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

Healthcare professional is referred to regulator for delaying seeing a patient because of lack of PPE

A healthcare professional is facing a fitness to practise investigation for delaying attending to a COVID-19 positive patient because of inadequate personal protective equipment (PPE), in what may be the first case of its kind.
The revelation came from a healthcare regulatory solicitor, Andrea James, who tweeted, “Was expecting it, but still disgusted to have received first #FitnessToPractise case arising from NHS trust disciplining healthcare professional who expressed concern about/delayed attending to a Covid+ patient without PPE (NHS Trust having failed to provide said PPE). For shame.”
Doctors and nurses reacted with outrage to the tweet, and the Medical Protection Society issued a strong statement condemning the move. But James said that her client wanted to remain anonymous and declined to identify the profession or the regulator involved. She said that the treatment in question was expected to be an aerosol generating procedure.
Rob Hendry, medical director at the Medical Protection Society (MPS), said, “It is appalling enough that healthcare professionals are placed in the position of having to choose between treating patients and keeping themselves and their other patients safe. The stress should not be compounded by the prospect of being brought before a regulatory or disciplinary tribunal.
“MPS members who are faced with regulatory or employment action arising from a decision to not see a patient due to lack of PPE can come to us for advice and representation. However, it should not come to this: healthcare workers should not be held personally accountable for decisions or adverse outcomes that are ultimately the result of poor PPE provision.”
Read full story
Source: BMJ, 12 August 2020
Patient Safety Learning

NHS staff to be given ‘COVID-19 passports’ so they can be redeployed quickly in any second wave

NHS staff will be given “COVID-19 passports” to help hospitals redeploy workers during a feared second wave of infection.
Bosses at NHS England say the digital passports, which are stored on workers’ phones, have been successful in pilots across the country and are being rolled out “to support the COVID-19 response”.
The COVID-19 crisis has triggered a major reorganisation of NHS care, with hospitals now having to plan to restart routine services while at the same time maintain their readiness for any increase in coronavirus cases.
The passports will help redeploy staff quickly to where they are needed most.
Read full story
Source: The Independent, 12 August 2020
Patient Safety Learning

Contact tracing app to give users COVID-19 ‘risk score’

The new version of the government’s contact tracing app will give users a ‘risk score’ based on how many people they interact with and where they live.
The news comes as the Department of Health and Social Care launches a trial for the latest model of the contact tracing app, two months after the initial version was scrapped. 
According to the DHSC, the new app will tell users whether their risk of contracting coronavirus is unknown, low or high based on how many people they are in significant contact with. They will also be told what the coronavirus risk level is in their local authority area and will be alerted if it changes.
Government guidance said the risk levels and alerts will be based on a local authority watchlist – which highlights areas that are of particular concern across the country, based on the number of coronavirus cases.
People will also be able to check into venues – such as restaurants, pubs and leisure centres – using the app by scanning a QR code. If there is then an outbreak in a venue those who have checked in via the app will be alerted and told to isolate.
The new NHS Test and Trace app trial was launched today for residents on the Isle of Wight and will expand to the London borough of Newham next week.
Read full story (paywalled)
Source: HSJ, 13 August 2020
Patient Safety Learning

Inspectors criticise poor nursing and leadership in latest damning report

A damning new report has exposed numerous lapses in nursing care on wards at Shrewsbury and Telford Hospital Trust amid a culture which left patients at risk of “unsafe and uncaring” treatment, the care watchdog has said.
Inspectors from the Care Quality Commission (CQC) cited multiple examples of nurses at the scandal-hit trust lacking the knowledge to look after patients safely and failing to record key information needed to keep patients safe during an inspection of medical wards in June this year.
The inspectors found poorly completed nursing records, equipment unavailable and nurses not following procedures. This meant some patients developed pressure sores, fell from their beds and were injured or suffered pain at the end of their life. Other patients were at risk of suffering similar harm.
Inspectors ruled the trust, which was rated inadequate and put into special measures in 2018, was unsafe and criticised the hospital leadership for what it said was a “collective failure” that was perpetuating the problems at the hospital.
Read full story
Source: The Independent, 14 August 2020
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Hospital has 'closed its doors' to patients, LMC warns NHS England

GP leaders have written to NHS England to demand that an NHS hospital trust urgently restores routine referrals as it has 'closed its doors' to some patients, ‘destabilising’ practices in the process. 
Oxfordshire LMC said local GPs are ‘concerned and angry’ about the ‘ongoing closure’ to routine referrals across multiple ‘high-demand’ specialties by Oxford University Hospital Foundation Trust, while warning GPs are also being asked to carry out tests that should be done in hospital.
A ‘significant’ number of specialties are affected, including ENT, general gynaecology, dermatology, ophthalmology, endoscopy and urology, as well as plastics and maxillofacial, it added.
The hospital trust said it had remained open for urgent and emergency care and was accepting clinically urgent and suspected cancer referrals, while reinstating services to support 'the vast majority' of routine referrals.
But Oxfordshire LMC has this week written to NHS England and the council of governors at OUHFT to demand that there are ‘no further delays’ in restoring the services amid concerns of ‘patient harm’.
It said: ‘The LMC believes the continuing closure of some specialty services to routine referrals is now so serious for patients that it has taken a decision to formally raise the concerns of Oxfordshire’s GPs with NHS England.’ 
Read full story
Source: Pulse, 13 August 2020
Patient Safety Learning

Record poor performance ‘dashes hopes of near normal’

Unprecedentedly poor waiting time data for electives, diagnostics and cancer suggests the chances of NHS England’s ambitions for ‘near normal’ service levels this autumn being met are very unlikely, experts have warned.
The statistics prompted one health think tank to urge NHS leaders to be “honest that with vital infection control measures affecting productivity, and a huge backlog, there are no shortcuts back to the way things were”.
NHS England data published today revealed there were 50,536 patients who had been waiting over a year for elective treatment as of June – up from 1,613 in February before the covid outbreak, a number already viewed as very concerning. The number represents the highest level since 2009 and 16 times higher than they were in March.
Nuffield Trust deputy director of research Sarah Scobie said: “These figures are a serious warning against any hope that the English NHS can get planned care back to normal before winter hits. The number of patients starting outpatient treatment is still a third lower than usual and getting back to 100 per cent by September will be a tall order.”
“The increase in patients waiting more than a year has continued to accelerate at a shocking pace, with numbers now at their highest since 2009 and 16 times higher than they were in March. 
“Unfortunately, despite the real determination of staff to get back on track, some of these problems are set to grow… We need to be honest that with vital infection control measures affecting productivity, and a huge backlog, there are no shortcuts back to the way things were.”
Read full story (paywalled)
Source: HSJ, 13 August 2020
Patient Safety Learning

Patient bleeds to death in hospital run by scandal-hit trust

Inspectors raise ‘serious concerns’ about medical wards and emergency care at Shropshire NHS trust
A patient bled to death on a ward at Shrewsbury and Telford Hospitals Trust after a device used to access his bloodstream became inexplicably disconnected, The Independent has learnt.
The incident came to light as new concerns arose about quality of care at the Shropshire trust, with the Care Quality Commission (CQC) warning of “serious concerns” about its medical wards and emergency department following an inspection last month.
Although the report from the inspection has not yet been published, it is understood that the trust has been served with a legal notice by the regulator to comply with more than a dozen conditions. It remains in special measures following the inspection and is rated inadequate overall.
See full article in The Independent here
Clive Flashman

Public Health England 'to be replaced'

Public Health England (PHE) is to be replaced by a new agency that will specifically deal with protecting the country from pandemics, according to a report.
The Sunday Telegraph claims Health Secretary Matt Hancock will this week announce a new body modelled on Germany's Robert Koch Institute. Ministers have reportedly been unhappy with the way PHE has responded to the coronavirus crisis.
A Department of Health and Social Care spokesperson said: "Public Health England have played an integral role in our national response to this unprecedented global pandemic."
"We have always been clear that we must learn the right lessons from this crisis to ensure that we are in the strongest possible position, both as we continue to deal with Covid-19 and to respond to any future public health threat."
The Telegraph reports that Mr Hancock will merge the NHS Test and Trace scheme with the pandemic response work of PHE.
The paper said the new body could be called the National Institute for Health Protection and would become "effective" in September, but the change would not be fully completed until the spring.
Read full story
Source: BBC News, 16 August 2020
Patient Safety Learning

Coronavirus: 200,000 defective gowns recalled from NHS hospitals

Two hundred thousand defective gowns supplied to NHS hospitals have been recalled by the government because of fears they could leave staff at increased risk of coronavirus infection.
Hospitals have been told to check their stocks of personal protective equipment (PPE) to identify the Flosteril non-sterile gowns and quarantine them immediately.
The Department of Health and Social Care (DHSC) said tests carried out on the gowns, which were delivered in June, had shown that they did not meet the fluid-resistance standards originally claimed by the manufacturer.
There may also be “inconsistencies” in the material used to make the gowns.
An estimated 200,000 gowns are thought to be in circulation within the NHS after 600,000 were supplied by the company Vannin Healthcare Global, which is registered in the Isle of Man.
Hospitals were told on Tuesday this week not to dispose of the gowns but to keep them for two weeks until they can be collected after 31 August.
It is another embarrassing blow for the government over the supply of PPE to hospitals – an issue that prompted major criticism during the height of the COVID-19 crisis, when many hospitals ran out of equipment.
Read full story
Source: The Independent, 15 August 2020
Patient Safety Learning

NHS ambulance wait figures prompt call to tackle shortages

Almost a million people waited at least half an hour for an ambulance after having a medical emergency such as a heart attack or stroke last year, NHS figures show.
Ambulance crews responding to 999 calls in England took more than 30 minutes to reach patients needing urgent care a total of 905,086 times during 2019–20. Of those, 253,277 had to wait at least an hour, and 35,960 – the equivalent of almost 100 patients a day – waited for more than two hours.
In addition to heart attacks and strokes, the figures cover patients who had sustained a serious injury or trauma or major burns, or had developed the potentially lethal blood-borne infection sepsis.
Under NHS guidelines, ambulances are meant to arrive at incidents involving a medical emergency – known as category 2 calls – within 18 minutes.
The Liberal Democrat MP Layla Moran, who obtained the figures using freedom of information laws, said: “It’s deeply shocking that such huge numbers of seriously ill patients have had to wait so long for an ambulance crew to arrive after a 999 call. It shows the incredible pressure our ambulance services were under even before this pandemic struck.
“Patients suffering emergencies like a heart attack, stroke or serious injury need urgent medical attention, not to be left waiting for up to two hours for an ambulance to arrive. These worryingly long delays in an ambulance reaching a seriously ill or injured patient could have a major long-term impact on their health.”
Read full story
Source: The Guardian, 16 August 2020
Patient Safety Learning

Coronavirus: Cover-up fears as reviews of COVID-19 deaths among NHS staff to be kept secret

Ministers have been accused of trying to cover up the findings from investigations into hundreds of health and social care worker deaths linked to coronavirus after it emerged the results will not be made public.
The Independent revealed on Tuesday that medical examiners across England and Wales have been asked by ministers to investigate more than 620 deaths of frontline staff that occurred during the pandemic.
The senior doctors will review the circumstances and medical cause of death in each case and attempt to determine whether the worker may have caught the virus during the course of their duties.
But now the Department of Health and Social Care (DHSC) said the results will be kept secret with the aim of helping local hospitals to learn and improve protection for staff.
Separately, trade unions and NHS Providers, which represents hospital trusts, have urged the government to ensure full investigations into every death and to be transparent about findings to reassure health and social care staff ahead of any second wave.
Sir Ed Davey, acting leader of the Liberal Democrats, said: “We currently have one of the highest number of deaths of health and care workers in Europe. The government has utterly failed to protect staff in both hospitals and care homes. The fact that now they are trying to cover up how and why each tragic death occurs is a disgrace."
Read full story
Source: The Independent, 15 August 2020
 
Patient Safety Learning

Cancer patients to pay heavy price for checks lost to lockdown

Five-year survival rates are expected to fall due to delays in getting urgent referrals or treatment at the height of the pandemic.
Thousands of lives may be lost to cancer because 250,000 patients were not referred to hospital for urgent checks, says a report to be published this week. Family doctors made 339,242 urgent cancer referrals in England between April and June, down from 594,060 in the same period last year — a drop of 43%.
The fall in the number of people seeing their GP with symptoms, and in referrals for scans, is resulting in cancers being spotted too late, according to the research by the Institute for Public Policy Research (IPPR) and Carnall Farrar, a healthcare management consultancy.
Full article on The Times website here (paywalled).
Clive Flashman

Long Covid: 'Life might never be normal again' (video)

Coronavirus patients who have lived with symptoms for up to five months have spoken about the huge impact it has had on their lives.
"Long Covid" support groups have appeared on social media and the government says "tens of thousands" of people have long-term problems after catching the virus, such as extreme fatigue.
Daliah, from Borehamwood, Hertfordshire, said: "It's scary because we don't know how permanent this is. There are times where I feel like life will never be normal again, my body will never be normal again."
The NHS has launched a Your Covid Recovery website to offer support and advice to people affected.
See video here
Clive Flashman

The medical school trying to become anti-racist

A major British medical school is leading the drive to eliminate what it calls "inherent racism" in the way doctors are trained in the UK.
The University of Bristol Medical School says urgent action is needed to examine why teaching predominantly focuses on how illnesses affect white people above all other sections of the population.
It comes after students pushed for reform, saying gaps in their training left them ill-prepared to treat ethnic minority patients – potentially compromising patient safety.
Hundreds of other UK medical students have signed petitions demanding teaching that better reflects the diversity of the country.
The Medical School Council (led by the heads of UK medical schools) and the regulator, the General Medical Council, say they are putting plans in place to improve the situation.
A number of diseases manifest differently depending on skin tone, but too little attention is given to this in training, according to Dr Joseph Hartland, who is helping to lead changes at the University of Bristol Medical School.
"Historically medical education was designed and written by white middle-class men, and so there is an inherent racism in medicine that means it exists to serve white patients above all others," he said .
"When patients are short of breath, for example, students are often taught to look out for a constellation of signs – including a blue tinge to the lips or fingertips – to help judge how severely ill someone is, but these signs can look different on darker skin."
"Essentially we are teaching students how to recognise a life-or-death clinical sign largely in white people, and not acknowledging these differences may be dangerous," said Dr Hartland.
Read full story
Source: BBC News, 17 August 2020
Patient Safety Learning

Leaked stats reveal 7,000 year-long waiters at major trust

Almost 7,000 patients have waited for treatment for a year or more at a major north London trust, according to NHS data seen by HSJ.
Royal Free Foundation Trust had 6,875 patients waiting 52 weeks or more, as of 26 July, according to a leaked document. It stopped reporting its elective waiting list to the centre in February 2019, citing concerns over accuracy. In a statement, it said these concerns continue.
But the document suggests the Royal Free accounted for around a third of the 20,000 year-long waiters across London at the end of July.
Minutes from the May meeting of the trust board’s quality, finance and compliance committee acknowledged “there was now a large number of RTT 52 week waiters on the trust patient tracking list… due to much of the elective work having been cancelled during covid-19, and these numbers were growing”.
Read full story (paywalled)
Source: HSJ, 18 August 2020
Patient Safety Learning

Coronavirus: NHS patient triage hotline stops nurses handling calls over safety fears

Nurses and non-medical staff have been stopped from taking patient calls to the NHS coronavirus helpline amid concerns over the safety of their advice.
An audit of calls to the telephone assessment service found more than half were potentially unsafe for patients, according to a leaked email shared with The Independent. At least one patient may have come to harm as a result of the way their assessment was handled.
The COVID-19 Clinical Assessment Service (CCAS) is a branch of the NHS 111 phone line and is designed to assess patients showing signs of coronavirus to determine whether they need to be taken to hospital or seen by a GP.
The helpline was set up at the start of the pandemic to divert patients with symptoms to a phone-based triage to relieve pressure on GPs and prevent them from turning up at surgeries and spreading the virus.
GPs, nurses and allied health professionals (AHPs) such as paramedics and physiotherapists were recruited to speak to patients after they were flagged by NHS 111 call handlers.
The use of non-medical staff was first paused in July amid concerns about the quality of call handling. Now it has emerged much wider safety issues have surfaced.
Read full story
Source: The Independent, 18 August 2020
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