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

NHS faces beds crisis as care homes stop taking patients from hospitals

The NHS faces a mounting beds crisis as care homes suffering unprecedented staff shortages are forced to stop taking patients from hospitals, health and care leaders have warned.

Ministers are desperately trying to free up space in the NHS to tackle a backlog of 5.6 million people – equivalent to almost 10% of people in England – awaiting treatment.

But efforts to speed up the discharge of hospital patients into the community are being hampered by care worker shortages. Britain’s largest not-for-profit care home provider, MHA, has already had to close 1 in 10 of its homes to admissions from hospitals, its chief executive, Sam Monaghan, told the Guardian.

The warning comes as a comprehensive assessment on Wednesday reveals that care homes in England are facing the biggest staff shortage on record, with 105,000 positions unfilled according to the 2021 State of the Adult Social Care Sector and Workforce report by Skills for Care, an industry body.
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Source: The Guardian, 13 October 2021
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COVID-19: Government’s handling of pandemic had “big mistakes,” MPs say

The government’s actions in dealing with the COVID-19 pandemic have received a mixed review from MPs in a report that set out the successes and failures of the UK response.
Although the joint report from the House of Commons’ Science and Technology Committee and Health and Social Care Committee  praised the UK’s covid vaccination programme as highly effective, it also condemned serious errors, especially delayed lockdowns and how a test, trace, and isolate system was set up.
Overall, the MPs’ inquiry found that some government initiatives were examples of global best practice but that others represented “serious mistakes.” 
The UK’s pandemic planning was based too narrowly on a flu model that had failed to learn the lessons from the SARS, MERS, and Ebola epidemics, said the MPs, which meant that its covid planning was worse than in other countries.
Delays in establishing an adequate test, trace, and isolate system hampered efforts to contain the outbreak, said the MPs, and the government’s initial decision to delay a comprehensive lockdown had revealed its then “fatalistic” assumption that it was impossible to suppress the virus, which amounted, in practice, to accepting that herd immunity by infection was inevitable.
The report said that many thousands of deaths could have been avoided if the government had not let hospitals discharge people into care homes in the initial phase of the pandemic and that this showed the “longstanding failure” to give social care sufficient priority and the same attention as the NHS.
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Source: BMJ, 12 October 2021
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Hospitals trigger emergency measures as patients wait 13 hours in the back of ambulances

An NHS trust has spent more than two weeks running on emergency measures after skyrocketing demand since mid-September, while others have kept people waiting for more than a dozen hours in the backs of ambulances.
The Independent has learnt one patient in the West Midlands spent 13 hours waiting to be handed over to staff at the Shrewsbury and Telford Hospitals Trust.
Gloucester Hospitals Trust declared its internal incident on 19 September and only stood it down on 5 October, while London’s Barnet Hospital took similar extraordinary action on Monday due to high demand. And at North Middlesex Hospital staff saw more than 200 patients crowd into the emergency department on Monday afternoon.
Declaring an internal incident is designed to activate measures that help hospitals deal with a sudden peak of demand and should only last for a short time.
Such pressures are being felt across the country with NHS managers seriously concerned about what the coming months will look like as temperatures dip. One said they had not seen things as bad in more than a decade.
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Source: The Independent, 13 October 2021
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HEE tells trusts to prioritise training, or services will suffer

The quality and performance of services will suffer if medical training is not ‘prioritised and funded’ by trusts, Health Education England (HEE) has warned.
HEE has set out actions in its “Covid training recovery interim report” that must be done alongside NHS England, the Department of Health and Social Care and others to protect post-covid workforce recovery.
At the beginning of the pandemic, junior doctors’ training was severely disrupted because thousands of staff were redeployed to covid wards, while most routine elective operations and diagnostic procedures were stopped.
HEE says training has still not returned to pre-covid levels, and fears there could be further disruptions over winter if significant volumes of elective care are cancelled.
According to its report, if medical training is not “prioritised and funded”, the “long-term costs to service are significantly greater”.
“If delivery recovery is prioritised over training recovery there will be an initial increase in service delivery time and value, but this will be followed swiftly by a reduction in service delivery time and value,” it warned.
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Source: HSJ, 13 October 2021
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Plan to boost face-to-face GP consultations

GPs in England are being told to see more patients face-to-face as ministers unveil a £250m winter rescue package.
The emergency funding is being handed to GPs so they can recruit extra locum staff with an emphasis on providing more same-day appointments. Social distancing rules are also expected to be relaxed so that GPs can bring more people into their buildings. 
It comes amid mounting criticism about the fall in face-to-face appointments since the start of the pandemic.
Only 58% of patients were seen face-to-face in August - the first full month following the ending of restrictions. That compares with 54% in January and more than 80% before the pandemic.
Patients have also complained of long waits on phone lines to book an appointment.
The £250m funding is part of the extra £5bn Covid fund announced last month to help the NHS through to the end of the year, and comes on top of the £12bn set aside for GP services this year.
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Source: BBC News, 14 October 2021
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Dentist NHS targets can not be reached without putting patients and staff at risk

A patients' group says it is concerned over a lack of access to NHS dentists in South Gloucestershire after two surgeries turned private.
Frampton and Flaxpits surgeries say NHS targets can not be reached without putting patients and staff at risk. and they must go private to survive.
Vicky Marriott, of Healthwatch, an independent statutory body representing patients, said not having an option to have NHS care was a "real concern".
In a letter to patients, Dr Dimitri Haddjeri, dentist at Framptom and Flaxpits surgeries, said "target-driven, high-volume dentistry" was "not fit for purpose" and did not put the patient first.
He said NHS targets could not be reached without putting patients and staff at risk.
Ms Marriott said there were "enormous problems" for people trying to find NHS care across South Gloucestershire, Bristol and North Somerset.
"Between July and September this year, in Bristol alone, we've had 73 people contact us saying that they've been emailing or phoning every single dental practice to see if they can get treatment and haven't been able to," she said.
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Source: BBC News, 13 October 2021
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Councillors call for NHS trust bosses to resign over maternity scandal

Senior managers at an NHS trust are facing calls to resign from local councillors after criticism of the trust’s culture and widespread bullying.
The chair of Nottinghamshire County Council's health scrutiny panel has called for the chair of Nottingham University Hospitals Trust Eric Morton to step down along with Keith Girling, the trust’s medical director.
Councillor Sue Saddington, chair of the council’s scrutiny committee, said she would be writing to health secretary Sajid Javid over concerns about leadership at the trust.
An investigation by The Independent and Channel 4 News earlier this year uncovered dozens of cases of negligent baby deaths and injuries costing millions of pounds in compensation. Families have accused the trust of trying to cover-up mistakes and not learning from errors.
More than 30 babies have died at the trust in the past decade with 46 children left with brain damage.
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Source: The Independent, 13 October 2021
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Charities say Covid booster rollout for immunosuppressed is ‘chaotic failure’

The programme of giving third Covid vaccinations to people with compromised immune systems has been a “chaotic failure”, charities have said, with fewer than half of those eligible contacted about a third jab before an NHS deadline this month.
Surveys by Blood Cancer UK and Kidney Care UK found that for both groups of patients, between 55% and 60% had yet to be invited to get a third injection, seen as particularly vital for conditions which affect people’s immune systems, as they are generally less protected by two jabs.
The charities said many of those who responded were desperately worried and were struggling to get information about a third vaccination. Some people with blood cancer had resorted to going to vaccination centres without an appointment, pleading for a third dose, Blood Cancer UK said.
Official figures show there were 45,066 confirmed new Covid cases in the UK on Thursday, the highest daily total since mid-July.
Kidney Care UK said the poor communication highlighted what seemed to be a “woeful lack of preparation” for the programme, the guidance for which was agreed on 2 September.
The third dose programme for people with compromised immune systems is separate to the wider rollout of booster jabs being offered to everyone over 50, and others with clinical vulnerabilities, which started on 15 September.
Read full story
Source: The Guardian, 15 October 2021
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White doctors in London are six times more likely to be offered jobs than black doctors

White doctors applying for medical posts in London are six times more likely to be offered a job than black applicants, figures released under the Freedom of Information Act show.
The new data also show that white doctors are four times more likely to be successful than Asian candidates or candidates from a mixed ethnic background.
The figures were uncovered by Sheila Cunliffe, a senior human resources professional who works in workforce transformation across the NHS and the wider public sector. Cunliffe sent freedom of information requests to all 18 NHS acute trusts in London asking for a breakdown by ethnicity for 2020-21 of the numbers of applicants for medical jobs, shortlisted candidates, and candidates offered positions. 
Twelve of the 18 trusts shared their full unredacted data with The BMJ on all grades of job applications. Across these 12 trusts, 29% (4675 of 15 853) of white applicants were shortlisted in 2020-21, compared with 13% (2041 of 15 515) of black applicants, 14% (8406 of 59 211) of Asian applicants, and 15% (1620 of 10 860) of applicants of mixed ethnicity.
Overall, 7% (1148) of white applicants were offered jobs, compared with 1% (188) of black applicants, 2% (1050) of Asian applicants, and 2% (188) of applicants of mixed ethnicity.
Cunliffe said that the findings were just one indicator of the barriers that applicants from ethnic minorities faced. “The racism some of these results point to will be replicated in the day-to-day lived experience of staff working within the trust,” she said. “NHSEI [NHS England and NHS Improvement] need to look at data in a more detailed way and, where needed, set out to trusts their clear expectations and targets for improvement.”
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Source: BMJ, 13 October 2021
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Covid test lab suspended over wrong results

Around 43,000 people in England may have been wrongly told their Covid-19 test was negative because of errors at a lab.
Testing at the Wolverhampton laboratory has been suspended following an investigation by NHS Test and Trace.
It is now contacting those affected, mainly in the south west region, to ask them to take another Covid test.
Concerns were raised when people had positive lateral flow tests but negative PCR results from the lab.
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Source: BBC News, 15 October 2021
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CQC criticises care scandal trust for 'unsafe staffing'

The trust at the centre of a maternity scandal does not have enough midwifery staff to keep women and babies safe, a Care Quality Commission (CQC)inspection has revealed.
East Kent Hospitals University Foundation Trust relied on community midwives to fill slots at its acute unit, with some of them working 20-hour days after being called in to help cover and feeling outside of their competence.
The trust had suspended a midwife-led unit and diverted women in labour to other hospitals – and when the CQC raised the understaffing issue at its inspection in July, it suspended its home birth service. But the CQC found that the number of midwives and maternity workers on duty rarely matched planned numbers and managers rarely calculated staffing numbers accurately, with some elements of the workload not being factored in.
Lack of staff meant there was a risk to the safe assessment and monitoring of women and babies at the trust’s William Harvey Hospital in Ashford. Unqualified staff were having to deal with telephone queries from women who needed advice and support.
Read full story (paywalled)
Source: HSJ, 15 October 2021
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Austerity since 2010 linked to tens of thousands more deaths than expected

Austerity measures introduced by David Cameron’s coalition government after 2010 can be linked to tens of thousands of additional deaths, according to a damning new study.
A paper published by researchers at the University of York concluded that reductions in funding to health can be linked to an extra 57,550 fatalities.
Researchers looked at the healthcare spending of the Conservative and Liberal Democrat government after 2010.
The researchers said the results of their paper confirmed what had been reported in previous studies.
But the conclusions of causal impact of social care, public health and healthcare expenditure on mortality in England, published in the BMJ Open journal, make “a major contribution by additionally estimating the effect of social care expenditure,” its authors said.
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Source: The Independent, 15 October 2021
Patient Safety Learning

Trusts failing to report ‘concerning’ numbers of hospital-acquired covid cases

Some acute trusts have failed to report large numbers of hospital-acquired covid infections as patient safety incidents, despite NHS England describing this as ‘fundamental’. 
HSJ examined the numbers of “infection control” patient safety incidents reported to the national reporting and learning system in 2020-21, and compared this to separate NHS England data on covid infections most likely to have been acquired in hospital.
The number of incidents reported to the NRLS in the 12-month period should in theory be higher, as it covers all types of hospital-acquired infections, while the NHSE data only covered covid infections in the last seven months of the year. 
This appears to hold true nationally, with almost 59,000 incidents reported to the NRLS, compared to around 36,000 likely hospital-acquired covid infections suggested by the NHSE data. But for around a third of trusts, the incident numbers reported to the NRLS were smaller, with some appearing to report very low numbers.
Helen Hughes, chief executive of patient safety charity Patient Safety Learning, said: “The scale of the under-reporting set out in these findings is particularly concerning.”
“As this data informs assessment of performance at both organisational and national levels, it is possible that this could create a false assurance about the extent of harm in this period,” Ms Hughes said.
“Where organisations are now retrospectively completing serious incident reports, there are obvious questions as to whether key insights will have been lost as memories of incidents fade over time and their causes.”
“However, they rely on the capacity and commitment of staff behind them. The pandemic has placed an enormous strain on the health service and we have heard from staff the time constraints this has put on them to report patient safety incidents,” she added. 
Read full story (paywalled)
Source: HSJ, 15 October 2021
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Pregnant women at risk from NHS workers’ mixed messages over safety of jab

Pregnant women are being advised by some health professionals not to have the Covid vaccine despite an edict from the NHS that they should encourage them to get the jab. One in six of the most critically ill Covid patients requiring life-saving care are unvaccinated pregnant women, figures released last week show.
Yet messages sent to the Vaccines and Pregnancy helpline, launched on 20 August to help pregnant women navigate information about the vaccine, suggest that some midwives are advising against the jab.
One said: “I was initially keen to have the vaccine and then advised by a midwife not to have it.” Another wrote: “I had my first dose before I knew I was pregnant. Now I’m pregnant I’ve been told I’m not allowed my second.” Another reported: “I’ve been advised by midwives not to get the vaccine due to the impact on ovulation and menstruation.”
The helpline was set up by the organisation Full Fact in partnership with the campaign group Pregnant Then Screwed. Many of those contacting it complained of conflicting advice while others were pushed from pillar to post. One said: “I’m pregnant and really confused about getting the vaccine. I’ve spoken to my health visitor, who said speak to your GP, the GP said speak to your midwife, and the midwife said they can’t advise me.”
Full Fact’s deputy editor, Claire Milne, said the helpline was established to counter misinformation about the vaccine. She explained: “It’s not right so many pregnant women have been left scared for their safety and that of their unborn children.
“Messaging around the safety of the vaccines in pregnancy has been, at times, confused. It’s vital that up-to-date information is available – especially when speaking with health professionals.”
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Source: The Guardian, 17 October 2021
Patient Safety Learning

World Menopause Day: "We have to better support women"

MP Carolyn Harris is part of a movement determined to smash the remnants of the menopause taboo, pushing a private member’s bill to turn up the volume on a debate about the menopause that is growing louder by the day.
As an increasing number of countries, businesses and individuals mark World Menopause Day today, Harris says she is ready to shame whoever stands in the way of progress.
Harris will lead a small army of supporters to Parliament Square in London before her bill, which is due to be heard on the 29 October, to demand free prescriptions for hormone replacement therapy in England – already available in Scotland and Wales. The government is said to be “interested” in the bill, with Harris adding that she has cross-party support from dozens of MP.
“In the last two years the narrative has completely changed,” says Harris, who adds that since the private members bill was announced she’s had calls from countries from Canada and the US, to Australia and Japan.
“People are waking up to the fact that we have to find a better way of supporting women through the menopause,” she says. “Women are enhanced coming through this process, but only if they get the support they need.”
The evidence suggests they all too often don’t. There are more than 13 million currently experiencing menopause or perimenopause in the UK. Menopause campaigners argue that medical sexism and a lack of training means many women are left to suffer the symptoms of menopause – which can include depression, anxiety, insomnia and brain fog as well as hot flushes.
Harris’s own experience with the menopause was brutal. Twenty years after losing her eight-year-old son in a road traffic accident she blamed herself for not processing her grief when she was hit by a deep depression. “It took me six years, having conversations with women, for me to realise I was going through the menopause,” she says.
Read full story
Source: The Guardian, 18 October 2021
Patient Safety Learning

Care increasingly disrupted by building failures as NHS repair bill grows

The increase in estates-related problems disrupting clinical services comes despite the government handing out £600m to trusts last year to modernise their facilities, and at a time when the NHS is struggling to bring down elective waiting lists and handle high emergency demand.
Annual figures published by NHS Digital yesterday show nearly 7,000 “clinical service incidents caused by estates and infrastructure failure” in 2020-21. This marks a 15% increase on the previous year, although it is less than the level of growth in 2017-18 (25 per cent) and 2018-19 (22%).
The incidents are defined as infrastructure failures which cause delays, cancellations or other interference with clinical services. This includes issues like power outages, building defects, and even a lack of estates and facilities staff such as porters.
High-risk estate is defined as needing “urgent priority” to prevent “catastrophic failure, major disruption to clinical services, or deficiencies” in safety which are “liable to cause serious injury and/or prosecution”.
Read full story (paywalled)
Source: HSJ, 15 December 2021
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