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

Confed chair: Trusts lacking senior diversity should not get top CQC ratings

Trusts underperforming on leadership diversity should not be rated “good” or “outstanding” by the Care Quality Commission (CQC), the NHS Confederation chair has told HSJ.
Victor Adebowale said he did not understand how organisations can achieve the top CQC ratings if they do not demonstrate sufficient diversity at senior levels.
Lord Adebowale was speaking to HSJ alongside Marie Gabriel, following Ms Gabriel being appointed last month to chair the new NHS Race and Health Observatory, which is being hosted by the confederation.
The influential peer’s comments also follow the new People Plan tightened criteria around equality, diversity and inclusion in the “well-led” aspect of the care quality regulator’s inspections.
He said: “I struggle to see [how] any NHS trust that performs badly, [on] racial equality and leadership, can be considered to be good and outstanding. I don’t get it.
“It seems to me there is enough regulation to take into account the requirement to lead all the people, all the time. But, obviously, if you’re not, then you shouldn’t be [getting] slaps on the back, and [be rated] outstanding or good in anything else.”
Read full story (paywalled)
Source: HSJ, 28 August 2020
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Not wearing a mask a ‘serious conduct issue’, CEO warns staff

A London acute trust has told its staff they may not be paid for time at home self-isolating if it transpires they were not wearing a mask near someone with coronavirus.
Staff at Chelsea and Westminster Hospital Foundation Trust were told that if they have to stay at home self-isolating because they were not wearing a mask, that time would have to be taken as annual or unpaid leave.
Chief executive Lesley Watts told all staff in an email today, seen by HSJ, that a worker had tested positive for COVID-19, and that four staff members had spent more than 15 minutes with them “without appropriate [personal protective equipment]” and must all now isolate themselves at home for 14 days.
The trust considers it “a serious conduct issue not to wear a mask where you are putting colleagues or our patients at risk – this will be dealt with under our formal processes going forward”, Ms Watts said in the email.
“If you are sent home to isolate for two weeks because you have not worn a mask, I am now informing you that you will be required to take this as annual or unpaid leave. The four staff members “would not be having to go home to isolate if the use of face masks and social distancing had been in place appropriately”.
A Chelsea and Wesminster Hospital spokesman told HSJ: “The guidance around PPE has changed a number of times over the course of the pandemic and we felt it was important to be clear on the trust’s position and to reiterate how seriously we take staff and patient safety."
Read full story (paywalled)
Source: HSJ, 28 August 2020
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NHS ‘lifeline’ for hundreds of stroke survivors

Hundreds of NHS patients have received personal, specialised care thanks to a new service set up during the coronavirus pandemic.
Stroke Connect, a partnership with the NHS and the Stroke Association provides stroke survivors with support and advice in the early days following hospital discharge, without having to leave the house.
Experts have said that the new offer is providing a ‘lifeline’ during the pandemic and has helped more than 500 people to rebuild their lives after having a stroke since it launched last month.
Patients are contacted for an initial call within a few days of discharge from hospital, from a trained ‘Stroke Association Connector’, an expert in supporting people after stroke.
The connector provides reassurance, support with immediate concerns and links the stroke survivor to support they can access in the long-term as part of their recovery journey as well as signposting them to other sources of support. A further call is offered within the month to check in on the stroke survivor’s progress and identify any further support needed.
The new service complements existing rehabilitation services and ‘life after stroke’ care, which has continued throughout the pandemic.
Read full story
Source: NHS England, 31 August 2020
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Midwives and paramedics to deliver flu and Covid vaccines, proposes DHSC

An 'expanded workforce' will be delivering flu and a potential COVID-19 vaccine, under proposals unveiled by the Government today.
The three-week consultation also focuses on a proposal of mass vaccinations against COVID-19 using a yet-to-be-licensed vaccine, if one becomes available this year.
The Department of Health and Social Care (DHSC) is hoping new legislation could come into effect by October, ahead of the winter season.
The consultation proposes to amend the Human Medicine Regulations 2012 to "expand the workforce legally allowed to administer vaccines under NHS and local authority occupational health schemes, so that additional healthcare professionals in the occupational health workforce will be able to administer vaccines".
It said this would include 'midwives, nursing associates, operating department practitioners, paramedics, physiotherapists and pharmacists'.
The consultation said: "This will help ensure we have the workforce needed to deliver a mass COVID-19 vaccination programme, in addition to delivery of an upscaled influenza programme, in the autumn."
The consultation also said that "there is a possibility that both the flu vaccine and the COVID-19 vaccine will be delivered at the same time, and we need to make sure that in this scenario there is sufficient workforce to allow for this". 
Read full story
Source: Pulse, 28 August 2020
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As a paramedic in England, I’m shocked at assaults on ambulance staff during Covid

We have been coughed on and shouted at by people refusing to wear face masks. We need more protection, says NHS paramedic Jake Jones.
The outpouring of appreciation for NHS staff during the COVID-19 crisis has been extraordinary. Yet reports of a recent rise in attacks on emergency workers, including ambulance crews, in England and Wales suggests the Thursday evening applause was hiding a less positive reality. Abuse of emergency workers is a growing issue: a 2018 survey found that 72% of ambulance staff have been attacked on duty, and figures have repeatedly pointed to an upward trend. As an NHS paramedic for 10 years, this aligns with Jake's own experience.
The consultation on increasing sentences for assaults on emergency workers seeks to discourage attacks on them. Jake's hope is that it will also challenge what has become an ingrained view – that being abused and assaulted somehow goes with the territory.
Read full story
Source: The Guardian, 1 September 2020
Read Jake's book 'Can you hear me? An NHS paramedics encounters with life and death'
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Major A&E shake-up plans to be rolled out in coming weeks

Pilots for a new urgent care model requiring walk-in patients to book slots in emergency departments are expected to be rolled out in at least one site in every health system in the coming weeks, HSJ has learned.
The move comes amid concerns from trust managers who warned some 111 providers’ systems were too “risk averse” and were sending too many patients who could have been treated in other care settings to hospitals.
Local managers believe NHS 111 not directing enough people to alternative services was a cause of a major incident at Gloucestershire Hospitals Foundation Trust’s emergency services earlier this month, HSJ understands. And trust leaders in other parts of the country are understood to have similar concerns.
Trials of 111 First have already been publicly confirmed at Portsmouth Hospitals Trust, Royal Cornwall Trust, Newcastle Hospitals FT and Blackpool Hospitals FT. HSJ also understands five London sites, one for each integrated care system in the capital, are also running trials.
These “early adopter” trusts have been given autonomy to trial different models for “111 First”. Most EDs at these sites still treat “walk-in patients” as normal. But in Portsmouth, patients with minor injuries who turn up at ED without calling ahead have, on three different days, been instead told to call 111 following assessments.
NHS England said further trials will take place in the Midlands and East of England, but the specific trusts undertaking these trials have not been decided yet.
Read full story (paywalled)
Source: HSJ, 2 September 2020
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Patients at risk as cash-strapped councils outsource services in middle of pandemic, warn NHS bosses

Nurses and essential healthcare staff could be left redundant in the middle of the pandemic as local authorities look to make changes to healthcare contracts that would leave patients facing major disruption, NHS bosses have warned.
NHS Providers, which represents all NHS trusts, and NHS Confederation, which represents health and care organisations, said that the decision to put contracts for public health services out to tender as workers battle coronavirus in the community is “completely inappropriate” and a “damaging distraction”, creating uncertainty for those who have spent the past six months on the COVID-19 frontline.
Shadow health minister Jonathan Ashworth told The Independent: “This process is disruptive and wasteful at the best of times, but to be doing this mid-pandemic is risky, unnecessary and undermines the ability of frontline health workers to focus not only on preparations for a potential second wave, but a whole host of other health issues, such as Covid rehabilitation, community mental health services and children’s health, all of which are now urgent priorities.”
Read full story
Source: The Independent, 1 September 2020
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Pregnant women with coronavirus are more likely to need intensive care, study finds

Pregnant women in hospital with COVID-19 are less likely to show symptoms than non-pregnant women of similar age but may have an increased risk of admission to intensive care, a study published in The BMJ has found.
Researchers from the UK, the US, Spain, China, Switzerland, and the Netherlands found that pregnant women with COVID-19 were also more likely to have a preterm birth and that their newborns were more likely to be admitted to a neonatal unit. Other factors that increased the risk of severe COVID-19 in these women included being older, being overweight, and having pre-existing medical conditions such as hypertension or diabetes.
The authors concluded that healthcare professionals needed to be aware that pregnant women with COVID-19 might need access to intensive care and specialist baby care facilities and suggested that mothers with pre-existing comorbidities should be considered to be a high risk group for COVID-19, along with those who were obese or older.
Read full story
Source: BMJ, 2 September 2020
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Coronavirus: Charity seeks judicial review on care home visit guidance

A dementia charity is seeking a judicial review of the government guidance on care home visits.
John's Campaign says many care homes in England are still refusing regular face-to-face visits, often essential for people with severe dementia. Dr Angela McIntyre, a retired doctor backing the campaign, has not seen her 92-year-old mother since March.
A Department of Health spokesman said: "We know limiting visits in care homes has been difficult for many families."
He added: "Our first priority is to prevent infections in care homes, and this means that visiting policy should still be restricted with alternatives sought wherever possible.
"Visiting policies should be tailored by the individual care home and take into account local risks in their area."
But John's Campaign believes the guidance does not take into account how important visits from family members are for dementia patients and believes it could be in breach of the law.
Read full story
Source: BBC Health, 3 September 2020
 
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Nasal swab followed by antibody test may catch incorrect COVID-19 diagnoses

Testing people twice for the coronavirus, with a nasal swab followed by an antibody finger prick test, would catch most of those people who fail to get the right COVID-19 diagnosis, researchers believe.
Nose and throat swabs miss around 30% to 50% of infections, say the University of Cambridge team, as the virus can disappear from the upper respiratory tract into the lungs. But they say adding an antibody test can plug that gap. Antibodies show up from about six days after infection.
A team at Addenbrooke’s hospital in Cambridge has piloted the use of combined tests for patients arriving at the hospital. Many arrive with flu-like symptoms and need an accurate diagnosis to ensure they are put on the right wards, so that there is no risk of COVID-19 patients infecting others.
Read full story
Source: The Guardian, 2 September 2020
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Twenty-one ‘wholly preventable’ patient safety incidents reported in private hospitals last year

There were 21 “wholly preventable” patient safety incidents of the most serious category at private hospitals last year, new data has shown, as NHS bosses prepare to invest up to £10bn in the sector.
This is the first time that a comprehensive dataset of 'never events’ within private hospitals has been published in the UK, and comes ahead of plans to outsource both inpatient and outpatient services, routine surgery operations and cancer treatment to private providers.
The audit conducted by the Private Healthcare Information Network (PHIN), established in 2014 to bring greater transparency to the private health sector, showed that 287 out of 595 private hospitals and NHS private patient units (PPUs) provided information on Never Events between 1 January and 31 December 2019.
This group accounts for an estimated 86 per cent of privately-funded admitted patient care, PHIN said. It attributed the “gaps in the data” to NHS PPUs, rather than independent hospitals.
The fact that more than 300 hospitals or PPUs were unable or unwilling to hand over this data highlights the private sector’s continuing lack of transparency, said the Centre for Health and the Public Interest, a social care and health think tank.
Read full story
Source: The Independent, 2 September 2020
Private Healthcare Information Network press release
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Steroids reduce risk of death in critically ill COVID-19 patients, new study shows

The use of inexpensive steroids in treating patients hospitalised with COVID-19 has been found to reduce the risk of death by 20%, according to a new international study.
The research encompassed seven clinical trials, which focused on three different types of anti-inflammatory corticosteroids, and was co-ordinated by the World Health Organization (WHO).
Following the publication of the findings, the WHO issued new guidelines in which it recommended the use of corticosteroids as standard treatment for patients with “severe and critical” COVID-19.
The study, analysed by the National Institute for Health Research (NIHR) at the University of Bristol, looked at patient mortality over a 28-day period after treatment. It found that corticosteroid treatment led to an estimated 20% reduction in the risk of death.
Researchers said it was equivalent to about 68% of critically ill patients surviving after treatment with the steroids, compared to approximately 60% surviving without them.
Jonathan Sterne, professor of medical statistics and epidemiology at the University of Bristol, said: “Steroids are a cheap and readily available medication, and our analysis has confirmed that they are effective in reducing deaths amongst the people most severely affected by COVID-19."
Read full story
Source: The Independent, 2 September 2020
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Patients don’t feel safe in A&E, research finds

Visiting A&E or relatives is considered much riskier than attending hospital for other reasons, according to the first in-depth piece of research into the subject. 
The research, authored by the University of Leicester and NIHR Leicester Biomedical Research Centre Bioinformatics Hub, asked 400 participants how they felt about attending hospital across a range of scenarios during the pandemic. It also revealed that consistent staff use of PPE is seen as a top priority by patients, with staff testing receiving significant but much less support. 
Participants in the Leicester research were asked to rank how ”safe and confident” they felt coming into hospital for a number of reasons on a scale 1-100. The median score given to “visiting a friend or family member” was 49. The score for attending accident and emergency was 50.
Attendance at A&E’s fell sharply during the pandemic peak. It is now rising, but has not reached pre-covid levels. The research suggests that fear could still be playing a significant part in the drop off.
Attending hospital for elective care received a median score of 61. Participants were most confident in visiting hospital for essential surgery (median score 78), and clinical scans or x-ray (77).
Read full story (paywalled)
Source: HSJ, 3 September 2020
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Gene-edited babies: Current techniques not safe, say experts

Current scientific techniques are not yet safe or effective enough to be used to create gene-edited babies, an international committee says.
The technology could one day prevent parents from passing on heritable diseases to children, but the committee says much more research is needed.
The world's first gene-edited babies were born in China in November 2018. The scientist responsible was jailed, amid a fierce global backlash. The committee was set up in response.
Gene-editing could potentially help avoid a range of heritable diseases by deleting or changing troublesome coding in embryos. But experts worry that modifying the genome of an embryo could cause unintended harm, not only to the individual but also future generations that inherit these same changes.
It made several recommendations, including:
Extensive conversations in society before a country decides whether to permit this type of gene-editing. If proven to be safe and effective, initial uses should be limited to serious, life-shortening diseases which result from the mutation of one or both copies of a single gene, such as cystic fibrosis. Rigorous checks at every stage of the process to make sure there are no unintended consequences, including biopsies and regular screening of embryos. Pregnancies and any resulting children to be followed up closely. An international scientific advisory panel should be established to constantly assess evidence on safety and effectiveness, allowing people to report concerns about any research that deviates from guidelines. Read full story
Source: BBC News, 4 September 2020
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Rights watchdog backs court action over Covid deaths in English care homes

The human rights watchdog for England and Wales has backed a grieving daughter’s court action against the health secretary, Matt Hancock, over his handling of the coronavirus pandemic in care homes.
Cathy Gardner, who lost her father, Michael Gibson, to COVID-19 in a care home that accepted hospital discharges, is seeking a judicial review of policies that she alleges “failed to take into account the vulnerability of care home residents and staff to infection and death, the inadequacy of testing and PPE availability”.
The government denies acting illegally over care homes in England, where more than 15,000 people have died with confirmed or suspected COVID-19. But the Equalities and Human Rights Commission said the case “raises potentially important issues of public interest and concern as to the way in which the rights of care home residents have been and will be protected during the current coronavirus pandemic”.
“The bereaved families group isn’t backing down in its call for a public inquiry and I am not backing down in my call for a judicial review into policies I believe led to deaths in care homes,” Gardner said. ”I am delighted the EHRC have written to the court. This is a Human Rights Act case.”
Read full story
Source: The Guardian, 3 September 2020
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Plans for 150 new diagnostic hubs to cut rising waits

Plans for up to 150 new community diagnostic hubs to tackle the NHS’ ballooning diagnostic waiting lists are included in NHS England ‘blue print plans’ leaked to HSJ.
The document pointed out the hubs “were highlighted in the phase 3 letter [from Sir Simon Stevens] and will be recommended as part of new service models for diagnostics in the forthcoming [Sir Mike] Richards’ Review of Diagnostics Capacity”.
It said “at least 150 community diagnostic hubs should be established in the first instance (broadly equivalent to the number of acute hospitals)” although it appears many of these may be temporary facilities.
The phase 3 letter said systems should mange the “immediate growth in people requiring cancer diagnosis and/or treatment returning to the service by… the development of community diagnostic hubs” among other measures
The Richards review was commissioned by NHS England in 2019 as it had long been recognised that England has one of the lowest levels in Europe of diagnostic equipment as well as a shortage in facilities and staff. Last month think-tanks warned of significant worsening of cancer outcomes because of the backlog in diagnosis and treatment created by a fall in referrals during the pandemic..."
Read full story (paywalled)
Source: HSJ, 4 September 2020
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