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

‘Medically fit’ patients caught covid while waiting for discharge, trust admits

A hospital trust has admitted that ‘medically fit’ patients caught covid on its wards while waiting to be discharged, with some of the cases under investigation.
Bedfordshire Hospitals FT board papers said that a “number” of medically fit patients “acquired [covid] infection while awaiting appropriate and safe discharge”.
Trusts nationwide have struggled to discharge patients as quickly as they wanted, the reasons including a Department of Health and Social Care mandate to only allow designated care homes to accept covid patients; the resumption of NHS Continuing Healthcare tests; shortages of community beds; and capacity in the care sector.
The trust, formed in April by the merger of Luton and Dunstable University Hospital FT and Bedford Hospital FT, said a “significant proportion of [its covid] cases [were] due to acquisition in the hospital”.
It continued: “A significant additional factor was the length of stay for many patients who were medically fit for discharge but were unable to return to their place of residence. Case reviews have shown that a number of these patients acquired infection while waiting appropriate and safe discharge.”
The board papers said its covid serious incident reviews covered “some deaths on both sites… and the majority [were] patients with very severe co-morbidity”. It said six out of 15 serious incidents being investigated at its Bedford hospital site were “of potentially avoidable nosocomial covid infection (hospital acquired)”.
Read full story (paywalled)
Source: HSJ, 4 Februrary 2021
Sam

Civilians, not Toronto police, to take over mental health 911 calls in pilot programme in Canada

Toronto, Canada, will launch a pilot programme that will see civilians, not police officers, dispatched to 911 calls involving mental health crises — as long as violence is not being threatened.
Council also approved a motion by Mayor John Tory to fast-track parts of the plan and review 911 call services in 2021 to determine how best to dispatch help through the proposed new service.
The plan calls for four crisis support teams in different parts of the city, to respond to some of the roughly 30,000 calls for people in crisis that go through 911 each year. 
Pilot programmes are to be launched in early 2022, and were scheduled to be fully implemented in 2026 if proven successful. Tory’s motion called for full implementation by 2025.
“Putting something else in place is not a simple task. It is necessary that we do it properly,” said Tory, in bringing forward the motion. Nonetheless, the mayor said, he believes it can be done more quickly.
Asante Haughton, a mental health advocate and co-founder of the Reach Out Response Network, focused on transformational change in mental-health crisis response, said the move is another rung on the ladder to a more equitable society.
“I really see this as an opportunity to transform the way that we think about mental health and transform the way that we think about social service and community building in general,” he said.
Read full story
Source: Toronto Star, 2 February 2021
Patient Safety Learning

NHS: Government plans to reverse Cameron-era reforms

The government is planning to reverse reforms of the NHS in England introduced under David Cameron in 2012, a leaked document suggests. 
The changes would aim to tackle bureaucracy and encourage health services from hospitals to GP surgeries and social care to work more closely. The draft policy paper also says the health secretary would take more direct control over NHS England.
The reforms by Mr Cameron's government in 2012 saw the creation of NHS England - to run the health service - and the scrapping of primary care trusts in favour of GP-led clinical commissioning groups to organise local services.
Under the latest proposals, set out in a leaked document published by health news website Health Policy Insight, there will be "enhanced powers of direction for the government" to "ensure that decision makers overseeing the health system at a national level are effectively held to account".
Instead of a system that requires competitive tendering for contracts - sometimes involving private companies, the NHS and local authorities will be left to run services and told to collaborate with each other, says the draft White Paper, designed to set out proposed legislation.
There will also be more focus on GPs, hospitals and social care services working together to improve patient care.
Read full story
Source: BBC News, 6 February 2021
Sam

Majority of people with long Covid ‘struggle to return to work after six months’

The MP leading an investigation into coronavirus fears Long Covid will be one of the biggest issues facing the UK for the next decade, after emerging research revealed most sufferers are still unable to work six months in.
Layla Moran branded the scale of the problem ‘enormous’, as various experts warned that even healthy young adults have been left struggling to function for months on end.
With hundreds of thousands of Brits now believed to have Long Covid, medics fear its impact on the world of work could herald another ‘massive economic crisis’. Workers in their 20s and 30s have told of a host of debilitating symptoms keeping them out of the office for much of last year and making simple tasks like walking to the toilet seem ‘like climbing a mountain’.  
Speaking exclusively to Metro.co.uk, Ms Moran – who chairs the All Party Parliamentary Group (APPG) on coronavirus – said: "The scale of this, in terms of the future prosperity of our country, is enormous. It is going to be, I think, one of the main issues that we are going to deal with not just in ten years but beyond."
Read full story
Source: Metro, 4 February 2021
Sam

Mutated virus may reinfect people already stricken once with covid-19, sparking debate and concerns

A trial of an experimental coronavirus vaccine detected the most sobering signal yet that people who have recovered from infections are not completely protected against a variant that originated in South Africa and is spreading rapidly, preliminary data presented this week suggests.
The finding, though far from conclusive, has potential implications for how the pandemic will be brought under control, underscoring the critical role of vaccination, including for people who have already recovered from infections. Reaching herd immunity — the threshold when enough people achieve protection and the virus can’t seed new outbreaks — will depend on a mass vaccination campaign that has been constrained by limited supply.
Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, noted that it appears a vaccine is better than natural infection in protecting people, calling it “a big, strong plug to get vaccinated” and a reality check for people who may have assumed that because they have already been infected, they are immune.
Read full story
Source: The Washington Post, 6 February 2021
Sam

More deaths, worse care: inquiry opens into NHS maternity ‘systemic racism’

An urgent inquiry to investigate how alleged systemic racism in the NHS manifests itself in maternity care will be launched on Tuesday with support from the UK charity Birthrights.
The inquiry will apply a human rights lens to examine how claimed racial injustice – from explicit racism to bias – is leading to poorer health outcomes in maternity care for ethnic minority groups.
Data published last month by MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the country) showed black women were four times more likely than white women to die in pregnancy or childbirth in the UK while women from Asian ethnic backgrounds face twice the risk.
Barrister Shaheen Rahman QC, who will lead the inquiry, said: “In addition to these stark statistics there are concerns about higher rates of maternal illness, worse experiences of maternity care and the fact black and Asian pregnant women are far more likely to be admitted to hospital with COVID-19.
“We want to understand the stories behind the statistics, to examine how people can be discriminated against due to their race and to identify ways this inequity can be redressed.”
Read full story
Source: The Guardian, 7 February 2021
 
Patient Safety Learning

Coronavirus: Hospitals defy authorities to protect staff as 35,000 patients are infected with Covid on wards

NHS hospitals are defying official rules to give nurses and doctors masks with greater protection amid fears over the spread of coronavirus within hospital wards.
An analysis of the latest NHS data by The Independent shows more than 35,000 patients were likely to have been infected with coronavirus while already in hospital between 1 August and 31 January.
NHS England has estimated as many as 20% of infections could be due to spread within hospitals. Outbreaks at some hospitals have seen whole teams of doctors or nurses affected, in some cases leading to wards having to be closed.
The Independent has learnt several hospitals are now supplying higher grade masks to staff working in general wards, despite Public Health England saying only surgical masks are needed. Research this week suggested staff exposed to coughing were at greatest risk of infection from the virus.
Read full story
Source: The Independent, 7 February 2021
Patient Safety Learning

NHS patients 'asked to pay for private care'

Some NHS dental patients have been asked to pay for private care "if they want any treatment", according to a watchdog. Others are facing waits of up to two years for an NHS appointment, Healthwatch England has warned.
One patient was in so much pain he decided to extract his own teeth, said its chairman Sir Robert Francis QC.
The NHS said over 650 urgent dental hubs have been set up so patients can access a dentist.
Hundreds of people contacted Healthwatch England between October and December last year complaining about dentistry issues.
A briefing document from the watchdog said that "a lack of NHS dentist appointments" remains the most common issue - with people asked to wait for up to two years.
Read full story
Source: BBC News, 8 February 2021
Sam

Concerns over ‘local leadership’ helped drive doubling of whistleblowing in December

The NHS’ response to the third wave of the coronavirus pandemic saw the number of whistleblowing concerns raised with the Care Quality Commission (CQC) almost double in December, with the strength of local leadership among the most frequent complaints.
Many parts of the NHS, particularly in the South East, were suffering major covid pressures in December, and the regulator received 204 whistleblowing concerns, compared to 105 in the same month in 2019.
The most common complaints were around staffing levels, infection control and leadership.
The rise in complaints was revealed by CQC chief inspector of hospitals Ted Baker in an interview with HSJ. Professor Baker also said the pandemic had proved that the NHS’ emergency care system lacked “resilience”.
Trusts which the regulator has received concerns about in recent months have included Liverpool University Hospitals Foundation Trust, over poor staffing levels and infection controls, University Hospitals Birmingham FT, around staffing levels and leadership concerns, and Mid and South Essex FT, over concerns around the provision of oxygen.
Professor Baker told HSJ: “One of the really positive things that has happened during the pandemic is an increase in the number of people raising concerns with us. It’s been really helpful for us in assessing the risk in the system."
Read full story (paywalled)
Source: HSJ, 8 February 2021
Sam

Today is International Epilepsy Day

Despite being one of the world's oldest known medical conditions, public fear and misunderstanding about epilepsy persists, making many people reluctant to talk about it. That reluctance leads to lives lived in the shadows, lack of understanding about individual risk, discrimination in workplaces and communities, and a lack of funding for new therapies research. People with epilepsy die prematurely at a higher rate compared to the general population. The most common cause of death from epilepsy is sudden unexpected death in epilepsy, known as SUDEP. For many people living with epilepsy, the misconceptions and discrimination can be more difficult to overcome than the seizures themselves.
International Epilepsy Day seeks to raise awareness and educate the general public on the true facts about epilepsy and the urgent need for improved treatment, better care, and greater investment in research.
hub resources
Safety advice for people with epilepsy RCPCH: Epilepsy passport Antiepileptic drugs: review of safety of use during pregnancy (MHRA)
Sam

Hancock will face difficult questions over his power grab to stop ‘NHSE games’

The NHS bill due to land in Parliament before the summer break will be the first for nearly 10 years, so will address various overdue changes and is certain to be significant.
The bill’s thrust has become clear from the draft of the government’s white paper leaked on Friday, though some important details might change before a final version is published in the next few weeks. Many of the white paper proposals are what NHS England has been asking for in formal proposals over the last 18 months, and reflect the direction the NHS has been moving slowly but inexorably towards for several years.
NHSE’s central aim of clearing up the NHS landscape by turning integrated care systems into statutory agencies, but without overdoing the central specification of how they will work, is largely intact. Clinical commissioning groups are reconstituted as ICSs, a move unpopular with some but accepted by most. There is a formal role for local authorities planned in the shape of “partnership councils”. This creates a little extra bureaucracy but does not give them real power in the NHS. NHSE and ICSs are given a bit more sway over foundation trusts, but probably not enough to set off a huge row with NHS Providers.
The leaked version of the white paper also includes proposals which NHSE will not be happy about, including giving the health secretary a sweeping “general power to direct NHS England on its functions”, another to transfer functions between all arm’s length bodies and even abolish them, and ability to intervene at any stage in NHS service reconfigurations.
If pursued, these risk bringing even more toxic politics back into the NHS, both in the process of putting through the legislation itself, and beyond that, in the day to day running of the service.
Read full story (paywalled)
Source: HSJ, 6 February 2021
Patient Safety Learning

NHS gowns 'suspended' from use due to packaging concern

The use of ten million surgical gowns, bought by the UK government, has been suspended for frontline NHS staff because of how the items were packaged.
Sterile gowns were bought for £70m from a US firm last year, but safety concerns were raised when they arrived in one layer of protective packaging.
The contract had not requested double packaging, as used in sterile settings.
The government says all personal protective equipment (PPE) is quality assured, but Labour has called for an inquiry into the awarding of contracts.
The BBC has been investigating the purchase of PPE - or personal protective equipment - for NHS staff since the beginning of the pandemic. It has already been revealed how millions of face masks bought by the UK government cannot be used in the NHS as intended.
Read full story
Source: BBC News, 8 February 2021
Patient Safety Learning

Covid: Over-70s can contact NHS for vaccine in England

People aged 70 or older in England who have not yet had their coronavirus vaccine but would like to are being asked to contact the NHS.
A national booking system can be accessed online or people can call 119 free of change between 7am and 11pm.
At a Downing Street news briefing, deputy chief medical officer Prof Jonathan Van-Tam urged people to get the vaccine "without delay".
"Protect yourself against the clear and present danger," he said.
He said the vaccines worked very well against the "immediate threat" of the Kent variant of coronavirus circulating in the UK.
Read full story
Source: BBC News, 8 February 2021
Patient Safety Learning

A third of Covid patients put on ventilator report PTSD symptoms

One in three Covid patients put on a ventilator experience extensive symptoms of post-traumatic stress disorder (PTSD), according to research, which adds to mounting evidence of the virus’s impact on mental health.
The study of 13,049 patients with confirmed or suspected coronavirus, by Imperial College London and the University of Southampton, found that one in five who were admitted to hospital but did not require a ventilator also experienced extensive symptoms of PTSD.
The most common PTSD symptom experienced by COVID-19 patients was intrusive images, sometimes known as flashbacks. Examples of these could be images of the intensive care unit (ICU) environment, ICU doctors wearing full personal protective equipment or other patients in the ICU.
The study, published in the Royal College of Psychiatrists’ BJPsych Open, on Tuesday, found lower levels of extensive symptoms of PTSD for patients given medical help at home (approximately one in six) and patients who required no help at home but experienced breathing problems (one in ten).
Dr Adam Hampshire, from Imperial College London, said: “We can see that the pandemic is likely to be having an acute and lasting impact, including for a significant proportion of patients who remained at home with respiratory problems and received no medical help. This evidence could be important for informing future therapy and reducing the long-term health burden of this disease.”
Read full story
Source: The Guardian, 9 February 2021
Patient Safety Learning

Covid vaccine: tens of thousands of UK nurses yet to receive first dose

Tens of thousands of nurses across the UK have not had their first coronavirus vaccine, sparking fears that they could contract COVID-19 or infect patients.
A Royal College of Nursing (RCN) survey of 24,370 nurses found that 85% had had at least one dose, with the remaining 15% unvaccinated.
The findings show that the government is in danger of failing to deliver one of the main elements of its pledge that all 15 million Britons in the top four priority groups for immunisation – which includes all health and social care staff – should have been offered a first shot by next Monday, 15 February.
“It is extremely worrying that, as our survey suggests, many thousands of nursing staff have yet to be given their COVID-19 vaccine less than a week before the government’s deadline,” said Dame Donna Kinnair, the RCN’s chief executive and general secretary.
“With only days to go, every effort must be made to reach all nursing staff to ensure their protection and that of the patients and vulnerable people they care for.”
Read full story
Source: The Guardian, 9 February 2021
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