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

NHS to give therapy for depression before medication under new guidelines

Millions of people with mild depression in England should be offered therapy, exercise, mindfulness or meditation before antidepressants, according to the first new NHS guidelines in more than a decade.
Under draft guidance, the National Institute for Health and Care Excellence (NICE) recommends the “menu of treatment options” be offered to patients by health professionals before medication is considered.
Currently, those with mild depression are offered antidepressants or a high-intensity psychological intervention, such as cognitive behavioural therapy (CBT). The shake-up forms part of the first new recommendations to identify, treat and manage depression in adults since 2009.
According to the Office for National Statistics (ONS), about one in six (17%) adults experienced some form of depression this summer. The rate is higher than before the pandemic, when 10% of adults experienced it. Younger adults and women are more likely to be affected, the ONS found.
A 2019 review showed 17% of the adult population in England (7.3 million people) had been prescribed antidepressants in the year 2017-18.
Dr Paul Chrisp, director of the centre for guidelines at NICE, said: “The Covid-19 pandemic has shown us the impact depression has had on the nation’s mental health. People with depression need these evidence-based guideline recommendations available to the NHS, without delay.”
Nav Kapur, professor of psychiatry and population health at the University of Manchester and chair of the guideline committee, said: “As a committee we have drawn up recommendations that we hope will have a real impact on people who are suffering from depression and their carers. In particular we’ve emphasised the role of patient choice – suggesting that practitioners should offer people a choice of evidence-based treatments and understanding that not every treatment will suit every person.”
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Source: The Guardian, 23 November 2021
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Trust focused on ‘reputation’ failed to address patient harms

A focus on “reputation management” was a factor in how an acute trust failed to properly investigate serious safety concerns in a dysfunctional department where consultants were “divided along ethnic lines”.
An external review into the urology services at University Hospitals of Morecambe Bay Foundation Trust has identified 520 cases where patients suffered “actual or potential harm”, including several cases where patients died.
The review, commissioned by NHS England, has found there were “multiple individual, team, organisational, and regulatory shortfalls which have resulted in a systemic failure to deliver good urological care at all times”.
Much of the report focuses on the trust’s failure to properly investigate concerns being raised, and to sort out poor relationships within the department which dated back 20 years.
Read full story (paywalled)
Source: HSJ, 24 November 2021
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Progesterone recommended to prevent early miscarriage

Women who experience bleeding in early pregnancy and have had at least one miscarriage should be treated with the hormone progesterone.
The new guidance, from the National Institute for Health and Care Excellence (NICE), is based on research suggesting the treatment could lead to 8,450 more births each year in the UK.
The more miscarriages a woman had, the more effective progesterone was, the trial found. The naturally occurring hormone helps prepare the womb for the growing baby.
About one in five women experience bleeding, or spotting as it is sometimes called, in the first 12 weeks of pregnancy. It often causes no problems but they are advised to have it checked out with their doctor or midwife to be sure.
Some may experience a "threatened miscarriage", where bleeding continues along with the pregnancy. Most are told to go home and wait and see what happens next.
The new (NICE) guidance recommends inserting progesterone pessaries into the vagina twice a day.
A trial carried out by researchers at the Tommy's National Centre for Miscarriage Research which the new guidance is based on, found that progesterone didn't make much of a difference for women who just had bleeding and no previous miscarriages. But the more miscarriages a woman had suffered, the more effective progesterone was.
One of those behind the Tommy's National Centre for Miscarriage Research research, Prof Arri Coomarasamy, from the University of Birmingham, said: "This is a very significant moment.
"We have an intervention that works that can stop a miscarriage. This gives hope to thousands of couples throughout UK."
"But it's really important to appreciate that only some miscarriages can be prevented by progesterone."
"There are other causes for miscarriages."
"We still need to study them. We need to find other effective treatment."
Read full story
Source: BBC News, 24 November 2021
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G7 presidency statement – patient safety: from vision to reality

On Monday 22 November, the UK under its G7 Presidency convened a meeting on ‘Patient safety: from vision to reality’, co-sponsored with the World Health Organization (WHO). Patient safety is a critical global public health issue and is essential if health systems are to advance and achieve universal health coverage (UHC). This event provided an important opportunity to demonstrate the continued importance of patient safety as an urgent global endeavour, facilitate international collaboration, and support strategic initiatives designed to eliminate avoidable harm in healthcare globally.
Since 2016, the UK has worked closely with international partners, including in the G7, to raise the profile of patient safety issues and work together to drive solutions. This engagement led to the establishment of the annual Global Ministerial Summit on Patient Safety and adoption by the 72nd World Health Assembly (2019) of a UK co-led Resolution on ‘Global Action on Patient Safety’ (creating an annual World Patient Safety Day on 17 September) and WHO’s ‘Global Patient Safety Action Plan 2021 to 2030’ by the 74th World Health Assembly (2021).
The event on 22 November brought together G7 countries, UK devolved administrations, system partners and patient advocates to share learning and reaffirm the importance of this critical issue. With the unprecedented coronavirus (COVID-19) pandemic, patient safety has become an even more crucial area for international cooperation, and the event underlined the importance of countries continuing to work together to maintain momentum on improving patient safety worldwide.
The event was chaired by Dr Aidan Fowler, National Director of Patient Safety for NHS England and NHS Improvement, and was very well attended by global experts. The importance of continued international work to improve patient safety was underlined in the keynote speeches from Dr Tedros Adhanom Ghebreyesus, Director General of WHO, as well as Sajid Javid, Secretary of State for Health and Social Care, and Jeremy Hunt, Chair of the Health and Social Care Committee.
The event also provided an important opportunity for sharing learning from around the world; and highlighted the need for and value of continued collaboration between countries on health issues. Interventions from G7 countries and UK devolved administrations provided important insights into how different countries are tackling this shared aim of eliminating avoidable harm in healthcare. It was clear that although health systems differ from country to country, many threats to patient safety have similar causes and similar solutions.
 
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Source: Department of Health and Social Care, 23 November 2021
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Treasury’s dead hand over NHS policy is the biggest patient safety threat

Patients are dying in the backs of ambulances or on trolleys in A&E while others languish in beds unable to be discharged due to the collapse in social care. Others waiting in pain are desperate to get a bed for much-needed surgery.
While there are many ingredients mixing together to create the current NHS crisis, a widespread shortage of nurses, doctors and other essential staff is one of the major contributory factors.
Many in the NHS reacted with disbelief on Tuesday after 280 MPs voted with the government to reject a bid to force through better workforce planning for the NHS.
Former health secretary Jeremy Hunt had pulled together a coalition of health organisations and charities who backed his proposal which demanded ministers draw up and publish workforce plans every two years.
Mr Hunt’s amendment fell victim to the fear of the cost of actually training enough doctors and nurses to work in the NHS.
The Treasury’s dead hand over NHS policy has and continues to be one of the biggest patient safety threats in the UK.
As Mr Hunt told MPs, the costs are borne not only from huge bills for locum doctors and nurses who earn incredible pay working alongside exhausted full-time staff, but also in the safety failures caused by staff shortages.
Exhausted nurses will make mistakes. One nurse cannot safely look after a ward of 16 elderly patients. A doctor can only see one patient at a time in A&E.
Speaking to MPs, Mr Hunt pleaded with the Commons to offer some hope to the NHS workforce.
He said NHS staff were “exhausted” but also “daunted” by the challenges they were seeing. He added: “All they ask is one simple request, that they can be confident we are training enough of them for the future.”
Read full story
Source: The Independent, 23 November 2021
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Two thirds of hospital’s transplant patients died after five years

Lung transplant patients in Birmingham are facing significantly worse survival rates as a “sobering” report has revealed two-thirds of patients have died within five years, The Independent has learned.
Survival rates for lung transplant patients at University Hospitals Birmingham Foundation Trust after five years are now almost 20 percentage points lower than the other main hospitals specialising in lung transplants.
The latest figures from NHS Blood and Transplant (NHSBT) have revealed Birmingham’s five-year survival rates decreased from 79% in 2015-16 to 31% in 2020-21, and have consistently been the lowest compared to the other four other transplant hospitals in Newscastle, Cambridgeshire, London and Manchester.
The latest NHSBT’s report showed of those patients who had a transplant in Birmingham between 2012 to 2016, 31 per cent survived. During the same period in Newcastle 47 per cent of patients survived, in Papworth and Manchester 51%, while London’s Royal Harefield recorded a 56 per cent survival rate.
Birmingham recorded the lowest patient survival rates 90 days after surgery and for one year after surgery between 2016-17 to 2020-21. Although for these measures the hospital was within the national average, unlike its five-year survival rates.
One transplant surgeon has raised concerns over the continued poor survival rates at Birmingham, claiming they showed the “staggering” failure for the programme in the city to improve.
Read full story
Source: The Independent, 23 November 2021
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‘Humiliated’ trust staff complain of ‘unprofessional behaviour’ and ‘lack of compassion’

‘Unprofessional’ behaviours, a lack of compassion, and tension among staff and managers are all contributing to pockets of ‘poor culture’ at an acute trust.
A Freedom to Speak Up report presented to the board of Buckinghamshire Healthcare Trust found there had been an increase in bullying and reports of staff members being “humiliated” during the last three months.
The report, which covers the first two quarters of 2021-22, highlighted a “lack of compassion, kindness, and understanding” between colleagues and noted “increasing levels of frustration” that people are not being held to account for “unprofessional” poor behaviours.
The report added the findings were not surprising due to the pressures of the pandemic experienced by staff.
It found: “There appears to be an increase in the proportion of concerns around interpersonal behaviours and communication issues as well as levels of frustration and tension amongst staff and managers.”
Read full story (paywalled)
Source: HSJ, 24 November 2021
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NHS Digital and NHSX to merge with NHS England

It has been revealed that both NHS Digital and NHSX are to be incorporated into NHS England and Improvement.
In a letter to staff, NHS England and Improvement’s chief executive, Amanda Pritchard said: “As a single organisation, we can further accelerate the digital transformation of the NHS and redouble our efforts to address health inequalities...”
Pritchard praised NHSX and NHS Digital for their critical role throughout the pandemic delivering the NHS Covid Pass, Covid vaccine systems, virtual wards and many other innovations.
Going forward she said: “Our Transformation Directorate will continue to lead the digital transformation agenda for the NHS and social care at national and ICS level, alongside colleagues from Improvement and Innovation, Research and Life Sciences.”
In other major changes, Pritchard also announced that Health Education England is to merge with NHS England and Improvement.
Secretary of state for health and social care, Sajid Javid, said:  “To ensure our record NHS investment makes a lasting impact, I am bringing workforce planning and digital transformation into the heart of the NHS."
“These reforms will support our recovery from Covid-19 and help us tackle waiting lists to give patients excellent care in years to come.
Read full story
Source: Digital Health, 22 November 2021
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Burnt out staff ‘triggered’ by ‘it’s OK’ messaging from ministers

Frontline staff are being ‘triggered’ by ministers playing down the ‘overwhelming’ pressures facing the health service with “a ‘move along, no story here’-type attitude”, a royal college president has warned.
The Royal College of Emergency Medicine’s Katherine Henderson said the intentions of those making such comments may be “well meaning” but that it was important ministers and NHSE leaders were “humble and transparent about the scale of the problem [facing the NHS] at the moment”.
Katherine Henderson said: “The scale of the problem feels quite overwhelming, and the kind of ‘move along, no story here’-type attitude I think is not great for the people working in healthcare. They need to feel heard.”
Read full story (paywalled)
Source: HSJ, 24 November 2021
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100 people held more than 20 years in ‘institutions’

One hundred people with learning disabilities and autism in England have been held in specialist hospitals for at least 20 years, the BBC has learned.
The finding was made during an investigation into the case of an autistic man detained since 2001. Tony Hickmott's parents are fighting to get him housed in the community near them.
Mr Hickmott's case is being heard at the Court of Protection - which makes decisions on financial or welfare matters for people who "lack mental capacity".
Senior Judge Carolyn Hilder has described "egregious" delays and "glacial" progress in finding him the right care package which would enable him to live in the community. He lives in a secure Assessment and Treatment Unit (ATU) - designed to be a short-term safe space used in a crisis. It is a two-hours' drive from his family.
This week, Judge Hilder lifted the anonymity order on Mr Hickmott's case - ruling it was in the public interest to let details be reported. She said he had been "detained for so long" partly down to a "lack of resources".
Like many young autistic people with a learning disability, Mr Hickmott struggled as he grew into an adult. In 2001, he was sectioned under the Mental Health Act. He is now 44.
In addition to the 100 patients, including Mr Hickmott, who have been held for more than 20 years - there are currently nearly 2,000 other people with learning difficulties and/or autism detained in specialist hospitals across England.
In 2015, the Government promised "homes not hospitals" when it launched its Transforming Care programme in the wake of the abuse and neglect scandal uncovered by the BBC at Winterbourne View specialist hospital near Bristol. But data shows the programme has had minimal impact.
Read full story
Source: BBC News, 24 November 2021
Sam

Plan to scrap tens of millions of NHS appointments ‘could put patients at risk’

Plans to scrap tens of millions of “unnecessary” hospital follow-up appointments could put patients at risk and add to the overload at GP surgeries, NHS leaders and doctors are warning.
Health service leaders in England are finalising a radical plan under which hospital consultants will undertake far fewer outpatient appointments and instead perform more surgery to help cut the NHS backlog and long waits for care that many patients experience.
The move is contained in the “elective recovery plan” which Sajid Javid, the health secretary, will unveil next week. It will contain what one NHS boss called “transformative ideas” to tackle the backlog. Thanks to Covid the waiting list has spiralled to a record 5.8 million people and Javid has warned that it could hit as many as 13 million.
Under the plan patients who have spent time in hospital would be offered only one follow-up consultation in the year after their treatment rather than the two, three or four many get now.
“While it is important that immediate action is taken to tackle the largest ever backlog of care these short-term proposals by the health secretary have the potential to present significant challenges for patients and seek to worsen health disparities across the country,” said Dr David Wrigley, the deputy chair of council at the British Medical Association.
Read full story
Source: The Guardian, 25 November 2021
Sam

Health regulator accused of moral corrupt

A doctor has accused England's health and care regulator of "moral corruption".
Consultant orthopaedic surgeon Shyam Kumar says the Care Quality Commission misled the public over patient safety.
Mr Kumar alleges he was unfairly dismissed from his role as a special adviser to the CQC because he acted as a whistleblower.
His claims were made during an employment tribunal hearing in Manchester.
Seconded by his employer, University Hospitals of Morecambe Bay NHS Foundation Trust, Mr Kumar had been giving the CQC expert advice on surgical departments during hospital inspections.
But he was dismissed from this role, in early 2019.
The CQC said a letter he had written to a colleague he had been in dispute with at his trust was incompatible with the standards expected of its special advisers.
But Mr Kumar claims he was dismissed because, in 2018, he raised concerns with senior CQC figures that he was expected to simply rubber-stamp the final report following an under-resourced inspection.
And he accused the regulator of sweeping his concerns under the carpet and providing false assurances on patient safety.
Read full story
Source: BBC News, 25 November 2021
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Drug and alcohol treatment sees rise in deaths in England

There has been a 27% rise in people dying while in treatment for drug and alcohol addiction during the pandemic, an official report shows.
Changes to support and reduced access to healthcare during lockdowns are likely to have been factors, it says.
Between April 2020 and March 2021, 3,726 people died while in contact with drug and alcohol services - up from 2,929 the year before.
The figures, published by the Office for Health Improvement and Disparities, for England, show a small 2% rise in the overall numbers of adults receiving help for drug and alcohol problems from 2020 to 2021.
Out of more than a quarter of a million people affected, more than half were in treatment for problems with opiates - medicines to treat pain - and a quarter with alcohol problems.
The proportion of deaths in treatment for alcohol addiction rose by 44% to 1,064 and for opiate addiction by 20% to 2,418.
UKAT, a group providing residential detox treatment, said a "concerning" number of services closed their doors to addicts during the pandemic.
"But drug and alcohol treatment is critical care intervention and cannot be simply put on pause," said Nuno Albuquerque, head of treatment for the group.
"It cannot be a coincidence that more people have subsequently lost their lives when they were in fact trying to save it."
Read full story
Source: BBC News, 25 November 2021
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Late diagnosis of breast cancer rises as NHS struggles in Covid crisis

Soaring numbers of women are being diagnosed with advanced breast cancer, undermining their chances of survival, because of Covid’s disruption of NHS care, a charity has warned.
The number of women being diagnosed with the disease at stage 4 is as much as 48% higher in some months than expected, with the pandemic to blame, says Macmillan Cancer Support.
At the same time, fewer women are being confirmed as having breast cancer at stage 1, when their chances of responding well to treatment and living longer are much higher.
Macmillan estimates that there is now a backlog of 47,300 people across the UK who have not yet been diagnosed with some form of cancer, as a direct result of Covid. They include people who could not access care in the usual way because many NHS services were scaled back, and also those who were too scared to seek help or did not want to add to the pressure the health service was already under. None have had a confirmed diagnosis of cancer, though some may be undergoing tests or screening.
Steven McIntosh, Executive Director of Advocacy and Communications at Macmillan Cancer Support, says:
“Nearly two years into the pandemic, there is still a mountain of almost 50,000 people who are missing a cancer diagnosis. Thousands more are already facing delays and disruption as they go through treatment. While hard-working healthcare professionals continue to do all they can to diagnose and treat patients on time, they are fighting an uphill battle. Cancer patients are stuck, waiting in a system that doesn’t have the capacity to treat them fast enough, let alone deal with the backlog of thousands who have yet to come forward.”
“The Government has promised an NHS Elective Recovery Plan. This must show how it will tackle spiralling pressures on cancer services. It has never been more crucial to boost NHS capacity to treat and support everybody with cancer, so people receive the critical care they need now and in the years to come.”
Read full story
Source: The Guardian, 26 November 2021
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Mental health crisis referrals leap by almost 75%

Referrals to mental health crisis services in England have increased by almost 75% ‘post-pandemic’, senior NHS leaders have revealed.
Documents submitted to NHS England and Improvement’s November board meeting capture the scale of demand facing the sector, which national director Claire Murdoch described to fellow leaders as “huge”.
Bed occupancy rates in adult acute services have remained above the recommended ‘safe’ level of 85% since June 2020, performance reports suggest.
Above that threshold, experts warn that patient safety, out of area placements, and surge demand risks are likely to increase.
Ms Murdoch wrote in her report to the board that between 180,000 and 200,000 calls per month were being fielded by covid-19 response crisis lines in the first quarter of 2021-22 — more than 6,000 each day.
She added that there had been a 74% increase in referrals to crisis services ‘post-pandemic’: ”We’re now seeing huge demand and we’re back to pre-covid levels.” She said some people had not sought help during pandemic peak periods and this was leading to more severe demand."
Read full story (paywalled)
Source: HSJ, 25 November 2021
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NHS race body commits to avoiding blanket terms such as ‘BAME’

An independent body set up by the NHS to tackle health inequalities has formally committed to never use blanket acronyms such as “BAME” after feedback that they are not representative.
The NHS Race and Health Observatory launched a four-week consultation with the public in July on how best to collectively refer to people from black, Asian and minority ethnic groups.
The Observatory said it has become the norm in public policy to use initialisms to refer to a “hugely diverse” group of people, but that renewed scrutiny has been spurred on by the Black Lives Matter movement.
It said terminology that “crudely conflates” different groups “does not just erase identities; it can also lead to broad brush policy decisions that fail to appreciate the nuance of ethnic inequality in the UK”.
Generic collective terms such as “BAME”, “BME” and “ethnic minority” are “not representative or universally popular”, the Observatory said after receiving responses from 5,104 people.
It found no single, collective umbrella term to describe ethnic groups was agreed by the majority of respondents.
The body had previously said it was committed to avoiding the use of acronyms and initialisms, but has now formalised this as one of five key principles it is adopting in its communications.
Where possible it will be specific about the ethnic groups it is referring to, but where collective terminology is necessary it will “always be guided by context and not adopt a blanket term”.
Read full story
Source: The Independent, 26 November 2021
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