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

COVID-19: Packed hospitals raised death risk by 20%

COVID-19 patients in England's busiest intensive care units (ICUs) in 2020 were 20% more likely to die, University College London research has found.
The increased risk was equivalent to gaining a decade in age.
By the end of 2020, one in three hospital trusts in England was running at higher than 85% capacity. Eleven trusts were completely full on 30 December, and the total number of people in intensive care with Covid has continued to rise since then.
The link between full ICUs and higher death rates was already known, but this study is the first to measure its effect during the pandemic.
Tighter lockdown restrictions are needed to prevent hospitals from being overwhelmed, says study author Dr Bilal Mateen.
Researchers looked at more than 4,000 patients who were admitted to intensive care units in 114 hospital trusts in England between April and June last year. They found the risk of dying was almost a fifth higher in ICUs where more than 85% of beds were occupied, than in those running at between 45% and 85% capacity. That meant a 60-year-old being treated in one of these units had the same risk of dying as a 70-year-old on a quieter ward.
The Royal College of Emergency Medicine sets 85% as the maximum safe level of bed occupancy. However, the team found there was no tipping point after which deaths rose - instead, survival rates fell consistently as bed-occupancy increased.
This suggests "a lot of harm is occurring before you get to 85%".
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Source: BBC News, 14 January 2021
Sam

Past COVID-19 infection provides some immunity but people may still carry and transmit virus

People who recover from coronavirus have a similar level of protection against future infection as those who receive a Covid vaccine – at least for the first five months, research suggests.
A Public Health England (PHE) study of more than 20,000 healthcare workers found that immunity acquired from an earlier Covid infection provided 83% protection against reinfection for at least 20 weeks.
The findings show that while people are unlikely to become reinfected soon after their first infection, it is possible to catch the virus again and potentially spread it to others.
“Overall I think this is good news,” said Prof Susan Hopkins, a senior medical adviser to PHE. “It allows people to feel that prior infection will protect them from future infections, but at the same time it is not complete protection, and therefore they still need to be careful when they are out and about.”
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Source: The Guardian, 14 January 2021
Public Health England press release
Sam

NHS England: Hospitals must ‘surge’ ICU so other regions don’t have to ration care

NHS England has asked hospitals across the country to open hundreds more intensive care beds so they can take in patients from the hardest hit areas, to prevent those patches having to ration access.
A letter sent to dozens of acute trusts today by NHS England asks them to enact their “maximum surge” for critical care from tomorrow, opening up hundreds of beds, which will rely on them redeploying staff and cancelling more planned care.
The letter is to trusts in the Midlands but HSJ understands a similar approach is being taken in the other regions where critical care is not currently under as much pressure as London, the East of England and the South East.
The message to surge capacity to support a “national critical care service” was reinforced to trusts nationwide in a call with Keith Willett, NHS England covid incident director, also on Wednesday.
The letter, from the NHSE Midlands regional team, said there had been a national request for the region to surge beyond its own needs to support London and the East of England. “Significant” numbers are likely to be transferred, HSJ was told.
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Source: HSJ, 13 January 2021
Sam

Pharmacies in England start covid vaccinations

Some High Street pharmacies in England will start vaccinating people from priority groups on Thursday, with 200 providing jabs in the next two weeks.
Six chemists in Halifax, Macclesfield, Widnes, Guildford, Edgware and Telford are the first to offer appointments to those invited by letter. But pharmacists say many more sites should be allowed to give the jab, not just the largest ones.
More than 2.6 million people in the UK have now received their first dose.
Across the UK, the target is to vaccinate 15 million people in the top four priority groups - care home residents and workers, NHS frontline staff, the over-70s and the extremely clinically vulnerable - by mid-February.
The vaccines – made by either Oxford-AstraZeneca or Pfizer-BioNTech – are being administered at hospitals, care homes, GP surgeries and vaccination centres.
It comes as the UK saw its highest number of daily reported coronavirus deaths since the pandemic began, with the government announcing a further 1,564 deaths of people within 28 days of a positive Covid test.
On Wednesday evening, the Scottish government published its detailed 16-page plan for rolling out the vaccine, including details of how many vaccines it expects to receive every week until the end of May.
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Source: BBC News, 14 January 2021
Sam

Life-saving transplants delayed as coronavirus patients fill beds

Patients are missing out on potentially life-saving organ transplant surgery because hospital intensive care beds are filled by coronavirus patients, The Independent has learnt.
Major organ transplant centres in London, as well as the Queen Elizabeth Hospital in Birmingham and Addenbrooke’s Hospital in Cambridge, have been forced to close their doors to transplant cases because of a lack of beds, the increased risk to patients, and the need to redeploy doctors and nurses to the coronavirus front line.
The impact on organ transplant services follows hundreds of urgent cancer operations being delayed in London and across the country, as NHS trusts run out of spare beds to treat non-Covid patients. Most routine operations have also been stopped in the hardest-hit areas.
Teacher Shona McFadyen was diagnosed with liver cancer in December 2018 and needs an urgent liver transplant at the Queen Elizabeth Hospital in Birmingham. She has already waited 22 months for her surgery.
She told The Independent: “It’s not the hospital’s fault. I get that. But it just adds to the feeling of hopelessness and it feels like as patients we have been forgotten about. It is life and death for us.”
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Source: The Independent, 13 January 2021
Sam

One in 10 hospital nurses now off work with covid absences still rising

More than one in 10 hospital nurses are now off work in areas hard-hit by covid, according to internal data leaked to HSJ.
The data shows the toal absence rate among acute trust nurses has risen steadily over the last month.
Nationally the total absence rate among acute trust nurses was 9.7% as of Monday, up from around 7% at the start of December, pushed up by rapidly rising absences due to covid. These make up more than half of total absences, and have now hit rates last seen in early May.
Senior NHS sources said staff absences are severely compounding operational pressures in the hardest hit regions, limiting hospitals’ capacity to operate more than is suggested in official bed capacity figures.
The highest rate was in the East of England where 11.4% of nurses off work, with coronavirus accounting for 7.5%. This is likely to mask even higher rates in particular hospitals, services and wards.
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Source: HSJ, 14 January 2021
Sam

People who think they are ‘invincible’ urged to be aware of long Covid impact

Younger people who think they are “invincible” need to be aware of the shocking life-changing reality of long Covid, according to health professionals who are living with the condition.
Long Covid, also known as post-Covid syndrome, is used to describe the effects of COVID-19 that continue for weeks or months beyond the initial illness.
Speaking at the All-Party Parliamentary Group (APPG) on Coronavirus, Dr Nathalie MacDermott, 38, said neurologists believe Covid has damaged her spinal cord and she can only walk about 200 metres without some form of assistance.
She said the damage has affected her bladder and bowel too, causing urinary tract infections, and she gets pain in her arms and has weakness in her grip.
Dr MacDermott, a clinical doctor sub-specialising in paediatric infectious diseases in the NHS, told MPs there needs to be “better recognition” from employers that long Covid is a “genuine condition” and that people may need to be off work for a significant period of time.
She added: “And I think we need better recognition in the public, particularly the younger public who think that they’re invincible.
“I’m 38 and I wonder if I’ll ever be able to walk properly without crutches again. Will this continue to get worse? Will I end up in a wheelchair?”
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Source: 12 January 2021, Lancashire Post
Sam

Leaked data reveals nearly quarter of a million year-plus waiters

Nearly a quarter of a million people have been waiting more than a year for operations and other hospital procedures, HSJ has learned. 
Official NHS England data for November, released on Thursday, showed 192,000 patients had been waiting for treatment for more than a year.
However, figures leaked to HSJ of weekly data up to 3 January showed a steep increase to 223,000 patients — the highest reported so far throughout the COVID-19 pandemic and before.
According to the leak, just under 4.2 million people are waiting for treatment, of which year-long waiters comprise 5.4%. The data also showed 175 patients across England had waited more than two years for treatment.
In February, before the pandemic, 1,613 patients were waiting more than a year — meaning there has been a 138-fold increase.
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Source: HSJ, 15 January 2021
Sam

Black mothers in the UK are four times more likely to die in childbirth than their White counterparts

When pharmacist Ifeoma Onwuka, known to her friends as Laura, went into hospital to have her daughter, she and her husband hoped the delivery would go smoothly, and that they would soon be able to take their new arrival home  to meet her siblings. 
Onwuka's labor was induced at James Paget University Hospital in Great Yarmouth in late April 2018. Things progressed quickly and there were soon signs that her baby was in distress, causing staff to begin preparations for an emergency Caesarian section, but Onwuka's daughter was born in the recovery room.
Shortly after the birth, Onwuka's condition began to deteriorate. According to the family's lawyer, Tim Deeming, she began to bleed heavily, and was taken into surgery where attempts were made to stem the loss of blood. Hours later, and only after a second consultant had been called in, she was given an emergency hysterectomy. The mother-of-three died three days later.
The coroner, Yvonne Blake, said an expert had told Onwuka's inquest that the delay to surgery contributed to her death, since acting early could have controlled the bleeding. 
Black mothers have worse outcomes during pregnancy or childbirth than any other ethnic group in England. According to the latest confidential inquiry into maternal deaths (MBRRACE-UK). Black people in England are four times more likely to die in pregnancy or within the first six weeks of childbirth than their White counterparts. 
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Source: CNN. 14 January 2021
Sam

Whistleblower nurse calls for new body to tackle bullying in NHS

A nurse who was threatened by colleagues for speaking out about care failings at Mid Staffordshire Foundation Trust has said bullying remains a “real problem” in the NHS.
Helene Donnelly has told MPs that more than 10 years on from the scandal – commonly known as Mid Staffs – she was still seeing “echoes” of what she experienced happening across the country.
“Although it is in the minority, as we saw at Mid Staffs the results can be absolutely catastrophic”
She called for the development of a national body to improve workplace cultures in the NHS and “stamp out bullying once and for all”.
The inquiry into poor standards of care and deaths at Mid Staffordshire indentified issues around staff behaviour, inadequate staffing levels and skills, and lack of effective leadership and support.
Ms Donnelly told a Health and Social Care Committee hearing today that there were “real negative behaviours” at the trust that created a “real bullying culture of fear and intimidation”.
“There was not a culture that encouraged and enabled staff to speak up and if they did as I did, we were bullied and threatened,” said Ms Donnelly, who now holds the roles of ambassador for cultural change and lead Freedom to Speak Up Guardian at the organisation where she works.
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Source: The Nursing Times
Sam

Fake news 'causing UK South Asians to reject jab'

Fake news is likely to be causing some people from the UK's South Asian communities to reject the Covid vaccine, a doctor has warned.
Dr Harpreet Sood, who is leading an NHS anti-disinformation drive, said it was "a big concern" and officials were working "to correct so much fake news". He said language and cultural barriers played a part in the false information.
Dr Sood, from NHS England, said officials were working with South Asian role models, influencers, community leaders and religious leaders to help debunk myths about the vaccine.
Much of the disinformation surrounds the contents of the vaccine.
He said: "We need to be clear and make people realise there is no meat in the vaccine, there is no pork in the vaccine, it has been accepted and endorsed by all the religious leaders and councils and faith communities."
"We're trying to find role models and influencers and also thinking about ordinary citizens who need to be quick with this information so that they can all support one another because ultimately everyone is a role model to everyone", he added.
Dr Samara Afzal has been vaccinating people in Dudley, West Midlands. She said: "We've been calling all patients and booking them in for vaccines but the admin staff say when they call a lot of the South Asian patients they decline and refuse to have the vaccination.
"Also talking to friends and family have found the same. I've had friends calling me telling me to convince their parents or their grandparents to have the vaccination because other family members have convinced them not to have it".
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Source: BBC News, 15 January 2021
Sam

MHRA refuses to approve mass daily Covid testing at English schools

Boris Johnson’s plans to test millions of schoolchildren for coronavirus every week appear to be in disarray after the UK regulator refused to formally approve the daily testing of pupils in England, the Guardian has learned.
The Medicines and Healthcare products Regulatory Agency (MHRA) told the government on Tuesday it had not authorised the daily use of 30-minute tests due to concerns that they give people false reassurance if they test negative. This could lead to pupils staying in school and potentially spreading the virus when they should be self-isolating.
The regulator’s decision undermines a key element of the government’s strategy to bring the pandemic under control – and is bound to raise fresh questions about the tests, and the safety of the schools that have been asked to use them.
Prof Jon Deeks, a biostatistician of the University of Birmingham and Royal Statistical Society, described the use of rapid tests in this context as “ridiculous and dangerous” and welcomed the MHRA’s stance.
He said: “It is really important that we have confidence in the safety and effectiveness of tests for Covid-19 and all other diseases - this is the responsibility of our regulator.
“This clarification of the unsuitability of lateral flow tests for saying people are not infected with SARS-CoV-2 from the MHRA demonstrates that they are taking their responsibility seriously to ensure that tests are used in a safe way."
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Source: The Guardian, 14 January 2021
Sam

HSIB investigates oxygen issues during the COVID-19 pandemic

The Healthcare Safety Investigation Branch (HSIB) have launched a national investigation into the provision of piped oxygen gas supplies to hospitals.
During the COVID-19 pandemic there has been an increased demand for oxygen gas on hospital wards, with more patients needing oxygen therapy. Insufficient oxygen supply to seriously ill patients can have very severe consequences, including death.
The investigation is examining a major incident that took place at an acute hospital. Demands on their oxygen supply led to patients being diverted to other hospitals. In addition, patients were also transferred between clinical environments.
As part of HSIB's final investigation report, they will make safety recommendations to the appropriate national bodies in order to improve patient safety.
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Source: HSIB, 15 January 2021
Sam

'Shocking' care home Covid outbreaks at levels not seen since first peak

Covid outbreaks in care homes have more than trebled in a month. Figures show that infection levels are now similar to the peak of the first wave, with last week having the second highest weekly total since records began in April.
Senior figures said the numbers were "shocking" and warned: "Care homes cannot be neglected again".
Ministers have pledged that all care home residents would be vaccinated by the end of this month. But The Telegraph has been told the care home rollout was taking longer than officials had anticipated.
The new figures come after The Telegraph revealed the Government is proposing to send hospital patients into care homes without tests, despite being warned that was responsible for driving up cases in the first wave.
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Source: The Telegraph, 14 January 2021
Sam

Covid vaccine: 72% of black people unlikely to have jab, UK survey finds

Advisers from the Scientific Advisory Group for Emergencies (Sage) have raised fresh concerns over Covid vaccine uptake among black, Asian and minority ethnic communities (BAME) as research showed up to 72% of black people said they were unlikely to have the jab.
Historical issues of unethical healthcare research, and structural and institutional racism and discrimination, are key reasons for lower levels of trust in the vaccination programme, a report from Sage said.
The figures come from the UK Household Longitudinal Study, which conducts annual interviews to gain a long-term perspective on British people’s lives.
In late November, the researchers contacted 12,035 participants to investigate the prevalence of coronavirus vaccine hesitancy in the UK, and whether certain subgroups were more likely to be affected by it. Overall, the study found high levels of willingness to be vaccinated, with 82% of people saying they were likely or very likely to have the jab – rising to 96% among people over the age of 75.
Women, younger people and those with lower levels of education were less willing, but hesitancy was particularly high among people from black groups, where 72% said they were unlikely or very unlikely to be vaccinated. Among Pakistani and Bangladeshi groups this figure was 42%. Eastern European groups were also less willing.
“Trust is particularly important for black communities that have low trust in healthcare organisations and research findings due to historical issues of unethical healthcare research,” said the Sage experts.
“Trust is also undermined by structural and institutional racism and discrimination. Minority ethnic groups have historically been underrepresented within health research, including vaccines trials, which can influence trust in a particular vaccine being perceived as appropriate and safe, and concerns that immunisation research is not ethnically heterogenous.”
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Source: The Guardian, 16 January 2021
Patient Safety Learning

Essex mental health trust told safety 'needs to improve'

A mental health trust prosecuted for failings after 11 patients died must make further safety improvements, the Care Quality Commission (CQC) said.
Inspectors found safety issues on male wards and psychiatric intensive care units run by Essex Partnership University NHS Foundation Trust (EPUT).
The Trust said it had taken "immediate action" to remedy the concerns.
In November, EPUT pleaded guilty to safety failings related to patient deaths between 2004 and 2015.
The CQC's report followed inspections in October and November last year at the Finchingfield Ward - a 17-bed unit in the Linden Centre in Chelmsford which provides treatment for men experiencing acute mental health difficulties.
The CQC said the visit was prompted "due to concerning information raised to the commission regarding safety incidents leading to concerns around risk of harm".
The inspection, which looked at safety only, found the following concerns:
Some staff did not follow the required actions to maintain patient safety. Closed-circuit television showed staff who were meant to be observing were not present, and this contributed to an incident of patient absconding. Staff did not keep accurate records of patient care and managers did not check the quality and accuracy. of notes. Shifts were not always covered by staff with appropriate experience and competency Stuart Dunn, head of hospital inspection at the CQC, said EPUT had "responded quickly to concerns raised" including improving security measures.
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Source: BBC News, 14 January 2021
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