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

Cancer care under threat as NHS loses covid private sector back-up

Cancer surgery in London is under threat as rising covid admissions put pressure on services that no longer have back-up capacity from the independent sector, HSJ has learned.
Research by HSJ has discovered that NHS England ended contracts with HCA, The London Clinic and the Cromwell Hospital at the end of August, after concerns about underutilisation.
Under the previous deal with the private sector, rules were in place to make sure low-priority private patients were not treated ahead of NHS patients who needed surgery urgently.
HCA and The Cromwell have confirmed the contracts were ended in August and were not renewed. The London Clinic did not respond to a request for comment.
As of 19 December, there were 2,909 covid inpatients being treated in London hospitals, a rise of 39% over the previous seven days. Barts Health Trust and Barking, Havering and Redbridge University Trust in the east of the city are under particular pressure.
Should the number of covid patients reach a level that requires the capital to instigate surge protocols, theatre space set aside for cancer operations is likely to be commandeered. Under this scenario, the NHS in the capital would no longer have the option to transfer cancer patients to private facilities as it did during the first wave of the pandemic.
A senior London-based source said: “This is a real and imminent threat to London’s ability to perform cancer surgery."
Read full story (paywalled)
Source: HSJ, 21 December 2020
Patient Safety Learning

Thousands of clinically vulnerable patients in tier 4 areas told to stay indoors

Thousands of people who are at extreme risk from the coronavirus and live in tier 4 areas have been told to stay indoors at all times unless they are exercising or have medical appointments.
The Department of Health and Social Care (DHSC) issued new advice on Monday warning people classed as “clinically extremely vulnerable” to stay home, in a bid to protect them from the new, more infectious strain of COVID-19.
Those affected have been told not to leave their homes even if they cannot work remotely. The government said residents could be eligible for statutory sick pay, employment support allowance, or universal credit as well as the coronavirus job retention scheme.
The DHSC said the high-risk group should stay at home as much as possible. Children who have been advised to shield should not attend school, the department added. 
Read full story
Source: The Independent, 21 December 2020
Patient Safety Learning

Doctors and nurses at London’s frontline hospital denied coronavirus vaccine

Doctors and nurses on the front line of the fight against coronavirus at the Royal London Hospital – which has the largest number of Covid patients in the capital – have been denied the Pfizer vaccine, The Independent has learnt.
Hospital bosses at Barts Health Trust have written to staff today expressing their frustration over the decisions by NHS England, which meant the northeast of London – where the rate of infections and hospitalisations are worst – has not been given access to any vaccines.
The Independent has learned that staff from the Royal London booked appointments to be vaccinated at University College London, but they were turned away because the vaccinations had been earmarked for NHS staff from University College London Hospital Trust.
The trust’s chief medical officer wrote to senior doctors on Monday warning them the crisis facing the hospital would get worse before it gets better.
Professor Alistair Chesser told staff: “It has been frustrating to see the vaccine delivered to other trusts and to GP surgeries but not to us in the last few days given the pressure we are under. Please be assured we are lobbying for our staff and our patients at the very highest levels and will not let this rest.”
Read full story
Source: The Independent, 22 December 2020
Patient Safety Learning

Long Covid sufferers should be offered psychiatric care if symptoms last more than 12 weeks

People who suffer from the debilitating effects of long Covid should be offered psychiatric care, the first clinical guidance to be published on the subject recommends.
The guidelines urge healthcare professionals to look out for signs that patients who continue to suffer symptoms of COVID-19 for weeks after contracting the virus are at risk of self-harm.
In the new advice, the National Institute for Health and Care Excellence (NICE) and the Royal College of General Practitioners, say people with ongoing symptomatic COVID-19 or suspected post-Covid 19 syndrome, whose symptoms last longer than 12 weeks, should be “urgently” referred for assessment if they have severe psychiatric symptoms or are at risk of self-harm or suicide.
The guidelines state: “Follow relevant national or local guidelines on referral for people who have anxiety and mood disorders or other psychiatric symptoms. Consider referral for psychological therapies if they have common mental health symptoms, such as symptoms of mild anxiety and mild depression, or to a liaison psychiatry service if they have more complex needs (especially if they have a complex physical and mental health presentation).”
Read full story (paywalled)
Source: The Telegraph, 18 December 2020
Patient Safety Learning

Call-before-you-walk: Acutely ill patients being diverted from A&E departments, GPs warn

Acutely ill patients requiring emergency care are being diverted to their GP via the new NHS 111 First call-before-you-walk A&E triage system, Pulse has learned.
GPs have reported receiving inappropriate NHS 111 referrals including:
an acutely dizzy elderly patient who was later confirmed to have had a posterior circulation stroke;  a patient with acute coronary syndrome; and a patient with acute UTI symptoms. Meanwhile, GPs are also warning that patients are using the triage system as a way of ‘jumping the queue’ because the route is likely to get them an appointment quicker than calling their practice.
From this month, patients in England are being asked to call 111 before attending A&Es – with 111 triaging them to the most appropriate service, including GP practices.
Scottish patients are also being asked to phone ahead of attending A&E; while pilots are ongoing in Northern Ireland; and Wales is in the process of rolling out a ‘contact first’ model following summer pilots.
The BMA has said the influx of inappropriate referrals by NHS 111 is likely being ‘compounded’ by the new 111 First system, which is ‘contributing to the immense pressures currently facing primary care’.
GPs have raised concerns about several cases in which patients should not have been sent to them by 111 because they required more urgent care.
One GP, who asked not to be named, told Pulse: "I had a patient with UTI symptoms – a temperature of 39°C, a heart rate of 140, nausea and abdomen/loin pain. They were told: speak to your GP."
Read full story
Source: Pulse, 21 December 2020
Patient Safety Learning

Specialised Commissioning Patient and Public Voice (PPV) roles (closing date 17 January 2021

Patient and Public Voice (PPV) partners play a crucial role in specialised services and are represented across the board on NHS advisory groups and governance structures to ensure that the views of patients, carers and the public are at the heart of what we do.
Specialised Services are currently recruiting to a range of vacancies for PPV partners, all of which can be found here.
NHS England and NHS Improvement are committed to promoting equality and inclusion to ensure that our PPV partners reflect and represent our diverse population, and particularly encourage people from Black, Asian and Minority Ethnic (BAME) backgrounds to apply.
Read more
Source: NHS England/Improvement
Patient Safety Learning

NHS leaders raise concerns over pace of Covid vaccine rollout

NHS leaders have raised concerns about the rollout of the coronavirus vaccine, with more than half of hospital trusts and two-thirds of GPs yet to receive supplies amid growing alarm over the new fast-spreading variant.
Dr Richard Vautrey, the chair of the British Medical Association’s GP committee, urged the government to speed up delivery of the Pfizer/BioNTech vaccine in order to save lives. Experts also demanded greater transparency from ministers on how many doses are available.
Vautrey said: “We need millions of doses to be made available as soon as possible – urgently – because it’s the number one priority for GP practices, our patients and the nation, especially given the new mutant strain.
“GPs who haven’t got it yet are frustrated because they want to be getting on and vaccinating their patients as well. Their frustration is understandable. They want to protect their patients, especially their vulnerable patients, as quickly as possible.”
Read full story
Source: The Guardian, 22 December 2020
Patient Safety Learning

Private hospital in Bradford placed in special measures over patient safety

A hospital for men with learning disabilities has been placed in special measures after the Care Quality Commission (CQC) identified “serious risks to patient safety”.
The CQC said it had also suspended its current rating of “good” for caring for Cygnet Woodside, Bradford, West Yorkshire, following an inspection in September.
The commission said it carried out the unannounced inspection following allegations of abuse by staff towards a patient, which are subject to an ongoing police investigation.
The hospital said it was “disappointed” with the CQC’s assessment, stressing that the inspection was triggered by its own management notifying the commission of a concern it had identified. It said the report “does not provide an entirely accurate representation” of the hospital.
Dr Kevin Cleary, the CQC deputy chief inspector of hospitals and lead for mental health, said: “Our latest inspection of Cygnet Woodside found that the hospital was not ensuring its patients’ safety.”
Cleary added: “The service showed warning signs that increased the likelihood of a closed culture developing. This would have put people at serious risk of coming to harm if we didn’t take action.”
He said care was compromised because there was not always the right number or skill level of staff looking after patients.
Read full story
Source: Guardian, 23 December 2020
Patient Safety Learning

NHS Trust chiefs warn funding needed for post-COVID digital uptake

A major survey of NHS IT chiefs has revealed that despite more positive attitudes and uptake towards technology as a result of COVID-19, the long-term challenges of digital transformation within hospital trusts remain unchanged and only 14% of respondents believe they have sufficient funding to cover business priorities.
The Digital Health Intelligence NHS IT Leadership Survey, carried out annually by Digital Health Intelligence, offers a 'state of the nation' insight into the priorities, concerns and challenges faced by NHS chief clinical information officers (CCIO’s), Chief Information Officer’s (CIOs) and other relevant digital health leaders.
It revealed that despite record levels of positivity for digital transformation - 83% of respondents said the pandemic had resulted in a more positive attitude to digital among board members, up on 63% the previous year - just 24% are expecting a significant rise in funding and 14% think budgets will decrease.
Read full story
Source: Digital Health, 15 December 2020
Patient Safety Learning

The trusts set to have at least a third of beds filled by covid patients on 31 Dec

There are 14 hospital trusts on course to have at least a third of their beds filled by covid patients on New Year’s Eve.
HSJ analysed current occupancy and growth at each general acute trust in the seven days to 21 December. Projecting the same rate of growth forward, the number of trusts with at least a third of their bedbase likely to be taken by covid patients would increase from 5 at present to 14.
Three of the four acute trusts in Kent are projected to have covid bed occupancy of over 40%.
Another two trusts are in areas covered by tier two restrictions. They are Queen Elizabeth in Norfolk, and Countess of Chester. A third, East Sussex, has one of its two general hospitals in “tier four” (St Leonards), and the other in Eastbourne, which is outside the Sussex “tier four” zone.
There are also 27 trusts not in tier four areas which had more than 50 covid patients on 21 December, and where the number of covid patients grew by at least 20 per cent in that week. These include Liverpool University Hospitals and Sheffield Teaching Hospitals.
HSJ last week projected that, if trends continued, English hospitals would have just short of 19,000 covid patients on New Year’s Eve in total — almost exactly the same as the 12 April first wave peak. Current projections put that number at over 20,000.
Read full story (paywalled)
Source: HSJ, 23 December 2020
Patient Safety Learning

'Horrendous' ambulance delays at West Midlands hospitals

An ambulance crew had to wait seven hours to hand over a patient in the West Midlands, it has been revealed.
The case on 11 December was highlighted in the West Midlands Ambulance Service's in-house magazine, which said average waits had "ballooned".
It said average waits at one hospital were running at nearly three hours in early December.
The ambulance service said it hoped to put another 40 crews on the road by January.
Delays in hospitals taking over care of patients is considered "risky", NHS England said, because it not only delayed patients receiving specialist assessment and treatment, but also reduced the number of ambulances available to respond to emergencies.
The West Midlands trust's weekly briefing magazine, published on 17 December, said only the East of England trust had experienced a similar level of "horrendous" delays. It added that another four hospitals in the West Midlands had average delays of about two hours.
The "knock-on" effect it said was some high-risk patients were waiting longer for an ambulance than they should.
Meanwhile, some staff had to work late beyond their shifts and missed meal breaks.
Read full story
Source: BBC News, 23 December 2020
Sam

New heart failure drug for thousands of UK patients given go ahead

More than a quarter of a million patients living with heart failure could be eligible for a new drug that reduces deaths and hospitalisation after medical regulators gave it the greenlight.
The National Institute for Health and Care Excellence (Nice) has approved dapagliflozin, made by AstraZeneca, for use on the NHS.
It can help treat patients with a form of chronic heart failure that means their blood does not pump blood out to the body as well as it should.
It is estimated almost one million people are living with heart failure in the UK which causes an estimated 65,000 unplanned hospital admissions a year. Around half of patients will die within five years of being diagnosed.
Evidence from a clinical trial shows that adding dapagliflozin to standard care lowers the risk of dying from heart disease and decreases hospitalisation or an urgent outpatient visit because of heart failure by 26% compared with standard care alone.

Read full story
Source: The Independent, 24 December 2020
Sam

NHS told to prepare for use of Nightingale hospitals in coming weeks

NHS England has told hospitals to begin planning for the use of Nightingale Hospitals as the numbers of coronavirus patients in hospitals is expected to surge in coming weeks.
In a letter sent on Wednesday night hospitals were told to activate all of their emergency capacity to cope with the expected pressures over the coming weeks.
This is likely to mean the mass redeployment of staff and designating wards, surgical theatres and recovery areas as makeshift intensive care units for patients.
NHS England did not explain how the Nightingale Hospitals would be staffed if the decision was made to activate them.
Read full story
Source: The Independent, 24 December 2020
Sam

Clinicians warn of ‘serious’ safety risk at crowded teaching hospital

Staff at a teaching hospital which has struggled with emergency care pressure this winter have warned that patient safety is being compromised as crowding is becoming “normalised”.
A letter sent by a group of clinical staff at Cambridge University Hospitals Foundation Trust to the trust board calls for immediate action to tackle concerns.
It says: “The normalisation of crowding, the lack of effective flow management and the lack of effective escalation policies and procedures are resulting in patient safety, dignity and comfort being repeatedly and seriously compromised.”
Details of the letter were shared with HSJ but it is unclear how many and which staff it is signed by.
Read full story (paywalled)
Source: HSJ, 23 December 2020
Sam

Trusts told: prepare for ‘top quartile productivity’ as covid inpatients rise ‘almost everywhere’

New planning guidance asks local NHS organisations to prepare for a major waiting-list catch-up by seeking “top quartile performance in productivity”, but also to “safely mobilise all… available surge capacity over the coming weeks” as the service battles rising covid levels “in almost all parts of the country”. 
An end-of-year planning letter was issued by NHS England to local NHS chief executives last night.
It warns: “With covid-19 inpatient numbers rising in almost all parts of the country, and the new risk presented by the variant strain of the virus, you should continue to plan on the basis that we will remain in a level 4 incident for at least the rest of this financial year and NHS trusts should continue to safely mobilise all of their available surge capacity over the coming weeks.
“This should include maximising use of the independent sector, providing mutual aid, making use of specialist hospitals and hubs to protect urgent cancer and elective activity and planning for use of funded additional facilities such as the Nightingale hospitals, Seacole services and other community capacity.”
Read full story (paywalled)
Source: HSJ, 24 December 2020
Sam

I'm a consultant in infectious diseases. 'Long Covid' is anything but a mild illness

With the excitement of the Covid vaccine’s arrival, it may be easy to forget and ignore those of us with “long Covid”, who are struggling to reclaim our previous, pre-viral lives and continue to live with debilitating symptoms. Even when the NHS has managed the herculean task of vaccinating the nation, COVID-19 and the new mutant variants of the virus will continue to circulate, leaving more people at risk of Long Covid. Data from a King’s College London study in September suggested as many as 60,000 people in the UK could be affected, but the latest statistics from the Office for National Statistics suggest it could be much higher.
Joanna Herman is a consultant in infectious diseases. "Long Covid' is anything but a mild illness". Nine months on from having the virus, she is seriously debilitated. She explains how the new NHS clinics need to help the thousands of people with Long Covid.
Read full story
Source: The Guardian, 27 December 2020
Sam
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