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

NHS bosses accused of ‘putting politics before patient safety’

An NHS hospital at the epicentre of the coronavirus second wave is facing the threat of action by the care watchdog as it struggles to keep patients safe, The Independent has learned.
Senior NHS bosses in the northwest region have been accused of putting politics ahead of patient safety and not doing enough to help the hospital to cope with the surge in Covid patients in recent weeks.
The Care Quality Commission (CQC) warned the Liverpool University Hospitals Trust on Friday that it could face action after an inspection carried out last week in response to fears raised with the regulator. 
In a message to his colleagues on Friday, Liverpool University Hospitals (LUH) Trust medical director Tristan Cope warned the hospital had been overwhelmed by coronavirus and standards of care could no longer be maintained. He criticised NHS England and said the trust had been “abandoned” as coronavirus cases surged.
He confirmed the CQC’s intention to take action against the trust but said the regulator had failed to appreciate the pressure staff in the hospital were under.
Dr Cope, a consultant in anaesthesia and critical care, said: “LUH is now essentially overwhelmed by the demand. We cannot maintain patient flow and usual standards of care. We have put forward a proposal to further reduce elective [planned] activity, but maintaining capacity for the most urgent cases that would suffer from a two-four week delay."
“It is a very sound plan that our divisional teams have worked up. However, NHS England are prevaricating and delaying with the usual request for more detail, more data, etc. It is clear to me that the politics is outweighing the patient safety issues of the acute crisis."
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Source: The Independent, 3 November 2020
Patient Safety Learning

CQC orders staffing and safety improvements at trust scrutinised over deaths

A mental health trust has been told to make ‘urgent improvements’ by regulators after a fourth inpatient death occurred with similar themes to three other patients dying within 12 months.
The warning, issued by the Care Quality Commission (CQC) to Devon Partnership Trust, was made after an unannounced inspection at the trust’s Langdon Hospital – following the death of a patient who died by suspected suicide in July.
Last week HSJ revealed how the death was the fourth inpatient death within the last 12 months at the trust, with each incident having recurring themes.
The latest death happened at Langdon Hospital in Dawlish, on one of the trust’s medium secure wards (Ashcombe), with the patient using a ligature point. It was a similar incident to another serious incident in May on a different ward (Holcombe) at the hospital, and it prompted the inspection from the CQC in mid-August.
While the death remains under investigation by the trust, early details shared with the CQC reveal that the incident happened in an area of the ward which had been changed to an “isolation area” under the trust’s COVID-19 infection prevention strategy. However, this meant there were not “good lines of sight” for staff monitoring patients – according to the CQC’s inspection report.
There were also “low staffing levels on the wards”, according to staff which spoke to the CQC. The staff also told inspectors they were “stressed, exhausted and burnt out following the demands of the pandemic”.
According to the CQC, some staff had concerns about areas on the ward where patients had “unrestricted access to items including sports equipment that could be used as weapons for self-harm”.
Although the ward’s ligature assessment claimed those areas were always supervised by staff, this was disputed by the staff themselves, the report said.
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Source: HSJ, 3 November 2020
Patient Safety Learning

Hospitals 70% cent more full than April

There are 70% more people in hospital now as when England was approaching its spring COVID-19 peak, and twice as many non-covid patients, according to official figures leaked to HSJ.
In some regions, the contrast is even sharper. In the North East and Yorkshire, where COVID-19 hospitalisations are still mounting rapidly, there are now twice as many patients in acute hospitals than there were in early April.
The information also shows that there are now 13% more patients than there were on 3 April in mechanical ventilation beds – which are reserved for the most seriously ill patients. These include more than double the number of non-covid patients than there were in the spring.
The information — shared with HSJ and The Independent by NHS sources — also reveals that 1 in 10 hospital beds are now occupied by confirmed covid patients – up from about 6% two weeks ago.
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Source: HSJ, 3 November 2020
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Judge says care home residents in England are legally allowed visitors

A senior judge has said friends and family can legally visit their loved ones in care homes, in an apparent challenge to recent government policy that has in effect banned routine visits in areas of high COVID-19 infection.
Mr Justice Hayden, vice-president of the court of protection which makes decisions for people who lack mental capacity, said courts are concerned about the impact on elderly people of lockdowns. He has circulated a memo that sets out his analysis that regulations do “permit contact with relatives” and friends and visits are “lawful”.
He was responding to guidance from the Department of Health and Social Care (DHSC) last month telling thousands of care homes in England that visiting should be stopped in areas with tier 2 and tier 3 lock down restrictions, apart from in exceptional circumstances such as the end of life.
It triggered blanket prohibitions by some councils and sparked anguish from relatives who warn a lack of contact is leading to misery and early death in some cases. Within a week, Gloucestershire county council told care homes in its area to stop visits until next spring.
With the England-wide lockdown starting on Thursday, care home providers, families and groups including Age UK and Alzheimer’s Society, have called on ministers to this time make clearer provisions for visiting. 
Hayden said exceptions in the existing regulations mean contact with residents staying in care homes is lawful for close family members and friends. He said the court of protection was concerned about “the impact the present arrangements may have on elderly people living in care homes,” citing their suffering.
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Source: The Guardian, 2 November 2020
Patient Safety Learning

Basildon maternity unit handed 'urgent' safety deadline

An NHS hospital where a woman bled to death in childbirth has been given an "urgent" deadline to keep patients at its maternity unit safe.
A letter seen by the BBC reveals the Care Quality Commission (CQC) found unsafe staffing levels at the unit at Basildon Hospital throughout August. The CQC said the trust that runs it had until next Monday to implement appropriate measures.
The trust said it had a "robust improvement plan in place".
The seven-page document, sent by the CQC on 7 October, puts the Mid and South Essex NHS Foundation Trust on notice that it has to "implement an effective governance system", among other measures.
Consequences for missing the deadline were not stated, but the CQC said it was using its powers under the Health and Social Care Act to impose conditions on the trust's registration.
The Act does allow the CQC to temporarily close health services.
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Source: BBC News, 3 November 2020
Patient Safety Learning

1 in 3 doctors have suffered verbal or physical abuse during COVID-19

Over a third (35%) of healthcare professionals say they have suffered verbal or physical abuse from patients, or patients’ relatives during COVID-19, according to a survey by Medical Protection.
The Medical Protection survey of 1250 doctors in the UK, also showed that a further 7% have experienced verbal or physical abuse from a member of the public outside of a medical setting, with some saying they have been sworn at for using the NHS queue at the supermarket.
This follows reports that GP’s are facing abuse and complaints from patient’s who believe they aren’t offering enough face-to-face appointments, despite face-to-face appointments increasing in recent months. 
Medical Protection said the abuse presents yet another source of anxiety for doctors at the worst possible time. In the same survey, 2 in 5 doctors say their mental wellbeing is worse compared to the start of the pandemic.
“I have been sworn at for using the NHS queue at the supermarket.”
“I have had more unpleasantness from patients in the last 6 months than in all my previous 50 years in healthcare.I am almost at the point of stopping all clinical practice.”
“There is too much verbal abuse to mention but the most upsetting is patients believing that we haven`t been open – we are all on our knees.”
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Source: Medical Protection, 31 October 2020
 
Patient Safety Learning

Nearly 40,000 wrongly told to get a flu jab

The NHS has erroneously written to thousands of patients who have had glandular fever in the past asking them to get a flu jab from their GP.
The error left some GPs with practice phone lines blocked last week while reception staff have had to explain to patients they are not actually eligible for free flu vaccination.
Nearly 40,000 letters were sent out to patients with a past history indicating glandular fever because of a coding error at NHS Digital. This was meant to identify patients with suppressed immune systems which would include those who currently have glandular fever and encourage them to contact their GP practice to arrange vaccination.
However, the historical cases were not excluded, leading to the letters being automatically generated even when the glandular fever diagnosis was decades old.
When NHS Digital realised the error, it contacted NHS England – which was responsible for posting out the letters – and managed to stop others being sent out.
An NHS Digital spokesman said: “During a process to identify patients eligible for a flu vaccination, glandular fever was incorrectly included in a complex list of conditions that cause persistent immunosuppression. This led to some patients incorrectly receiving a letter encouraging them to seek a flu vaccination.
“There has been no adverse clinical impact for patients and the issue was quickly resolved before the majority of letters were sent.” NHSD said patients who had received the letter would receive another one to explain and to reassure them."
Read full story (paywalled) 
Source: HSJ, 4 November 2020
Sam

Weekly Covid deaths at highest rate since early June, new statistics show

The number of weekly coronavirus deaths in England and Wales has risen to its highest figure since early June, new statistics show.
In the week ending 23 October, a total of 978 registered deaths mentioned COVID-19 on the death certificate, according to the Office for National Statistics (ONS). This marks a 46% increase on the number of deaths reported in the previous week, and is the highest figure on record since 12 June.
Of the 978 deaths that involved COVID-19, 874 had this recorded as the underlying cause of death (89.4 per cent), the ONS said.
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Source: The Independent, 3 November 2020
Sam

Cornwall care home abuse 'not investigated'

Abuse in Cornwall care homes was not properly investigated until after a BBC investigation, a review has found.
The Morleigh Group operated seven homes in the county until closing in 2016 after undercover filming by BBC Panorama at one home revealed abuse.
An official review found there had been hundreds of reports of concerns since 2013. These included physical abuse, people being left "soaked in their own urine" and a lack of food and heating.
The Cornwall and Isles of Scilly Safeguarding Adults Board review highlighted the failings and missed opportunities to address the problems.
Its report specifically questioned why it took a BBC programme to "bring about change" despite the "wealth of evidence" already available.
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Source: BBC News, 2 November 2020
Sam

Patients unable to get help to eat on dangerously understaffed NHS wards at centre of second wave

Vulnerable patients at a major NHS hospital at the centre of England’s coronavirus second wave have been left without help to eat or drink because wards are so dangerously understaffed, The Independent can reveal.
Dozens of safety incidents have been reported by doctors and nurses at the Liverpool University Hospitals Trust since April, citing the lack of nurses as a key patient safety risk.
Across several wards, just two registered nurses per ward were being expected to look after dozens of sick patients – a ratio of nurses to patients far below recommended safe levels.
On one ward there were 36 patients to two registered nurses – with the nurse in charge of the ward having only qualified six months earlier.
The safety concerns also include a diabetic patient – where there was no evidence nurses had monitored their blood glucose levels and insulin medication, which if left unchecked could prove fatal.
Other patients have been forced to eat food and drink which has gone cold by the time staff are ready to help them.
The hospital is among the worst affected by the surge in coronavirus cases in the north of England. It’s medical director warned on Friday that it was at 100 per cent capacity and unable to maintain standards of care.
Read full story
Source: The Independent, 5 November 2020
Patient Safety Learning

Milestone 1 million Yellow Card report for suspected side effects in #MedSafetyWeek

The Medicines and Healthcare products Regulatory Agency (MHRA) has received its one millionth Yellow Card. The Yellow Card scheme is the UK’s system for reporting suspected side effects to medicines and adverse events with medical devices. This major milestone coincides with the launch of the 5th annual #MedSafetyWeek (2-8 November), which highlights the value of the Yellow Card scheme to the nation’s health, and the importance of reporting suspected side effects from medicines.
The MHRA has seen an increased rate of Yellow Card reports and would like to continue to encourage more reporting this #MedSafetyWeek.
MedSafetyWeek is a global campaign, with over 70 countries participating, worldwide. This year, the theme is ‘every report counts’. The MHRA will be calling upon patients and carers, as well as healthcare professionals and their organisations to report suspected side effects from medicines.
Reporting helps to identify new side effects, as well as unexpected and serious safety problems. It also adds to existing information about known effects. By reporting, patients and the public can help the safe use of medicines for everyone. 
Read press release
Source: GOV.UK, 2 November 2020
Patient Safety Learning

Coronavirus: Nurse arrested for trying to take mother with dementia out of care home for lockdown

A woman has been arrested after attempting to take her 97-year-old mother out of a care home for lockdown.
Qualified nurse Ylenia Angeli, 73, wanted to care for her mother, who has dementia, at home. But when she told staff at the care home, they called the police who then briefly arrested Ms Angeli.
The family have not been able to see their elderly relative for nine months, and decided to act ahead of the second national lockdown.
Assistant Chief Constable Chris Noble, from Humberside Police, said: "These are incredibly difficult circumstances and we sympathise with all families who are in this position."
"We responded to a report of an assault at the care home, who are legally responsible for the woman's care and were concerned for her wellbeing. We understand that this is an emotional and difficult situation for all those involved and will continue to provide whatever support we can to both parties."
The incident came to light on the day the government announced new rules for families wishing to visit their loved ones in care homes.
Under the guidance, issued hours before lockdown, families can meet relatives through a window or in a secure outdoor setting. Visits will need to be booked in advance, but the Department of Health and Social Care advice said care homes "will be encouraged and supported to provide safe visiting opportunities".
All care home residents are allowed to receive visits from friends and family during the second national lockdown.
Read full story
Source: Sky News, 5 November 2020
Patient Safety Learning

NHS England reinstates central control powers as covid risk rating is increased

The NHS has been returned to the highest level of risk on its emergency preparedness framework, a move which allows national leaders tighter control over local resources and decision making.
NHS England chief executive Sir Simon Stevens announced the decision at a press conference this morning.
He said: “Unfortunately, again we are facing a serious situation [due to rising coronavirus infections and hospital admissions]. That is the reason why at midnight tonight the health service in England will be returning to its highest level of emergency preparedness, EPPR level 4, which of course we had to be at from the end of January to the end of July.”
Placing the NHS on level 4 of Emergency Preparedness Reslience and Response framework allows system leaders to take control of decisions over mutual aid and other local priorities.
Sir Simon was joined by NHSE/I medical director Steve Powis and Alison Pittard, dean of the Faculty of Intensive Care Medicine. They used the press conference to stress the threat the NHS faced from the second covid peak, but also set out more positive news on the covid vaccine programme.
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Source: HSJ, 4 November 2020
Patient Safety Learning

Covid-positive care home plan failing to relieve pressure on crowded hospitals

Trusts in more than half English local authorities still do not have an agreed safe place to discharge recovering covid patients to, despite the government asking councils to identify at least one such ‘designated setting’ by the end of October.
The situation is leading to an increase in delayed discharges from hospital just as the service comes under increased pressure from the second covid wave and returning elective and emergency demand. 
In a letter last month, the government told local authorities to identify at least one “designated setting” – typically a care home – which hospitals could discharge covid positive patients to when they no longer need secondary care. The designated setting would also take discharged patients who had not received a negative covid test.
The plan is designed to protect residents in other homes, after thousands of care home residents died due to outbreaks of the virus in the spring.
But a well-placed source in the care sector told HSJ less than half of the 151 upper tier councils met the 31 October deadline, due to a range of reasons including insurance costs, fear of high mortality rates and reputational damage to the designated homes.
It means that in many parts of the country, there are a lack of options when it comes to discharging patients, which is causing a rise in delayed discharges.
Read full story (paywalled)
Source: HSJ, 5 November 2020
Patient Safety Learning

Talking Medicines raises £1.1m to scale up AI patient tracking

Talking Medicines, a social intelligence company for the pharmaceutical industry, has secured £1.1 million funding deal to scale up its AI-based platform for measuring patient sentiment.
Tern, an investment company specialising in the Internet of Things (“IoT”), is the lead investor in a syndicated funding round alongside The Scottish Investment Bank, Scottish Enterprise’s investment arm.
Led by CEO Jo Halliday alongside co-founders Dr Elizabeth Fairley and Dr Scott Crae, Talking Medicines will use the funds to support the launch and roll-out of a new AI data platform, which will translate what patients are saying into intelligence by providing a global patient confidence score by medicine. As part of these plans, the business intends to immediately recruit 9 new employees to the NLP data tech team.
Formed in 2013 to create new ways of capturing the voice of the patient, the Glasgow-based firm uses a combination of AI, machine learning and Natural Language Processing (NLP) tech tools to capture and analyse the conversations and behaviours of patients at home, with the aim of transforming big pharma’s understanding of patient sentiment. Through mapping the patient voice from social media and connected devices to regulated medicine information, it is able to build data points to determine trends and patterns of patient sentiment across medicines.
The round brings the total raised by the firm to £2.5m, including three previous seed funding rounds with previous investors including impact investor SIS Ventures and the Scottish Investment Bank. Talking Medicines CEO Halliday, said: “This investment will scale our team and the development of our AI, ML, NLP tech tools to translate what patients are saying into actionable pharma grade intelligence through our global patient confidence score by medicine.”
Clive Flashman

Covid: Care home visits advice impractical, say charities

The government is facing criticism over its guidance on safe visits to care homes in England.
Labour and a number of charities have described the suggestions, including floor-to-ceiling screens, designated visitor pods and window visits, as impractical. Alzheimer's Society has said it "completely misses the point".
Justice Secretary Robert Buckland told BBC Radio 4's Today programme the guidance was "non-exhaustive".
The updated government advice, which came into effect on Thursday, says care homes - especially those which have not allowed visits since March - "will be encouraged and supported to provide safe visiting opportunities".
Labour's shadow care minister Liz Kendall said many care homes would not be able to comply with the government's requirements which meant "in reality thousands of families are likely to be banned from visiting their loved ones".
She said instead of suggesting measures such as screens, the government should "designate a single family member as a key worker - making them a priority for weekly testing and proper PPE".
Kate Lee, chief executive at Alzheimer's Society, said: "We're devastated by today's new care home visitor guidance - it completely misses the point: this attempt to protect people will kill them."
She said the pandemic had left people with dementia isolated and thousands had died. The guidelines "completely ignore the vital role of family carers in providing the care for their loved ones with dementia that no one else can", she added.
She said the "prison-style screens" proposed by the government with people speaking through phones were "frankly ridiculous when you consider someone with advanced dementia can often be bed-bound and struggling to speak".
That view was echoed by Caroline Abrahams, charity director at Age UK, who said she was "acutely aware" that the methods being sanctioned were "unlikely to be useable by many older people with dementia, or indeed sensory loss".
Read full story
Source: BBC News, 5 November 2020
Sam
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