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

Deaths of people with learning disabilities deserve proper scrutiny

The critical finding at the inquest into Laura Booth’s death raises alarming concerns about the failing system of investigation into the deaths of people with learning disabilities.
Initially, Laura’s death was said to be expected and was attributed to natural causes on the basis of a death certificate signed by a hospital doctor. Without the determination of Laura’s family and the intervention of the media, this inquest would never have happened, and the truth about her death from malnutrition and neglect would not have been uncovered. 
The concerns about how many other avoidable deaths have not been scrutinised because there is no one to speak up on behalf of those who died or because families are obstructed in their search for answers by the prevailing assumption that people will die early. The premature deaths of people with learning disabilities (on average 30 years before their non-disabled peers) demand robust scrutiny particularly as when inquests do take place, they so often reveal basic failings in healthcare. The way in which the Booth family were so nearly failed by the coronial system is a sharp reminder of how urgently reform of these processes is needed.
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Source: The Guardian, 2 May 2021
Patient Safety Learning

‘It’s terrifying’: parents’ struggle to get help for children with long Covid

On Christmas Day, Gail Jackson’s 16-year-old daughter said she was in so much pain she thought she would die. Liliana had been briefly admitted to hospital with Covid in September. Her symptoms never went away and, as time went on, new ones had emerged.
“For months she had a relentless, agonising headache, nausea, tinnitus, fatigue and insomnia, but the worst thing was the agonising nerve pain,” said Jackson. “I couldn’t even touch her without her screaming in pain.”
On Christmas morning, Jackson drove to hospital with her daughter vomiting from pain in the passenger seat. When they got to the hospital, however, the A&E doctor said there was no such thing as long Covid in children. “He said she just needed to go home and get on with her life,” Jackson said. “It was jaw-dropping.”
It is extremely rare for children and young people to contract severe Covid, but recent research has shown that even mild or asymptomatic infection can lead to long Covid in children. A study at UCL is investigating long Covid in 11- to 17-year-olds who were not hospitalised with the disease.
The National Institute for Health and Care Excellence (NICE) has recommended more research to produce guidance on how children and young people are affected and how they can be treated. However, there is no case definition of long Covid in children and young people in the way there is in adults.
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Source: The Independent, 3 May 2021
Patient Safety Learning

NHS introduces 3D heart scans to diagnose patients in 20 minutes

Patients with life-threatening coronary heart disease will be treated five times faster thanks to 3D scans being introduced on the NHS that allow for a diagnosis in just 20 minutes.
The revolutionary technology can turn a regular CT scan of the heart into a 3D image, allowing doctors to diagnose them rapidly, NHS England said.
It added that about 100,000 people will be eligible to use the HeartFlow technology over the next three years.
Patients – who would previously have had to undergo an invasive and time-consuming angiogram in hospital – will now be seen, diagnosed and treated around five times faster.
The new technology, introduced from last month, is part of the NHS long-term plan to cut the number of heart attacks and strokes by 150,000.
NHS England said more people here will have access to the potentially life-saving technology than anywhere else in Europe, the US or Japan.
Matt Whitty, director of innovation and life sciences for NHS England, said HeartFlow had been a “huge success” in clinical trials and would now help “tens of thousands of people a year receive quick diagnosis and treatment and ultimately save lives”.
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Source: The Guardian. 4 May 2021
Patient Safety Learning

Europe must act now to stop the spread of deadly diseases due to COVID-19

Healthcare workers and patients are being put at risk not only from COVID-19 but other deadly diseases as a result of an increase in sharps injuries due to the pandemic. 
Sharps injuries are accidents where a needle or other medical sharp instrument penetrates the skin with the potential to transfer blood borne viruses, including HIV or hepatitis B or C, from the patient to healthcare worker and vice versa. Sharps injuries cause increased costs and disruption in the healthcare system, which have all been exacerbated by the pandemic anyway. Sharps injuries also have a major emotional and mental impact on staff who always put patients first and literally have put their lives on the line during COVID-19.
The European Biosafety Network has commissioned a survey to be published in June on the impact COVID-19 has had on sharps injuries in Europe. The preliminary findings of the survey by Ipsos MORI, covering more than 300,000 healthcare workers in 80 large public hospitals across Europe, show that the number of sharps injuries has increased by some 276,000 injuries (23%) over the last year: with 98% of respondents saying that the increase was a result of the increased pressure and stress due to COVID-19.
Other recent published survey results also show that the number of reported sharps injuries has increased as a result of the pandemic. We need to ensure that other existing legislation and regulations which prevent sharps injuries are both understood and complied with.
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Source: The Brussels Times, 28 April 2021
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We need to stop calling NHS staff heroes – for a very important reason

When we put people on a pedestal, my experience is that they are less likely to be asked, ‘are you OK?’, writes Samantha Batt-Rawden, a senior registrar in intensive care medicine.
Like many she has been touched by the groundswell of support from the public. But there’s a problem with this hero image, she says. 
"It’s not just that many NHS staff are feeling increasingly uncomfortable with being hailed as heroes for what they see as simply doing their jobs. Of course, we were going to step up to the plate when the COVID-19 pandemic hit. As doctors it was our duty. There was never any question.
"But there’s something more than just feeling undeserving of the cape weighing heavily on our shoulders. The worst thing about being seen as a superhero? Very few think to ask if you’re OK.
And herein lies the problem. Because healthcare workers are not heroes, we are human. Completely, painstakingly, fallibly human."
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Source: The Independent, 2 May 2021
 
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Women bear brunt of ‘gargantuan challenges’ for health and care services during pandemic

Women are bearing the overwhelming brunt of the “gargantuan challenges” health and care services are grappling with during the Covid pandemic, health leaders have said.
A new study by the NHS Confederation’s Health and Care Women Leaders Network found female health and care workers’s physical and mental health substantially deteriorated due to working during the coronavirus crisis.
The survey, which polled more than 1,200 NHS staff in February and March this year after the virus peaked, found issues with mental and physical health had notably worsened since last summer.
Researchers found more than 80% of women said the pandemic meant their job had greater detrimental repercussions on their emotional wellbeing. This is a significant rise from 72% of female workers who said the same during equivalent research carried out in June.
The report, which polled nurses, doctors, administrative staff, allied health professionals and managers, warned there are “still many mountains to climb” as services strive to cope with the chaos unleashed by the Covid crisis, as well as dealing with the long-term consequences of the pandemic.
The study said: ”This includes tackling the growing issue of long Covid, meeting increased demand for mental health services, continuing to deliver the largest vaccination programme the UK has ever seen, and addressing a backlog of treatment that could extend to nearly seven million people by the end of 2021."
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Source: The Independent, 5 May 2021
Patient Safety Learning

Children’s lives at risk from failures in asthma care, warns safety watchdog

Children with asthma are at risk of avoidable deaths in England because of poor NHS systems and a failure to appreciate the dangers posed by the condition.
A new investigation by NHS safety watchdog the Healthcare Safety Investigation Branch (HSIB) has revealed a series of risks to children with asthma, as concerns emerge of the impact of the pandemic on asthma patients more generally.
The latest inquiry was sparked by the deaths of three children between 2014 and 2017. All were caused by asthma attacks which were later the subject of warnings by coroners.
In each case HSIB said there were missed opportunities to recognise asthma as a life-threatening condition as well as problems with how the children were managed by doctors working in different parts of the NHS.
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Source: The Independent, 5 May 2021
Patient Safety Learning

GPs are at “breaking point” and in need of respite, leaders warn

General practices are “reaching breaking point” because of the “intense” workload pressure facing doctors and staff, the country’s most senior GP leaders have warned.
The warning came as new figures from NHS Digital showed that practices in England delivered almost five million more appointments in March 2021 than the month before and nearly three million more than in March 2019.
Richard Vautrey, chair of the BMA General Practitioners Committee, said that the figures underlined the huge efforts practices were going to and the workload pressure on staff. He said, “GPs and their teams are consistently telling us they’re busier now than they have ever been, and this data—which does not include a large proportion of the vaccine programme undertaken by practices, nor a vast amount of other daily tasks—backs this up.”
Last week the Ivy Grove Surgery in Derbyshire provided an example of the strain facing some practices in a 16 page open letter to its patients about the huge demand it was facing and the resulting risk of staff burnout. The surgery said it would be reducing its use of the video consultation tool eConsult, as it had seen a doubling of demand over recent months, with some patients submitting several requests a day.
In a statement the practice told The BMJ, “We are aware of the stir our letter has caused but have also been overwhelmed by the kind feedback from our own patients, and the many encouraging messages of support we have received from GP surgeries all around the country. We therefore know that many of our GP colleagues are experiencing the same issues, but they may be fearful of articulating what is happening."
“We feel that open and honest debate about demand and workload in general practice is vital. If this letter goes even a little way towards sparking some much needed discussion then it will have been a good thing.”
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Source: BMJ, 4 May 2021
Patient Safety Learning

Half of all hospitals inspected broke covid safety law

Nearly half the hospitals targeted in covid-related spot checks were found to be breaching health and safety laws.
An unpublished Health and Safety Executive report found just five out of 17 acute hospitals inspected had high levels of compliance with measures to manage the risks around covid. 
Meanwhile, letters were sent to eight hospitals “formally requiring them to take remedial action to remedy contraventions of health and safety law”. The remaining four hospitals were given advice.
The inspections — which involved 13 hospitals in England and two each in Scotland and Wales — focused on seven areas: risk assessment; management arrangements specific to covid; social distancing; cleaning and hygiene; ventilation; dealing with suspected covid cases; and personal protective equipment.
The health and safety watchdog highlighted social distancing in non-clinical areas — which covered areas outside of clinical wards such as offices, rest areas, changing rooms and workshops — as needing improvement in some hospitals. 
The inspectors — who visited between November last year and January this year — also found some hospitals needed more robust covid security measures if they were to comply with government guidance.
HSE also noted that, although all the hospitals had adequate supplies of PPE, not all had adequate arrangements in place for ensuring it was used effectively.
Read full story (paywalled)
Source: HSJ, 5 May 2021
Sam

Pfizer vaccine ‘95% effective against coronavirus,’ new data shows

Two doses of the Pfizer-BioNTech vaccine can provide more than 95% protection against infection, severe illness and death from Covid, according to a groundbreaking study in Israel.
The middle eastern country currently leads the world in its inoculation programme, with more than half (56 per cent) of its population having already received both doses of the Pfizer vaccine.
The research, published today in The Lancet journal, also concluded that a single dose of the jab provides 58 per cent protection against infection, 76% against hospital admission, and 77% against death.
The researchers said their study highlights the importance of fully vaccinating adults against the virus but acknowledged challenges remain to get the pandemic under control – including uncertainty around how long immunity lasts, from both vaccines and natural infection, and the emergence of variants that may be resistant to jabs currently on the market.
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Source: The Independent, 6 May 2021
Patient Safety Learning

Early cancer diagnoses plummeted in England during Covid pandemic

The number of people being diagnosed with cancer early in England has plummeted during the Covid pandemic, sparking fears that many will only be treated when it is too late to save them.
Official figures show a third fewer cancers were detected at stage one, when the chances of survival are highest, in the early months of the pandemic than during the same months a year before.
Cancer experts fear that the figures, which have been collected by Public Health England’s National Cancer Registration and Analysis Service, mean thousands of people have the disease but have not yet started treatment because of “a shift to later diagnosis”. They urged anyone with possible symptoms of the disease to get them checked out immediately.
“While it’s fantastic that Covid rates are dropping and lockdown is easing, the knock-on impact of the pandemic on cancer care cannot be overstated,” said Steven McIntosh, the executive director of advocacy and communications at Macmillan Cancer Support. “We are likely to be dealing with Covid’s long shadow for many years to come.”
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Source: The Guardian, 5 May 2021
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Wards to get ‘star ratings’ under first new NHS cleaning rules for 14 years

The first new hospital cleaning standards for 14 years have been outlined by regulators, including confirmation of new food hygiene-style star ratings.
Wards and theatres will be given ratings from one to five stars – based on audits which score the cleanliness of areas against safe standards – and these ratings will be made visible to patients.
The plans for the new star ratings, which are expected to be easier for patients to understand than the current cleanliness percentage scores, were first revealed by HSJ in 2019.
The ratings are also designed to encourage a more collaborative approach, by reflecting the cleanliness score for whole areas, as opposed to the performance of individual parties responsible for cleaning certain elements.
Areas rated one to three stars would require improvement plans and be automatically placed under review, with “immediate action” being required in one-star rated areas.
Read full story (paywalled)
Source: HSJ, 6 May 2021
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Covid: Depression rises in young and women during second peak

Women and younger adults were more likely to feel depressed during the second UK coronavirus peak than men and other age groups, Office for National Statistics (ONS) data suggests.
Four in 10 women aged between 16 and 29 were affected, compared to 26% of men. One in five adults experienced depression in early 2021 - more than double pre-pandemic levels.
But GPs in England diagnosed fewer cases of depression in adults in 2020 compared with the year before. Many people may not be seeking medical help, the ONS says.
Health experts have always warned that the combined effects of ill health, isolation and job losses during the pandemic would have a negative impact on people's mental health and wellbeing.
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Source: BBC News, 5 May 2021
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UK needs £102bn boost to NHS and social care, says major report

Spending on the NHS, social care and public health needs to rise by £102bn over the next decade, funded by big tax rises, to improve Britain’s health in the wake of the coronavirus pandemic, an inquiry has said.
The massive funding boost would cut avoidable deaths from cancer and heart disease, tackle glaring health inequalities and rebuild the NHS after Covid exposed weaknesses such as a lack of beds and staff, a team of experts have urged ministers.
The money would come largely from increases in income tax, national insurance and VAT, which evidence suggests the public is willing to pay, according to a four-year commission of inquiry by the London School of Economics and the Lancet medical journal.

“Without concerted action and increased funding we risk the UK falling further behind other high-income countries in health outcomes and life expectancy, continued deterioration in service provision and worsening inequalities, increased reliance on private funding and an NHS that is poorly equipped to respond to future major threats to health,” said Dr Michael Anderson of the LSE, the commission’s joint research lead.
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Source: 6 May 2021
Patient Safety Learning

Pregnant women struggling to get Covid jab says MP

Pregnant women are struggling to get the coronavirus vaccine because clinics are unable to guarantee they will have the right type of jab available, Labour MP Stella Creasy has said.
The Pfizer-BioNTech or Moderna jabs are preferable for pregnant women because there is more safety data available.
But the online booking system in England does not allow them to specify which vaccine they require.
Pregnant women are advised to speak to their GP instead of booking online. But Ms Creasy, 44, said GPs do not always know when local vaccination centres will have specific types of the jab available.
The MP for Walthamstow, who is currently pregnant with her second child, said she had received five invitations to be vaccinated but she could not take them up because there is no system to specify she needs the Pfizer or Moderna jab.
"I don't think it's been made enough of a priority because there's a presumption it will become more of a priority as they move through the age groups, which is a misreading of the data about pregnancy," she told the BBC.
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Source: BBC News, 7 May 2021
Patient Safety Learning

Infection rules for NHS staff leave them at risk from airborne Covid, warn experts

Pressure is growing on the government to change its stance on coronavirus infection rules which it is feared may leave NHS staff and patients at risk from airborne transmission.
Experts told The Independent the current guidance from Public Health England (PHE), which effectively says staff working on general wards can rely on just surgical masks for protection, was “outdated and potentially misleading” and put NHS staff at risk.
At the start of the pandemic the emphasis on stopping infection was focused around droplets containing the virus both in the air over short distances and on surfaces. Increasingly scientists have begun to warn the virus can also spread through much smaller aerosols which can remain airborne for a lot longer and over further distances.
On Friday, the World Health Organisation updated its information on how Covid spreads to acknowledge the risk of aerosols and last month papers released by the government’s Scientific Advisory Group for Emergencies (Sage) said health workers may need to use better protection for longer.
Read full story
Source: The Independent, 6 May 2021
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