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

Housebound people being missed for vaccination, NHS warned

People who need to receive their covid vaccinations at home are missing out because their eligibility is not being recognised by GPs, experts have warned.
There have been numerous reports of housebound people being told they are ineligible for a home visit in recent weeks, with some home care providers saying only a minority of their elderly clients have been vaccinated so far.
Chit Selvarajah, policy manager at the charity Independent Age, said: “We have heard from people who say they are housebound being told they weren’t considered as housebound and told to go to a vaccination centre as they are not eligible for a home visit."
“We don’t know how many people have been vaccinated but it’s likely to be very small numbers at the moment.”
Ruthe Isden, head of health and care influencing at Age UK, believes some older people have “slipped into being effectively housebound” over the last year, and are not yet registered as such on GP databases.
She said: “The pandemic has hit the fast forward button on ageing for a lot of people. They’ve aged a long way in a short period and seen their health really deteriorate, and often they are not going to proactively identify themselves as needing more help."
“It’s vital we are thinking systematically about reaching this group. At the moment, there seems to be considerable variation in how people are followed up.”
Read full story (paywalled)
Source: HSJ, 22 February 2021
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Covid vaccine: HIV clinics to make confidential referrals

People living with HIV in England and Wales can now choose to have their Covid vaccine through specialist clinics, without notifying their GP.
NHS England has updated its guidance for people not comfortable with sharing their status. 
Everyone with HIV should be in vaccine priority groups four or six, and offered a jab by mid-April at the latest. But campaigners worried stigma would cause some to miss out.
The updated guidance, obtained by the i newspaper, follows the lead of NHS Wales which put the same measures in place last week.
Head of leading HIV charity the Terrence Higgins Trust, Ian Green, said: "Some may be surprised to hear that a significant number of people living with HIV feel unable to talk to their GP about their HIV status, but this underlines how much stigma still surrounds the virus even in 2021."
"This is great news and the right decision from the NHS as it means people living with HIV will be able to take up the potentially life-saving Covid-19 vaccine at their earliest opportunity. We are working towards a society where everyone living with HIV feels comfortable sharing their status with their doctor and other health professionals, but we're not there yet and we welcome this fast, pragmatic action."
Read full story
Source: BBC News, 22 February 2021
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COVID-19: GPs opt to prioritise all patients with learning disabilities for vaccination

Local groups of GPs have decided to prioritise all patients with learning disabilities for COVID-19 vaccination, after fresh evidence showed that disabled patients were at much higher risk from the disease.
Latest figures from the Office for National Statistics1 showed that 60% of people in England who died from covid-19 from January to November 2020 (30 296 of 50 888) had a disability.
This week an extra 1.7 million people in England—including some with severe learning disabilities—are being added to the list of people identified as clinically extremely vulnerable to COVID-19, although this does not include people with mild or moderate learning disabilities. But some clinical commissioning groups (CCGs) have deviated from national guidance and said that they will prioritise all patients with learning disabilities for vaccination given the disproportionate impact on them.
In a statement published on its website, Kent and Medway CCG said that it had decided to include all adults with learning disabilities in the current priority phase for vaccination delivery. “Given the evidence of covid-19 inequalities increasing deaths amongst people with learning disabilities, the NHS in Kent and Medway has agreed to prioritise vaccinating the 9500 people on GP learning disability registers,” it said.
Oxfordshire CCG was also praised by local campaigners for adjusting its priority list so that everybody with a learning disability is included in priority group 6, regardless of its severity.
Read full story
Source: BMJ, 19 February 2021
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Watchdog forced to hand over NHS staff names in safety failure cases

A national safety watchdog has been forced to release almost 100 pieces of evidence, including names of NHS staff, after being ordered to by courts.
A freedom of information request, submitted by HSJ, has revealed the Healthcare Safety Investigation Branch (HSIB) has been required to release 93 interviews with staff, family members and external experts, along with their identities, over the last two years. 
The interviews, which relate to HSIB investigations involving hospital trusts across England, were released to coroner’s courts through eight separate orders dating from February 2019.
A further four court orders compelled HSIB to release other information to coroners, including reports into trusts, findings of internal panel reviews, and evidence from external experts. The orders were made under the Coroners and Justice Act 2009.
When HSJ asked whether any NHS staff or family members were named in open court, HSIB said it was “not able to comment on specific instances”, but added that all those whose evidence was shared with the coroners were notified in advance.
Read full story (paywalled)
Source: HSJ, 23 February 2021
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Smear tests: Women to trial 'do-it-at-home' kits for NHS

About 31,000 women in London are being offered "do-it-at-home" tests to check for early warnings of cervical cancer, as part of an NHS trial.
It could be a way to encourage more women to get screened, experts hope.
Embarrassment, cultural barriers and worries about Covid, along with many other factors, can stop women going for smear tests at a clinic or GP surgery.
Smear-test delays during the pandemic prompted calls for home-screening kits from cervical cancer charities. The swabbing involves using a long, thin cotton bud to take a sample from inside the vagina, which is then sent by post for testing.
If the results reveal an infection called human papillomavirus (HPV) they will be invited to their GP for a standard smear test to closely examine the cells of their cervix.
Dr Anita Lim, from King's College London, who is leading the YouScreen trial, said: "Women who don't come for regular screening are at the highest risk of developing cervical cancer.
"So it is crucial that we find ways like this to make screening easier and protect women from what is a largely preventable cancer. Self-sampling is a game-changer."
Read full story
Source: BBC News, 24 February 2021
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NHS pulls a million face masks from use after safety warning

The NHS has been warned not to use or distribute a batch of high-grade face masks after government officials warned they may not meet safety standards.
The Department of Health and Social Care (DHSC) said it had “received urgent information” suggesting the items did not meet UK government specifications.
Hospital bosses and others including GPs have been told to stop using the FT-045A FFP3 masks, quarantine any remaining supplies and then track down any they might have sent on to other health providers through mutual aid schemes.
DHSC said it was pausing further distribution while a rapid review was carried out. Some 1.12 million masks are affected, the department said.
DHSC’s warning document told health bosses: “Please be assured that we are working with regional teams and providers to fit-test staff to alternative models and provide of them with alternative masks in the quantities needed. We have a good supply of other FFP3 masks.”
Rob Harwood, consultants committee chairman of the British Medical Association, told the BBC: “Healthcare staff working on the frontline do so facing the grave risk of contracting Covid, and deserve the best protection from this deadly virus."
“Many will be incredibly concerned to learn that some masks designed to offer enhanced protection, as well as gloves, may not meet standards, potentially placing them at greater risk.”
Read full story
Source: The Independent, 24 February 2021
Patient Safety Learning

‘Rapid’ assessment launched to help NHS organisations pick new tech

NHSX has launched a ‘simpler and faster’ technology assessment process to help healthcare providers pick digital tools that meet NHS standards.
The new digital technology assessment criteria provides NHS and social care teams with guidance to decide which tools to use or to recommend to patients. NHS organisations, national bodies and social care will be encouraged to apply the DTAC when considering any form of digital health technology procurement.
NHSX described DTAC as “a new simpler and faster assessment process to help give staff, patients and the public confidence that the digital health tools they use meet NHS standards”, adding it “is a rapid process that can be completed in days”.
It has previously taken as long as two months for tools to go through assessment processes. 
The guidance brings together legislation and best practice across five areas. Tools will receive a pass or fail score in the first four categories — clinical safety, data protection, technical security and interoperability — and an additional percentage score for usability and accessibility. 
Read full story (paywalled)
Source: HSJ, 23 February 2021
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Tribunal ‘astonished’ by trust’s handling of legitimate race discrimination concerns

A children’s nurse who raised legitimate concerns over racial discrimination at a major London trust was suspended and victimised by her managers for doing so, an employment tribunal has ruled.
Jeyran Panahian-Jand, who worked on a children’s ward at Whipps Cross Hospital, parts of Barts Health Trust, had raised concerns with her manager in 2019 that staff were divided on “racial lines”, with an “unfair allocation of work”, as well as bullying of two junior staff.
Her manager Heather Roberts, as well as other superiors, told Ms Panahian-Jand she should raise a formal complaint, without offering to look at the issues raised and keep the complaint informal, which the tribunal said they should have done under whistleblowing policies.
Ms Roberts later accused Ms Panahian-Jand, who identified as white, of continuing to talk about her allegations on the ward, and with the agreement of Ghislaine Stephenson, the associate director of nursing for children, Ms Panahian-Jand was suspended for the “disruption” and “upset” she was causing, the tribunal judgment said.
Ms Panahnian-Jand then lodged a formal complaint over race discrimination, as well as accusing two other bank nurses of making “racially abusive” remarks. A subsequent internal investigation supported three allegations of race discrimination made by Ms Panahian-Jand, while a separate probe into her own alleged misconduct found there was no case to answer.
Read full story (paywalled)
Source: HSJ, 23 February 2021
Patient Safety Learning

Key NHS long-term plan target to be missed ‘due to covid’

The NHS is set to miss a major national target to eliminate inappropriate out of area placements within mental health by the end of March, HSJ can reveal.
At least eight of the 52 English NHS mental health trusts surveyed by HSJ are predicting they will miss the national deadline of getting rid of their inappropriate OAPs by the end of next month.
The national target was one of the headline mental health pledges set out in  2014’s Five Year Forward View. The pledge was also in 2019’s long-term plan.
Inappropriate OAPs refer to people being sent out of their region to an inpatient mental health bed if no beds are available within their area. Patients are regularly sent hundreds of miles away from their homes.
Read full story (paywalled)
Source: HSJ, 23 February 2021
Patient Safety Learning

All adults with learning disability to be offered Covid vaccine in priority u-turn

All adults with a learning disability will be offered the vaccine against coronavirus after new advice from government experts warned they were at greater risk from the virus.
The decision is a major win for disability charities and campaigners. The decision will mean as many as 150,000 more people could be offered the vaccine.
The government’s Joint Committee on Vaccination and Immunisation (JCVI) has issued new advice saying any adult on GP Learning Disability Register should be prioritised for vaccination along with adults with related conditions such as cerebral palsy.
The JCVI had previously said only those were severe learning disabilities and those living in care homes should be prioritised for vaccinations. Disability rights campaigners and charities warned this left vulnerable people at increased risk from the virus.
Read full story
Source: The Independent, 24 February 2021
Patient Safety Learning

Paramedics issued body cams after surge in violent attacks

Paramedics in London have started wearing body cameras after a 34% jump in the number of violent attacks on ambulance crews.
A trial of the technology is being rolled out across the capital in areas where workers are thought to be more at risk based on past incidents.
Paramedics can press a button to start recording if patients or the public become aggressive or abusive towards them.
London Ambulance Service told The Independent there had been an increase in physical assaults in recent years. Attacks jumped from 468 in the financial year 2018-19 to 625 in the year 2019-20, a 34% rise.
Gary Watson, based at Croydon Ambulance Station, will be one of the first staff members to wear a camera. He was violently assaulted by a drunk patient three years ago.
He said: “We need these cameras. We get up every day to help people, not to be severely beaten.
“Wearing these cameras should act as a deterrent and if it doesn’t then at least there will be evidence which will hopefully mean tougher sentences for criminals.”
Read full story
Source: The Independent, 23 February 2021
Patient Safety Learning

One in five Covid survivors experienced hair loss, cohort study finds

One in five people hospitalised with COVID-19 experienced hair loss within six months of first being infected with the virus, a cohort study of patients found.
A team of Chinese experts looking into the long-term health consequences of the disease surveyed patients who had been discharged from Jin Yin-tan Hospital in Wuhan last year.
Of the 1,655 people who took part 359 (22%) reported losing hair.
Fatigue or muscle weakness, difficulty sleeping, smell disorder, anxiety and depression were some of the other most commonly reported symptoms, with a higher percentage of these reported among women.
The long-term consequences of Covid-19 after six months remained "largely unclear", the study concluded.
Read full story
Source: The Independent, 23 February 2021
Patient Safety Learning

Ministers warned over new powers to control patient safety watchdog

Plans to give the health secretary control over a patient safety watchdog risks “massive untold consequences” for the NHS, experts have warned.
Under proposals, Matt Hancock would be able to determine which incidents the Healthcare Safety Investigation Branch (HSIB) should investigate, while also being able to remove protections for NHS staff that mean they can give evidence without fear of reprisals.
The move, outlined as part of wider reforms to the NHS, would give the health secretary far greater control over the HSIB than ministers currently have over the Air Accident Investigation Branch – on which the watchdog was modelled.
Experts said the proposals cut across the original intention of an independent body that would act without fear or favour and earn the confidence of NHS staff.
It is designed to operate under a so-called “safe space” for NHS staff to provide evidence of what went wrong during an incident without their testimony being used against them.
Martin Bromiley, chair of the Clinical Human Factors Group and member of the expert panel that recommended the creation of HSIB in 2016, said he was seriously concerned over the plans.
He said: “I am concerned about the reference to lifting safe space. As it stands with the Air Accident Investigation Branch people can apply to the High Court for it to be lifted and that makes sense because a judge can consider the whole case and the longer-term impact."
Carl Macrae, Professor of Organisational Behaviour and Psychology at Nottingham University Business School, told The Independent: “I am very pleased to see there are concrete plans to establish HSIB as an independent body, but I am concerned this independence appears to be undermined by giving the secretary of state the power to tell it what to investigate."
“People need to be able to trust that the healthcare investigator is acting with the sole purpose of improving safety and isn’t subject to political interference.”
Read full story
Source: The Independent, 24 February 2021
Sam

Health apps for long COVID self-management

Amongst the 3.9 million confirmed COVID-19 cases in the UK to date, it is estimated that around one in five people experience symptoms that last for five weeks or longer, and one in ten have symptoms that last for twelve weeks or longer.
Termed Long COVID, people report a myriad of symptoms including chronic fatigue, breathlessness, loss of sense of smell, depression and concentration difficulties. Already totalling an estimated 186,000 people, long COVID will bring mounting pressure on primary care services.
Within its COVID-19 rapid guideline for managing the long-term effects of COVID-19, NICE recommends health apps as part of giving advice and information on self-management.
ORCHA has assessed almost 6,500 health apps to date against more than 350 measures and all major standards. From this research, they identified the top-scoring apps across each of the long COVID symptoms to help primary care, community settings and multidisciplinary assessment and rehabilitation services make informed decisions on the best apps for their patients.
Read report
Sam

Scottish care homes still breaching infection control safety

A Care Inspectorate report shows many homes are still failing to maintain infection control safety standards in Scottish care homes. Infection prevention was weak or unsatisfactory in half of the Scots care homes most recently checked by government regulators.
Almost a year on from the start of the pandemic, the latest round of inspection reports highlighted poor practice in 11 out of 22 care homes.
Read report
Patient Safety Learning

Two in five NHS staff feel anxious, NHS England reports

Around 40% of NHS staff reported feeling anxious during the recent coronavirus surge, but results were 10 percentage points worse for minority ethnic workers, according to NHS England’s surveys.
Prerana Issar, NHSE chief people officer, highlighted national data from the health service’s ‘people pulse’ survey during a Commons health and social care committee hearing.
The survey was launched last July to help gauge how the health service’s workforce was coping with the pressures of the pandemic, asking questions such as whether they felt supported, motivated, or anxious and what made the biggest difference to their experience at work. It involves findings from 114 local NHS organisations.
Ms Issar said the percentage of staff who reported they were feeling supported “was at a high of 68% during the first few months and started dipping from November onwards to 62%. It is still at 62%”.
Meanwhile, the share of those “feeling anxious” was at a “low” of 29% during the summer and autumn but has since increased to 40%.
The 40% finding may seem surprisingly low to many, considering the enormous impact of the winter surge of coronavirus demand, the very widespread extra asks of staff, potential health risks, and redeployment of roles.
Ms Issar added: “We have seen ‘feeling supported’ come down a little bit and ‘feeling anxious’ go up, and we used that feedback to then augment our offer and communication.”
Read full story (paywalled)
Source: HSJ, 24 February 2021
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