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

Ambulance service placed in ‘special measures’ to make drastic improvements

Following a damning report by the Care Quality Commission (CQC), the East of England Ambulance Service NHS Trust (EEAST) has been placed into special measures.
It comes after inspectors uncovered a culture of bullying and sexual harassment at the trust. As a result of the decision, EEAST will receive enhanced support to improve its services.
A statement from NHS England and NHS Improvement outlined that the Trust would be supported with the appointment of an improvement director, the facilitation of a tailored ‘Freedom to Speak Up’ support package, the arrangement of an external ‘buddying’ with fellow ambulance services and Board development sessions.
This follows a CQC recommendation to place the trust in special measures due to challenges around patient and staff safety concerns, workforce processes, complaints and learning, private ambulance service (PAS) oversight and monitoring, and the need for improvement in the trust’s overarching culture to tackle inappropriate behaviours and encourage people to speak up.
Ann Radmore, East of England Regional Director said, “While the East of England Ambulance Service NHS Trust has been working through its many challenges, there are long-standing concerns around culture, leadership and governance, and it is important that the trust supports its staff to deliver the high-quality care that patients deserve."
“We know that the trust welcomes this decision and shares our commitment to reshape its culture and address quality concerns for the benefit of staff, patients and the wider community.”
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Source: Bedford Independent, 19 October 2020
Sam

Long COVID: The debilitating after-effects of coronavirus

COVID-19 became a pandemic in March 2020, but the after-effects of it are becoming more apparent as many people are suffering from a wide variety of symptoms months after contracting the disease.
Long COVID – as it is being called – has been affecting some of the earliest COVID-19 sufferers since the first few months of 2020, but little is known about it and the huge variety of symptoms is making research very difficult.
Sky News looks at what the symptoms of long COVID are, how it has affected people's lives, how many are suffering, what treatments there are and how it could affect the economy.
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Source: Sky News, 19 October 2020
Sam

‘Putting lives at risk’: Ministers deny coronavirus tests for care home inspectors

Ministers have denied care home inspectors access to weekly testing for coronavirus – despite fears they could contribute to the spread of COVID-19 as cases rise across the country, The Independent can reveal.
The Care Quality Commission (CQC) was told by the Department of Health and Social Care last month it could not have access to regular testing for inspection teams as the watchdog prepares for 500 inspections of care homes during the next six weeks.
Officials said the teams, who are assessing care conditions for the vulnerable and elderly, did not get close enough to people to present a risk.
During the first wave of the virus, after Public Health England initially said there was no risk to care homes, an estimated 16,000 residents died from the virus.  At the height of the crisis up to 25,000 NHS patients were discharged to care homes by the NHS, with many not having been tested for the virus.
Labour MP Barbara Keeley said: “The refusal of the Department of Health and Social Care to treat CQC inspectors in the same way as other staff going into care homes puts lives at risk.”
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Source: The Independent, 20 October 2020
Sam

Hundreds of Victoria hotel quarantine guests must be screened for HIV over blood testing contamination fears

More than 200 people who went through hotel quarantine in Victoria, Australia, must be screened for HIV amid fears of cross-contamination from incorrect usage of blood glucose test devices.
Several such devices were used on multiple people in quarantine between 29 March and 20 August, necessitating screenings for blood-borne diseases such as hepatitis B and C and HIV.
These monitors, which take a small sample of blood from a fingertip, are intended for repeated use by only one person. While the needle is changed between usages, microscopic traces of blood can remain within the body of the machine, creating a low clinical risk of cross-contamination and infection.
Safer Care Victoria, the state’s healthcare quality and safety agency, has assured the public there is no risk of COVID-19 spread as the disease is not transmitted by blood.
These devices have since been taken out of circulation.
In a statement, a spokesman for the agency said they have identified 243 people who had been tested by one of the shared machines during the timeframe in question, and will be contacted for screening. Everyone “who had conditions or episodes that may have required the test will also be contacted as a precaution”.
The Victorian premier, Daniel Andrews, labelled the incident a “clinical error that was made some time ago”.
“Safer Care Victoria have made some announcements in relation to a clinical error that was made some time ago, very low risk, but you can’t take any risks with these things. You have to follow them up properly and that’s exactly what has happened,” he said at a press conference on Tuesday.
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Source: The Guardian, 20 October 2020
Sam

South East sees ‘striking’ levels of excess deaths at home

Parts of the South East saw “striking” levels of excess deaths occurring in people’s homes between July and October.
Analysis of official data by HSJ shows the region, which excludes London, had almost 900 excess deaths in the 10 weeks to 2 October (around 10 per 100,000 population), which accounted for almost three-quarters of the national total in that period.
Excess deaths means the number taking place above the seasonal average of previous years.
Deaths in people’s homes — as opposed to in hospitals or care homes, for example — more than accounted for the total excess. Meanwhile, only 132 of the region’s deaths in this period mentioned COVID-19 on the death certificate.
Experts have described the South East numbers as “very striking”, but said it is not immediately clear what was causing it to be such a significant outlier.
Possible explanations for excess mortality during the pandemic have included disruptions to normal health services, as well as anxiety among patients about attending hospital or GP surgeries.
Read full story (paywalled)
Source: HSJ, 20 October 2020
Patient Safety Learning

Trust in NHS ‘poor and diminishing’ among communities hit hardest by covid

There is growing distrust for the NHS and government in communities that are of fundamental importance to the national effort to counter covid, according to research by NHSX.
People in so-called “hard to reach” communities are faced with stigma and racism due to the covid pandemic but have dwindling trust in the health service, the research found.
They are worried about how their personal data will be used by the NHS and other state bodies. They are particularly concerned that their details will be passed on to the police or immigration services.
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Source: HSJ, 20 October 2020
Patient Safety Learning

Long Covid: St Annes man 'never recovered' from long-term effects

A man who was the last patient to leave Blackpool Victoria Hospital's intensive care unit after being treated for COVID-19 in July has died.
Roehl Ribaya spent 60 days in intensive care in the summer but "never recovered" from the long-term effects of the virus. 
The Filipino aerospace engineer's family said the virus had taken a heavy toll on the 47-year-old even after he was discharged from hospital on 14 August. He had a cardiac arrest on 13 October and was in a coma until he died two days later.
His wife, Mrs Ricio-Ribaya, who lives in St Annes in Lancashire, said: "He was never the same. He was so breathless all the time.
"Please follow the government's advice so we can stop this virus. We don't want any more to die."
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Source: BBC News, 20 October 2020
Patient Safety Learning

Reviewer ‘felt bullied by CCG’ over findings on young man’s death

An independent review found that commissioners’ investigation of a young boy’s death was ‘mismanaged’, and heard allegations that the person who coordinated it was bullied over the contents.  
The independent review, commissioned by NHS England, has published its final report following an investigation into Bristol, North Somerset and South Gloucestershire clinical commissioning group’s LeDer review into the death of Oliver McGowan.
Chaired by Fiona Ritchie, the independent review was commissioned last year after evidence emerged that the CCG had rewritten earlier findings of the review, removing suggestions his death at North Bristol Trust in 2016 was avoidable.
Oliver died in November 2016 after being given anti-psychotic medication against his own and his parents’ wishes and despite medical records showing he had an intolerance to anti-psychotics. He developed severe brain swelling because of the drugs and died.A local LeDer review — part of a programme aimed at improving care based on deaths among people with learning disabilities — was launched in 2017, seven months after his death, by the CCG (then operating as three separate organisations), then published in 2018. 
In 2018, a coroner concluded Oliver’s care prior to his death was “appropriate” and made no recommendations. His death is also currently the subject of a police investigation. 
The lead reviewer (Ms A) stated in her panel interview that during the time she was undertaking this LeDeR she had felt bullied, overworked and overly stressed by the demands placed on her by the various correspondences with solicitors and her line management. The fact that Ms A believed she was isolated and unsupported during this review illustrates evident failures in the CCG assurance and management processes at the time.
In a final report by the subsequent independent review, published today, the panel led by Ms Ritchie “unanimously” agreed Oliver’s death was “potentially avoidable”.
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Source HSJ, 20 October 2020
Sam

New tool predicts person’s risk of hospitalisation and death from COVID-19

UK researchers have developed a new risk prediction tool that estimates a person’s chance of hospitalisation and death from COVID-19.
The algorithm, which was constructed using data from more than eight million people across England, uses key factors such as age, ethnicity and body mass index to help identify individuals in the UK at risk of developing severe illness.
It’s hoped that the risk prediction tool, known as QCOVID, will be used to support public health policy throughout the rest of the pandemic, in shaping decisions over shielding, treatment or vaccine prioritisation.
The research, published in The BMJ, was put together by a team of scientists across the UK, and has been praised for the depth and accuracy of its findings.
“This study presents robust risk prediction models that could be used to stratify risk in populations for public health purposes in the event of a ‘second wave’ of the pandemic and support shared management of risk,” the researchers say.
“We anticipate that the algorithms will be updated regularly as understanding of COVID-19 increases, as more data become available, as behaviour in the population changes, or in response to new policy interventions.”
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Source: The Independent, 21 October 2020
Patient Safety Learning

Hospital cancels operations as Covid patient numbers soar

A hospital in Yorkshire has said it is cancelling planned surgeries for at least two weeks as the number of coronavirus patients there hits levels not seen since May.
Bradford Teaching Hospitals said it was being forced to stop non-urgent surgery and outpatient appointments for two weeks from Tuesday because of the numbers of severely ill COVID-19 patients.
In statement the hospital said it had seen a spike in admissions in the last few days with 100 coronavirus patients now on the wards with 30 patients needing oxygen support – the highest number of any hospital in the northeast and Yorkshire region.
It also said more patients were needing ventilators to help them breathe in intensive care.
The trust is the latest to announce cancellations, joining the University Hospitals of Birmingham, Nottingham University Hospitals and Plymouth Hospitals as well as those in Liverpool and Manchester where hundreds of Covid patients are being looked after.
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Source: The Independent, 21 October 2020
Patient Safety Learning

Covid: Lockdown had 'major impact' on mental health

Lockdown had a major impact on the UK's mental health, including increased rates of suicidal thoughts, according to new research.
The study, led by the University of Glasgow, examined the effects of COVID-19 during the height of the pandemic. Certain groups are said to be particularly at risk, including young people and women. 
This publication is the most detailed examination of how the UK's adult population coped during the first weeks of lockdown, when people were given strict orders to stay home.
Researchers say public health measures, like lockdowns, are necessary to protect the general population, but warn they may have a "profound and long-lasting" effect on mental health and will extend beyond those who have been affected by the virus.
The study, published in the British Journal of Psychiatry, looked at three blocks of time between March 31 and May 11.
Just over 3,000 adults in the UK were surveyed and a range of mental health factors were considered, including depression, loneliness, suicide attempts and self-harm.
The study found suicidal thoughts increased from 8% to 10% and they were highest among young adults (18-29 years), rising from 12.5% to 14%. The researchers say that, even though those are relatively small rises, they are significant because of the short period of time they happened over.
"The majority of people did not report any suicidal thoughts, but this creeping rise over a very short period of time is a concern," says Prof Rory O'Connor, chair in health psychology at the University of Glasgow's Institute of Health and Wellbeing.
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Source: BBC News, 21 October 2020
Patient Safety Learning

Health Secretary warns of long-term effects of COVID-19 as new film released

The Health Secretary is urging the public – and especially young people – to follow the rules and protect themselves and others from COVID-19, as new data and a new film released today reveal the potentially devastating long-term impact of the virus.
The symptoms of ‘long COVID’, including fatigue, protracted loss of taste or smell, respiratory and cardiovascular symptoms and mental health problems, are described in a new film being released today as part of the wider national Hands, Face, Space campaign. The film calls on the public to continue to wash their hands, cover their face and make space to control the spread of the virus.
The emotive film features the stories of Jade, 22, Jade, 32, Tom, 32 and John, 48, who explain how their lives have been affected – weeks and months after being diagnosed with COVID-19. They discuss symptoms such as breathlessness when walking up the stairs, intermittent fevers and chest pain. The film aims to raise awareness of the long-term impact of COVID-19 as we learn more about the virus.
A new study from King’s College London, using data from the COVID Symptom Study App and ZOE, shows one in 20 people with COVID-19 are likely to have symptoms for 8 weeks or more. The study suggests long COVID affects around 10% of 18 to 49 year olds who become unwell with COVID-19.
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Source: Gov.uk, 21 October 2020
Patient Safety Learning

Racial discrimination widespread in NHS job offers, says report

Doctors from black, Asian and minority ethnic backgrounds have been hindered in their search for senior roles because of widespread “racial discrimination” in the NHS, according to a report from the Royal College of Physicians.
The RCP, which represents 30,000 of the UK’s hospital doctors, found that ingrained “bias” in the NHS made it much harder for BAME doctors to become a consultant compared with their white counterparts.
“It is clear from the results of this survey that racial discrimination is still a major issue within the NHS,” said Dr Andrew Goddard, the RCP’s president. “It’s a travesty that any healthcare appointment would be based on anything other than ability.”
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Source: The Guardian, 21 October 2020
Patient Safety Learning

Long Covid: Who is more likely to get it?

Old age and having a wide range of initial symptoms increase the risk of "long Covid", say scientists. 
The study estimates one in 20 people are sick for least eight weeks. The research at King's College London also showed being female, excess weight and asthma raised the risk.
The aim is to develop an early warning signal that can identify patients who need extra care or who might benefit from early treatment.
The findings come from an analysis of people entering their symptoms and test results into the COVID Symptom Study app.
Scientists scoured the data for patterns that could predict who would get long-lasting illness.
"Having more than five different symptoms in the first week was one of the key risk factors," Dr Claire Steves, from Kings College London, told BBC News.
COVID-19 is more than just a cough - and the virus that causes it can affect organs throughout the body. Somebody who had a cough, fatigue, headache and diarrhoea, and lost their sense of smell, which are all potential symptoms,- would be at higher risk than somebody who had a cough alone. The risk also rises with age, particularly over 50, as did being female.
Dr Steves said: "We've seen from the early data coming out that men were at much more risk of very severe disease and sadly of dying from Covid, it appears that women are more at risk of long Covid."
No previous medical conditions were linked to long Covid except asthma and lung disease.
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Source: BBC News, 21 October 2020
Sam

CQC reveals some patients have spent a decade in seclusion

The Care Quality Commission (CQC) has called for ‘ministerial ownership’ to end the ‘inhumane’ care of patients with learning difficulties and autism in hospital – after finding some cases where people had been held in long-term segregation for more than 10 years.
Following its second review into the uses of restraint and segregation on people with a learning difficulty, autism and mental health problems, the CQC has warned it “cannot be confident that their human rights are upheld, let alone be confident that they are supported to live fulfilling lives”.
The review was ordered by health and social care secretary Matt Hancock in late 2018 in response to mounting concerns about the quality of care in these areas.
According to the report, published today, inspectors found examples people being in long-term segregation for at least 13 years, and in hospital for up to 25 years. It also found evidence showing the proportion of children from a black or black British background subjected to prolonged seclusion on child and adolescent mental health wards was almost four times that of other ethnicities.
Looking at care received in hospital the CQC found many care plans were “generic” and “meaningless” and patients did not have access to any therapeutic care.
Reviewers also found people’s physical healthcare needs were overlooked. One women was left in pain for several months due to her provider failing to get medical treatment.
The regulator also reviewed the use of restrictive practices within community settings. While it found higher quality care, and the use of restrictive practices was less common, it said there was no national reporting system for this sector.
Read full story (paywalled)
Source: HSJ, 22 October 2020
Sam

Trust accused of ‘racism, discrimination and bullying’ as staff partnership halted

The staff-side committee of a major hospital trust has stopped working with its leadership, with its chair alleging an ‘endemic’ culture of ‘racism, discrimination and bullying’.
Irene Pilia, staff-side committee chair at King’s College Hospital Foundation Trust, told colleagues that the decision was taken “in the interests of staff”, especially black, Asian and minority ethnic workers, and expressed concerns about the organisation’s disciplinary procedures. She said the decision had the backing of staff committee officers and delegates.
Ms Pilia, who is also the senior KCHFT Unite representative, said she was open to resuming partnership working again, but told trust executives: “I have lost trust and confidence in the ability of [KCHFT] to conduct fair, impartial and no-blame investigations.
“Until there is tangible and credible evidence that racist behaviour at all levels is proactively eliminated, such that perpetrators face real consequences (including to the detriment of their careers) for their actions and are no longer allowed to behave in racist ways with impunity, I take a stand for the hundreds, possibly thousands of KCHFT staff whose voices are not being heard."
Read full story (paywalled)
Source: HSJ, 22 October 2020
Sam
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