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

GPs in dark over plans to drop care warn move could ‘swamp NHS’

GPs and hospital leaders have been left hanging over plans to drop “non-urgent” care, and warn there’s no way to safely stem demand without impacting patients health or “swamping” the NHS further.
On Monday evening the NHS published guidance for GPs and hospital leaders over expectations to deliver the government’s new deadline for all adults to be offered a booster vaccine by the new year.
The guidance comes as reports surfaced on Tuesday that ministers were warned the NHS should expect a “significant” increase in hospitalisations, as modelling showed Omicron cases may reach 200,000 a day.
NHS England sent letters to all GP practices and Trust chiefs on Monday evening setting out some plans to support the vaccine drive, which included opening community vaccine clinics 12 hours a day every day of the week. However, the guidance was not clear on what work GPs and trusts could specifically drop to support the drive.
Several NHS leaders raised concerns over the “nightmare” of deciding what care can be reduced, in lieu of any detailed guidance from the government or NHS England, with one leader calling for “clear directive”.
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Source: The Independent, 14 December 2021
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COVID-19: Is it possible to offer every over-18 a booster vaccine dose by New Year's Eve?

Everyone over the age of 18 in England has been promised they can book their coronavirus booster appointment by the end of this year.
In a televised address on Sunday evening, Prime Minister Boris Johnson promised to deliver up to a million vaccine doses a day to ensure everyone eligible is offered a slot a month earlier than planned.
As part of the "Omicron emergency national mission" he asked NHS staff "to make another extraordinary effort" to meet the new target. This will include more vaccine centres and walk-in sites with extended opening hours, "thousands" more volunteers to deliver jabs and help from the military to oversee operations.
However, COVID ICU anaesthetist Dr Ed Patrick told Sky News there are already staff shortages "all over" the NHS, including intensive care, with boosters threatening to make them even worse.
"It's a massive concern," he said. "You're taking a really scant resource and then you're pushing it elsewhere, which means that other services get cut."
Pat Cullen, general secretary of the Royal College of Nursing, said she is worried about the "scale and pace" of the new rollout, as the "same nurses are already facing huge demands under existing unsustainable pressures".
While Chris Hopson, chief executive of NHS providers, warned the health service is "already beyond full stretch" and the changes would see more procedures postponed in the coming days.
Read full story
Source: Sky News, 13 December 2021
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Health staff 'kicked, spat at, hit and scratched'

Attacks against health and social care workers in Northern Ireland have risen sharply during the pandemic, available data suggests.
Workers have reported being bitten, spat at, hit, scratched, kicked, abused on social media and sexually assaulted.
Most of the 5,500 attacks recorded in the six months to March were physical, said a forum representing local health bodies and the Fire and Rescue Service.
It has called on politicians and the public to support their staff.
The abuse affected staff across the sector, and those targeted were often already exhausted and caring for people in difficult conditions, said the chairman of the Health and Social Care Chairs' Forum, Peter McNaney.
"This is beyond intolerable," he added.
GPs, pharmacy, dental and ophthalmology staff had all been affected, and some had resigned as a result, said Eileen Mullan, chairwoman of the Southern Health and Social Care Trust.
"Even just in the last few days, with the uptake of the vaccinations across our centres, we've seen a significant increase in the amount of verbal abuse at those centres when people are waiting," she said.
"Some are abusing our staff while they are there."
Read full story
Source: BBC News, 15 December 2021
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Pregnant women angry at long waits for boosters

Pregnant women say they are queuing for hours at busy vaccination centres for a booster jab, despite being at greater risk from Covid-19 if seriously ill.
All adults in England, Scotland and Wales have been offered a booster by the end of 2021.
Pregnant women have not been prioritised, but doctors say they should be first in line to protect them and their babies against Omicron.
The NHS is urging people to book a jab appointment to avoid waiting in queues.
And the UK's vaccine advisory committee, the JCVI, said women who were pregnant and already had two vaccine doses were included in the accelerated booster programme.
However, the charity Pregnant Then Screwed said thousands of pregnant women had "encountered unnecessary barriers" which had "left many without the protection they need".
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Source: BBC News, 16 December 2021
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Many Covid hospital patients do not feel fully recovered year later

Fewer than one in three patients who have ongoing Covid symptoms after being hospitalised with the disease say they feel fully recovered a year later, according to a study that offers new insights into potential treatments.
As the pandemic has unfolded, a growing body of research has revealed that Covid not only causes health problems in the short-term, but also has long-term effects. Now a study has revealed many of those who had ongoing symptoms after hospitalisation are showing little improvement, with their condition similar at about 12 months after discharge to seven months earlier.
“Only one in three participants felt fully recovered at one year,” said Dr Rachel Evans, one of the co-leads of the post-hospitalisation Covid-19 study – or Phos-Covid – which is led by the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, although the team says missing data means the figure could be as low as 2 in 10 or as high as 6 in 10.
The research – which has yet to be peer-reviewed – reveals how the team collected both self-reported and objective measures of health, such as physical performance and organ function, among 2,320 adults about five months after they were discharged from hospital after having had Covid. They then looked at similar measures for 924 participants at about one year after discharge, 807 of whom had attended the previous follow-up.
Between five months and one year after discharge, the proportion of participants reporting feeling recovered remained very similar – at just under 30% at 12 months – as did the prevalence of symptoms including breathlessness, fatigue and pain. Little or no improvement was seen for areas including organ function, physical function and cognitive impairment – or “brain fog” – with about one in 10 participants having a significant degree of the latter 12 months after discharge.
“Unfortunately, we weren’t seeing improvements at one year from where people were at five months post-discharge,” said Evans.
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Source: The Guardian, 16 December 2021
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NHS cannot be used as vaccination service every few months, jab chief warns

The national chief for the Covid vaccination programme has warned that the NHS cannot become a vaccination service every few months.
Emily Lawson also told healthcare staff in a briefing on Wednesday: “I have fed back to the Department of Health yesterday that I think realistically we don’t have the capacity to do anything else new over the next two-and-a-half weeks.
“And that when we plan for things and have the right lead-up to them, we deliver them more effectively, which in the end is very critical for public confidence.”
Her warning comes after the government announced plans on Sunday to rapidly accelerate the national Covid vaccination programme by offering all adults a booster jab by the new year.
On Monday, NHS England sent letters to hospital chiefs, GPs and local healthcare leaders setting out plans to speed up the programme, and said the first priority for primary care would be delivering vaccines.
Healthcare leaders were told they could drop non-urgent care in efforts to support the vaccine drive, however specific details on what treatments can be dropped are yet to be finalised.
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Source: The Independent, 15 December 2021
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Swift action needed to prevent 'cancer catastrophe' as NHS fails to meet target

Swift action is needed from the Scottish Government to prevent a “cancer catastrophe”, campaigners have claimed, as new figures showed the NHS has again failed to meet a key waiting times standard.
Ministers have set the target of having 95% of patients begin treatment within 62 days of being referred for help because cancer is suspected.
But the latest data showed another decline in performance against this in the period July to September, with only 83.1% beginning treatment in this timeframe – down from 84.1% in the previous quarter and below the 87.3% that was achieved in July to September last year.
None of Scotland’s health boards met the goal of starting to treat patients within two months of referral – and nor was this target achieved for any cancer types.
The latest figures from Public Health Scotland showed that in NHS Orkney, only two out of five (40%) of patients referred with an urgent suspicion of cancer began treatment within two months, the lowest rate in Scotland.
And less than three quarters (71.8%) of those suspected of having bowel cancer began treatment within two days, compared to 76 per cent of those with cervical cancer, 91.5% of those with lung cancer and 92.7% of those with breast cancer.
It comes as the number of people being referred to help increased by almost a third from the same time last year.
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Source: The Scotsman, 14 December 2021
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Nurse sacked for allegedly trying to discredit hospital during CQC inspection cleared by tribunal

A nurse who was sacked by a private hospital provider treating NHS patients which believed she had deliberately tried to sabotage its Care Quality Commission inspection has won a tribunal. 
An employment tribunal found Care UK’s dismissal of Lorna Jarrett carried “the taint of race discrimination” and said the company had provided no evidence of any malice on her part.
Ms Jarret worked at the North East London Treatment Centre. The judgment said management at the facility were convinced Ms Jarrett had deliberately faxed confidential patient identifiable data to the inspectorate instead of the GP surgery they were supposed to be sent to. This incident occurred in the week of the centre’s CQC inspection.
However, the tribunal ruled Care UK “did not explore any evidence that might support the claimant’s account and disbelieved her explanation”. It added: “Finding that she sent the fax deliberately and maliciously demands an explanation.”
The tribunal judgment said it was Ms Jarrett’s case that “subconscious bias was in play” and found Care UK had not explained the “lack of any motive”.
Employment judge Lewis said: “Whilst we accept that Mr O’Brien did not consciously discriminate against the claimant because of her race we find that the factors relied on, her demeanour, attitude, her supposed lack of remorse, are matters that demonstrate subconscious bias and are not free from the taint of race discrimination. We find that the respondent has failed to discharge the burden on it to explain the difference in treatment.”
Read full story (paywalled)
Source: HSJ, 15 December 2021
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Government blocks ‘blanket’ rule to suspend all staff where safety is at risk

The government has rejected advice from an independent inquiry into the actions of disgraced surgeon Ian Paterson to suspend all healthcare professionals who are suspected of posing a risk to patient safety.
The Department of Health and Social Care today published its response to 15 recommendations from the inquiry, which found Mr Paterson, jailed for 20 years in 2017 for 17 offences of wounding with intent, may have conducted up to 1,000 botched and unnecessary operations over a 14-year period.
Of its 15 recommendations, the DHSC accepts nine in full, five in principle, rejects one entirely and there is another further point which it is keeping under review.
In particular, the inquiry panel members recommended that when a hospital investigates a healthcare professional’s behaviour, including the use of an HR process, any perceived risk to patient safety should result in the suspension of that healthcare professional.
DHSC chiefs said they agree practice exclusions and restriction can be necessary, and in some cases immediate exclusion is an appropriate response while an investigation is ongoing.
But they added: “However, we do not believe it would be fair or proportionate to impose a blanket rule to exclude practitioners in such cases.
“Such a step may inadvertently cause a chilling effect, dissuading healthcare professionals from raising concerns and negatively impacting patient safety.”
Read full story (paywalled)
Source: HSJ, 16 December 2021
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Quarter of ambulances getting stuck in A&E queues

Nearly a quarter of patients brought to hospital in an ambulance are facing dangerous delays getting into hospital in England, NHS data shows.
Ambulances are meant to hand over patients within 15 minutes of arriving. But in the past week 23% out of nearly 84,000 patients brought in waited over 30 minutes.
Staff are warning patients are being put at risk by the delays - and they think the situation is only going to get worse as Covid infections rise.
At seven NHS trusts more than half patients were left waiting over half an hour with nearly two thirds delayed at Gloucestershire Hospitals NHS Trust.
Association of Ambulance Chief Executives managing director Martin Flaherty said the situation was a major concern.
"The extent of potential harm that is being caused to patients when there are lengthy delays remains a significant and growing problem."
He said work was going on to tackle the issue, but around a quarter of hospitals were really struggling.
Read full story
Source: BBC News, 16 December 2021
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London hospitals in ‘dangerous situation’ as staff sickness soars amid Omicron wave

London’s hospitals have been plunged into a “dangerous situation” as the Omicron wave has sent staff sickness levels soaring to around 10%, a top doctor has warned.
Dr Katherine Henderson, a consultant at a central London hospital but speaking as President of the Royal College of Emergency Medicine, said so many doctors and nurses are having to be off that it was already having an impact on patient safety.
She told BBC Radio 4’s Today programme: “We are seeing increasingly that our staff are testing positive and that means that they have to go off."
“Usually, staff sickness would last a couple of days but of course, if you test Covid positive, you are off for ten days.
“People need to understand that this is a dangerous situation,” she added.
“The acute problem is actually to do with staffing, with workforce. “Because there is so much in circulation, even if we are not seeing a big rise in hospitalisations yet, we are already seeing the effect on not having the staff to run shifts properly and safely."
“So we are worried about patient harm coming about because we just don’t have the staff to keep the eye on the person on the trolley who is maybe a bit agitated.”
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Source: The Evening Standard, 16 December 2021
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‘A test from yesterday is not enough’: The perks and perils of at-home Covid testing

The spread of the Omicron variant, which is racing through the population at a staggering speed, has brought renewed focus to the value and reliability of the at-home lateral flow test (LFT).
These rapid testing devices were initially viewed with caution by some scientists, who were concerned that the LFTs simply weren’t effective enough in detecting infections.
But as more data has accumulated over the past year, the consensus around the devices has shifted and become far more positive.
Research from University College London, published in October, suggested that LFTs are likely to be more than 80 per cent effective at detecting Covid, and up to 90 per cent effective for those who are most infectious.
However, the emergence of Omicron has changed the conversation. Its rapid acceleration throughout the UK, with more than a million infections expected by next week, has placed the country’s key testing routes – both at-home (LFT) and lab-based (PCR) – under immense strain.
“Testing capacity will almost certainly fail to keep up with Omicron,” said Dr Jeffrey Barrett, director of the Covid-19 Genomics Initiative at the Wellcome Sanger Institute. “Even with best efforts we can scale supply linearly, but demand will grow exponentially.”
Experts have called on the government to temporarily drop the reliance on PCR lab testing, which typically takes 24 hours or more to return a result but is seen as more reliable, in favour of the lateral flow devices. These can be taken from the comfort of your own home and give a result in a matter of minutes.
“LFT will be good enough, especially on people showing symptoms,” said Alan McNally, a professor of microbial evolutionary genomics at Birmingham University.
Read full story
Source: The Independent, 17 December 2021
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NHS whistleblower in West Suffolk will ‘never be the same again’

A whistleblower at the centre of a bullying scandal at West Suffolk hospital says she will “never be the same again” after being “pursued” by NHS managers when she raised concerns about a doctor injecting himself with drugs while on duty.
Dr Patricia Mills was exonerated last week in an independent NHS review that was highly critical of the way she was ignored and then subjected to disciplinary investigation that verged on “victimisation”.
The review, by Christine Outram, chair of the Christie NHS foundation trust, said Mills’s concerns about the self-injecting doctor were “well founded” and yet, instead of acting on them, managers subjected her to an investigation that lacked “fairness, balance and compassion”.
It included what Outram called the “incendiary” and “extremely ill-judged” demand to Mills and other doctors for fingerprint samples as part of a management hunt for an anonymous letter-writer who had tipped off a grieving family about a potentially botched operation.
“I do feel vindicated,” Mills, a 53-year-old anaesthetist, told the Guardian, but she said the 21-month investigation into her conduct, which was only formally dropped in September, has had a lasting impact.
“I will never be the same again. To be absolutely pursued like that by your employer inevitably has long-term consequences in terms of psychological wellbeing. It was an orchestrated campaign that really floored me.”
Read full story
Source: The Guardian, 17 December 2021
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People hospitalised with COVID-19 are likely to face a limited recovery

People who were hospitalised with COVID-19 and continued to experience symptoms at five months show limited further recovery one year after hospital discharge, a key finding of the Post-hospitalisation COVID-19 study (PHOSP-COVID) has revealed.
The NIHR/UKRI-funded study, led by the NIHR Leicester Biomedical Research Centre, also confirmed that people who were less likely to make a full recovery from COVID-19 were female, obese, and required invasive mechanical ventilation (IMV) to support their breathing during their hospital stay.
The study found that one year after hospital discharge, less than three in ten patients reported they felt fully recovered, largely unchanged from at five months. The most common ongoing symptoms were fatigue, muscle pain, physically slowing down, poor sleep and breathlessness. Participants felt their health-related quality of life remained substantially worse one year after hospital discharge, compared to pre-COVID. This suggests the physical and mental health impairments reported in the study are unlikely to be pre-existing conditions.
Professor Chris Brightling said: “The PHOSP-COVID study is further evidence of the UK’s ability to combine expertise across both disease area and geography to rapidly gather data to help us understand the longer term implications of Long-COVID in hospitalised patients with persistent symptoms. Our findings show that people who were hospitalised and went on to develop Long-COVID are not getting substantially better a year after they were discharged from hospital. Many patients in our study had not fully recovered at five months and most of these reported little positive change in their health condition at one year.
“When you consider that over half a million people in the UK have been admitted to hospital as a result of COVID-19, we are talking about a sizeable population at risk of persistent ill-health and reduced quality of life.”
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Source: National Institute for Health Research, 16 November 2021
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Resident died after treatment at failing care home

A resident at an inadequate care home died after their blood glucose increased to high levels and staff acted too slowly, a report found.
Inspectors said The Berkshire Care Home in Wokingham breached guidelines in nine areas and must improve. They found residents were put at risk after medicines were not used properly and that records were not up to date.
The Care Quality Commission (CQC) said an ambulance was only called for the person who died when they were found to be unresponsive. They later died in hospital.
Its report said staff were "not sufficiently skilled" to safely care for people with diabetes.
A resident was given paracetamol and co-dydramol eight times over three days, when they should not be used together because they both contain paracetamol, the report said.
Another person was burned by a cup of tea and staff did not treat the injury properly, leading to the person developing an infection and later being admitted to hospital.
Staff sometimes felt "rushed and under pressure", the report found.
Read full story
Source: BBC News, 18 December 2021
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England hospital units may close as staff revolt over jab mandate, says NHS leader

Entire hospital units could be forced to shut because of staff quitting in protest at the government’s order that they must all be vaccinated against COVID-19, a senior NHS leader has warned.
Chris Hopson, the chief executive of NHS Providers, said that at one hospital trust in England, 40 midwives were refusing to get jabbed, raising fears that the maternity unit may have to close.
“Trust leaders are acutely aware that, from April onwards, when Covid vaccinations will become mandatory, decisions by staff to remain unvaccinated could – in extreme circumstances – lead to patient services being put at risk,” said Hopson.
“If sufficient numbers of unvaccinated staff in a particular service in a particular location choose not to get vaccinated, the viability and/or safety of that service could be at risk.”
Hopson did not name the trust. But he cautioned that its maternity unit is “one representative example” of potential closures on grounds of patient safety that the government’s decision to compel NHS staff in England to be vaccinated or risk losing their job could lead to.
Hopson said: “I was talking to a [trust] chief executive who said that 40 of the midwives on their midwifery service … were saying they were not prepared to be vaccinated. Those staff, given their skills and their expertise, are not easily redeployed but they’re also extremely difficult to replace."
Read full story
Source: The Guardian, 20 December 2021
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