
The ONS said on Tuesday it had asked Public Health England to investigate why care home deaths were rising so sharply.
Read full story
Source: The Financial Times, 22 April 2020
Patient Safety Learning

Military appalled by planning fiasco over NHS protective kit

Military personnel have criticised the NHS for its “appalling” handling of distributing personal protective equipment. The armed forces are helping with the distribution of equipment and staff have been seconded to help planning across seven hubs.
A senior army source lambasted the health service for its logistics for PPE, alleging that masks, aprons, gloves and other items were being assigned to hospitals without regard to relative need, leading to oversupply in some areas and shortages in others.
Read full story (paywalled) 
Source: The Times, 22 April 2020
Patient Safety Learning

Thousands missing out on cancer diagnosis

Delays in diagnosing and treating people with cancer could lead to more years of lost life than with COVID-19, according to a leading cancer expert.
A drop-off in screening and referrals means roughly 2,700 fewer people are being diagnosed every week, Cancer Research UK says.
Cancer screening has paused in Wales, Scotland and Northern Ireland, with few invitations sent out in England.
People are still advised to contact their GP with worrying symptoms.
But Richard Sullivan, professor of cancer and global health at King's College London, said there was more fear of Covid-19 than of having cancer at the moment. With GPs more difficult to contact than normal, this was resulting in a "dramatic drop-off" in referrals to specialists, he said.
"Most modellers in the UK estimate excess of deaths is going to be way greater than we are going to see with Covid-19," he said.
Read full story
Source: 22 April 2020, BBC News
Sam

Deaths of NHS staff from COVID-19 analysed

In recent weeks, there has been sustained public and media interest in the death from COVID-19 of health and social care workers. Both mainstream and social media outlets have been reporting on these deaths individually or collectively, but there has been no formal analysis of this data. 
The deaths of 119 NHS staff have now been analysed by three leading clinicians and the results are been published by HSJ.
HSJ highlights three key findings from the analysis:
1. The disproportionately high rate of BAME individuals among those who have died;
2. The absence of those members of staff considered at high risk of viral exposure and transmission; and
3. The overall rate of fatalities compared to the population.
Read full story
Source: HSJ, 22 April 2020
Sam

One in three pharmacists unable to access PPE, finds RPS survey

A third of pharmacists cannot obtain continuous supplies of personal protective equipment (PPE), according to a survey conducted by the Royal Pharmaceutical Society (RPS).
The survey found that 34% of respondents said they were not able to source continued supplies of PPE as they work in the face of COVID-19.
The poll of 445 pharmacists also revealed that 94% were unable to maintain social distancing of two metres from other staff in their pharmacy, mainly because the pharmacies — and the dispensaries in particular — were too small. A further 40% of respondents said they were unable to maintain social distancing of two metres from patients.
The results of the survey, which ran between 14 and 20 April 2020, have come after Public Health England (PHE) updated its PPE guidance on 10 April 2020, which recommends that pharmacy staff only wear fluid-resistant (type IIR) surgical masks (FRSMs) when in “contact with possible or confirmed cases of COVID-19” and not around other pharmacy staff.
Read full story
Source: The Pharmaceutical Journal, 22 April 2020
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