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

Celebs and lockdown heroes urge public to get cancer symptoms checked and attend routine appointments

Famous faces, including TV chefs Gordon Ramsay, Nadiya Hussein, and actress Emma Thompson are backing a major new campaign urging anyone concerned about cancer to get checked and to keep routine appointments, as new research found that even now, nearly half (48%) of the public would delay or not seek medical help at all.
A fifth (22%) would not want to be a burden on the health service while a similar number said that fear of getting coronavirus or passing it onto others was a major reason for not getting help.
More than four in ten people would leave it longer to get health advice than they normally would have before the coronavirus outbreak, however delaying can have serious consequences for some cancers.
NHS staff have pulled out all the stops to keep cancer services going throughout the pandemic, with almost one million people referred for checks or starting treatment since the virus took hold.
The NHS’s Help Us Help You access campaign will use TV adverts, billboards and social media to urge people to speak to their GP if they are worried about a symptom that could be cancer, and also remind pregnant women to attend check-ups and seek advice if they are worried about their baby.
People with mental health issues are also been encouraged to access NHS support.
Read full story
Source: NHS England, 9 October 2020
Sam

Today - The Big Event for Mental Health

Today is World Mental Health Day and the World Health Organization will, for the first time ever, host a global online advocacy event on mental health.
At this event—the Big Event for Mental Health—world leaders, mental health experts and celebrity guests will join WHO Director-General, Dr Tedros Adhanom Ghebreyesus, to tell the world what we can all do to improve our mental health and how we can help make sure that quality mental health care is available to everyone who needs it.
Tune in from one of WHO’s social media channels:
Facebook, Twitter, LinkedIn, YouTube, TikTok and Twitch channels 
Start time: 10:00 New York, 16:00 Geneva, 19:30 New Delhi                          
The Event will last approximately 2 hours 30 minutes. 
More information
 
Sam

Mental health in the Punjabi community: 'I see stigma everywhere'

Seeking help for mental health is never easy but for some members of London's Punjabi community, the shame and stigma associated means they have struggled more than most.
Anyone having "problems of the mind" is often considered a burden upon the family says Dr Rakish Rana, founder of the Clear Coach, who added that a lack of education on mental health means it is considered a taboo subject.
"To support those with mental health issues, there needs to be more awareness in the South Asian community, whether that's through religious or community leaders, schools and families," he said.
"As with all cases of mental health, it needs to be openly discussed and normalised."
Shuranjeet Singh, the founder of Taraki, a not-for-profit mental health organisation, said its research carried out into the Punjabi community found more than half of respondents reported a decline in their mental health as a result of Covid-19.
"I can see stigma slowly reducing and I hope that community-focused solutions are well researched and funded, because no community is truly 'hard to reach'."
Read full story
Source: BBC News, 3 October 2020
Sam

Covid: What is the mental health cost to the young?

Young people's risk of becoming ill with COVID-19 is tiny - but could the long-term mental health impact of virus restrictions be far more damaging?
A growing number of psychologists, psychiatrists and child health experts believe the needs of the young are being ignored in this pandemic.
Prof Ellen Townsend, an expert in child and adolescent self-harm and suicide from Nottingham University, says the way students are being treated "is massively damaging for their mental health".
"It doesn't make sense to lock up young people," she says. "We have to move past this one disease - a more nuanced approach is needed."
She is not alone - a group of UK academics who work with children and adolescents have set up an online noticeboard collecting scientific evidence that these age groups are being forgotten by policy-makers.
Problems such as self-harm and anxiety were already on the rise before lockdown, particularly among teenagers, with one in eight children and young people estimated to have a mental health condition. There is a lack of hard evidence, but research suggests growing feelings of loneliness and social isolation during the pandemic have had a negative impact.
A study in The Lancet Psychiatry found children's mental health deteriorated most during that period compared with other age groups.
More worrying was the "massive drop-off" in troubled children and teenagers being sent to specialist psychiatrists over several months - from 40 a day to four a day, according to the Royal College of Psychiatrists.
Although services stayed open during lockdown, either the message didn't get through or people were too frightened to make contact. The fear is that these young people could now become more seriously ill without the help they need. Eating disorders, which have a high death rate, are a particular concern.
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Source: BBC News, 10 October 2020
Sam

Alcoholic anaesthetist's error that killed Briton unforgivable, court told

An anaesthetist who had been drinking before an emergency caesarean that led to the death of a British woman should serve the maximum three years in jail if convicted and should be banned from working as a doctor, a French prosecutor has demanded.
Helga Wauters is on trial in Pau, south-west France, for the manslaughter of Xynthia Hawke in 2014. She is accused of starving Hawke of oxygen for up to an hour after pushing a ventilation tube into the wrong passageway.
Orlane Yaouang, prosecuting, described the scene in the operating theatre when Hawke turned blue as “carnage” and spoke of the “surreal situation” in which the panicked hospital staff called the emergency services.
Read full story
Source: The Guardian, 9 October 2020
Sam

Women bear brunt of Covid-related work stress, UK study finds

Women are being disproportionately affected by a rise in mental health problems caused by increasing workloads as people do their jobs from home amid the pandemic.
The length of the working day has increased steadily, resulting in a 49% rise in mental distress reported by employees when compared with 2017-19. Women are bearing the brunt of problems as they juggle work and childcare, according to a report by the 4 Day Week campaign and thinktanks Compass and Autonomy.
The report, Burnout Britain, cshows that women are 43% more likely to have increased their hours beyond a standard working week than men, and for those with children, this was even more clearly associated with mental health problems: 86% of women who are carrying out a standard working week alongside childcare, which is more than or equivalent to the UK average, experienced problems in April this year.
The report warns that “as well as an impending recession and mass unemployment, we are heading into an unprecedented mental health crisis”.
Read full story
Source: The Guardian, 9 October 2020
 
Sam

BAME groups hit hard again as Covid second wave grips UK nations

One of the earliest signs that black, Asian and minority ethnic (BAME) people were being disproportionately harmed by the coronavirus pandemic came when the Intensive Care National Audit and Research Centre (ICNAR) published research in early April showing that 35% of almost 2,000 Covid patients in intensive care units in England, Wales and Northern Ireland were non-white.
A lot has happened in the intervening six months with numerous reports, including by the Office for National Statistics and Public Health England (PHE), confirming the increased risk to ethnic minorities and recommendations published on how to mitigate that risk. However, as the second wave intensifies, the demographics of those most seriously affected remain remarkably similar.
ICNARC figures show that the non-white proportion of the 10,877 Covid patients admitted to intensive care up to 31 August was 33.9% in England, Wales and Northern Ireland. This rises to 38.3% of patients admitted since 1 September, albeit of a much smaller cohort (527 intensive care admissions).
The government mantra “we’re all in this together” proved to be little more than an empty rallying cry early in the pandemic and the ICNARC figures show it remains the case that people in the most deprived socioeconomic groups make up a greater proportion of patients in critical care.
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Source: The Guardian, 9 October 2020
Sam

Pregnant women are likely to have mild COVID-19 cases but suffer prolonged symptoms, study finds

One of the largest studies of its kind suggests that most pregnant women who become infected with the coronavirus will have mild cases but suffer prolonged symptoms that may linger for two months or longer in some cases.
The study, published in the journal Obstetrics and Gynecology, found that most women who participated had mild cases of COVID-19 — a finding consistent with previous studies. Among the nearly 600 women followed, only 5% were hospitalised and 2% were admitted to intensive care units.
Despite the mildness of their cases, 25% of the participants continued to experience symptoms eight weeks after becoming sick. The median length of symptoms was 37 days. Although pregnancy is known to cause major changes to the immune system, the length of time for continuing symptoms was surprising, said co-principal investigator Vanessa Jacoby, vice chair of research in the obstetrics, gynecology and reproductive sciences department at the University of California at San Francisco.
Read full story
Source: The Washington Post, 10 October 2020
Sam

Patients die after coronavirus outbreak on cancer ward

A number of patients in a cancer ward have died in hospital after a coronavirus outbreak and more have tested positive for the virus. 
NHS Lothian have not confirmed how many died but said it was fewer than five and a ‘very small number’ of patients.
The health board is investigating the Western General Hospital in Edinburgh which has had to put measures in place to further contain the outbreak. Another six patients have tested positive for the virus so the hospital has closed the oncology ward to new patients being admitted. The hospital has also asked patients, who would usually be allowed to go home over the weekend and return to hospital on Monday, to stay in hospital the whole week. 
Dr Donald Inverarity, consultant microbiologist at NHS Lothian, said: ‘Our thoughts are with the family of the deceased and I would like to express our sincere condolences."
"A multidisciplinary Incident Management Team was immediately established and all necessary infection control measures are in place. The situation will continue to be reviewed and monitored very closely."
The health board’s Health Protection Team and the nationwide Test and Protect teams are carrying out contact tracing of visitors and outpatients where necessary. Routine coronavirus screening of staff and patients is also taking place as part of an enhanced regime.
Read full story
Source: Metro, 10 October 2020
Sam

Watchdog’s prosecution sends a strong message to safety laggards: Time’s up

The announcement on Friday by the Care Quality Commission (CQC) that it will bring criminal charges against an NHS trust for failing to provide safe care to a patient is a hugely significant milestone in efforts to bring about greater accountability and safer care in the health service.
The CQC has had the power to bring such prosecutions against hospitals since April 2015 when it was given a suite of new legal powers to hold hospitals to account on the care they give to their patients.
Bringing in the new laws, the so-called fundamental standards of care, was one of the most significant actions taken after the care disaster at the Mid Staffordshire NHS Trust, where hundreds of patients suffered shocking neglect, with some dying as a result.
Prosecuting East Kent Hospitals University Trust over the tragic 2017 death of baby Harry Richford is a big step for the CQC and a consequence of the long-forgotten battles of many patients and families in Stafford who were told they were wrong in their complaints against the hospital.
It will almost certainly lead to more calls for criminal charges against hospitals from families who have been failed.
There are countless examples of NHS trusts not acting on safety warnings and patients coming to harm as a result. Just this week an inquest into the case of baby Wynter Andrews at Nottingham University Trust revealed fears over safety had been highlighted to the trust board 10 months before her death.
At Shrewsbury and Telford Hospitals Trust there are hundreds of families asking the same questions as more evidence emerges of long-standing failures to learn from its mistakes.
CQC's chief executive, Ian Trenholm, has provoked anger among NHS leaders and clinicians when he advocated taking a tougher line when trusts break the law.  But it is unlikely the CQC will launch a slew of prosecutions. It has said it will bring cases only where it sees patterns of behaviour and systemic failings. That is the correct approach as healthcare is complex and single errors will sadly happen despite everyone doing their best.
Read full story
Source: The Independent, 10 October 2020
Sam

Non-Covid infectious disease cases down in England, data suggests

The social restrictions imposed upon our lives because of coronavirus have taken a toll on our emotions, finances, and our waistlines, but there may yet be a silver-lining: a reduction in cases of other infectious diseases. From the common cold to chickenpox, there has been a substantial drop in the number of infections being reported to GPs, despite children returning to school – and that looks set to continue as winter approaches and lockdown restrictions tighten across the country.
According to the latest GP surveillance data for England there were 1.5 cases of common cold for every 100,000 people during the week ending 6 October – compared to 92.5 cases reported during the same week last year. The rate of other non-Covid respiratory illnesses was also lower, at 131 for every 100,000 people, compared to 303 last year. Influenza-like illness is also down, at 131 cases for every 100,000 people, versus 303 cases in 2019.
Although there has been in increase since the start of the school term, for all of these illnesses, infection rates remain below expected seasonal levels for this time of year, the report by the Royal College of General Practitioners’ research and surveillance centre said. Equivalent data was not immediately accessible for Wales and Scotland.
GP consultations for other infectious diseases like strep throat, tonsillitis and impetigo, as well as infectious intestinal diseases like norovirus are also well below the five-year average – and have been since late March – the report suggests.
Read full story
Source: The Guardian, 9 October 2020
Sam

Sask. nurse who was disciplined over Facebook comments wins court appeal

Saskatchewan's highest court has ruled in favour of a nurse who was disciplined after she complained on Facebook about the care her grandfather had received in a long-term care facility.
In a decision delivered Tuesday, the Saskatchewan Court of Appeal set aside a decision by the province's Registered Nurses Association that found Carolyn Strom guilty of unprofessional conduct. 
Strom was off-duty when she aired her concerns on Facebook in 2015, a few weeks after her grandfather's death. In her Facebook post, she said staff at St. Joseph's Integrated Health Centre in the town of Macklin, about 225 kilometres west of Saskatoon, needed to do a better job of looking after elderly patients.
The lawyer for the Saskatchewan Registered Nurses Association argued that Strom personally attacked an identifiable group without attempting to get all the facts about her grandfather's care. In 2016, she was found guilty of professional misconduct by the Saskatchewan Registered Nurses Association and ordered to pay a $1,000 fine and $25,000 to cover the cost of the tribunal.
After the association's decision, she received support from the Saskatchewan Union of Nurses, as well as nurses and civil liberties groups across the country.
"Once I understood what this case meant ... once it was past being just about me, I didn't want someone else to have to go through the same thing. Because it's been rough," Strom said. 
Strom says she continued to fight the decision because she wanted nurses to be able to talk about, and advocate for, better care for family members publicly and in a respectful manner.
"You should be able to properly advocate for family members, regardless of whether you're a health-care member."
"And I felt that if this decision went wrong, it would actually hurt people who have healthcare members as family members. because they would have to be a little more careful and not express concerns for fear of punishment."
Appeal court Justice Brian Barrington-Foote wrote in his decision that Strom's freedom of expression was unjustifiably infringed, and she had a right to criticise the care her grandfather received.
The judge ruled that criticism of the healthcare system is in the public interest, and when it comes from front-line workers it can bring positive change.
Read full story
Source: CBC News, 6 October 2020
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Patient Safety Learning

Inquiry begins into blanket use in England of Covid 'do not resuscitate' orders

An urgent investigation into blanket orders not to resuscitate care home residents has been launched amid fears some elderly people may still be affected by the “unacceptable” practice.
After COVID-19 cases rose slightly in care homes in England in the last week, with 116 residences handling at least one infection, the Care Quality Commission (CQC) said it was developing the scope of its investigation “at pace” and it would cover care homes, primary care and hospitals.
In March and April, there were reports that some GPs had applied “do not attempt resuscitation” (DNAR) notices to groups of care home residents that meant people would not be taken to hospital for potentially life-saving care. This was being done without their consent or with little information to allow them to make informed decisions, the CQC said. Cases emerged in care homes in Wales and East Sussex.
Care homes said the blanket use of the orders did not appear to be as prevalent ahead of a possible second wave of infections and families were reporting fewer concerns, although that could be because visiting restrictions meant they had less access to the homes and were getting less information.
There are also concerns that steps may not have been taken to review DNAR forms added to care home residents’ medical files, and so they could remain in place, without proper consent.
The CQC review will examine the use of “do not attempt cardiopulmonary resuscitation” (DNACPR) notices, which only restrict chest compressions and shocks to the heart.
Dr Rachel Clarke, a palliative care expert in Oxford, has described the CPR process as “muscular, aggressive, traumatic” and said it often resulted in broken ribs and intubation. The review will also investigate the use of broader do not resuscitate and other anticipatory care orders.
“We heard from our members about some pretty horrific examples of [blanket notices] early in the pandemic, but it does not appear to be happening now,” said Vic Rayner, the executive director of the National Care Forum, which represents independent care homes. “DNAR notices should not be applied across settings and must be only used as part of individual care plans.”
It will also investigate the use of broader do not resuscitate and other anticipatory care orders.

Read full story
Source: The Guardian, 12 October 2020
Sam

How East Cheshire NHS is tackling a major cancer problem

East Cheshire faces a serious issue with head and neck cancer, with missed target times and inefficient practices leading to worsening outcomes for patients.
That’s prompted officials from the NHS Cheshire Clinical Commissioning Group (CCG) to come up with a plan of action to tackle the problem — but as Cheshire East councillors heard this week, it’s hit a snag.
Since 2014, the East Cheshire NHS Trust and Manchester Foundational Trust (MFT) have co-delivered the head and neck cancer pathway. This means that patients are seen by staff at Macclesfield Hospital for diagnostic tests — and if malignant cells are detected, then the patient will be referred on to Wythenshawe for surgery or, if sadly needed, East Cheshire’s own palliative care team for supportive care.
In a presentation to CEC’s health scrutiny committee, the CCG said just 10% of patients in the borough were seen at Macclesfield within the 62-day target time in Q3 of 2019/20 — against a desired level of 85%.
Simon Goff, chief operating officer of East Cheshire NHS Trust, told the committee: “There is no one stop service - which is where a patient gets diagnostics all on the same day. Biopsies are not always up to the standards required so patients need to have it again. This is a key weakness in the existing service.”
The lack of a ‘one stop service’ means there are no on-site pathology services — so samples are taken off-site for testing, and with biopsies needing to be analysed within 24 hours of collection, it results in 39% of all patients having to undergo the procedure again.
So what did East Cheshire do about it?
The first step was to launch a consultation, with 64 former patients out of roughly 300 eligible providing feedback to the Trust over the summer. The ‘robust’ consultation, saw patients express their desire to ‘know what is going on as soon as possible’, with the ‘issue of travel being outweighed by [the desire for] a quick diagnosis’.
Fortunately for health chiefs in Cheshire, there are ‘outstanding’ hospitals surrounding the county — with the Care Quality Commission giving top marks to hospitals in Salford, St Helens, and The Christie in Didsbury.
So with East Cheshire’s patients happy to travel a distance in order to gain a quick and accurate diagnosis, and the existing partnership with Manchester’s trust, officials are proposing moving some patients experiencing positive diagnoses and ‘bad news’ cases to MFT sites, such as The Christie or Wythenshawe Hospital.
The idea is that ‘neck lump’ patients will be immediately sent to Wythenshawe, with all other patients undergoing initial tests in Macclesfield first before being either sent home with the all clear, or referred on.
Biopsies will be done in Wythenshawe, as will ‘breaking bad news’ appointments — where patients are told of a positive cancer diagnosis.
Officials say this solution ‘would start to address some of the clinical and performance concerns’ by cutting the average diagnosis wait time from four weeks down to one, reducing the amount of appointments patients need to attend, and allowing for continuity of care throughout treatment.
Read full story
Source: Knutsford Guardian, 10 October 2020
Patient Safety Learning

Changes to medicines and medical devices evaluation proposed

As part of wide-reaching work being carried out to review the methods and processes the National Institute for Health and Care Excellence (NICE) uses to develop guidance, the organisation has launched a public consultation on proposals for changing how it selects the topics it will develop guidance on.
Covering guidance on medicines, medical devices and diagnostics, the proposals clarify the criteria which would see a device or diagnostic selected for NICE guidance development.
In particular, these include where costs and impacts are expected to be significantly cost-incurring or cost-saving – or there is uncertainty around the likely cost or the impact it would have on the healthcare system.
With regard to medicines, the new proposals would confirm the commitment made in the 2019 Voluntary Scheme for Branded Medicines Pricing and Access that pledged NICE would appraise all new active substances and significant licence extensions for existing medicines, except where there was a clear rationale not to do so.
Similarly, all new or significantly modified interventional procedures that would protect patient safety will be selected if they are available to the NHS or independent sector, or set to be used outside of formal research.
This proposed approach would move away from the 15 criteria currently used to select topics for evaluation by NICE’s Centre for Health Technology Evaluation and provide a clearer and simpler process.
Helen Knight, Programme Director for Technology Appraisals and Highly Specialised Technologies at NICE, said: “Topic selection plays an important role in the development of NICE guidance and is designed to ensure that the guidance we produce is on topics that support healthcare professionals and others to provide care of the best possible quality.
“These proposals will ensure we can continue to meet these ambitions at a time of unprecedented change in the healthcare system.”
The consultation on the proposals runs until 19 November. This will be followed by a separate public consultation on the case for change to its processes in February and March 2021.
Read full story
Source: NHE, 12 October 2020
Sam

Liverpool hospitals cut back on operations to cope with COVID-19 rise

Hospitals in Liverpool are scaling back non-urgent operations to help them cope with COVID-19 patients despite NHS bosses insisting that normal care continues during the second wave.
NHS trusts elsewhere in north-west England, as well as in the north-east and Midlands, are also preparing to cancel routine surgery such as joint replacements and hernia repairs amid a rapid rise in seriously ill coronavirus patients.
A potential second suspension of non-Covid care is looming despite warnings that this may lead to many thousands dying because their cancer, heart problem or other illness is not diagnosed or treated.
Steve Warburton, the chief executive of Liverpool University Hospitals NHS trust, acknowledged that doing less surgery would be “distressing” for patients affected but said the city’s three main acute hospitals had reached a “critical point”.
It is the first trust in England to make clear it cannot provide normal levels of non-Covid care during the second coronavirus surge, even though NHS England has told all hospitals to do so. The decision is likely to lead to other trusts doing the same.
Warburton said: “We will continue to prioritise surgery based in clinical need with a view to maintaining urgent and cancer surgery where possible.” He promised that the trust would continue to provide outpatient appointments “wherever possible” and keep giving patients diagnostic tests such as CT and MRI scans.
Read full story
Source: The Guardian, 12 October 2020
Sam
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