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

GPs in England left waiting up to a month for flu vaccine supplies

GP surgeries are waiting up to a month for supplies of this winter’s flu vaccine amid unprecedented numbers of patients seeking jabs ahead of the second wave of COVID-19, family doctors have said.
The Royal College of GPs (RCPG) has written to the health secretary, Matt Hancock, seeking assurances that they will have enough doses of the vaccine to cope with demand. The struggle to get jabs has prompted fears that vulnerable groups, including elderly people and those with underlying conditions, will go unprotected.
“We have heard anecdotally that some surgeries are waiting up to a month for replenished supplies of vaccine, which raises concerns that there are significant distribution problems,” Prof Martin Marshall, the RCGP’s chair and a family doctor in London, said in the letter.
One GP in Nottingham said there had been “a huge uptake compared to previous years, well over what we anticipated” at their surgery among groups eligible for the free jab, “so supplies ran out quickly”.
“The next delivery is several weeks away and there are patients in at-risk groups who are having to wait. We have a patient aged 70 with heart disease who wants the vaccine but we currently have none to give her until the next delivery in mid to late October,” the GP said.
Shortages mean that people aged 50 to 64, who are being offered a jab for the first time on the NHS, may have to wait until those with a greater medical need have been immunised first.
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Source: The Guardian, 4 October 2020
Sam

Surge of Covid cases in London health workers sparks fear of spread on wards

Covid infection rates among doctors, nurses, and other hospital and care home staff have risen more than fivefold over the past month in London, scientists have discovered. The figures – provided by the Francis Crick Institute – have triggered considerable concern among scientists, who fear similar increases may be occurring in other regions of the UK.
Increasing numbers of infected healthcare workers raise fears that the spread of COVID-19 into wards and care homes – which triggered tens of thousands of deaths last spring – could be repeated unless urgent action is taken.
“It is very, very worrying,” said Professor Charles Swanton, who helped set up the institute’s Pipeline testing service. “Keeping hospitals and care homes free of the virus is crucial but these figures suggest we are heading in the wrong direction.”
The Francis Crick Institute – one of Britain’s leading biomedical research centres – decided in March to use its array of powerful laboratory devices to set up a Covid testing service for hospital and care home staff in central and north London. Many other UK academic institutions offered to start similar services but were discouraged by the Department of Health and Social Care which said it wanted to centralise testing operations.
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Source: The Guardian, 3 October 2020
Sam

Covid: 16,000 coronavirus cases missed in daily figures after IT error

A technical glitch that meant nearly 16,000 cases of coronavirus went unreported has delayed efforts to trace contacts of people who tested positive.
Public Health England (PHE) said 15,841 cases between 25 September and 2 October were left out of the UK daily case figures. They were then added in to reach Saturday's figure of 12,872 new cases and Sunday's 22,961 figure.
PHE said all those who tested positive had been informed. But it means others in close contact with them were not.
The issue has been resolved, PHE said, with outstanding cases passed on to tracers by 01:00 BST on Saturday.
The technical issue also means that the daily case totals reported on the government's coronavirus dashboard over the past week have been lower than the true number.
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Source: BBC News, 5 October 2020
Sam

Covid: Care homes policies violated human rights, says Amnesty

Sending thousands of older untested patients into care homes in England at the start of the coronavirus lockdown was a violation of their human rights, Amnesty International has said.
A report says government decisions were "inexplicable" and "disastrous", affecting mental and physical health.
More than 18,000 people living in care homes died with COVID-19 and Amnesty says the public inquiry promised by the government must begin immediately.
According to Amnesty's report, a "number of poor decisions at both the national and local levels had serious negative consequences for the health and lives of older people in care homes and resulted in the infringement of their human rights" as enshrined in law.
Researchers for the organisation interviewed relatives of older people who either died in care homes or are currently living in one; care home owners and staff, and legal and medical professionals.
Amnesty said it received reports of residents being denied GP and hospital NHS services during the pandemic, "violating their right to health and potentially their right to life, as well as their right to non-discrimination".
It adds that care home managers reported to its researchers that they were "pressured in different ways" to accept patients discharged from hospital who had not been tested or had COVID-19.
Amnesty says the public inquiry into the pandemic should begin with an "interim phase". "The pandemic is not over," it added. "Lessons must be learned; remedial action must be taken without delay to ensure that mistakes are not repeated."
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Source: BBC News, 4 October 2020
Sam

Long Covid could be bigger public health crisis than excess deaths leaving patients in agony, expert warns

Long Covid could be a bigger public health crisis than excess deaths as the condition leaves patients in agony, experts have warned.
Patients overcoming the coronavirus and suffering with long Covid have reported symptoms such as chronic fatigue - months after they first contracted the virus.
It was previously reported that 60,000 Britains struck by “long-Covid” have been ill for three months with some left in wheelchairs. People who were previously fit and healthy who have recovered from the virus have in some cases been left bed ridden and unable to climb the stairs.
Now a report from the Tony Blair Institute for Global Change is recommending that the Government highlight the issue in awareness campaigns.
The report, titled 'Long Covid: Reviewing the Science and Assessing the Risk', states that awareness campaigns could encourage the use of face masks and coverings.
The authors of the report state: “Long Covid is likely a bigger issue than excess deaths as a result of Covid, but, crucially, the risk must be considered alongside the economic impact and other health impacts linked to Covid restrictions."
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Source: The Sun, 5 October 2020
Sam

Care watchdog to target NHS maternity units after baby death scandals

The Care Quality Commission (CQC) is to target poorly performing NHS maternity units after a series of maternity scandals. It is drawing up plans to spot high-risk maternity units and will use data on their patient outcomes and culture to draw up a list of facilities for targeted inspection.
The watchdog has voiced concerns over the wider safety of maternity units in the NHS after a number of high-profile maternity scandals in the past year.
Almost two-fifths of maternity units, 38%, are rated as “requires improvement” by the CQC for their safety.
The Independent has joined with charity Baby Lifeline to call on the government to reinstate a national maternity safety training fund for doctors and midwives. The fund was found to be successful but axed after just one year.
On Tuesday, the CQC’s chief inspector of hospitals, Professor Ted Baker, told MPs on the Commons Health and Social Care Committee that he was concerned about the safety of mothers and babies in some maternity units which had persistent problems.
“Those problems are of dysfunction, poor leadership, of poor culture, of parts of the services not working well together,” he said. “This is not just a few units; this is a significant cultural issue across maternity services.”
Now the CQC has confirmed it is planning to draw up a list of poor-performing units or hospitals where it suspects there could be safety issues. The new inspection programme will specifically look at issues around outcomes and teamworking culture although the full methodology has yet to be decided.
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Source: The Independent, 4 October 2020
 
Patient Safety Learning

Did early focus on hand washing and not masks aid spread of COVID-19?

From the moment coronavirus reached UK shores, public health advice stressed the importance of washing hands and deep-cleaning surfaces to reduce the risk of becoming infected.
The advice was informed by mountains of research into the transmission of other respiratory viruses: it was the best scientists could do with such a new pathogen. But as the pandemic spread and data rolled in, some scientists began to question whether the focus on hand hygiene was as crucial as it seemed.
The issue has resurfaced after Monica Gandhi, a professor of medicine at the University of California, San Francisco, told the US science magazine Nautilus that the easiest way to catch the virus was through droplets and aerosols sprayed from an infected person’s mouth or nose.
“It’s not through surfaces,” she said. “We now know the root of the spread is not from touching surfaces and touching your eye. It’s from being close to someone spewing virus from their nose and mouth, without in most cases knowing they are doing so.”
Gandhi’s is not a lone voice. Her comments follow a prominent paper in the Lancet from Emanuel Goldman, a professor of microbiology at Rutgers University in New Jersey. He was sceptical about the relevance of scientific studies that showed the virus could survive on surfaces for days at a time.
“In my opinion,” he wrote, “the chance of transmission through inanimate surfaces is very small, and only in instances where an infected person coughs or sneezes on the surface, and someone else touches that surface soon after the cough or sneeze.” He defined soon as within one to two hours.
Dr Julian Tang, an honorary associate professor of respiratory sciences at the University of Leicester, thinks hand washing should stay but agrees the risk from contaminated surfaces has been overplayed.
He points to documents from the UK government’s Scientific Advisory Group for Emergencies (Sage) that estimate hand washing can reduce acute respiratory infections by only 16%. Meanwhile, he adds, the World Health Organization has warned about surfaces being a likely route of transmission while conceding there are no reports demonstrating infection this way.
Tang believes that a preoccupation with contaminated surfaces distracted countries from taking airborne transmission seriously and played down the necessity of wearing masks. “What we’ve always said is that the virus transmits by all routes. There might be some transmission by hand and fomites and we’re not opposed to hand washing, but the emphasis is wrong,” he told the Guardian.
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Source: 5 October 2020
Patient Safety Learning

Woman, 33, scared she'll 'never be the same again' after six-month COVID-19 battle

A 33-year-old woman says she's been suffering awful coronavirus symptoms for six months and says it's "ruined her life".
Stephanie, from London, says her symptoms began in mid-March when she started experiencing loss of taste and smell, body aches, headaches, a fever, shivering, hot and cold sweats, and sickness. But six months later she still has had no sense of taste and smell, she suffers brain fog and chronic fatigue and says just walking across her flat leaves her chest feeling tight.
The photographer, who lives alone, says she sleeps for 10-12 hours but is still always tired. "I'm only 33," she said.
Stephanie wants to raise awareness of 'long Covid' and says more research needs to be done on how to treat the long-term effects of the disease.
She said she's scared she'll 'never be the same again'.
Stephanie says she has a hospital appointment on Friday to have tests on her lungs and heart as doctors are concerned she has lung damage.
She added: "I think some people don't believe in long Covid, so I want to raise awareness of what people are going through. We need more research of how to treat people with long Covid because there isn't much available, it's so awful."
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Source: Mirror, 1 October 2020
Patient Safety Learning

Need for tech to reduce medication error and improve patient safety

Omnicell UK & Ireland, a leading provider of automated healthcare and medication adherence solutions, hosted a health summit on the eve of World Patient Safety Day, to discuss the impact of medication errors on patients and the NHS. The session focussed on the role technology can play in preventing such issues.
The summit, this year held via webinar, comes off the backdrop of the Department of Health and Social Care disclosing that in England 237 million mistakes occur every year at some point in the medication process.  These errors cause serious issues for patient safety, but also place a significant cost burden on an already stretched NHS. The 2019 Patient Safety Strategy published by NHS England and NHS Improvement also found the NHS failed to save 11,000 lives a year due to safety concerns with the cost of extra treatment needed following incidents being over £1bn.
A number of high-profile panel members answered a series of questions from the audience on solutions and best practice to improve patient safety with the aim of debating and sharing ideas on how to meet challenges and the impact of COVID-19.
One of the panelists, Patient Safety Learning's Chief Digital Office Clive Flashman, agreed with the other panel members that the NHS had become more collaborative and familiar with technology since Covid: “We’ve seen a definite increase in telehealth and telemeds. Covid has forced cultural blockers that were there before to be removed out of necessity. There has been a growth in robotic pharmacy automation to free up staff time from high volume administration tasks to do more complex work that adds value for patients.”
But with the second-wave of COVID-19 still a very real threat he advised: “We don’t want to wait until the next wave to learn a lesson – we need to learn lessons now. Quality Improvement Leads should be focussed on what went right and what went wrong over that period between March and May. They need to be looking at what we can learn from that now and what we can do differently next time. If we don’t do that, we won’t succeed in the second wave where we might fail.”
Ed Platt, Automation Director, Omnicell UK & Ireland, added: “Challenges within the NHS throughout Covid has forced them to embrace technology and drive innovation."
"It’s important that when things go back to normal, we don’t go back to the same status quo. We need to invest in the right infrastructure in hospitals so unnecessary demands and stress are not put on pharmacy, supply managers and nurses so they are free to focus on patient care not administration tasks."
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Source: NHE, 17 September 2020
You can watch the webinar on demand here
Patient Safety Learning

Long Covid: the evidence of lingering heart damage

Melissa Vanier, a 52-year-old postal worker from Vancouver, had just returned from holiday in Cuba when she fell seriously ill with COVID-19. “For the entire month of March I felt like I had broken glass in my throat,” she says, describing a range of symptoms that included fever, migraines, extreme fatigue, memory loss and brain fog. “I had to sleep on my stomach because otherwise it felt like someone was strangling me.”
By the third week of March, Vanier had tested negative for Sars-CoV-2 – the virus that causes Covid-19. But although the virus had left her body, this would prove to be just the beginning of her problems. In May, she noticed from her Fitbit that her heart rate appeared to be highly abnormal. When cardiologists conducted a nuclear stress test – a diagnostic tool that measures the blood flow to the heart – it showed she had ischaemic heart disease, meaning that the heart was not getting sufficient blood and oxygen.
Similar stories illustrate a wider trend – that the coronavirus can leave patients with lasting heart damage long after the initial symptoms have dissipated.
Cardiologists are still trying to find out exactly why some people are left with enduring heart problems despite having had an apparently mild bout of COVID-19. The underlying mechanisms are thought to be slow and subtle changes that are quite different to those that put strain on the heart during the acute illness, especially in patients who have been hospitalised with the disease.
Some cardiologists have suggested that treatments such as cholesterol-lowering drugs, aspirin or beta blockers may help patients with lingering cardiovascular effects many weeks or months after the initial infection, but the evidence remains limited.
“It is too early to share data on this,” says Mitrani. “But these therapies have proven efficacy in other inflammatory heart muscle diseases. They have anti-inflammatory effects and we believe may help counter some of the lingering pro-inflammatory effects from Covid-19.”
But for patients such as Vanier, there remains a long and uncertain road to see whether her heart does fully recover from the impact of the virus. “Psychologically this has been brutal,” she says. “I haven’t been back to work since I went on holiday in February. The heart hasn’t improved, and I now have to wait for more tests to see if they can find out more.”
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Source: The Guardian, 4 October 2020
Patient Safety Learning

NHS compensation payouts have doubled in six years, figures show

NHS Payouts linked to medication blunders have doubled in six years, fuelling record spending, official figures show.
The NHS figures show that in 2019/20, the health service spent £24.3 million on negligence claims relating to medication errors - up from £12.8 million in 2013/14. The statistics show that in the past 15 years, almost £220 million has been spent on claims relating to the blunders.
Previous research has suggested that medication errors may be killing up to 22,000 patients in England every year. Errors occur when patients are given the wrong drugs, doses which are too high or low, or medicines which cause dangerous reactions.
In some cases, patients have been given medication which was intended for another person entirely, sometimes with fatal consequences. Other studies suggest that 1 in 12 prescriptions dispensed by the NHS involve a mistake in medication, dose or length of course. 
In some cases, patients have died after being given a dose of morphine ten times that which should have been administered, with other fatalities involving fatal reactions. Confusion often occurs when drugs are not labelled clearly, or when packaging of different medications looks similar.
Jeremy Hunt, now chairman of the Commons Health and Social Care Committee, said the NHS needed to make far more progress preventing harms, instead of seeing an ever increasing negligence bill.
He said: “It is nothing short of immoral that we often spend more cleaning up the mess of numerous tragedies in the courts, than we actually do on the doctors and nurses who could prevent them."
Read full story (paywalled)
Source: The Telegraph, 3 October 2020
Patient Safety Learning

Seven NHS hospital trusts to receive share of £8.7m for e-prescribing

A further £8.7million is to be dished out to seven NHS hospital trusts to introduce digital records and e-prescribing. The money is part of a £78million investment which was announced in February 2018 and aims to accelerate the roll out of electronic prescribing systems across the NHS.
The latest funding is part of the third wave of the investment, which will be handed out over three years. In 2018/ 19, £16.2 million was awarded, £29.4 million was given in 2019/20 and another £12 million will be invested later this year.
The seven trusts which will benefit from this latest round of finding are:
Portsmouth Hospitals NHS Trust (£1.7m) Solent NHS Trust (£988,000) Sussex Community NHS Foundation Trust (£637,000) United Lincolnshire Hospitals NHS Trust (£1.26m) North Cumbria Integrated Care NHS Trust (£2m) East Lancashire Hospitals NHS Trust (£1.6m) Birmingham Community NHS Trust (£531,000) National director of patient safety, Dr Aidan Fowler, said: “Patient safety is of paramount importance and is something we are continuously looking at ways to improve, whether through new technology, such as the introduction of electronic prescribing, or by building a safety culture where all NHS staff feel supported and safe to speak up.”
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Source: Digital Health, 1 October 2020
Patient Safety Learning

Covid could cause 'tsunami of cancelled NHS operations'

There could be a "tsunami" of cancelled operations this winter as the NHS copes with rising numbers of coronavirus patients, leading surgeons are warning.
Members of the Royal College of Surgeons of England say they doubt the NHS can meet targets to restore surgery back to near pre-pandemic levels.
Planned procedures such as hip replacements were paused to free up beds during lockdown in the spring. And hospitals have since been dealing with a backlog.
In July, NHS England boss Sir Simon Stevens told trusts hospitals should by September 2020 be performing at least 80% of their September 2019 rates of:
overnight planned procedures outpatient or day-case procedures And by October, this proportion should rise to 90%.
But data suggests more than two million people have been waiting longer than 18 weeks for routine operations, with 83,000 waiting more than a year - up from 2,000 before the pandemic.
Read full story
Source: BBC News, 6 October 2020
Sam

Coronavirus: Doctors' letter of concern about rising Covid cases

Senior doctors specialising in infectious diseases have written an open letter expressing "concern" about the rapid increase in COVID-19 cases in Northern Ireland.
The letter is signed by 13 medics from hospitals across Northern Ireland. It calls for the public to stick to government guidance on reducing social interactions and  also warns against "stigmatising people and areas with high levels of infection."
The letter reads: "We need to support people who test positive. This pandemic requires us to work together to bring it under control urgently. We need to reduce the potential for transmission to protect our health service, and we need to fix our test and trace system to try and gain better control of this virus in our community."
On Monday, 616 new cases of COVID-19 were identified in Northern Ireland, bringing the total during the pandemic to 14,690. The number of deaths recorded by the Department of Health remains at 584.
Among those who have signed the letter are Dr Claire Donnelly, a consultant physician who specialises in infectious diseases; consultant virologist Dr Conall McCaughey and consultant paediatrician Dr Sharon Christie.
Entitled an "appeal to people to adhere to Covid public health guidance", the letter lays bare the stark reality of the infections rates.
The letter adds: "Worryingly the number of cases is increasing rapidly in many areas over the last week, indicating that we have widespread community transmission in many parts of Northern Ireland."
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Source: BBC News, 6 October 2020
Sam

Largest hospital building programme in a generation confirmed

The Prime Minister has confirmed a £3.7bn funding package to facilitate the construction of 40 new hospitals around the England by 2030, with a further eight schemes invited to bid for future funding.
Talked about over the coming months, the funding announcement comes as the first official confirmation to deliver on the Government’s manifesto commitment.
New standards are set to be developed over the coming months to help standardise the design of new hospitals and make use of modular construction methods to speed up the build process.
Originally launched last September with a £2.8bn investment which provided six new hospitals with the funding to go ahead, alongside seed funding for trusts to work up business cases, the health infrastructure plan (HIP) represents the largest hospital building programme in the UK for a generation.
The trusts which received seed funding will now all be fully funded to deliver 25 new hospitals. An additional site – a new hospital in Shotley Bridge – has also been added to the programme.
The new Shotley Bridge hospital represents a commitment from the Government to ensure much of the funding also goes to rebuilding across the North of England, as part of its levelling up agenda.
As part of welcoming new schemes to bid for funding for the eight further new hospitals down the line, the Government also committed that a proportion of these would be new mental health hospitals.
Prime Minister Boris Johnson said: “The dedication and tireless efforts of our nurses, doctors and all healthcare workers have kept the NHS open throughout this pandemic. But no matter what this virus throws at us, we are determined to build back better and deliver the biggest hospital building programme in a generation."
Read full story
Source: NHE, 5 October 2020
40hospitals.pdf
Patient Safety Learning

Coronavirus: NHS staff struggle with burnout as they warn hospital bosses about looming second wave

NHS workers are at breaking point after months of upheaval and high pressure during the coronavirus outbreak with hospital leaders warning the health service is facing a “perfect storm” of workforce shortages and a second wave of COVID-19.
In a survey of 140 NHS trust leaders almost all of them said they were worried about their staff suffering burnout ahead of winter.
They also sounded the alarm over concerns there had not been enough investment into social care before this winter.
NHS Providers, which carried out the survey ahead of its annual conference of hospital leaders, warned the first wave of COVID-19 had made a lasting impact on the health service which had yet to fully recover.
Chris Hopson, chief executive of NHS Providers, which represents NHS trusts, said there had been “no let-up in the pressure” during the pandemic, which followed a difficult winter for staff.
“And while the response to the spring surge in COVID-19 cases showed the NHS at its best, the pressures took their toll on staff who gave so much,” he said.
“The worry is that the sustained physical, psychological and emotional pressure on health staff is threatening to push them beyond their limits of endurance.”
Almost all those who responded to the survey, 99 per cent, said they were either extremely or moderately concerned about the current level of burnout across the workforce.
Read full story
Source: The Independent, 6 October 2020
Sam
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