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

Coronavirus: Hundreds of learning disability deaths in just eight weeks, new data shows

More than 460 people with a learning disability have died from coronavirus in just eight weeks since the start of the outbreak in England.
New data shows between the 16 March and 10 May 1,029 people with a learning disability died in England, with 45 per cent, 467, linked to coronavirus.Overall the number of deaths during the eight weeks is 550 more than would be expected when compared to the same period last year.
The charity Mencap warned people with a learning disability were “being forgotten in this crisis” and called for action to tackle what it said could be “potentially discriminatory practice.”
It highlighted the percentage of Covid-19 related deaths among learning disabled people was higher than those in care homes, where the proportion of Covid-19 deaths was 31 per cent for the same period.
The data has been published after an outcry over the lack of transparency about the impact of Covid-19 on mental health patients and people with a learning disability or autism.
Read full story
Source: The Independent, 19 May 2020
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Second more deadly wave of coronavirus 'to hit Europe this winter'

European countries should brace themselves for a deadly second wave of coronavirus infections because the pandemic is not over, the World Health Organization’s top official in Europe has said. 
In an exclusive interview with The Telegraph, Dr Hans Kluge, director for the WHO European region, delivered a stark warning to countries beginning to ease their lockdown restrictions, saying that now is the "time for preparation, not celebration".
Dr Kluge stressed that, as the number of cases of COVID-19 in countries such as the UK, France and Italy was beginning to fall, it did not mean the pandemic was coming to an end. The epicentre of the European outbreak is now in the east, with the number of cases rising in Russia, Ukraine, Belarus and Kazakhstan, he warned.
Read full story (paywalled)
Source: The Telegraph, 20 May 2020
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Agency is criticised over its investigation into baby’s death from hypoxia

The coroner investigating the botched birth of a baby boy who died from hypoxia has strongly criticised the Healthcare Service Investigation Branch (HSIB) over its report on his death.
Karen Henderson, who conducted the inquest into the death of baby Theo Young in May 2018 at East Surrey Hospital said that the HSIB had asked Surrey and Sussex Healthcare NHS Trust not to undertake its own investigation, “effectively preventing the recognition of causes of concern and therefore being unable to undertake any immediate and necessary remedial action at the earliest opportunity to prevent future deaths.”
Read full story (paywalled)
Source: BMJ, 19 May 2020
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Coronavirus: Cancer surgery delays risk 'thousands' of deaths

The NHS must ensure cancer-surgery delays do not cost more lives than the number of COVID-19 patients saved, the Institute of Cancer Research says.
In some cancers, a three-month delay could make the difference between a tumour being curable or not, Prof Clare Turnbull said.
And her modelling suggested delaying surgery risked thousands of additional deaths.
NHS England is already urging people to seek help for worrying symptoms, but by the end of April, cancer referrals had dropped by an estimated 70%.
Cancer doctors have told BBC News of having to make difficult decisions to postpone some patients' care during the coronavirus crisis.
As normal service resumed, the NHS should prioritise "certain cancer types in particular", Prof Turnbull said.
Lung and colorectal cancers, for example, were particularly fast moving. But for others, such as prostate and certain breast cancers, treatment could more safely be delayed.
Read full story
Source: BBC News, 20 May 2020
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GPs warned to stock up on flu jabs as NHS fears double risk this winter

GPs have been warned of a double risk from flu and COVID-19 this winter which could hit the NHS just months after its recovery from the coronavirus surge.
NHS England has told practices to stock up on flu vaccines while discussions are ongoing as to whether to widen the eligibility for flu jabs to try and protect as many people as possible from September onwards.
A second wave of coronavirus during winter, when the NHS is typically under strain from flu could overwhelm services with those most at risk from flu similarly vulnerable to coronavirus.
In a letter from NHS chiefs, including chief medical officer Chris Whitty, GPs were told: “Flu vaccination is one of the most effective interventions we have to reduce pressure on the health and social care system this winter. We are currently seeing the impact of COVID-19 on the NHS and social care, and this coming winter we may be faced with co-circulation of COVID-19 and flu.
“Those most at risk from flu are also most vulnerable to COVID-19. We must do all we can to help protect them this winter.”
Read full story
Source: The Independent, 20 May 2020
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Coronavirus: Time running out on track and trace, NHS leaders warn

Time is running out to finalise a track and trace strategy that would avoid a potential second surge in coronavirus cases, NHS leaders have said.
The NHS Confederation warned of "severe" consequences to staff and patients if the right system was not established quickly and that lockdown measures should not be eased until a clear plan was in place.
Contact tracing identifies those who may have come into contact with an infected person, either through an app or by phone and email, so they can avoid potentially passing the disease on.
It follows the Prime Minister's pledge to introduce a "world-beating" contact tracing system in England from June.
Niall Dickson, chief executive of the confederation, which represents health and care leaders, welcomed Boris Johnson's pledge made at Prime Minister's Questions on Wednesday. But in a letter to Health Secretary Matt Hancock, Mr Dickson said without a clear strategy the UK was at greater risk of a second peak of the virus.
He said a strategy should have been in place sooner and if the right system was not instigated rapidly the ramifications for the NHS "could be severe".
Speaking on the Today programme, Mr Dickson said: "We are absolutely clear that contact tracing is the right thing to do, it is absolutely critical, it has got to be in place to prevent any notion of a second surge if the lockdown is being further released."
Read full story
Source: 21 May 2020
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NHS scoring system used to identify patients at risk of dying based on flawed evidence, suggests study

Early warning scores are used in the NHS to identify patients in acute care whose health is deteriorating, but medics say it could actually be putting people in danger.
The rollout of an early warning system used in hospitals to identify patients at the greatest risk of dying is based on flawed evidence, according to a study published in the BMJ which suggests that much of the research supporting the rollout of NEWS was biased and overly reliant on scores that could put patients at greater risk..
Medical researchers said problems with NHS England's National Early Warning Scores (NEWS) system had emerged "frequently" in reports on avoidable deaths.
The system sees each patient given an overall score based on a number of vital signs such as heart rate, oxygen levels, blood pressure and level of consciousness. Doctors and nurses can then prioritise patients with the most urgent NEWS scores.
But some professionals have argued that the system has reduced nursing duties to a checklist of tasks rather than a process of providing overall clinical assessment.
Professor Alison Leary, a fellow of the Royal College of Nursing and chair of healthcare and workforce modelling at London South Bank University, told The Independent: “In our analysis of prevention of future death reports from coroners, early warning scores and misunderstanding around their use feature frequently".
“It's clear that some organisations use scoring systems and a more tick box approach to care as they lack the right amount of appropriately skilled staff, mostly registered nurses.”
“Early warning scores might not perform as well as expected and therefore they could have a detrimental effect on patient care,” the authors of the research conclude. “Future work should focus on following recommended approaches for developing and evaluating early warning scores, and investigating the impact and safety of using these scores in clinical practice.”
Read full story
Source: The Independent, 21 May 2020
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Recovery concerns as most ICUs still well above normal capacity

Dozens of intensive care units are still running well over their normal capacity – in some cases more than double – weeks after the peak of demand, figures seen by HSJ reveal.
It contrasts with the picture painted at some government coronavirus press conferences that there is huge “spare capacity” in critical care and has been throughout the outbreak, with Downing Street charts putting England-wide occupancy at around 20% currently.
The government’s assertions include the additional “surge” capacity which was hurriedly established at the start of the outbreak. But intensive care staff have been frustrated by this being labelled spare capacity, when the number of patients being treated is still well above normal levels.
In addition, the ongoing reliance on keeping surge beds open – with ICUs still spilling over other spaces and calling on staff and equipment from other services – will limit hospitals’ ability to resume normal care, such as planned surgery.
Steve Mathieu, a consultant in intensive care medicine in the south of England, said: “The majority of ICUs will currently be operating at over 100 per cent capacity and typically somewhere around 130-150 per cent, although there is significant regional variation".
“There are uncertainties whether this will now represent the ‘new normal’ for the foreseeable future and there is a national need to plan for further potential surges in activity requiring more critical care demand."
Read full story
Source: HSJ, 21 May 2020
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Stepping Hill Hospital A&E rated 'inadequate' amid safety fears

A hospital A&E department has been rated "inadequate" after inspectors found patients at "high risk of avoidable harm".
The Care Quality Commission (CQC) reported a "range of regulation breaches" and a shortage of nurses at Stepping Hill hospital's A&E unit. It also criticised maternity and children's services.
Stockport NHS Foundation Trust's chief executive said the trust had taken "immediate steps" to improve.
The CQC inspected Stepping Hill Hospital in January and February and found A&E performance "had deteriorated significantly" since its last inspection in 2018.
Inspectors found shortcomings "relating to patient-centred care, dignity and respect, safe care and treatment, environment and equipment, good governance, and staffing".
Their report said the service "could not assure itself that staff were competent for their roles" and patient outcomes "were not always positive or met expectations in line with national standards".
Read full story
Source: BBC News, 19 May 2020
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Asymptomatic people will have to self-isolate after contact with COVID-19 cases

People will be asked to self-isolate for two weeks even if they are asymptomatic after coming into ‘high-risk’ contact with a person who has tested positive for COVID-19 – a testing chief has told NHS executives.
This marks a change from the official guidance given to users of the government’s contact tracing app – on NHS’ COVID-19 website – which states: “If you do not have symptoms, you do not need to self-isolate at this time.”
John Newton, a leader of the UK’s testing programme, would be “directed towards those people at high risk” instead of the wider public. He added the government faces a “huge communications exercise” next week ahead of the launch of the test and trace programme.
Giving an update on the test and trace programme – which is due to launch on 1 June – Professor Newton said: “People who are deemed high risk contact of confirmed [COVID-19] cases will be told to self-isolate for 14 days, even if they have no symptoms at the time.
Professor Newton said: “The point is there will still be a requirement to contain the virus, but the impact in terms of containment will be directed towards those people at high risk so the rest of the population can enjoy more normal life."
He said the programme’s success would depend on the public’s response in terms of:
Presenting themselves for a test if they have symptoms; Providing the information needed to identify high risk contacts; and Those people identified as high risk contacts complying with advice to self-isolate. Read full story
Source: HSJ, 21 May 2020
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Lack of social distancing in NHS staff social areas alarms national chiefs

National leaders have said healthcare workers must do better on social distancing amid growing evidence that staff-to-staff transmission is the significant factor in the spread of coronavirus throughout hospitals.
NHS England national clinical director for trauma Dr Chris Moran, said: “I’ve witnessed and I’m sure you’ve all witnessed that actually healthcare workers are not necessarily been the best at managing social distancing. We know when directly managing patients that it [social distancing] is impossible, that’s what PPE is for to protect both sides of the equation. But I think in the staff-only areas we could do quite a lot better in some of the places that I’ve visited.”
National director for acute care Keith Willett added: “The evidence we’ve seen coming through suggests the infection risks from staff to patients or patients to staff seems very low but the risks to staff of infection, COVID-19 infection, within hospitals is much, much, much higher between staff and staff, and patients and patients.”
The warning comes after NHS England’s patient safety director Dr Aidan Fowler said he was concerned about the rates of "nosocomial spread within our hospitals”.
Following national guidance designed to facilitate an increase in elective operations and other routine work, NHS trusts have been asked to set up “covid free” green zones and blue zones with a higher COVID-19 risk.
Read full story
Source: HSJ, 21 May 2020
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Coronavirus: People in deprived areas face higher risk of death – with women disproportionately affected

The risk of dying from coronavirus is more than twice as great in the most deprived areas of England – with the disparity largest for women, analysis shows.
A study by the Health Foundation of deaths from COVID-19 showed women in the most deprived parts of the country had a risk of dying that was 133% higher than those in the least deprived neighbourhoods.
Between men the difference in risk was 114% higher in worse-off areas, suggesting that while deprivation is a key factor in risk of death from coronavirus for both sexes, its effect is worse for women.
Experts say the evidence shows the impact of COVID-19 is falling disproportionately on the poorest in society.
Mai Stafford, principal data analyst at the Health Foundation, told The Independent: “This pandemic could and should be a watershed moment in creating the social and political will to build a society that values everyone’s health now and in the long term. Without significant action, there is a real risk that those facing the most disadvantage will eventually pay the highest price.”
Read full story
Source: The Independent, 21 May 2020
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WHO halts hydroxychloroquine trial for coronavirus amid safety fears

The World Health Organization has said it will temporarily drop hydroxychloroquine — the malaria drug Donald Trump said he is taking as a precaution — from its global study into experimental coronavirus treatments after safety concerns.
The WHO’s director-general Tedros Adhanom Ghebreyesus said in light of a paper published last week in the Lancet that showed people taking hydroxychloroquine were at higher risk of death and heart problems than those who were not, it would pause the hydroxychloroquine arm of its solidarity global clinical trial.
“The executive group has implemented a temporary pause of the hydroxychloroquine arm within the solidarity trial while the safety data is reviewed by the data safety monitoring board,” Tedros said on Monday. “The other arms of the trial are continuing,”
Read full story
Source: The Guardian, 25 May 2020
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Coronavirus: Care watchdog urged to re-start routine inspections of care homes and mental health units

A dozen charities and voluntary organisations have now called on the Care Quality Commission (CQC) to re-start routine inspections of care homes and mental health units amid concerns about care of patients during the coronavirus pandemic.
The watchdog suspended its routine inspections of care providers on 16 March, but said it would inspect providers in “a very small number of cases” where it had concerns for patients such as allegations of abuse.
The CQC’s chief executive said the watchdog’s decision was designed in part to limit the spread of the disease but he added that since inspections were curtailed inspectors had maintained contact with providers and helped to source protective equipment for staff.
The Relatives and Residents Association, a national charity for older people in care and their relatives, has written to the CQC’s chief executive Ian Trenholm asking him to “urgently reconsider” the decision to stop inspections.
Edel Harris, chief executive of Mencap has also highlighted concerns for hundreds of children with learning disabilities who she said were detained in “modern-day asylums” adding: “Some families are rightly terrified about what might be happening to their loved ones behind closed doors. With family contact cut and CQC inspections reduced during lockdown, there is huge concern about who is making sure that some of the most vulnerable people in society are being kept safe and well during this national crisis.”
Read full story
Source: The Independent, 26 May 2020
 
 
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Coronavirus: Disabled and vulnerable patients must be involved in treatment decisions including resuscitation, says NHS England

NHS England has said disabled and vulnerable patients must not be denied personalised care during the coronavirus pandemic and repeated its warning that blanket do not resuscitate orders should not be happening.
In a joint statement with disabled rights campaigner and member of the House of Lords, Baroness Jane Campbell, NHS England said the COVID-19 virus and its impact on the NHS did not change the position for vulnerable patients that decisions must be made on an individualised basis.
It said: “This means people making active and informed judgements about their own care and treatment, at all stages of their life, and recognises people’s autonomy, as well as their preferences, aspirations, needs and abilities. This also means ensuring reasonable adjustments are supported where necessary and reinforces that the blanket application of do not attempt resuscitation orders is totally unacceptable and must not happen.”
Read full story
Source: The Independent, 26 May 2020
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Hospital stops admitting patients following covid spike

Weston General Hospital has stopped admitting new patients – including to the accident and emergency department – following a spike in coronavirus cases. The hospital announced yesterday it was taking this “precautionary measure”  due to the “high number of coronavirus patients” on site.
MP for Weston-super-Mare John Penrose tweeted that he had spoken to local health chiefs and a deep clean is being carried out at the hospital “following a spike in infections”. He added that a temporary A&E has been set up outside the hospital, while inpatients will be re-directed to hospitals in Taunton or Bristol.
Out of hours GP practices, pharmacies and walk-in services at the minor treatment unit in Clevedon and Yate have also been given as alternative options for patients seeking medical treatment.
Read full story
Source: HSJ, 25 May 2020
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