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

Rapid Covid testing in England may be scaled back over false positives

Senior government officials have raised “urgent” concerns about the mass expansion of rapid coronavirus testing, estimating that as few as 2% to 10% of positive results may be accurate in places with low Covid rates, such as London.
Boris Johnson last week urged everyone in England to take two rapid-turnaround tests a week in the biggest expansion of the multibillion-pound testing programme to date.
However, leaked emails seen by the Guardian show that senior officials are now considering scaling back the widespread testing of people without symptoms, due to a growing number of false positives.
In one email, Ben Dyson, an executive director of strategy at the health department and one of health secretary Matt Hancock’s advisers, stressed the “fairly urgent need for decisions” on “the point at which we stop offering asymptomatic testing”.
On 9 April, the day everyone in England was able to order twice-weekly lateral flow device (LFD) tests, Dyson wrote: “As of today, someone who gets a positive LFD result in (say) London has at best a 25% chance of it being a true positive, but if it is a self-reported test potentially as low as 10% (on an optimistic assumption about specificity) or as low as 2% (on a more pessimistic assumption).”
He added that the department’s executive committee, which includes Hancock and the NHS test and trace chief, Dido Harding, would soon need to decide whether requiring people to self-isolate before a confirmatory PCR test “ceases to be reasonable” in low infection areas where there is a high likelihood of a positive result being wrong.
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Source: The Guardian, 15 April 2021
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Covid death rates twice as high in zero-hours and casual jobs, study suggests

Coronavirus death rates are twice as high in insecure jobs as in other professions, new research suggests.
The TUC said workers on a contract that does not guarantee regular hours or income, such as zero-hours contracts or casual work, and those in low-paid self-employment, have been more at risk of infection.
It’s thought that key workers such as those in social care and delivery driving, which cannot be done from home and require people to come into contact with others, are more insecure.
The COVID-19 mortality rate among men in insecure occupations was 51 per 100,000 people aged 20-64, compared with 24 per 100,000 in more secure work, said the union organisation.
The mortality rate among women in insecure jobs was 25 per 100,000 people, compared with 13 per 100,000 in more secure occupations.
The TUC, which called the figures stark, said more research was needed to understand the links between precarious work and risk of infection and death.
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Source: The Independent, 16 April 2021
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COVID-19: Colleges publish guidance after patients attend emergency departments with vaccine concerns

A group of royal colleges has produced guidance for doctors seeing patients who have concerns about symptoms after receiving the Oxford AstraZeneca COVID-19 vaccine.
The Royal College of Emergency Medicine, the Society for Acute Medicine, and the Royal College of Physicians say that anyone who presents with symptoms suggestive of COVID-19 vaccine induced thrombosis and thrombocytopenia (VITT)1 should have a full blood count to check their platelet level. Symptoms of concern include persistent or severe headaches, seizures, or focal neurology; shortness of breath, persistent chest, or abdominal pain; and swelling, redness, pallor, or cold lower limbs.
The advice comes after the HSJ reported that emergency clinicians had raised concerns over a surge in patients attending emergency departments as a result of anxiety over the safety of the AstraZeneca vaccine. Investigations by EU and UK regulators into reports of unusual blood clots after receiving the vaccine concluded that these are a “possible” and “extremely rare” side effect.
Katherine Henderson, president of the Royal College of Emergency Medicine, said that following the announcements, patients had been attending emergency departments after receiving the AstraZeneca vaccine. “I saw 21 patients with concerns in an eight hour shift, so we have to have a way of dealing with this. It was important for us to have a strategy for managing those patients that didn’t mean that they were getting over-investigated but they were getting reassurance. We also need to be aware that if somebody has significant symptoms it is always possible, given the rarity of VITT, that it is something else,” she said.
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Source: BMJ, 13 April 2021
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Maternity scandal investigation has received nearly 200 cases, says family

Nearly 200 families have now reported experiences of poor maternity and neonatal care in East Kent, according to the family whose baby’s death sparked both an independent investigation and a court case against the trust.
Baby Harry Richford died seven days after his birth at the Queen Elizabeth, the Queen Mother, Hospital in Thanet in 2017.
Next week, the Care Quality Commission is taking East Kent Hospitals University Foundation Trust to court, alleging it failed to meet fundamental standards of care in the treatment of both Harry and his mother Sarah.
An independent investigation, led by Bill Kirkup, is also looking into maternity and neonatal services at the trust.
In a statement, the Richford family told HSJ  they had had numerous contacts from other families who had had bad experiences of maternity and neonatal care at the trust. “We have encouraged such families to come forward to the Kirkup Inquiry and now believe that the number of families is approaching 200,” they said.
Read full story (paywalled)
Source: HSJ, 16 April 2021
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‘Staff have been treated like cannon fodder’: NHS bosses issue stark warning on future of health service

Hundreds of senior NHS managers have voiced their fears for the future of the health service amid the ongoing coronavirus crisis without a significant pay rise to help retain staff on the frontline.
A survey of more than 800 senior NHS managers has revealed the extreme pressure some have been working under, with many working 20 or more hours of unpaid extra hours each week.
More than 90 per cent backed a significant pay rise for NHS staff to try and head off a feared exodus of nurses, doctors and other staff leaving the NHS after the pandemic. This would help shore up the service as it faces the daunting task of tackling record waiting lists now totalling 4.7 million patients.
Some managers said that the government’s planned 1 per cent pay rise was an “insult” and made them feel “worthless”, in responses to the survey, run by the Managers in Partnership union.
Another described NHS staff as being treated like “cannon fodder” during the crisis.
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Source: The Independent, 16 April 2021
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New WHO Centre of Excellence for Quality of Care and Patient Safety opens in Athens

WHO/Europe and the Hellenic Republic of Greece today open a new sub-office in the country focusing on quality of care and patient safety. Acting as a centre of excellence, the sub-office will work towards achieving the highest level of well-being, health and health protection in the WHO European Region, in line with the Sustainable Development Goals (SDGs).
Speaking at its opening, WHO Regional Director for Europe Dr Hans Henri P. Kluge said, “Better quality of care relies on a strong primary health care system, where most preventive activities, diagnostics, consultations and treatments occur. Let us make no mistake – the quality of care encompasses all levels of a health system, hence the need to integrate quality policies across the board.”
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Source: WHO, 15 April 2021
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English NHS breaches 52 weeks

The NHS in England is required by legislation to ensure that at least 92 per cent of patients on the waiting list have been waiting no longer than 18 weeks from referral to treatment. At the end of February, following a year of covid restrictions, that waiting time measure exceeded 52 weeks.
How much longer than 52 weeks? We don’t know, because the data stops at “52 plus”. But there is good news, because this is about to change.
Guidance was issued during March requiring two major improvements to the published RTT data.
Firstly, instead of stopping at 52 weeks plus, the weekly waiting time cohorts will continue up to 104 weeks plus.
Secondly, we are going to get a lot more information about mental health and other RTT waiting times, because the catch-all “Other” specialty is going to be broken down into medical, surgical, mental health, paediatric and the rest.
Read full story (paywalled)
Source: HSJ, 16 April 2021
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Sickle cell patients are being ignored because they’re black, warn campaigners

Public services are dismissing sickle cell patients because the illness disproportionately affects Black people, campaigners have warned.
The blood disorder is prevalent among African and Caribbean communities and advocacy groups say this means it remains poorly understood within state institutions, often leading to the needless suffering and even death of those diagnosed.
The issue has gained wider attention following the high-profile cases of two Black men, Richard Okorogheye and Evan Nathan Smith, who lived with the disease and died amid claims their vulnerabilities were overlooked by the NHS and police.
Chris Abdullahi, co-founder of charitable initiative Sound of Sickle, told The Independent it is common for sickle cell patients’ painful symptoms to be ignored by healthcare practitioners.
He said he has heard similar accounts “well over 100 times” from across the UK.
“Just last week someone else mentioned that they were in hospital and had to battle their nurses for pain medication from opioids to something as simple as ibuprofen,” the 27-year-old, who also lives with sickle cell, said.
These experiences serve to further entrench the “massive sense of distrust” in the healthcare system which is evidenced through lower vaccine uptake in Black communities, Mr Abdullahi explained.
A lack of awareness about the disease has led sickle cell patients to often form informal support networks, through which information can be exchanged about the best hospitals at which to maximise the chances of their condition being taken seriously.
Read full story
Source: The Independent, 18 April 2021
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‘I was told to live with it’: women tell of doctors dismissing their pain

As a teenager, Kelly Moran was incredibly sporty: she loved to run and went to dancing lessons four times a week. But by the time she hit 29, she could barely walk or even drive, no longer able to do all the activities she once enjoyed. She had pain radiating into her legs.
Her pain was repeatedly dismissed by doctors, who told her it was in her head. She moved back to her parents’ house in Manchester and left her job. She decided to seek treatment privately and was told she had endometriosis. Soon, with the right treatment, her life improved.
Kelly is among dozens of women who got in touch to share their stories with the Guardian on the topic of women’s pain. Women are almost twice as likely to be prescribed powerful and potentially addictive opiate painkillers than men, a Guardian analysis shows. Data from the NHS Business Services Authority, which deals with prescription services in England, shows a large disparity in the number of women being given these drugs compared with men, with 761,641 women receiving painkiller prescriptions compared with 443,414 men, or 1.7 times, and the pattern is similar across broad age categories.
The women who reached out said they felt that they were often “fobbed off” with painkillers when their problems required medical investigation.
Read full story
Source: The Guardian, 16 February 2021
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‘If we catch Covid, we die’: UK shielders reflect on still feeling unsafe

Sarah Spoor and her two adult sons have spent the past 14 months shielding in a one-bedroom apartment, with no garden, in west London. Her youngest sleeps in the bedroom, his brother has a pull-out bed in the kitchen, while Spoor takes the living room in another fold-out bed.
All three have complex medical conditions that leave them vulnerable to Covid, and despite the strain of living in such close quarters, they don’t feel safe leaving home any time soon.
“If we catch it, we die; it’s that simple. In the 14 months, I have probably been out about four times, and that’s usually in some dire emergency,” said Spoor, who provides round-the-clock care for her sons, 20 and 24, after their medical team decided it was too risky for their usual carers to continue visiting.
The family has yet to be vaccinated as their medical conditions, which include type 1 diabetes, adrenal insufficiency, pernicious anemia and thyroid failure, mean they are likely to experience a severe reaction leading to hospital admission, and they are concerned about the risk of catching Covid in hospital when cases are still prevalent.
Spoor is not alone in fearing a return to life after lockdown, with disability charity Scope estimating 75% of disabled people plan to continue shielding until after their second vaccine dose, and some for longer.
“I think there is a potential long-term impact that groups of people become squirrelled away and it’s potentially easy for governments and local authorities to forget about them,” said James Taylor, executive director of strategy and social change at Scope. “We’re really worried that, in the long-term, lots of the rights that disabled people have fought for, the visibility, the recognition of disabled people as equal, that all falling away and going backwards.”
Read full story
Source: The Guardian, 19 April 2021
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Pregnant women should be offered Covid vaccine

Pregnant women should be offered a Covid jab when other people their age get one, the UK's vaccine advisers say.
They say the Pfizer and Moderna vaccines are preferable because data from the US in 90,000 pregnant women has not raised any safety concerns.
Up until now, only women with underlying health conditions or those whose risk of exposure to the virus was high were eligible.
The shift in advice brings the UK into line with other countries.
The Joint Committee on Vaccination and Immunisation now advises that pregnant women should all be offered the Pfizer-BioNTech or Moderna vaccines where available, at the same time as the rest of the population.
They are encouraged to discuss the risks and benefits of the vaccines with their doctor before making the appointment, but it is not a requirement.
"There is no evidence to suggest that other vaccines are unsafe for pregnant women, but more research is needed," it added.
Currently, there is a lack of data on the AstraZeneca vaccine in pregnancy because pregnant women were not included in trials, but the JCVI says more evidence may be forthcoming in the near future.
Read full story
Source: BBC News, 17 April 2021
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‘Save Black mothers’ lives’: Labour urges government to commit to closing maternal mortality gap

The Labour Party will call on the government to commit to a target of ending the Black maternal mortality gap during a landmark debate about the topic later on Monday.
This comes as shocking figures show Black women are over four times more likely than white women to die during or after pregnancy or childbirth in the UK.    
MPs will debate a petition relating to Black maternal healthcare and mortality.
Scheduled to take place at 6.15pm this evening, the session will be led by Petitions Committee Chair Catherine McKinnell MP.
Read full story
Source: The Independent, 19 April 2021
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Scandal to shake your faith in our 'wonderful' NHS: This nurse saved a life – but NHS chiefs said she broke protocol, then relentlessly pursued her and tried to have her struck off. Four years on, she's in the clear... and they're in the dock

A nurse of the year finalist who faced being struck off after she saved a woman's life has been cleared by an official inquiry, the Mail can reveal.
Leona Harris, 48, who gave a blood transfusion in a speeding ambulance to a woman who was haemorrhaging after losing her baby, has faced a four-year nightmare, including the potential loss of her 24-year career and home to pay legal costs.
Through no fault of Mrs Harris's, the required prescription for the use of the blood had not been taken on to the ambulance with the patient.
Now, four years on, the Nursing and Midwifery Council (NMC) has concluded Mrs Harris 'undoubtedly acted in the best interests of the patient' and has 'no case to answer'.
The ruling raises major concerns about the conduct of the East Lancashire Hospitals Trust, which used inexplicably altered statements about Mrs Harris's conduct.
The 600-page report will heap new pressure on Health Secretary Matt Hancock, who pledged that 'eradicating the curse' of NHS bullying would be one of his 'top priorities'.
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Source: Mail Online, 20 April 2021
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Muckamore Abbey Hospital: seven face prosecution for alleged mistreatment and wilful neglect of patients

Seven individuals face prosecution for alleged ill-treatment and wilful neglect of patients at a hospital for people with severe learning disabilities.
The alleged offences took place at the psychiatric intensive care unit at Muckamore Abbey Hospital in County Antrim, Northern Ireland.
Prosecution follows ongoing police inquiries
A police investigation into claims of abuse at the hospital has been ongoing since 2018, following reports of inappropriate behaviour and alleged physical abuse of service users by staff.
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Source: Nursing Standard, 19 April 2021
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Hospital trust pleads guilty over baby death

An NHS trust has admitted failing to provide safe care and treatment for a mother and her baby boy, who died seven days after an emergency delivery.
Mother Sarah Richford said it brought "some level of justice" for baby Harry's death in 2017.
Lawyers for the East Kent Hospitals Trust pleaded guilty to the charge at Folkestone Magistrates Court.  The trust said it had made "significant changes" and would "do everything we can to learn from this tragedy".
Mrs Richford said: "Although Harry's life was short, hopefully it's made a difference and that other babies won't die".
She added: "If somebody had done this before Harry was born he may be alive today."
The prosecution by the Care Quality Commission followed an inquest in 2020, which found Harry's death was wholly avoidable and contributed to by neglect at Margate's Queen Elizabeth the Queen Mother Hospital.
The inquest found more than a dozen areas of concern in the care of Harry and his mother, including failings in the way an "inexperienced" doctor carried out the delivery, followed by delays in resuscitation.
Coroner Christopher Sutton-Mattocks criticised the trust for initially saying the death was "expected", adding that an inquest was only ordered due to the family's persistence.
Read full story
Source: BBC News, 19 April 2021
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NHSE sends improvement director into struggling acute trust

Regulators have sent an improvement director into a North West acute trust amid multiple allegations of poor care and ‘cover up’ across different specialties.
University Hospitals of Morecambe Bay Foundation Trust, which spent 18 months in special measures midway through the last decade, is again now the subject of significant regulatory intervention from NHS England.
The regulator has appointed Simon Bennett as a board-level improvement director, which comes after he undertook a similar assignment at the struggling Stockport FT.
It comes amid ongoing external investigations into the trust’s urology and trauma and orthopaedics specialties, where serious allegations have been made about attempts to cover up poor care.
The trust has a troubled history of care failings and regulatory intervention, including a major maternity scandal which culminated in the Kirkup Inquiry in the first half of the 2010s, and being placed in special measures in 2014.
It was widely recognised that positive progress was subsequently made to implement the inquiry recommendations and improve services, which culminated in the trust exiting special measures in late 2015, and being rated “good” by the CQC in early 2017. However, the recent allegations and investigations have again brought regulatory intervention.
Read full story (paywalled)
Source: HSJ, 20 April 2021
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