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

NHS guidance ‘too long to read,’ say hospital staff as safety watchdog exposes systemic risks to patients

NHS guidance ‘too long to read,’ say hospital staff as safety watchdog exposes systemic risks to patients.
The Healthcare Safety Investigation Branch (HSIB) revealed some NHS staff had admitted not reading official guidance on how to avoid the ‘never event’ error as part of a new report identifying deeper systemic problems that it said left patients at an increased risk.
The independent body warned patients across the NHS remained vulnerable to being injured or even killed by the error that keeps happening in hospitals despite warnings and safety alerts over the last 15 years.
HSIB launched a national investigation into the problem of misplaced nasogastric (NG) tubes after a 26-year-old man had 1,450ml of liquid feed fed into his lungs in December 2018 after a bike accident.
The patient recovered but the error was not spotted, even after an X-ray.
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Source: The Independent, 17 December 2020
Patient Safety Learning

'Great day for safety': Patients harmed by drugs and devices back commissioner role

An Independent Patients' Commissioner is set to be appointed to act as champion for people who have been harmed by medicines or medical devices.   
Baroness Cumberlege, who recommended the new role in a landmark report earlier this year, announced that the government had budged on the issue after initial resistance.
She welcomed the move saying: "Had there been a patient safety commissioner before now, much of the suffering we have witnessed could have been avoided."
But she added "the risk still remains" and further urgent action is needed to protect patients from potentially harmful drugs."
At an online meeting of parliamentarians, the baroness described the testimony of a victim of the medical device vaginal mesh, which has left some patients in chronic pain.
The woman had told her review team: "This device took everything from me. My health, my life, my job, my dignity, my marriage, my freedom."
Reflecting on this the baroness added: "The scale of suffering we witnessed means nothing short of profound change is necessary. Not necessary in a couple or three years, but necessary now."
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Source: Sky News, 16 December 2020
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Nurses reissue call for safe staffing levels one year after strike

More needs to be done to tackle safe staffing levels in Northern Ireland's health service, according to the Royal College of Nursing (RCN).
A year on from the nurses' strike, the union has warned that problems caused by poor workforce planning and chronic underfunding have not been addressed.
Instead they have been exacerbated by the CoOVID-19 pandemic, said the RCN.
The Department of Health said dealing with staff shortfalls was a "key priority" for the health minister.
Pat Cullen, the Northern Ireland director of the RCN, said "very little has actually changed" since about 15,000 healthcare workers took to the picket line in December last year for a series of protests over pay and safe staffing levels.
"We need to remind the government that many of these issues have sadly not gone away," she added.
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Source: BBC News, 18 December 2020
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London hospitals cancel operations to free up staffing as critical care beds fill up

London’s hospitals are already beginning to run out of critical care beds ahead of the Christmas relaxation of rules – which is expected to increase cases further, a leaked NHS briefing has warned.
The update on the situation in the capital comes as major hospitals have already started to cancel operations for other patients in order to find enough staff to deal with the rise in patients as NHS trusts open up extra surge capacity.
More operations are expected to be cancelled in hospitals across London, with staff warned they could be redeployed at short notice.
On Wednesday, there were a total of 2,289 coronavirus patients in London hospitals, an increase of 2 per cent on the day before. But the numbers of coronavirus patients in critical care beds jumped 8.6% in a single day, increasing from 302 to 345 patients on Wednesday, while an additional 900 people who have tested positive were receiving oxygen.
Across London, there were just 49 adult critical care beds available on Wednesday. In total there were 904 beds occupied, 328 by patients with COVID-19. This meant the capital’s total critical care bed occupancy rate was almost 95%.
Although the number of patients is much lower than it was the first wave, many hospitals are still treating routine and non-Covid patients – meaning they are struggling to staff critical wards and keep other services running.
A briefing for NHS managers warned them: “A reduction of elective [routine] activity is likely to be needed in line with increasing acute activity.”
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Source: The Independent, 17 December 2020
Patient Safety Learning

How patient safety and innovation can work hand in hand

The year 2020 has been extraordinary. It would have been inconceivable 12 months ago that the process of developing and testing medicines would be a topic of intense political and public interest. The UK pharmaceutical sector has taken centre stage, with more support than ever before for Britain’s gold-standard regulatory framework. 
After a difficult year, this winter has seen a steady drumbeat of positive news about COVID-19 vaccines, demonstrating that the pharmaceutical industry can deliver world-leading clinical research at pace and at scale within the UK’s regulatory system.
As the crisis of the COVID-19 pandemic hopefully eases over the coming months and the transition period for Britain’s exit of the EU comes to an end, we must seize the opportunity to strengthen this framework.   
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Source: New Statesmen, 14 December 2020
Sam

Long COVID patients to get help at more than 60 clinics

Thousands of patients suffering with the long term symptoms of coronavirus can now access specialist help at more than 60 sites, NHS England announced today.
The assessment centres are taking referrals from GPs for people experiencing brain fog, anxiety, depression, breathlessness, fatigue and other debilitating symptoms.
NHS England has provided £10 million for the network of clinics, which started opening last month. There are now 69 operating across the country with hundreds of patients already getting help.
The new centres bring together doctors, nurses, physiotherapists and occupational therapists to offer both physical and psychological assessments and refer patients to the right treatment and rehabilitation services.
Ten sites are now operational in London, seven in the East of England, eight in the Midlands, South East and South West respectively, nine in the North West and a further 18 across the North East and Yorkshire.
A further 12 sites are earmarked to launch in January in the East Midlands, Lancashire, Cornwall and Isle of Wight.
The National Institute for Clinical Excellence (NICE) has today also issued official guidance on best practice for recognising, investigating and rehabilitating patients with long COVID.
Patients can access services if they are referred by a GP or another healthcare professional, so that doctors can first rule out other possible underlying causes for symptoms.
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Source: NHS England, 18 December 2020
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Troubled children’s service taken out of special measures

An independent children’s and adolescents’ mental health service has been taken out of special measures after cutting beds by two-thirds.
The Care Quality Commission has rated St Andrew’s Healthcare’s CAMHS unit in Northamptonshire “requires improvement” but removed it from special measures. Among improvements noticed were a major change in the service’s leadership and staff raising concerns openly and honestly.
The unit was rated “inadequate” and served with a section 31 notice following inspections in June and December last year. 
After its December inspection, the charity reduced the number of beds within its CAMHS offering from 90 to 30. Around the same time, St Andrew’s Healthcare chief executive Katie Fisher also revealed plans to shrink its services by half to address the serious quality issues.
Speaking to HSJ, St Andrew’s Healthcare chief executive, Kate Fisher, who was appointed in 2018, said: “this isn’t just words, we are absolutely walking the walk and seeing through the strategy we set ourselves.”
Read full story (paywalled)
Source: HSJ, 18 December 2020
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Clapped-out kit, long delays, too few beds and staff: NHS enters 2021 in a sorry state

Think 2020 has been awful for the NHS? Next year is shaping up to be far worse – and most of the huge hole it’s in was dug long before Covid. The virus has merely finished off the job.
The health service does not have the beds, staff or equipment to recover the ground it lost during the first two waves of the coronavirus pandemic, but the government is blocking desperately needed improvements, and another round of organisational upheaval is on its way.
Roughly one in 11 clinical posts are vacant, and it would hardly be a surprise to see many staff rush for the retirement door once the worst of the pandemic is behind us. The NHS can’t solve the problem without long-term certainty over funding for staff.
Around 140,000 patients in England have been waiting more than a year for surgeries such as a hip replacements, up a hundredfold from a year ago. With the whole system beset by delays long before we had even heard of coronavirus, the lack of spare capacity means it will take years to help many patients.
Unprecedented interruptions and delays to cancer tests and treatments have been exacerbated by the pitiful state of diagnostic equipment. Access to CT and MRI scanners is far behind countries with a fraction of our wealth, such as Slovenia and Slovakia. Y
In the midst of all this turmoil, the NHS in England faces another round of legislative and organisational upheaval next year, the likely arrival of a new chief executive, and a potential fight with Downing Street over the extent of political control.
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Source: The Guardian, 18 December 2020
Sam

Teaching trust’s staff ‘utterly rinsed and completely wiped out’ by elective targets

A major London trust’s critical care staff have urged leaders to review elective work targets amid serious concerns over workload, safe staffing and burnout, HSJ  has learned.
In a letter to Guy’s and St Thomas’ Foundation Trust’s board, staff represented by trade union Unite said they had “repeatedly” raised concerns about the provider’s approach to elective work, as well as winter pressures and second wave planning, and the implications this has had for “the health, safety and wellbeing of both staff and patients”. 
The letter — which was also addressed to the trust’s health and safety committee and has been seen by HSJ —  said: “Our primary concern is that the trust’s endeavours, and understandable need to square these circles, may be unrealistic given the current pressures on staffing and the high rates of sickness and burnout the trust is continuing to experience.
“This is especially in critical care, where we are concerned this may compromise patient safety and is already damaging staff wellbeing and morale.”
Read full story (paywalled)
Source: HSJ, 18 December 2020
Sam

Long Covid: Hospital patients to get checks at six weeks

Patients in hospital with coronavirus should be offered a follow-up six weeks later to check for "long Covid" symptoms, doctors are being advised.
The guidance, drawn up by health officials across the UK, says the long-term effects can be "significant". They identified 28 of the most common symptoms, from breathlessness and dizziness to chest pain.
Mental health problems including depression, anxiety and struggling to think clearly, have also been reported.
"Because this is a new condition, there is still much that we don't know about it," said Paul Chrisp of the National Institute for Health and Care Excellence, which produces health guidance.
The NHS has opened 69 specialist clinics across England to offer rehabilitation to people recovering from the disease.
Read full story
Source: BBC News, 18 December 2020
Patient Safety Learning

Shortages of staff and equipment weigh on doctors’ decisions, survey reveals

Staff shortages and a lack of equipment are affecting the day-to-day decisions about patient care by doctors and nurses, a new YouGov survey has revealed.
The representative survey of NHS clinicians revealed more than half, 54%, admitted that factors such as a lack of staff played a role in their decisions about patients beyond what was in their best interests.
Almost a third of staff, 31%, said staffing levels were the top factor affecting decisions about patients. A fifth said the availability of services such as key tests were a significant factor; 16% cited a lack of equipment; and 12% cited beds. 10% of clinicians said a fear of being sued was part of their decision-making.
YouGov carried out the research for JMW Solicitors and weighted the responses to be representative of the NHS workforce population.
It also revealed more than two-fifths of clinicians, 42%, believe a “blame culture” in the NHS plays a top role in preventing staff admitting to mistakes in care.
In maternity services specifically, 68% of nurses and midwives said at least one factor other than what was in patients’ best interest played a role in their decisions.
Read full story
Source: The Independent, 20 December 2020
Patient Safety Learning

Doctors use pandemic as excuse not to offer effective pain relief claim campaigners

Women are undergoing “painful and distressing” diagnostic tests as doctors use the COVID-19 pandemic as an excuse not to offer them their choice of pain relief, HSJ has been told.
At least 70 women who have had hysteroscopies this year in English NHS hospitals said they were left in extreme pain following the procedures, with many suffering trauma for several days, according to a survey by the Campaign Against Painful Hysteroscopies group.
Some women claimed doctors used COVID-19 as an “excuse” not to offer sedation or general anaesthetic. Others said they were offered an inpatient appointment with general anaesthetic, but were also told it would be a long wait and would likely be cancelled due to covid pressures.
Women also said they were told an outpatient procedure would reduce the time spent in hospital and consequently reduce the risk of contracting covid. The only pain relief on offer was often just ibuprofen and some women said facilities like recovery rooms were unavailable.
The vast majority of the women surveyed — more than 90% — said they were traumatised for a day or longer by the pain from the procedure,
A RCOG spokeswoman said: “We are concerned to hear that women are going through painful and distressing hysteroscopy procedures and that they feel COVID-19 is being used as an excuse not to offer a choice of anaesthetic."
“The covid-19 pandemic has put incredible strain on the health services, and the risk of transmission of the virus has meant they’ve had to adapt their procedures. Whilst all women should be offered a choice of anaesthesia and treatment settings for hysteroscopic procedures, an outpatient setting avoids hospital admission and reduces the risk of exposure to the virus."
“The RCOG guidance on this is very clear — all pain relief options should be discussed with women, as well as the risks and benefits of each. Women should be given the choice of a local or general anaesthetic. If the procedure is still too painful, no matter what anaesthetic options are chosen, it must be stopped and a further discussion of pain relief options should then take place. It’s vital that women are listened to and their choice is fully supported.”
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Source: HSJ, 21 December 2020
Sam

Covid infections caught in hospital rise by a third in one week

The number of people likely to have caught COVID-19 in NHS hospitals in England has risen by more than a third in the last week.
The 35% rise in probable hospital-acquired COVID-19 from 6 to 13 December is the highest weekly increase since 30 October, HSJ analysis of NHS England data reveals.
Hospital-acquired infections are rising across areas such as London, the South East, and South West, and also at some hospitals in the North East, Yorkshire and the Midlands.
At some trusts, the weekly total of likely hospital-acquired COVID-19 infections has more than doubled since last week.
Read full story (paywalled)
Source: HSJ, 18 December 2020
Patient Safety Learning

Layla Moran secures first Commons debate on Long Covid

Layla Moran, Lib Dem MP for Oxford West and Abingdon and Chair of the APPG on Coronavirus, has secured the first Commons debate on Long Covid on Thursday 7 January following cross-party support.
The Backbench Business Committee granted the application by Layla Moran, co-sponsored by Dr Dan Poulter MP (Con) and Andrew Gwynne MP (Lab) and supported by many others.  Layla said that the debate “is long overdue” and called on “those with lived experience and clinical experience to tell us your stories” in advance of the debate.
Layla Moran said: “I’m pleased that we’ve been able to secure this important debate on Long Covid, which is long overdue. The APPG on Coronavirus, which I chair, has submitted recommendations to the Government on this, and the debate will give us the opportunity to hold them to account and represent our constituents suffering from it."
“What’s really important now is that as many MPs as possible take part in the debate, so we can give this the profile it deserves and give the Government the opportunity to listen and respond to our concerns. Thank you to my cross-party colleagues for supporting this. I’m calling on those with lived experience and clinical experience to tell us your stories between now and the 7 January. This is a crucial opportunity.”
Read full story
Source: Liberal Democrats, 19 December 2020
Patient Safety Learning

Pressure on hospitals 'at a really dangerous point'

Nearly 90% of hospital beds in England are full as hospitals try to cope with the demands of Covid in addition to normal winter pressures.
Ambulances queuing to offload patients, staff sickness and a lack of beds mean hospitals are "at a really dangerous point", say emergency doctors. This could result in some trusts facing the decision to stop non-Covid work.
Rises in hospital admissions are particularly affecting areas in the south.
The percentage of NHS hospital beds which are occupied is increasing and has reached almost 89% in England for the week ending December 13.
This is the highest occupancy rate so far this year - it's still lower than the same time last year, although the extra burden of Covid is likely to make hospitals feel they are much busier.
A safe level for bed occupancy is below 90% but nearly half of NHS trusts report a figure currently higher than this - the largest proportion this season.
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Source: BBC News, 19 December 2020
Patient Safety Learning

Fife simulator helping medics across the world to prevent late miscarriage and premature labour

A new training aid, developed in Fife, is helping to equip trainee medical staff from around the world with the skills to prevent late miscarriage and premature labour.
It was invented by Dr Graham Tydeman, consultant in obstetrics and gynaecology at Kirkcaldy’s Victoria Hospital, in conjunction with the St Thomas’ Hospital, London, and Limbs and Things.
The lifelike simulator allows trainees to perform hands on cervical cerclage in advance of a real-life emergency. The procedure involves an emergency stitching around the cervix and is necessary when the cervix shortens or opens too early during pregnancy, helping to prevent late miscarriage or extreme premature labour.
It is not a common event and the simulator was developed by Dr Tydeman following a request from medical trainees across the UK.
The device has already been warmly received by hospitals and training institutions across the world – with orders from countries including New Zealand and India.
Dr Tydeman said: “The reason this was developed is that it is not a common procedure and is very difficult to teach trainees."
“Increasingly women are understandably asking  about the experience of their surgeon and anyone having this procedure understandably does not want it to be the first one that a doctor has ever done because if it goes wrong there could be tragic consequences with loss of the baby. However, if a trainee has shown suitable skills using this simulator, I would be able to confidently reassure women that the doctor had been adequately trained, although a more experienced person would always help during the actual operation for the first few procedures on real women."
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Source: The Courier, 19 December 2020
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