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

UK survey suggests 1.3 million have Long Covid

About 1.3 million people in the UK have Long Covid symptoms lasting more than four weeks after an initial infection, an Office for National Statistics survey suggests. Of those, 892,000 (70%) first caught the virus at least 12 weeks ago and 506,000 (40%) at least a year ago.
The survey asked nearly 352,000 people to record their own symptoms. There is no universally agreed definition of long Covid and different studies use varying definitions.
The ONS survey, over four weeks in November and December 2021, suggests, of those with Long Covid:
51% have fatigue 37% have loss of smell 36% have shortness of breath 28% have difficulty concentrating. University of Exeter senior clinical lecturer Dr David Strain said: "The stark warning here is that, based on this, in the previous waves, over 800,000 people have their day-to-day activities significantly affected over three months after catching Covid and nearly a quarter of a million report this has a dramatic impact on their quality of life.
"As we continue to see case numbers of Omicron rise, we must be wary that our reliance purely on hospitalisations and death as a measure of the risk from Covid could grossly underestimate the public-health impact of our current Covid strategy."
Read full story
Source: BBC News, 6 January 2022
 
Patient Safety Learning

Nurse ‘bullied’ for wearing cross wins unfair dismissal case

A Christian nurse who claimed she was discriminated against for wearing a cross at work has won her case for unfair dismissal.
Mary Onuoha, a theatre practitioner at Croydon University Hospital in London, said she was bullied and harassed for refusing to remove her necklace in 2018.
But an employment tribunal has ruled Croydon Health Services NHS Trust discriminated against and harassed Ms Onuoha over her refusal to remove the jewellery. The trust told her the necklace was a safety risk and must not be outwardly visible.
Ms Onuoha, supported by Christian Legal Centre, said she had worked at the hospital for 13 years before being asked to remove the symbol.
The tribunal found the employer’s uniform policy arbitrary, with many staff allowed to wear necklaces and other religious symbols were permitted.
Following the ruling, Christian Legal Centre chief executive Andrea Williams said the trust’s interpretation of uniform guidance had led to a campaign of harassment against a devoted, experienced, and highly professional nurse, who was in effect hounded out of the NHS.
Ms Onuoha said she was investigated and suspended from clinical duties when she refused to remove the item and she was demoted to receptionist duties. In June 2020, she went off work with stress and said she felt she had no alternative but to resign.
Read full story
Source: Nursing Standard, 6 January 2022
Patient Safety Learning

Patients at risk’ from ‘hastily rolled out virtual wards’

NHS England’s plans to rapidly expand virtual wards are being ‘hastily rolled out’ and could put patients at risk while taking up significant staffing capacity, leading clinicians have warned.
The Society for Acute Medicine and the Royal College of Physicians are among those who have raised concerns to HSJ about the huge increase in the use of the virtual wards model, under which patients are discharged home and given oximeters that fit on their finger so they can be remotely monitored by clinical staff.
The concerns follow NHSE ordering trusts to ensure a minimum of 15% of hospital covid patients were being treated in virtual wards, in plans to help ease pressures on hospital wards announced just before Christmas.
At the time NHSE announced the plans there were around 7,000 covid inpatients in English NHS hospitals, meaning around 1,000 patients should be in virtual wards. But the covid inpatient figure had more than doubled to nearly 16,000 by 5 January.
The project is hugely significant because NHSE and trust chiefs want to use virtual wards much more widely – including for non-covid patients – and believe they represent a potentially game-changing option when it comes to alleviating pressure on hospitals and speeding up discharges.
Many of the clinicians who spoke to HSJ were supportive of the principle of virtual wards but had serious concerns about the speed and timing of the rollout. They said there was a lack of evidence the approach was safe.
Society for Acute Medicine president Tim Cooksley said virtual wards had potential for the future but that they “simply cannot be seen as a short-term mitigation measure which can be hastily rolled out mid-pandemic”.
Read full story (paywalled)
Source: HSJ, 7 January 2022
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NHS to begin move to dismiss staff who refuse covid vaccine or redeployment

Trusts will be told next week how they should go about dismissing potentially thousands of NHS staff who have decided not to be vaccinated against covid, HSJ has learned.
Last year, the government decided all patient-facing NHS staff would need to have received their first dose of the covid vaccine by 3 February, and two doses by April 2022. The stipulation covers non-clinical staff who may have face-to-face contact with patients, such as receptionists, porters and cleaners.
NHS England published the first part of its guidance for employers in December last year, which warned staff who have to be redeployed because of a refusal to have the covid vaccination could be forced to compete for their job and also have their pay and pension affected.
HSJ understands NHSE will issue its ‘phase two’ guidance’ next week.
To date, government and NHSE announcements or guidance have not mentioned what will happen to patient-facing staff who refuse to be redeployed or are exempt from the requirement.
However, HSJ understands the new guidance will make it clear that — while redeployment remains the preferred outcome — some staff are likely to be dismissed and trusts should be prepared for taking that action next month.
Read full story
Source: HSJ, 6 January 2022
Patient Safety Learning

Absences hit 120,000 as military sends 200 staff to help hospitals

The government has announced 200 military personnel are being deployed to “support the NHS in London amid staff shortages due to COVID-19”. The 200 figure is equivalent to about 1.8% of the covid-related absences in acute trusts in the capital on Wednesday, and 0.2% of the national all-trust total of 120,000.
The Ministry of Defence will provide 40 defence medics and 160 general duty personnel, it said. The first were deployed this week, including in Whipps Cross in east London.
According to the minutes of an internal meeting held by senior leadership at the hospital, 10 general duty military personnel have been deployed. They do not have clinical training so cannot take blood, but will undertake general duties, such as feeding patients and communication with teams and relatives. 
Staff absences from NHS trusts hit nearly 120,000 on Wednesday after another increase, HSJ has learned.
Figures due to be published by NHS England are expected to show there were total absences across acute trusts of just over 80,000 on 2 January, down from more than 85,000 on 30 December. 
However, figures seen by HSJ show that, after the end of the new year bank holiday period, this acute trusts figure leapt to more than 92,000 by Wednesday (5 January).
Read full story (paywalled)
Source: HSJ, 7 January 2022
Patient Safety Learning

Trusts fall far short of NHSE discharge target

NHS trusts have been unable to get anywhere close to the target for reducing delayed discharges set by NHS England last month ahead of the omicron wave.
The latest NHSE data shows that, in the week beginning 27 December, there were on average 9,857 medically fit for discharge adult patients occupying hospital beds.
This is just 836 fewer than the average of 10,693 in the week of 13 December. This was when NHSE told trusts to discharge at least half of their medically fit patients to free up beds ahead of a surge in Covid patients.
The news follows ministers announcing £300m would be invested into the adult social care workforce to fund community placements to aid discharges. However, in the letter on 13 December, NHSE said “a significant proportion of discharge delays are within the gift of hospitals to solve”.
Meanwhile, ambulance handover delays remained a near record high levels last week as the urgent and emergency care system showed clear signs of pressure, including massive demand on NHS 111.
Read full story (paywalled)
Source: HSJ, 7 January 2022
Patient Safety Learning

Trust fined following patient’s death linked to ‘outdated’ IT system

A Norfolk hospital trust has been fined £60,000 after pleading guilty to criminal charges of exposing a 28-year-old patient who died to significant risk of avoidable harm.
Queen Elizabeth Hospital King’s Lynn Foundation Trust was sentenced on Thursday 8 December at Chelmsford Magistrates’ Court, as a result of a prosecution brought by the Care Quality Commission.
The dilapidated hospital’s “outdated” computer system, which is long overdue a major upgrade, was cited as a factor in the young patient’s death, which followed a mix-up over scans.
Lucas Allard, who was awaiting heart surgery, had attended the hospital’s emergency department on 12 March 2019 with chest pain.
He was sent home after staff determined his computerised tomography scan results meant he was fit for discharge. But two days later, a consultant discovered staff had been looking at the wrong scan, and the correct report showed significant abnormality.
Mr Allard was urgently called back to the hospital but suffered a cardiac arrest shortly after arriving, and died despite attempted resuscitation.
Read full story (paywalled)
Source: HSJ, 9 December 2022
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A WHO official weighs in on Covid, vaccines, and mistakes that were made

The Covid-19 pandemic has entered its third year, with no end in sight, and the world is fed up to the gills. A new and even more highly transmissible variant, Omicron, has been scorching through holiday gatherings over the past couple of weeks. People who are thrice vaccinated are among the infected.
STAT asks Mike Ryan, head of the health emergencies programme at the World Health Organization, if he expected the pandemic to last as long as it has, who should make the call on whether to update Covid vaccines, and what he thinks are the main mistakes the world has made.
“What’s shocked me most in this pandemic has been that absence or loss of trust,” he said of people’s unwillingness to follow the advice of public health leaders and the containment policies set out by governments," says Ryan.
Read full interview
Source: STAT, 3 January 2022
Patient Safety Learning

Pregnant women urged not to delay getting jab

Pregnant women are being urged not to delay getting their Covid jab or booster in a government campaign.
More than 96% of pregnant women admitted to hospital with Covid symptoms between May and October last year were unvaccinated, according to the UK Obstetric Surveillance System.
The campaign will share testimonies of pregnant women who have had the jab on radio and social media.
The government said the vaccine was safe and had no impact on fertility.
In December, the Joint Committee on Vaccination and Immunisation added pregnant women to the priority list for the vaccine, saying they were at heightened risk from Covid.
Around one in five pregnant women admitted to hospital with the virus needed to be delivered pre-term to help them recover, and one in five of their babies needed care in the neonatal unit, the Department of Health and Social Care (DHSC) said.
Prof Lucy Chappell, chief scientific adviser to the DHSC, told BBC Radio 4's Today programme that a third of unvaccinated pregnant women with COVID-19 needed help with breathing and one in six were admitted to intensive care.
"We've also seen stillbirths and neonatal deaths in the latest wave," she said.
Prof Chappell said the vaccine causes pregnant women to produce antibodies against the virus, which cross over to their babies and give them protection too.
Dr Jen Jardine, from the Royal College of Obstetricians and Gynaecologists, who is seven months pregnant and has had her booster jab, said: "Both as a doctor and pregnant mother myself, we can now be very confident that the Covid-19 vaccinations provide the best possible protection for you and your unborn child against this virus."
Read full story
Source: BBC News, 10 January 2022
Patient Safety Learning

Tory pledge to bolster GP surgery staff set to be broken, say health leaders

A manifesto pledge to hire 26,000 extra health professionals to work in GP surgeries is set to be broken by the government, health leaders have warned, leaving family doctors straining under a heavier workload.
About 9,500 of the promised physiotherapists, pharmacists, mental health therapists and other clinical staff so far have been recruited to help GPs and practice nurses.
Senior doctors have warned that patients will pay the price for the slow delivery of extra personnel by facing persistently long waits for an appointment.
The plan was to free up family doctors’ time by having physiotherapists see patients with sore backs, pharmacists undertaking medication reviews, counsellors supporting people with mental health problems and dieticians advising those with food-related problems.
Those 26,000 staff, alongside the arrival of “6,000 more doctors in general practice” in a separate pledge, would help GPs and their teams offer 50m more consultations, the Conservatives said. But in November the health secretary, Sajid Javid, admitted that Johnson’s often-repeated 6,000 extra GPs pledge would be missed.
“Whilst progress in meeting this target is better than the GP [recruitment] target, it’s still slow and very concerning that this could be another promise that won’t be met,” said Prof Matin Marshall, the chair of the RCGP.
“The impact of not having enough staff in general practice is being felt acutely both by GPs and our team members who are working to their limits, and our patients, who are facing longer waits for the care they need. Meeting this [extra staff] target – and the GP target – will be vital to addressing this.”
Read full story
Source: The Guardian, 9 January 2022
Patient Safety Learning

Trust tells clinicians ‘we’ll support you’ over safety risks caused by covid pressures

A trust has written to its registered workforce to reassure them of management support when delivering care in ‘extremely challenging circumstances’.
Derbyshire Community Health Services Trust sent out a “statement of support for professionally registered colleagues”, in which it thanked them for their “continued efforts”, and explained how they would support staff from a “professional and regulatory perspective”, when delivering services that require “a high level of clinical knowledge and autonomous decision-making”.
This week has seen NHS staff absences hit new highs – over 100,000 – and the military brought in to support care in London hospitals, in combination with very high community covid transmission rates and very busy acute trusts. 
The DCHST email, signed by executive director of nursing Michelle Bateman, executive medical director Ben Pearson and interim director of Allied Health Professionals Trish Bailey, said: “When services are at this high level of escalation it can mean that we are not always able to deliver care in the way we would like and that can challenge our professional values.”
Helen Hughes, chief executive of charity Patient Safety Learning, said Derbyshire Community Healthcare’s message needed to be echoed by every trust in the country.
“Without sufficient staffing resources, difficult decisions are required to prioritise care,” Ms Hughes said. “In some cases, delays in treatment as a result of these decisions could lead to avoidable harm.”
She stressed it was “imperative” that future investigations into safety incidents “properly reflect the systemic nature of reasons for error or harm, not simply blaming staff for failures to provide safe care”.
“Health professionals’ codes mean that they are not allowed to work outside their sphere of competence. But what if staff are being tacitly encouraged or required to work in an unsafe system? Staff need to be able to feel secure in raising any concerns they have, being listened to and being supported,” Ms Hughes added.
Read full story (paywalled)
Source: HSJ, 10 January 2022
Patient Safety Learning

Occupational health staff told not to get involved in decisions on mandatory covid vaccination

Occupational health professionals should avoid employment and management matters related to unvaccinated NHS staff, new guidance has warned.
The Faculty of Occupational Medicine guidance comes as trusts are considering their options of how to approach patient-facing staff who remain unvaccinated, including their potential redeployment or dismissal.
However, HSJ understands some occupational health practitioners are concerned they may become entangled in difficult ethical issues, such as the vaccination status of individual employees, or disciplinary processes.
Today’s FOM guidance said: “There is no scope for occupational health practitioners to provide an opinion on medical exemptions, whether to confirm or refute them…
“Redeployment, dismissal and other employment consequences of vaccine refusal by a worker, within the scope of the proposed regulations, are entirely employment and management matters, and not an area in which occupational health should be involved.”
FOM president Steve Nimmo said: “When the programme is implemented, occupational health professionals should be mindful of ethical and consent issues, and be careful not to be associated with any disciplinary process.”
Read full story (paywalled)
Source: HSJ, 7 January 2022
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NHS leaders accused of ‘bullying’ hospitals into silence over scale of Covid crisis

NHS leaders have been accused of downplaying the impact of the Covid crisis and putting hospitals under scrutiny for declaring critical incidents and postponing surgeries.
A leaked email urges hospitals to use the “correct terminology” and make NHS leaders aware when declaring their status.
Sources said the message was a “thinly veiled threat” and that there was “subtle pressure” amid rapid spread of Omicron.
At least 24 trusts have declared critical incidents this week, including one in Northamptonshire on Friday afternoon, while new figures show a 59% rise in staff absences in just seven days.
Trusts in London were told hospitals will be scrutinised for declaring a critical incident if there is “doubt” over the decision, according to an internal email sent from NHS England on Wednesday.
In light of media coverage, it would be “valuable” to “raise awareness of the key terminology and encourage you to ensure that you are clear ... when considering a declaration,” it said. “National scrutiny on the declaration on incidents has heightened ... and [senior managers] will need to make additional enquiries where there is doubt as to the status of an organisation’s incident.”
Shadow health secretary Wes Streeting said: “We know that the NHS is under enormous pressure and it is important that local trusts are able to be honest and open with parliament and the public about the challenges they’re facing. We are increasingly concerned that ministers are more interested in covering up problems than solving them.”
Daisy Cooper, the Lib Dem Health spokesperson, said: “This is an insult to every health worker who has given their all, and every patient with cancelled appointments and delayed surgeries.
Read full story
Source: The Independent, 9 January 2022
Patient Safety Learning

Scotland: Cancers with low survival rate 'being detected too late'

People with some of the deadliest forms of cancer are being diagnosed later than ever as a result of disruption to healthcare caused by the Covid pandemic, campaigners have warned.
Stomach, lung, pancreatic, brain, stomach and oesophageal cancers have some of the poorest long-term survival rates and have always been disproportionately diagnosed late following an emergency hospital admission. However, campaigners are concerned that the poor prognoses for these patients have been exacerbated by factors such as a reluctance to attend A&E or bother GPs during the pandemic, and by bottlenecks in the numbers of patients waiting for tests such as CT scans or endoscopy. 
A drive to raise awareness of the symptoms for these cancers – which are not subject to any routine screening programmes – along with a push for more investment into research for treatments has been launched today to mark the first Less Survivable Cancers Awareness Day.
Dawn Crosby, head of Scotland and Northern Ireland for Pancreatic Cancer UK and a member of the Less Survivable Cancers Taskforce, said: “We know that delays in diagnosis lead to much poorer outcomes for patients with these rapidly-advancing cancers. We also know the trauma associated with receiving a diagnosis in an emergency setting for both patients and families."
“These cancers are currently difficult or impossible to treat at later stages and the time from diagnosis to death is often brutally short compared to more survivable cancers.
“The situation is critical and has been exacerbated by the Covid-19 pandemic. The Taskforce is calling for a significant increase in research funding, as well as a commitment to increasing resources for early diagnosis for less survivable cancers so we can close the deadly cancer gap.”
Read full story
Source: The Herald, 11 January 2022
Patient Safety Learning

Urgent debate over cervical cancer screenings

An urgent debate has been called in the Senedd over a move to extend routine cervical screenings in Wales from every three years to five years.
Public Health Wales (PHW) said those aged 25-49 who had not tested positive for human papillomavirus (HPV) would now wait two more years between tests.
PHW said it was because the screening tests are now more accurate. However, 30,000 people signed a petition against it, citing the risk it could cause an increase in deaths.
Particularly concerned are those who have not received the HPV vaccine, a national immunisation programme for which began in 2008 for girls aged 12 to 13.
The number of signatures on the official petition on the Welsh Parliament's website was more than enough to trigger the issue to be looked at.
The change follows a recommendation from the UK National Screening Committee.
Last week, Public Health Wales apologised for causing "concern" over how it explained changes to screenings following its announcement.
Read full story
Source: BBC News, 10 January 2022
Patient Safety Learning

UK inmate gave birth to stillborn in prison toilets, inquiry finds

An inmate gave birth to a stillborn baby in shocking circumstances in a prison toilet without specialist medical assistance or pain relief, an investigation by the Prisons and Probation Ombudsman (PPO) has found.
A prison nurse who did not respond to three emergency calls from a prison officer to come to the woman’s aid when she developed agonising stomach cramps has been referred to the Nursing and Midwifery Council.
Louise Powell, 31, was unaware that she was pregnant. She gave birth on a prison toilet on 18 June 2020 at HMP & YOI Styal in Cheshire.
She previously said she believed her baby girl could have survived had she had more timely and appropriate medical intervention.
Her lawyer said they had obtained expert evidence that also suggested that the baby, who Powell named Brooke, may have survived had things been handled differently.
The report is the second by the PPO in six months to investigate the death of a baby in prison.
While Tuesday’s report found that there had not been failures before the day Powell gave birth, the ombudsman, Sue McAllister, found there were missed opportunities to establish that she needed urgent clinical attention in the hours beforehand.
“It’s not safe to have pregnant women in prison, we are just treated like a number,” Powell told the Guardian in a previous interview. “I can’t grieve for my baby yet because there are still things I don’t know, like why an ambulance wasn’t called. I want to get justice for Brooke and I decided to go public in the hope that things will change and pregnant women will stop being imprisoned.”
Read full story
Source: The Guardian, 11 January 2022
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