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

Women with chronic pain are already dismissed – new guidelines denying them painkillers are a disaster

New guidance from health officials on the treatment of chronic pain could be devastating for women already struggling to get doctors to take their pain seriously, write Sarah Graham, 
The guidelines, published last week by the National Institute for Health and Care Excellence (NICE), say that patients suffering from chronic pain that has no known underlying cause (known as chronic primary pain) should not be prescribed painkillers. Instead, it suggests, these patients should be offered exercise, antidepressants, talking therapies and acupuncture.
This has huge implications for the future treatment of anyone living with unexplained chronic pain – the majority of whom are women – and runs the risk of patients being viewed as hysterical until proven otherwise.
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Source: iNews, 7 April 2021
Patient Safety Learning

Covid: Asthma drug 'speeds up recovery at home'

A cheap drug, commonly used to treat asthma, can help people at home recover more quickly from COVID-19, a UK trial has found.
Two puffs of budesonide twice a day could benefit many over-50s with early symptoms around the world, said the University of Oxford research team. There are also early signs the drug could reduce hospital admissions.
The NHS says it can now be prescribed by GPs to treat Covid on a case-by-case basis from today.
At present, there are few options for treating people with Covid who are not in hospital, apart from paracetamol.
This widely-available asthma drug works in the lungs, where coronavirus can do serious damage, and could improve the recovery of at-risk patients who are unwell with Covid at home.
Prof Stephen Powis, national medical director of NHS England, said he was "delighted" by the trial results so far and he said GPs could prescribe it after "a shared decision conversation" with patients.
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Source: BBC News, 12 April 2021
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‘Flurry’ of whistleblowers raise concerns at troubled trust

A ‘flurry’ of whistleblowers have raised concerns about the culture within an NHS trust which is grappling with finance and governance problems, its directors were told today.
Staff at Cornwall Partnership Foundation Trust have reported a “command and control” culture at the trust, which last week apologised to its employees for overtime payments made to board members for extra hours worked during the first peak of the pandemic.
It comes as the trust’s new chair and interim chief executive both pledged to communicate “openly and honestly” with staff.
Read full story (paywalled)
Source HSJ, 12 April 2021
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‘I felt humiliated’: parents respond to NHS maternity care racial bias inquiry

Feeling manipulated into having medical procedures, dismissed by professionals and labelled with racial stereotypes are among the complaints of parents who responded to a national inquiry into racial injustice in UK maternity care.
A panel established by the charity Birthrights is investigating discrimination ranging from explicit racism to racial bias and microaggressions that amount to poorer care.
It comes as parliament is due on 19 April to debate the large racial disparity in maternal mortality in British hospitals, after a petition from the campaign group Five X More gathered 187,519 signatures. Black women are four times more likely than white women to die during pregnancy or childbirth in the UK.
Testimonies include that of a British Bangladeshi woman who said her labour concerns were dismissed. “I felt unsafe and like maternity professionals are not used to being challenged by brown women,” she said. “There is a stereotype of Asian women that we are tame, quiet and compliant people who have no voice and will be obedient.
“I was treated like a vessel, not like a human. The experience left me feeling humiliated, disempowered and ashamed.”
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Source: The Guardian, 13 April 2021
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Disabled woman who died in Sheffield hospital ‘ignored’, parents tell inquest

The parents of a young disabled woman who died after she went into hospital for a routine eye operation have told a coroner that doctors ignored their daughter’s attempts to communicate.
Laura Booth, 21, stopped eating after she was admitted to the Royal Hallamshire hospital in Sheffield, her mother told an inquest hearing in the city on Monday.
Patricia Booth, from Sheffield, said her daughter was ignored by clinicians after she went into the hospital in October 2016 despite her being able to communicate to some extent, including using Makaton signing. She said this was in contrast to her treatment at the Children’s hospital in the city.
Sitting next to her husband, Ken, on a remote link, Booth told the inquest: “They never discussed anything with Laura. They just ignored her. She couldn’t speak but she could understand everything.”
Booth explained how her daughter could make herself understood to her family and would hold her hands out to the doctors, but did not get a response.
“They never gave her a chance,” she said. “They never spoke to her.
“It’s really heartbreaking. Laura was trying to communicate with them but they just wouldn’t listen … It just upset Laura that the doctors ignored her.”
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Source: The Guardian, 12 April 2021
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Nine in 10 professional organisations say doctors should have to register their financial interests

Nearly 90% of organisations representing doctors agree that the UK should have a mandatory and public register of doctors’ interests, a survey by The BMJ has found.
Last year the Independent Medicines and Medical Devices Safety Review, chaired by Julia Cumberlege, called for the General Medical Council (GMC) to expand its register to include a list of financial and non-pecuniary interests for all doctors.
That review investigated harmful side effects caused by the hormone pregnancy test Primodos, the anti-epileptic drug sodium valproate, and surgical mesh. One of its key conclusions was that patients had a right to know if their doctor had financial or other links with pharmaceutical or medical device companies.
The BMJ wrote to six faculties, 14 royal medical colleges, and the Academy of Medical Royal Colleges about such a register. It received responses from two faculties, 12 colleges, and the academy, a 71% response rate.
Of the organisations that responded, 13 (87%) agreed that there should be a mandatory and public register of doctors’ interests in the UK.
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Source: BMJ. 8 April 2021
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Prescot care home investigated over resident's death rated inadequate

A care home under investigation over a resident's death has been rated inadequate for the second time.
Merseyside Police began investigating Prescot's Griffin House after the death of a 90-year-old man in June 2020.
The Care Quality Commission (CQC) rated it inadequate in September, highlighting safety concerns and a report from February, released on 9 April, found it had not improved.
The inspection on 24 February found management had failed to adequately address the problems previously identified by the CQC and there were new concerns relating to staff recruitment.
Inspectors found medicines were not always administered safely, COVID-19 guidance was not always followed and there was not always enough staff on duty.
They also noted some staff had not had proper background checks before starting work, but added that since the inspection, a new system had been introduced to ensure checks were carried out.
The report said the home's management "refused to follow government guidelines and participate in lateral flow testing for visitors to the home as they did not believe these tests were accurate".
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Source: BBC News, 13 April 2021
Patient Safety Learning

Review into series of ‘unexpected deaths’ identifies service shortcomings

A review sparked by the ‘unexpected’ deaths of 13 patients has found several shortcomings in the talking therapy services offered by a mental health trust.
The internal review at Tees, Esk and Wear Valleys Foundation Trust followed a series of deaths between October 2019 and September 2020.
The trust has said the key findings included a lack of family involvement in discussing risks, increased waiting times for face-to-face therapy, and a lack of contact or reassessment for patients on waiting lists.
Eight of the 13 deaths, six of which were suicides, were escalated to serious incident reviews, according to a freedom of information response received by HSJ.
However, when asked for the findings of the serious incident reviews, the trust said: “To break down the key issues and attribute any single one of them to an individual patient death would in itself lead to potentially identifying that person.”
The trust’s improving access to psychological therapies service assessed 11,839 people between October 2019 and September 2020.
It comes amid a series of separate investigations into concerns around the trust’s services.
Read full story (paywalled)
Source: HSJ, 13 April 2021
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Maternity units told to meet target staffing levels by next April

NHS maternity units have been told they have until next April to increase the numbers of midwives on wards to expected levels after a near £100 million investment.
NHS England has told hospitals they must bring staffing levels for midwives up the levels needed to meet their planned demand from mothers and to ensure women get safe care.
In a letter to NHS trusts, England’s chief nurse Ruth May said she expected hospitals to use their share of a recent £96 million investment by NHS England to boost staffing levels along with extra spending from local budgets.
NHS England has carried out an analysis of demand and supply with Health Education England as part of a four year plan to boost the number of midwives.
Hospitals are expected to set the level of midwives needed to deliver more one-to-one care and to try and ensure more than half of women see the same midwife throughout their pregnancy.
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Source: The Independent, 13 April 2021
Patient Safety Learning

Patient group set up over allegations of 'poor care' at Royal London

Relatives of elderly patients have set up a families action group to investigate allegations of “poor level of care” at the Royal London Hospital.  
The Royal London Hospital Patients and Families Group says it is in talks with lawyers this week after setting up a Facebook page to share their experiences of the east London hospital. 
Anger erupted after relatives were refused visits to wards during strict lockdown periods and there were claims elderly family members were not receiving attentive care on the wards.
Barts Health NHS Trust, which runs the hospital, said the pandemic has been an "extremely busy" time but insisted patient safety is its top priority, while promising to listen to any feedback and concerns.
The families' group is calling for changes and suggesting how standards "should be improved" by involving families with patient care. 
“Many don’t speak English,” the group’s chair Abdul Doyas explained. “They are unable to communicate with medical staff. Allowing a family member to be present during agreed hours will improve care."
"Vulnerable people are admitted to hospital in an unfamiliar environment, which is a frightening experience that causes anxiety. But having a family member by their side can improve chances of recovering.” 
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Source: East London Advertiser, 13 April 2021
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Endometriosis: Young woman 'pleading' for hysterectomy

A 23-year-old woman who begged doctors to remove her womb to relieve chronic pain says the surgery is being refused due to her age and childless status.
Hannah Lockhart has endometriosis, a condition that can cause debilitating pain, heavy periods and infertility.
Although she has always wanted her own children, Hannah says her daily pain is now so severe she wants a hysterectomy.
"It's heartbreaking that just because I'm so young I have to keep suffering," she told the BBC's Evening Extra.
Ms Lockhart, from Bangor in County Down, has been in hospital seven times in the past year because of crippling pain from endometriosis.
"Every single day I'm taking morphine, I'm taking different tablets for nerves to try and stop the pain and nothing works," she said.
Read full story
Source: BBC News, 14 April 2021
Sam

NHS considers standardised national nursing uniform

The NHS is currently considering implementing standardised uniforms for nursing staff and other healthcare workers.
Staff working in clinical roles across the health service in England are now being asked to take part in a seven week consultation on the proposals.
With significant variation in the styles and colours used by each individual profession between different NHS trusts, the 2013 Francis Report recommended concluded that a standardised approach could improve patient safety.
The consultation document reveals that a blue “smart scrub tunic” was shown to be favoured by nurses in recent workshops, moving from pale blue for junior staff to dark blue for the most senior.
Other colours have been suggested for matrons, specialist nurses, advanced clinical practitioners and heads of nursing.
Ruth May, Chief Nursing Officer for England said: “Patients have told us that, for them, contact with several NHS professionals in a hospital setting can sometimes feel confusing, frequently due to not knowing who does which role."
“We want patients and the public to be able to easily identify which nursing, midwifery or care professional is providing their care. Keeping patients and staff safe is fundamental to this consultation so please have your say.”
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Source: Nursing Notes, 14 April 2021
Sam

New victims of rogue surgeon blocked from using expert lawyers

New victims of rogue breast surgeon Ian Paterson are being blocked from using lawyers with experience of the scandal to bring fresh compensation claims against the private hospital where he worked, The Independent has learned.
Under the terms of a legal settlement for £37m in 2017, 40 law firms are barred from bringing any new claims against Spire Healthcare for 20 years – meaning that former patients who have learned since then that they were victims of the surgeon, who was jailed for carrying out needless surgeries on women, face having to find lawyers with no prior knowledge of the case.
When the deal was signed, it was thought that most of Paterson’s victims had been contacted by the hospital company, but an inquiry published in 2020 heavily criticised its failure to reach affected patients and accused the company of seeking to protect its reputation rather than the interests of patients.
In response, Spire Healthcare launched a mass recall of 5,500 former patients, with independent clinicians reviewing their medical records. Some are learning for the first time that they had needless surgery at the hands of the surgeon.
Read full story
Source: The Independent, 11 April 2021
Sam

Elective recovery requires ‘very radical’ service change, says Stevens

The NHS must think “very radically” about how it redesigns its elective pathways following the coronavirus pandemic, Sir Simon Stevens has told HSJ. 
Speaking at the HSJ Leadership Congress yesterday, NHS England’s chief executive said the service should ensure as much elective work is done as possible, while covid prevalence is low, while at the same time thinking about “different ways of doing things”.
He declined to outline how many very long-waiters the service had or would have in coming months, explaining that some predictions have been “significantly off” in the past, and that future demand is unknown.
The NHS chief stressed that other areas of the service would also face post-covid pressures, announcing a further investment in and expansion of long-covid clinics.
“We want to see equivalent attention paid to the increased needs we’ve seen in mental health services, including eating disorders, and we want to make sure that the health service continues to expand its offer for long covid,” he said.
“To that end we have 69 clinics identified last year, we will have 83 long covid clinics in place by the end of this month, so a significant expansion there.” There will be at least one in each integrated care system area, he said.
Read full story (paywalled)
Source: HSJ, 14 April 2021
Sam

More than 80 Long Covid clinics to be opened by NHS in England with extra £24m funding

More than 80 new clinics to assess patients suffering with symptoms of Long Covid are to be opened by the NHS by the end of this month with an extra investment of £24m.
NHS England chief executive Sir Simon Stevens said the health service must “continue to expand its offer for Long Covid” adding there will be even more funding earmarked for the problem in the future.
Speaking at the Health Service Journal’s leadership congress on Wednesday, Sir Simon said: “We have 69 clinics identified last year and we will have 83 long Covid clinics in place by the end of this month, so a significant expansion there.
“We will be backing that with at least £24 million revenue funding going into this New Year, up from the £10 million announced last year, and there will be more to come on the back of that as well.”
Recent estimates by the Office for National Statistics found more than a million people could be experiencing long Covid beyond four weeks with 674,000 people saying it was affecting their day to day lives. Almost 200,000 people have said their ability to carry out normal activities has been severely limited by the condition.
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Source: The Independent, 14 April 2021
Sam

4.7 million waiting for operations in England

Around 4.7 million people were waiting for routine operations and procedures in England in February - the most since 2007, NHS England figures show.
Nearly 388,000 people were waiting more than a year for non-urgent surgery compared with just 1,600 before the pandemic began.
During January and February, the pressure on hospitals caused by COVID-19 was particularly acute.
NHS England said two million operations took place despite the winter peak.
However, surgeons said hospitals were still under huge pressure due to the second wave of Covid, which had led to "a year of uncertainty, pain and isolation" for patients waiting for planned treatment.
Speaking on a visit to Dartmouth, Prime Minister Boris Johnson said the government would "make sure that we give the NHS all the funding that it needs... to beat the backlog".
He said the situation had been "made worse by Covid", and added: "We do need people to take up their appointments and to get the treatment that they need."
Read full story
Source: BBC News, 15 April 2021
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