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

Ministers and NHS bosses clash over surgery waiting list targets in England

A “very tense” behind-the-scenes row over how quickly hospitals in England can be expected to reduce the massive backlog of surgery has broken out between NHS bosses and ministers.
The dispute has delayed publication of the government’s “elective recovery plan”, which Downing Street had indicated would be part of Boris Johnson’s “Operation Red Meat” political fightback this week.
No 10, the Treasury and Department of Health and Social Care are pressing NHS England to ensure that hospitals do as many operations as they can, as quickly as possible, in order to tackle the backlog, which now stands at a record 6 million patients.
They want to impose “stretching and demanding” targets on hospitals, sources with knowledge of the discussions said.
However, NHS trust bosses say the ongoing impact of treating patients sick with Covid, due to the current Omicron surge, longstanding gaps in their workforce, exhaustion at the frontline and record levels of staff sickness, mean they need time to get back to doing as much surgery as they did before the pandemic.
The Treasury is said to be frustrated with NHS England and privately believes it is “foot-dragging” over the targets. NHS bosses for their part fear the plan is being driven by “political expediency”, given the growing concern at the sheer number of people facing long delays for care.
Read full story
Source: The Guardian, 20 January 2022
Sam

Babies at risk’ as NHS faces losing nearly one in 10 midwives over mandatory jabs

The NHS could be forced to dismiss almost 2,000 midwives by the government’s mandatory vaccination policy, amid warnings from a former chief nurse of England that mothers and babies will be put at risk.
Well-placed senior sources have told HSJ around 1,700 midwives remain unvaccinated nationally, according to the latest data from trusts.
Based on official headcount data that would amount to between 6.5-8% of the workforce, depending on whether it counts full time equivalent or total staff numbers.
However, they are mostly in London, with the latest estimate in the city said to be about 680 (representing between 12 and 14% of the workforce), several well placed sources told HSJ, meaning its maternity services could be seriously destabilised.
A former chief nurse of England, Sarah Mullally, who now sits in the House of Lords as the Bishop of London, said she believed about 12.5% of London’s midwives were unvaccinated, and called on the government to delay the mandatory health worker vaccination policy.
Speaking in Parliament yesterday, she warned mothers and babies would be put at risk, “in order to implement a policy that has been superseded by the evolution of the virus”.
She added: “I would strongly encourage everyone, including NHS staff and health care workers, to get fully vaccinated. However, having heard from midwives myself this week, I can see the anxiety that the requirement for mandatory vaccination is causing, as well as the potential risks to the heath service and its patients.
Read full story (paywalled)
Source: HSJ, 21 January 2022
Patient Safety Learning

Bullying, sexism and racism ‘prevalent and tolerated’ at national regulator

An external review into the Healthcare Safety Investigations Branch (HSIB), the national safety watchdog, has revealed ‘damaging’ cultural problems, including bullying, sexism and racism which go ‘right to the top of the organisation’.
The King’s Fund was commissioned by NHS England to undertake a review of the HSIB’s leadership and culture, as it prepares to be an independent organisation.
The review, seen by HSJ, concluded: “Bullying, sexism, racism and other forms of discrimination and unprofessional behaviours appear to be prevalent and tolerated – this goes right to the top of the organisation.”
The result of this was found to be “very damaging to the health and wellbeing of staff, diminished the culture and undermines the potential of the organisation”
The review also described a “perceived command-and-control approach to leadership, lack of openness to challenge, hierarchical approaches to management and behaviour that is out of step with the organisation’s values”.
The reviewers also identified a “strong voice from staff”, which felt that senior maternity investigation team leaders were “not being held accountable for behaviours that had a very negative impact on staff”.
Read full story (paywalled)
Source: HSJ, 21 January 2022
Patient Safety Learning

Vaginal mesh and Gardasil: Approval for general indemnity cover and product liability cover

The Irish Cabinet has approved general indemnity cover and product liability cover for claims to two public sector bodies relating to transvaginal mesh products and the Gardasil HPV vaccine. 
The Health Minister Stephen Donnelly brought forward a proposal to Cabinet Wednesday for the provision of this cover to the Irish Blood Transfusion Service (IBTS) and the Mental Health Commission (MHC) for claims relating to the mesh products or Gardasil. 
Gardasil is a type of vaccine used to protect against HPV. Vaginal mesh devices have been used in operations to treat stress urinary incontinence and pelvic organ prolapse; two conditions that can impact women after natural childbirth or in their later years.
Including the bodies in the State’s general indemnity scheme for these claims will eliminate the requirement for them to carry private insurance.
The State Claims Agency was consulted and indicated that it supports the inclusion of both bodies under the scheme.  
The clinical indemnity scheme indemnifies hospitals but is confined to clinical acts and/or omissions and doesn’t cover product liability matters.
Current legal cases around transvaginal mesh products involve allegations in relation to the product itself and allegations of clinical negligence. It has now been proposed to delegate the product liability claims for mesh products to the State Claims Agency to ensure hospitals aren’t exposed to uninsured liability. 
Thousands of women across the world have suffered complications after having a vaginal mesh device implanted. These complications include chronic pain and recurrent urinary tract infections and have been life-changing in many cases.
Read full story
Source: thejournal.ie, 19 January 2022
Patient Safety Learning

International trial aims to improve the quality of life for Long Covid patients

Researchers at the University of Derby and their regional, national and international partners are working collaboratively to develop bespoke support pathways for patients with Long Covid. 
Led by Dr Mark Faghy, they are currently running a series of projects to understand the determinants of recovery which captures the lived experience and informs a bigger piece of work to develop a holistic view of the key stakeholders that are required to develop pathways that can improve patient outcomes.
One part of this is the launch of a new Delphi Consensus statement which seeks to obtain input from patients, researchers and any healthcare professionals to inform the approaches to support people living with long COVID.  If you have an interest in this study, please click here.
For more information on the current work, please contact Dr Mark Faghy (@DrMark_Faghy and [email protected]) and also see:
https://www.derby.ac.uk/news/2022/international-trial-aims-to-improve-the-quality-of-life-for-long-covid-patients/ “
Patient Safety Learning

Women report waiting longer for operations and appointments in pandemic

Women are being forced to wait longer for operations and healthcare appointments in the wake of the pandemic, according to a new report.
Research carried out by the Care Quality Commission, England’s regulator of health and social care, found 53% of women experienced longer waiting times for appointments or healthcare procedures during the Covid crisis.
The report also found 3 in 10 women experienced appointment cancellations.
More women report grappling with these issues than men – with some 44% of men saying they have experienced longer waiting times for appointments or procedures.
Helena Mckeown, a GP who previously specialised in women’s health at the British Medical Association (BMA), told The Independent she is not surprised by the findings.
"Our world is full of sexism and we know of other examples of sexism and biases in healthcare. Some of them are racial biases. To stop unconscious biases, they need to be recognised and addressed.
Ms Mckeown, one of the directors of the Menopause Expert Group, a non-profit which provides education about menopause, said female patients are treated differently to men.
She added: “We need to make sure we are not taking women saying they are in pain differently to men saying they are in pain. It is really important that we address this problem of women waiting longer for operations and appointments.”
Read full story
Source: The Independent, 22 January 2022
Patient Safety Learning

HeartWare gadget was a ticking time bomb for our daughter

At the age of 36, Nola Borcherds could hardly walk ten steps without gasping for breath. A viral infection years earlier had weakened her heart and left her with a constant wheezy chest.
Her heart was failing and she needed a new one. No transplant was available, but the next best thing was an implant called HeartWare. Unlike pacemakers, which send an electrical pulse to keep it beating regularly, the device would attach to Nola’s heart and keep her alive by taking over its function, continuously pumping blood around the body.
Brochures promised the gadget could be life changing. It was smaller, safer and more effective than others, and designed to last up to ten years, raising her chance of a transplant.
When Nola’s pump was implanted in December 2018 it made a tremendous difference.  “Two to three months after she had it fitted, she could virtually run up the stairs,” her mother, Jenny Kiddie said.
But on 21 May 2021, two and a half years after the device went in, it stopped working. Doctors at Harefield Hospital in Hillingdon, west London, were carrying out maintenance when it failed to turn back on, cutting the supply of blood to her brain.
“The hospital called and said, ‘Nola’s become very unwell. How quickly can you get here?’” her mother said. “By the time we arrived, she was already in the morgue.”
What her family believe Nola did not know, and what the UK regulator, the Medicines and Healthcare products Regulatory Agency (MHRA), failed to react to, was that HeartWare pumps had already been linked to hundreds of deaths globally. 
As early as 2011 some doctors switched to alternatives. Yet the UK regulator allowed them to stay on the market — and they continued to be implanted on the NHS until last year. Some patients are still living with the pieces of equipment, because surgery to remove them is so risky.
Families, medical experts and lawyers want to know why the MHRA failed to take firm action despite repeated warnings about the devices, which they believe could have contributed to patients dying. By Nola’s death last year, the health regulator had passed on at least 16 safety alerts to doctors warning of problems identified by the manufacturer. 
Read full story
Source: The Sunday Times, 23 January 2022
Patient Safety Learning

Severe shortage of nurses in UK children’s intensive care units

Britain’s sickest children are being treated in intensive care units that are struggling with severe shortages of the specialist nurses needed to look after them, a report says.
The shortages in the UK’s 30 paediatric intensive care units (PICUs) are so severe that healthcare assistants are covering the work of nurses in an attempt to ensure that staffing levels are maintained.
Only one of the PICUs – at the James Cook University hospital in Middlesbrough – was found to have enough nurses to guarantee the standards of care expected. About 15,000 children and young people a year, often with life-threatening conditions, are cared for in PICUs.
Clinical standards that prevail in PICUs require them to ensure that seven nurses are on duty for each bed in a 24-hour cycle. However, the report by the Paediatric Intensive Care Audit Network (PICANet), a group of experts from Leicester and Leeds universities, found that 29 of the 30 had too few nurses to do that, and that all 30 had vacancies, sometimes large numbers of them.
“Parents will find this extremely alarming”, said Patricia Marquis, the Royal College of Nursing’s England director. “Most people wouldn’t believe that only one paediatric intensive care unit across the whole UK has enough staff to function properly, but this is the reality of the workforce crisis. Key roles in specialist nursing teams are lying vacant for years.”
Read full story
Source: The Guardian, 23 January 2022
Patient Safety Learning

Infected blood scandal: ex-pupils and relatives sue Hampshire school

A group of survivors and relatives of people who died in the infected blood scandal are suing a school where they contracted hepatitis and HIV after being given experimental treatment without informed consent.
A proposed group action lodged by Collins Solicitors in the high court on Friday alleges that Treloar College, a boarding school in Hampshire that specialised in teaching haemophiliacs, failed in its duty of care to these pupils in the 1970s and 80s.
The claim could result in a payout running into millions of pounds, and is based on new testimony given by former staff at the school to the ongoing infected blood inquiry.
Gary Webster, 56, a former pupil who was infected with hepatitis C and HIV after being treated with contaminated blood at the school in the early 80s and gave evidence to the inquiry last year, is the lead claimant of the 22 survivors in the group.
Speaking to the Guardian, he said: “We were lab rats or guinea pigs. We always thought that we may have been experimented on for research purposes, but we had no proof until the evidence given in the inquiry.”
Last year in testimony to the inquiry, the former headteacher of Treloars, Alec Macpherson, confirmed that doctors at the school were “experimenting with the use of factor VIII”, an imported pooled plasma that was later discovered to be contaminated with HIV and hepatitis.
He said he and other teaching staff did not question doctors about the trials. He told the inquiry: “We didn’t have any authority or reason to interfere. You can’t – doctors are god, aren’t they?”
Macpherson said he consented to the treatment because he trusted the doctors, and he could not recall if parents were informed and consulted.
Read full story
Source: The Guardian, 23 January 2022
Patient Safety Learning

Endometriosis care in Scotland not meeting 'base level'

Clinical care for sufferers of endometriosis is not meeting "base level", according to new research seen by BBC Scotland.
The debilitating condition affects 100,000 women in Scotland and is more common than diabetes, yet it takes eight and a half years to be diagnosed.
Almost half of those with endometriosis are in pain most days.
The study, commissioned as part of the Scottish government's Women's Health Plan, found that services were lacking.
The charity Endometriosis UK said the condition costs the UK economy £8.2bn each year in treatment, healthcare costs and loss of work.
It carried out the study and has recommended four main areas for improvement:
Implementing National Institute for Health and Care Excellence guidelines and quality standards on endometriosis care across Scotland - the research found that this base level of care "is not currently being met". Building relationships between healthcare services through managed clinical networks to allow for smoother referrals. Increasing education in primary and secondary care levels - including GPs and non-specialist gynaecologists. Investment in a public health campaign and improved menstrual education in schools. Read full story
Source: BBC News, 23 January 2022
Patient Safety Learning

Unvaccinated seniors 49 times more likely to be hospitalised than those with boosters – CDC

New data from the US Centers for Disease Control and Prevention (CDC) has revealed that unvaccinated adults infected with Covid-19 who are 65 and older are 49 times more likely to need hospitalisation compared to those who have received booster doses.
The CDC also found that in December, unvaccinated adults in that same age group experienced a rate of Covid-related hospitalisation 17 times higher than those who are fully vaccinated.
For unvaccinated adults between 50 and 64, they are 44 times more likely to require hospitalisation compared with those who are immunised.
In that same age group, unvaccinated adults were also 17 times more likely to experience Covid-related hospitalisation.
According to the CDC, adults who are 65 and older and have received both doses of either the Pfizer or Moderna vaccine showed a 94% reduced risk of Covid-related hospitalisations.
“Getting very sick means that older adults with Covid-19 might need hospitalization, intensive care, or a ventilator to help them breathe, or they might even die. The risk increases for people in their 50s and increases in 60s, 70s, and 80s. People 85 and older are the most likely to get very sick,” the CDC said on its website.
“Get vaccinated as soon as possible,” the agency added.
Read full story
Source: The Guardian, 21 January 2022
Patient Safety Learning

The evidence which shows poorer and ethnic minority patients wait longer for NHS care

The significantly longer waiting times suffered by patients from minority ethnic groups and in more deprived areas for a range of elective procedures have been laid bare in NHS analysis shared with HSJ.
The problem of waiting time disparities between different patient groups has been highlighted by health leaders for several years.
But the NHS chief who oversaw this new work quantifies the issue for a local NHS trust, provides a template for others to follow, and has led to an improvement in waiting times disparities in response.
The analysis of elective waiting lists by Calderdale and Huddersfield Foundation Trust found that in October last year patients from a minority ethnic background were waiting three weeks longer on average than white patients for a “priority two” operation – which must be done within a month.
It also found patients from the most deprived communities were waiting 2.5 weeks longer than those from the least deprived areas.
However, Owen Williams, who led the trust when the analysis was carried out, said the analysis, which began early last year, contributed to these disparities being cut significantly over the course of 2021.
In May last year the trust’s patients from the most deprived areas were waiting 8.5 weeks longer on average for priority two operations than those from more affluent areas, while patients from minority ethnic groups were waiting 7.8 weeks longer than white patients.
Mr Williams said NHS trusts boards must be proactive in undertaking similar analysis to reduce health inequalities.
Read full story (paywalled)
Source: The Guardian, 24 January 2022
Patient Safety Learning

Long Covid: nearly 2m days lost in NHS staff absences in England

NHS trusts in England lost nearly 2m days in staff absences due to long Covid in the first 18 months of the pandemic, according to figures that reveal the hidden burden of ongoing illness in the health service.
MPs on the all-party parliamentary group (APPG) on coronavirus estimate that more than 1.82m days were lost to healthcare workers with long Covid from March 2020 to September 2021 across England’s 219 NHS trusts.
The estimate is based on data obtained under the Freedom of Information Act from 70 NHS trusts and does not include the impact of the highly transmissible Omicron variant that has fulled record-breaking waves of infection in the UK and globally since it was first detected in November.
Layla Moran, the Liberal Democrat MP who chairs the APPG, said the government had paid “almost no attention to long Covid and the severe impact it was having on vital public services” and called for immediate support for those affected.
“Thousands of frontline workers are now living with an often debilitating condition after being exposed to the virus while protecting this country,” she said. “They cannot now be abandoned.”
Read full story
Source: The Guardian, 24 January 2022
Patient Safety Learning

NHS England plans dental ‘treatment blitz’ to tackle appointments backlog

Hundreds of thousands of dental patients in England are to be offered weekend and evening appointments under NHS plans to tackle the backlog exacerbated by the pandemic.
More than 350,000 extra dental appointments are to be made available in February and March, NHS England said, with a new £50m funding pot aimed at fuelling a dentistry “treatment blitz”.
However, senior dentistry sources said the cash was a “drop in the ocean”, with tens of millions of NHS appointments cancelled as a result of Covid-19 and the resulting backlog set to take years to clear.
Some also expressed doubts about whether there would be enough staff to offer the additional appointments, since hundreds of dentists have quit the profession in the last year amid warnings that NHS dentistry is increasingly “hanging by a thread”.
Millions of patients have struggled to access dental care since 2019. Some have spent weeks or months in pain as a result, and others believed they had no option but to conduct “DIY dentistry” while waiting for treatment, or felt coerced into “going private”.
Under the new plans to tackle the backlog, NHS England said dentists involved in the scheme would “be paid more than a third on top of their normal sessional fee” for delivering care outside their core hours.
Read full story
Source: The Guardian, 25 January 2022
Patient Safety Learning

I travelled to the US and paid £19,000 to have mesh implant removed

Anne Monie is one of hundreds of Scottish women to have suffered painful, life-changing side effects from mesh implants.
She was fit and healthy when she went to her doctor with anterior prolapse and mild stress incontinence in 2010. But an operation to fit transvaginal mesh left her in agony.
With nowhere to turn for help in Scotland, the 69-year-old spent £19,000 travelling to the US to get her implant removed.
Anne spoke to BBC Scotland as the Scottish Parliament looks set to pass a bill which would see her and others reimbursed for the cost of private surgery.
That may bring financial concerns to an end - but she is by no means cured. And she worries about other women still trying to go through the mesh-removal process.
Anne was offered a simple "gold standard" transvaginal mesh procedure when she first sought medical help 12 years ago.
But after the operation to fit it, she began to suffer from a range of problems and was left in chronic pain.
After years of frustration, she paid to go to Missouri to have mesh removal surgery with world-renowned expert Dr Dionysios Veronikis.
"It's a massive amount of money to be paying out, especially when you're retired. But then, what price do you put on health?"
Read full story
Source: The Guardian, 25 January 2022
Patient Safety Learning

Public urged to sign up for Covid drug trial

Over-50s and younger adults with underlying health conditions are being urged to participate in a study of life-saving treatments for COVID-19.
The study is open to those who test positive for Covid and had symptoms develop in the previous five days. Volunteers will be given pills to take at home.
The study will help decide how antiviral drugs will be used, Prof Sir Jonathan Van-Tam, the deputy chief medical officer for England, said.
Health Secretary Sajid Javid asked everyone eligible to "step forward" and "help us to learn more about medicines which could save thousands of lives".
Antivirals were "part of our approach as we learn to live with Covid, by preventing the most vulnerable from being hospitalised", he said.
The UK regulator has licensed both for treating Covid, with molnupiravir the first to be given the green light, in November. Both have completed clinical trials and shown promising results at reducing the risk of serious illness or death.
Launched in December, it already has 4,500 people signed up but needs 6,000 more as soon as possible.
You can sign up at the study website now or your GP may contact you to ask you to participate if you test positive for Covid.
Read full story
Source: BBC News, 25 January 2022
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