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

‘Unnecessary secrecy’: 42 NHS trusts criticised over Covid deaths data

Hospitals have been accused of “unnecessary secrecy” for refusing to disclose how many of their patients died after catching Covid on their wards.
The Patients Association, doctors’ leaders and the campaign group Transparency International have criticised the 42 NHS acute trusts in England that did not comply fully with freedom of information request for hospital-acquired Covid infections and deaths.
The Guardian revealed on Monday that up to 8,700 patients lost their lives after probably or definitely becoming infected during the pandemic while in hospital for surgery or other treatment. That was based on responses from 81 of the 126 trusts from which it sought figures.
The British Medical Association, the main doctors’ trade union, said the 42 trusts that did not reveal how many such deaths had occurred in their hospitals were denying the bereaved crucial information.
“No one should come into hospital with one condition, only to be made incredibly ill with, or even die from, a dangerous infectious disease,” Dr Rob Harwood, chair of the BMA’s hospital consultants committee, said.
“Families, including those of our own colleagues who died fighting this virus on the frontline, deserve answers. We will only get that if there is full transparency."
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Source: The Guardian, 25 May 2021
Sam

Serious safety concerns over third major specialty at struggling trust

Serious patient safety concerns have been raised about a third major specialty at a struggling acute trust, with inspectors also flagging wider leadership issues.
The Care Quality Commission (CQC) has issued an immediate warning notice in relation to the stroke service at University Hospitals of Morecambe Bay Foundation Trust, following an inspection earlier this month.
A full report will be published later this year, but the immediate issues have been outlined within various documents published ahead of the trust’s board meeting on 26 May.
According to a summary within the papers, the CQC warning notice has flagged “a range of incidents… identifying poor care that requires investigation”, governance concerns around the grading of incidents, poor levels of training and competencies, and worrying delays around administering thrombolysis.
The problems were predominantly found at Royal Lancaster Infirmary.
Read full story (paywalled)
Source: HSJ, 25 May 2021
Sam

Weaknesses that led to patients getting Covid in hospital remain

Almost as soon as the pandemic struck early last year, NHS England recognised that patients catching Covid-19 while they were in hospital for non-Covid care was a real risk and could lead to even more deaths than were already occurring. Unfortunately their fears have been borne out by events since – every acute hospital in England has been hit by this problem to some extent.
Over the last 15 months various NHS and medical bodies have looked into hospital-acquired Covid and published reports and detailed guidance to help hospitals stem its spread. They include the Healthcare Safety Investigation Branch (HSIB) and Public Health England (PHE). Last May, for example, PHE estimated that 20% of coronavirus infections in hospitalised patients and almost 90% of infections among healthcare staff may have been nosocomial, meaning they were caught in a hospital setting.
Before the pandemic the NHS was over-stretched and resources were limited. The crisis distorted it further out of shape and despite NHS staff making huge efforts to contain the virus in extremely challenging circumstances, too often they were overwhelmed.
There are many other reasons, including inadequate ventilation, the sharing of equipment, and nurses and doctors having to gather at nurses’ stations and in doctors’ messes. Some bereaved relatives also cite hospitals deciding – inexplicably – to put their Covid-free loved ones in a bay or ward with one or more people who had the disease, sometimes resulting in tragedy.
While some of these inherent weaknesses have been addressed, others remain, leaving further infections and even more deaths in this way a distinct possibility if the NHS is hit by another Covid surge.
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Source: The Guardian, 24 May 2021
Sam

New research calls for better care for people who seek emergency help following self-harm

Research has found that people who go to A&E following self-harm receive varying quality of care and this has a significant impact on what they experience subsequently.
The study in BMJ Open, which was codesigned and co-authored with people who have lived experience of self-harm and mental health services, found negative experiences were common, and revealed stigmatising comments about injuries from some hospital staff. Some participants reported being refused medical care or an anaesthetic because they had harmed themselves. This had a direct impact on their risk of repeat self-harm and suicide risk, as well as their general mental health.
According to the research, the participants who received supportive assessments with healthcare staff reported feeling better, less suicidal and were less likely to repeat self- harm.
"This research highlights the importance of learning from the experiences of individuals to help improve care for people who have harmed themselves. We involved patients and carers throughout the entire process and this enabled us to gain a greater insight into what patients want after they present to hospital having harmed themselves", said Dr Leah Quinlivan.
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Source: University of Manchester, 25 May 2021
Sam

GPs stricken by long Covid ‘shocked and betrayed’ at being forced from jobs

Family doctors are being forced out of their jobs after developing long Covid, prompting demands for the government to compensate NHS staff with the debilitating condition who cannot work.
GPs struggling with the condition have told the Observer they felt “shocked and betrayed” when their colleagues removed them from their posts because of prolonged sick leave.
“I received a lawyer’s letter on behalf of the other partners in the GP surgery telling me that they were ending my partnership. I understood why they did what they did, because I was too sick to work at the time. But it was also callous and mercenary,” said one doctor who lost her job.
“It was hard on me, as one of the partners was also my best friend. The partners were worried I’d be a ‘disabled partner’ and wouldn’t be able to pull my weight. Long Covid meant I simply couldn’t function normally and so couldn’t meet the return to work date they gave me, so they exercised their right under our partnership agreement to end my partnership at the surgery,” added the GP, who asked to remain anonymous.
The issue has prompted soul-searching within the medical profession about what duty of care family doctors owe each other when they cannot work because they have been laid low with exhaustion, brain fog, breathlessness and other symptoms of long Covid.
Locum medics and hospital doctors with the condition are also having problems including loss of income, trouble accessing sick pay, contractual difficulties and getting employers to accept that they cannot work normally, sometimes for months.
Read full story
Source: The Guardian, 23 May 2021
Patient Safety Learning

CQC to focus on services where there is a ‘greater risk of a poor culture going undetected’

The Care Quality Commission (CQC) has revealed a new strategy that will place more emphasis on a patient’s experience of care and seek to get a better grip on ”care settings where there’s a greater risk of a poor culture going undetected”.
Ian Trenholm, chief executive of the CQC told HSJ the CQC’s new approach would be informed by the belief that ”people’s experience of care is driven as much from the way different providers will interact with each other – both public sector, private sector, third sector - in a place as much as it by the individual performance of individual providers.”
He repeated his pledge, made to HSJ in August, that the CQC would endeavour to make inspections less time consuming for providers.
An important part of the CQC’s increased focus on patients’ experience of care would be taking more effort to determine the quality of services whose users may have trouble expressing their views, said Mr Trenholm.
Read full story (paywalled)
Source: HSJ, 27 May 2021
Patient Safety Learning

Rising patient numbers threaten to overwhelm GPs

Rising numbers of patients needing care and a shortage of GPs is threatening to overwhelm the system, doctors and patient groups are warning.
It comes after the pandemic has caused severe disruption to GP practices for more than a year.
Analysis of NHS England data by the Health Foundation found more than 28 million appointments were booked in March, among the highest recorded.
Doctor's leaders say what they are being asked to achieve is "undoable".
The analysis of NHS data in England carried out by the Health Foundation for the BBC also that that between 2019-20 and 2020-21:
The total number of appointments dropped by 10% - meaning 31 million fewer consultations with GPs and practice nurses Major shift from face-to-face to remote consultation, with the proportion seen in practices dropping from 79% to 54% The number of patients referred by GPs for urgent cancer check-ups dropped by 15%, putting lives at risk The escalating situation has prompted patient groups to call for an urgent review of access to services, amid reports that patients are struggling to get through.
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Source: BBC News, 27 May 2021
Patient Safety Learning

NHS England gives green light to scrap four-hour A&E target

NHS England is pushing ahead with plans to replace the NHS’s four-hour emergency target with a new set of 10 metrics, it has announced today.
The announcement follows a consultation launched in December on its latest proposals, although any final plans will still require government signoff (see box below for the 10 new metrics).
NHSE/I said in a press release: “In an NHS consultation four out of five respondents said they would welcome a bundle of measures. The specific proposals were endorsed by two thirds, 67%, of respondents and opposed by just 13%.”
However, NHSE/I said in a report on the proposals that it had not yet been established how the new basket of metrics would be used as a performance measure and that the proposals still needed government sign-off.
Read full story (paywalled)
Source: HSJ, 26 May 2021
Patient Safety Learning

Covid hospital admissions rising with most patients younger people, says NHS leader

The number of people being admitted to hospital with COVID-19 is rising in some regions but "few, if any" are from care homes, according to an NHS leader.
Younger people are making up most of coronavirus hospital admissions, with 70% of admissions in one hospital consisting of under-45s, NHS Providers chief executive Chris Hopson said.
Although the number of hospital admissions is "ticking up" in areas most affected by the Indian Covid variant, the rise is small compared with the levels seen earlier in the year.
Speaking to Times Radio, Mr Hopson said most hospitalisations were among younger people and those who have been offered the vaccine but have yet to take up the offer.
A number are among those who have only had their first dose of a COVID-19 vaccine, while “a very small number” are fully vaccinated with both doses.
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Source: The Independent, 26 May 2021
Patient Safety Learning

Ambulance trust reveals patient’s death amid handover delays row

An ambulance trust has highlighted the death of a woman which it says was due to “being delayed on the back of an ambulance”, just two days after it warned that lives were ‘at risk’ from long handovers.
West Midlands Ambulance Service University Foundation Trust’s board papers this month reveal the woman in her 90s — who has not been named — was taken to hospital because a severe nose bleed would not stop.
Its clinical quality board paper says the “patient story” showed ”how a patient being delayed on the back of an ambulance resulted in significant deterioration and ultimately the death of a patient”.
Read full story (paywalled)
Source: HSJ, 28 May 2021
Patient Safety Learning

Sisters with sickle cell had devastating, and preventable, strokes

It was 4am on a Sunday in San Antonio, US, when Dana Jones heard an ominous sound, barely audible over the whirring of box fans, like someone struggling to breathe. She ran down the hall and found her daughter Kyra, age 12, lying on her back, gasping for air. Terrified, she called 911.
A police officer, the first to arrive, dashed into Kyra’s bedroom, threw the slender girl over his shoulder and laid her on a leather sofa in the living room. He asked her mother, an oral surgery technician, to give her CPR.
Kyra’s lips were ice-cold. An ambulance whisked the girl to Methodist Children’s Hospital, where staff members swarmed her and put her into a medically induced coma.
Kyra, who has sickle cell, had suffered a devastating stroke — her second — a common complication of this inherited disease, which afflicts 100,000 Americans, most of them Black. She most likely would never have had the strokes if she had been given an annual screening test and treatment proven more than two decades earlier to prevent 9 out of 10 strokes in children with the disease and recommended by the National Institutes of Health. But like countless other children with sickle cell, she was never screened.
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Source: New York Times, 23 May 2021
Patient Safety Learning

Call for surgery hubs to tackle NHS backlog

Surgeons are calling for specialist hubs in England to help tackle what they call a "colossal backlog" of non-urgent operations because of COVID-19.
The Royal College of Surgeons (RCS) wants a network of hospital sites focused on routine surgery, such as hip and knee replacements.
The government says it is working "to accelerate the recovery of services".
In March, around five million patients were waiting for surgery - the highest number since modern records began.
Prof Neil Mortensen, president of the RCS, said the pandemic has had a devastating impact on surgical services - and that it must not be allowed to happen again.
"Surgery must be available on the NHS all year round, not stop and start," he said, adding that a "New Deal for Surgery" was required to help weather future pandemics. If a dangerous new variant of COVID-19 takes hold, or another bad flu arrives in the autumn, we cannot allow surgery to grind to a halt again or waiting lists will become insurmountable."
Read full story
Source: BBC News, 28 May 2021
 
Patient Safety Learning

'More work to do' to improve Nottingham maternity units

More needs to be done to bring maternity units at a city's two main hospitals up to scratch, inspectors have said.
In 2020 the Care Quality Commission (CQC) found serious concerns at Nottingham University Hospitals NHS Trust and labelled the units "inadequate".
A new report concluded the trust still has "some areas to address".
In October a coroner said the death of Wynter Andrews minutes after she was born was "a clear and obvious case of neglect".
Nottinghamshire assistant coroner Laurinda Bower also revealed a 2018 whistle-blowing letter from midwives to trust bosses outlining concerns over staffing levels as "the cause of a potential disaster".
In the same month "in response to concerns raised... and coronial inquests", the CQC carried out an unannounced inspection at the hospital and found some staff had not completed training and "did not always understand how to keep women and babies safe", and issued a warning notice over its concerns.
Its latest report, based on an inspection in April, found improvements in the way women at risk of deterioration were identified and found documentation and monitoring had improved.
However the CQC found a disconnect between online and paper record-keeping and said there were multiple systems in place that led to duplication and errors at times.
Read full story
Source: BBC News, 28 May 2021
Patient Safety Learning

Staff at UK GP surgeries facing abuse and ‘tsunami of demand’

NHS staff at GP surgeries are facing unprecedented abuse and aggression from patients, while stressed doctors are increasingly suffering from mental illness, because of an appointments system “in meltdown”, family doctors’ leaders have revealed.
The scale of the deep crisis in GP surgeries was revealed in an emergency summit of more than 60 NHS doctors, dentists and administrative staff in Salford, which the Guardian attended, triggered by a recent rise in verbal abuse.
"Patients are short-tempered and not happy waiting for anything … They want letters. The latest one was a request to speak to a GP because he needs a letter to confirm anxieties that cause him a problem in long queues – because he wants to take his son to [Southport amusement park] Pleasureland and does not want to queue," says Jan Crowshaw, a GP manager
It comes after a recent poll by the body representing GP surgery staff across the UK found that 75% of them face abuse every day, including assaults, threats, racism and sexism.
Read full story
Source: The Guardian, 28 May 2021
Patient Safety Learning

Cumberland Infirmary patient 'dropped' from operating table dies within weeks

A woman has died after being "dropped" on the floor during surgery on her hip, which she had broken while in hospital.
Jeannette Shields, 70, had been receiving treatment for gall stones in Cumberland Infirmary in Carlisle.
North Cumbria Integrated Care NHS Trust said an investigation was under way "in relation to an incident involving a patient in one of our theatres".
Mrs Shields' husband, John, said he told the hospital he would not be "pushing this thing under the carpet".
His wife left her bed to go to the toilet by herself after getting no response to her buzzer, Mr Shields said. She felt dizzy, fell and broke her hip, he told the BBC.
Two days later she had surgery to repair it, after which the hospital called Mr Shields to say the operation had been successful but that "unfortunately they dropped her off the operating [table] after the surgery", he said.
"Then they had to use the sliding board to pick her up and rush her in and do scans on her," he said. 
"She had a great big bump on the back of her head and she just deteriorated and then she just passed away, just died.
It is not clear what happened or how Mrs Shields ended up falling from the operating table.
Read full story
Source: BBC News, 28 May 2021
Patient Safety Learning

Some long Covid sufferers in England waiting months for treatment

People who remain chronically ill after Covid infections in England have had to wait months for appointments and treatment at specialist clinics set up to handle the surge in patients with long Covid.
MPs called on Matt Hancock, the health secretary, to explain the lengthy waiting times and what they described as a “shameful postcode lottery” which left some patients facing delays of more than four months before being assessed at a specialist centre while others were seen within days.
NHS England announced in December that people with long Covid, or post-Covid syndrome, could seek help at more than 60 specialist clinics. But despite government assertions in January that the network of 69 centres was already operating, the all-party parliamentary group on coronavirus found that some clinics were still not up and running three months later.
Freedom of information requests submitted to NHS trusts revealed that while some clinics had opened and were seeing patients, others had been delayed by the second wave of infections in January. 
Read full story
Source: The Guardian, 30 May 2021
Sam
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