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

Face-to-face GP appointments in Scotland 'still feel like a treat'

Nightclubs have reopened, concerts have been given the go-ahead and football stadiums are welcoming fans - but there are still restrictions on face-to-face GP consultations.
Only a limited number of patients are being invited into surgeries, where there continue to be strict rules on physical distancing.
Edinburgh GP Dr Carey Lunan says she understands why the situation is confusing.
"The difference between a healthcare setting and, say, a restaurant or a football stadium, is that we have people coming into our building who are much more vulnerable and frail and don't have a choice in being unwell," she tells BBC Scotland.
"So we have to have higher levels of safety than a setting where people can choose to go, knowing that there may be a little bit of risk."
According to the British Medical Association's Dr Andrew Buist, the balance between telephone and in-person consultations should continue to adjust as we move out of the pandemic, guided by evidence.
But many patients will "very easily" have their needs met by phone appointments. So-called telephone triage - where patients are assessed over the phone before being invited into the building - has now become the norm.
"For a lot of patients it works really well if it's a simple problem and it means not having to take time off work or travel," says Dr Lunan.
"It works less well if English isn't their first language or they've not got the privacy at home to have a conversation about something that is a bit more sensitive, if it's a very complex issue or it's just not clear what the diagnosis is."
She adds: "We deal with things when someone comes in with problem A, but actually we end up having a conversation about problem B when they are in the room with us.
"It is much more challenging to do that kind of health care on the phone and I think we just need to be honest that there are limitations.
Dr Lunan says she hopes a return to more face-to-face appointments will come "in the not too distant future. I miss seeing patients if I'm honest," she says.
"When we get to the point where we are able to bring in more people we will welcome that because it feels like a treat at the moment."
Read full story
Source: BBC News, 25 January 2022
Patient Safety Learning

Zoe Wilson inquest: Patient stayed on ward for 'low-risk patients'

A vulnerable woman judged to be at medium risk of self harm was on a mental-health ward that catered for low-risk patients, an inquest heard.
Zoe Wilson, 22, died on the Larch Ward at Bristol's Callington Road Hospital in June 2019 after being found unconscious in her room at 01.30 BST.
She had previously told staff that voices were telling her to kill herself, her inquest heard.
Healthcare assistant Sarah Sharma found her and immediately called for help. Addressing a jury inquest at Avon Coroners' Court, she said that "patients admitted to Larch should have all been low risk". 
This meant they would "preferably" have hourly observations by staff and be able to take their medication without any issues. Many were ready to be discharged and they were there because something was holding them up, normally housing, she said.
The experienced healthcare assistant said if the patient's risk increased they should be placed under "one to one" monitoring with a member of staff until they were moved to a more suitable unit.
The inquest heard earlier that Ms Wilson had been judged to be medium risk and was placed on 30-minute observations on 18 June.
Her risk level was re-assessed when she handed a belt to staff and informed them voices were telling her to kill herself.
Ms Sharma told the court that she was on her first overnight shift in two and a half weeks that night, and was informed in a handover that Ms Wilson was at risk of self-harming.
Having never met Ms Wilson - who had schizophrenia - she queried what kind of self-harm the patient was at risk of but said the nurse performing the handover told her he "didn't know".
Ms Sharma told the inquest she was unaware of the belt incident or that Ms Wilson had not been sleeping well and had requested medication to calm her down.
Read full story
Source: BBC News, 24 January 2022
Sam

Unvaccinated man denied heart transplant by Boston hospital

A US hospital has rejected a patient for a heart transplant at least in part because he is not vaccinated against COVID-19.
DJ Ferguson, 31, is in dire need of a new heart, but Brigham and Women's Hospital in Boston took him off their list, said his father, David.
He said the Covid vaccine goes against his son's "basic principles, he doesn't believe in it".
The hospital said it was following policy.
Brigham and Women's Hospital told the BBC in a statement: "Given the shortage of available organs, we do everything we can to ensure that a patient who receives a transplanted organ has the greatest chance of survival."
A spokesman said the hospital requires "the Covid-19 vaccine, and lifestyle behaviours for transplant candidates to create both the best chance for a successful operation and to optimise the patient's survival after transplantation, given that their immune system is drastically suppressed".
The hospital's carefully worded statement may suggest other factors lie beyond the patient's unvaccinated status for his ineligibility, but it refused to discuss specifics, citing patient privacy.
Dr Arthur Caplan, head of medical ethics at NYU Grossman School of Medicine, told CBS News that after any organ transplant a patient's immune system is all but shut down and even a common cold can prove fatal.
"The organs are scarce, we are not going to distribute them to someone who has a poor chance of living when others who are vaccinated have a better chance post-surgery of surviving," said Dr Caplan.
Read full story
Source: BBC News, 26 January 2022
Patient Safety Learning

Four-hour A&E standard is the ‘wrong target’, claims Javid

The four-hour standard for A&E waits is the ‘wrong target’, which ‘doesn’t work’ and leads to ‘perverse outcomes’, health and social care secretary Sajid Javid has said.
Mr Javid made the claim during an appearance before the Commons health and social care committee yesterday.
He also spoke about the requirement that NHS patient-facing staff must be vaccinated against covid and took the opportunity to restate his belief that radical action was needed to tackle “failing trusts”.
Mr Javid told the MPs: “Targets work if they are the right targets, and in the NHS I have already noticed there are targets which are the wrong targets and we’ve got to change them.
“The four-hour A&E target is the wrong target, it doesn’t work. It leads to really perverse outcomes.
“If you look at some NHS trusts, all of sudden when the individual in A&E has got to three hours and 55 minutes, guess what? They just admit it. That’s a poor outcome.
“There may have been a good reason to have that target in the past, but you’ve got to keep these targets constantly under review and that’s something I’m doing.”
The long-running clinical review of waiting time standards by NHS England had proposed replacing the four-hour target with a suite of other measures but the government has yet to formally respond.
Read full story (paywalled)
Source: HSJ, 26 January 2022
Patient Safety Learning

Long Covid: doctors find ‘antibody signature’ for patients most at risk

Doctors have discovered an “antibody signature” that can help identify patients most at risk of developing long Covid, a condition where debilitating symptoms of the disease can persist for many months.
Researchers at University hospital Zurich analysed blood from Covid patients and found that low levels of certain antibodies were more common in those who developed long Covid than in patients who swiftly recovered.
When combined with the patient’s age, details of their Covid symptoms and whether or not they had asthma, the antibody signature allowed doctors to predict whether people had a moderate, high or very high risk of developing long-term illness.
“Overall, we think that our findings and identification of an immunoglobulin signature will help early identification of patients that are at increased risk of developing long Covid, which in turn will facilitate research, understanding and ultimately targeted treatments for long Covid,” said Onur Boyman, a professor of immunology who led the research.
Read full story (paywalled)
Source: The Guardian, 25 January 2022
Patient Safety Learning

Almost 100,000 could unknowingly have potentially deadly heart valve disease

Experts have estimated that almost 300,000 people in Britain could have a potentially deadly heart valve disease called aortic stenosis - including almost 100,000 who are unaware they have it.
The condition carries a high death rate if left untreated and occurs when the main valve which takes blood from the heart stiffens and narrows.
Many people do not know they have the disease and only discover they do when it is too late for treatment.
An international team of scientists, including experts from the Universities of Glasgow and Southampton, set out to research the extent of the disease in the UK.
Their study, published in the journal Open Heart, estimated that in the UK in 2019 there were 291,448 men and women aged 55 and over with severe aortic stenosis.
Of these, an estimated 68 per cent would have symptoms. This means an estimated 92,389 people have the disease and do not know it.
The authors went on to estimate that more than 172,000 (59%) who have the disease will “die within five years without proactive management”.
They concluded that aortic stenosis is a “common condition” in the UK but warned that “without appropriate detection and intervention, survival prospects are likely to be poor”.
Read full story
Source: The Independent, 25 January 2022
Patient Safety Learning

Nearly 50% of blood cancer patients insufficiently protected against Omicron after three jabs, study says

Nearly half of patients with blood cancer are insufficiently protected against the Omicron variant after three vaccine doses, according to a new study.
Experts from the Francis Crick Institute and the Royal Marsden NHS Foundation Trust said their research highlights the need for a fourth jab among these vulnerable people.
As part of the ongoing Capture study, scientists have been monitoring the antibody response of hundreds of patients with different types of cancer, after one, two and three vaccine doses.
Specifically, the researchers measured levels of neutralising antibodies which identify, attack and block the Omicron variant from infecting the body’s cells.
Patients with solid tumours appeared to generate antibody responses similar to people without cancer. But among patients with blood cancer who had three doses of a Covid-19 vaccine, only 56 per cent generated neutralising antibodies, according to the study, which has been published as a research letter in The Lancet.
This means that 44% of patients with blood cancer did not generate a sufficient antibody response.
The study supports the need for four jabs among these immunocompromised groups of people.
“We found that a third vaccine dose boosted the neutralising response against Omicron in patients with cancer, but the effect was blunted in patients with blood cancer compared to those with solid cancer,” the authors wrote.
Read full story
Source: The Independent, 25 January 2022
Patient Safety Learning

Number of patients 'medically fit' to leave hospital increases

The number of patients in hospitals who are ‘medically fit’ to leave has increased in January, despite NHS England targets for trusts to dramatically reduce the numbers.
Internal data seen by HSJ suggests there were an average of 12,819 patients who no longer met the ‘criteria to reside’ in NHS hospitals in the week to January 23 – up from around 10,500 before the Christmas period.
Last month, NHS England told local systems to dramatically reduce their numbers of medically fit patients who remained in hospital, as they aimed to free up beds amid a surge in covid-19 admissions fuelled by the omicron wave. It told local leaders “a significant proportion of discharge delays are within the gift of hospitals to solve”.
The message was reiterated by NHSE’s regional teams at the start of January, with systems told to reduce their numbers of medically fit patients by between 30 and 50 per cent.
Yet the proportion of ‘medically fit’ for discharge patients occupying NHS general, acute or critical care beds has also been rising, from around 12% in December to around 14% in mid-January.
Delayed discharges are frequently cited as the main cause of long delays for patients being admitted through hospitals’ emergency departments, which have significantly worsened in recent months.
Read full story (paywalled)
Source: HSJ, 26 January 2022
Patient Safety Learning

NHSE calls on systems and maternity leads to vaccinate more pregnant women

An NHS England letter has warned of “significant variation” in the uptake of the COVID-19 vaccine amongst pregnant women, and called on systems to enable more “spontaneous” antenatal vaccination.
In the letter, sent to integrated care system vaccination programme leads, ICS maternity leads and other NHS clinical directors, NHS England said that while the rates of women who had received at least two doses of the vaccine before giving birth was on the rise, there was “significant variation in uptake between regions and systems and in every system, between women of different ethnicities, decile of deprivation in their local area, and age groups”.
The letter asks that covid vaccines are made available within antenatal clinics “to maximise uptake” and that partially vaccinated women “are offered vaccine confidence conversations and advised antenatally on the nearest available walk-in vaccinations”.
Vaccination programme and maternity service leads have also been told to make use of resources and funding available to drive uptake in at-risk groups.
It said: “Vaccination and maternity leads should discuss how this resource could be used to provide in-reach clinics within every maternity service, without creating additional burden on midwifery staff.”
Read full story (paywalled)
Source: HSJ, 26 January 2022
Patient Safety Learning

Review reveals trust’s ‘deep-seated’ cultural and governance issues

One of the NHS’ most high-profile mental health trusts has ‘multiple’ corporate governance problems and ‘deep-seated’ cultural issues, according to an external review.
Tavistock and Portman NHS Foundation Trust, which provides mental health, educational and training services in London, commissioned an external firm to look into its leadership amid a period of intense public scrutiny in the latter half of 2021.
Among cultural issues identified at the trust, which reviewers described as “deep seated”, was a reluctance of staff to speak up about concerns.
Assessors said a recent employment tribunal, which ruled the trust’s treatment of a whistleblower had damaged her professional reputation and “prevented her from proper work on safeguarding”, had impacted the ability of staff to raise concerns.
They urged leaders to review their Freedom to Speak Up and whistleblowing procedures. 
And while reviewers commended board members for commissioning an external review of race equality, they said it had “yielded an outpouring of emotion” which suggested many staff from minority ethnic groups do not feel consistently supported, respected or valued.
Read full story
Source: HSJ, 25 January 2022
Patient Safety Learning

Staff will quit if not given ‘time to recover’, says NHSE director

An NHS England director and trust chief says he ‘fears [the NHS] will see increasing numbers of resignations’ unless more is done to ensure burnt-out staff are given sufficient leave to recover mentally and physically.
Matthew Winn, NHSE’s director of community health and Cambridgeshire Community Services Trust chief executive, set out his concerns in a paper for discussion at his trust’s board meeting today.
While the service is grappling to keep tabs on the number of staff it is losing because of compulsory vaccination plans, the issue of staff leaving because of burnout is harder to quantify, but a huge concern to NHS leaders. Nearly two years of tackling coronavirus has taken a huge emotional and physical toll on a large proportion of the workforce and burnout was a growing issue even before the pandemic.
Mr Winn’s paper says: “As the NHS starts to focus on recovering from the current covid pressures, it is vital that the national, regional and local planning must take into consideration that our staff need time to recover and that they cannot (for example) be expected to catch up on the waiting lists that have accrued, without time and resources to support them.
“In the absence of such an approach, I fear that we will see increasing numbers of resignations and the care we will be able to provide will be far short of the standards we set ourselves and that the public expects from us.”
Read full story (paywalled)
Source: HSJ, 26 January 2022
Patient Safety Learning

Period changes after Covid jabs are short-lived

Small changes to periods can follow a Covid vaccine but they quickly return to normal, a leading UK menstruation expert has said.
Dr Victoria Male, from Imperial College London, called studies from the US and Norway which tracked women's cycles "reassuring".
And she blamed misinformation for fuelling concerns over infertility. The Medicines and Healthcare products Regulatory Agency (MHRA) says there is no evidence Covid vaccines affect the ability to have children.
The MHRA has received more than 37,000 reports of unexpected vaginal bleeding, heavier and delayed periods after a Covid jab. It has always said there is no evidence of a link to the vaccine, because women's cycles vary naturally - but scientists called for more research.
Dr Male said: "Changes to the menstrual cycle do occur following vaccination - but they are small compared with natural variation and quickly reverse."
Women's concerns arose "from misinformation that Covid-19 vaccines cause female infertility", she said.
And more studies of pregnancy rates in couples trying to conceive were needed to make it clear they do not.
A Covid infection, however, "may reduce sperm count and quality" - and understanding more about that would mean patients could be given the right advice.
Read full story
Source: BBC News, 27 January 2022
Patient Safety Learning

"I’m dying" – Son shares desperate 999 calls

Bina Patel, aged 56, died after struggling to breathe and waiting almost an hour for an ambulance.
Her son Akshay Patel has shared the six phone calls he made to North West Ambulance Service on the night of her death.
North West Ambulance say they "can never say sorry enough" for Bina's death.
"The amount of time it took for help to arrive is unacceptable and not how we want to care for our patients," a spokesperson said.
View video
Source: BBC News, 26 January 2022
Patient Safety Learning

Avoid “unproven and unethical” polygenic risk scores in embryo selection, say genetics experts

Geneticists have warned the public against buying polygenic risk score analyses, which some private fertility clinics claim can help parents using in vitro fertilisation in selecting embryos that carry the least risk of future disease.
It appears that at least one child has been born after such a procedure, but the use of polygenic risk score analysis in this respect is severely limited. No evidence shows that these tests can predict the likelihood of an unborn child being liable to a specific disease in the future, representatives from the European Society of Human Genetics wrote in the European Journal of Human Genetics.
Polygenic risk score analysis is mainly offered by fertility clinics in the US, although the practice is also being promoted in the UK.
Patients need to be properly informed on the limitations of its use and a societal debate, focused on what should be considered acceptable with regard to the selection of individual traits, should take place before any further implementation of the technique in this population.
Read full story (paywalled)
Source: BMJ, 26 January 2022
Patient Safety Learning

New report gives voice to “devastated” NHS patients

Injured NHS patients have spoken out about the human cost of clinical negligence in a new report published as MPs examine how to cut the health service’s bill for causing harm.
The House of Commons Health and Social Care Select Committee is gathering evidence for its inquiry on NHS litigation reform.
“There is a fixation on the financial cost of clinical negligence, rather than on the human cost and the reasons why injured patients have to make a claim for compensation at all,” said Guy Forster of the Association of Personal Injury Lawyers (APIL) a not-for-profit group which campaigns on behalf of injured patients and their families.
“There are a lot of voices and opinions in any debate which concerns the NHS and patient safety, but they are almost never the voices and opinions of the patients. This is why APIL has commissioned The Value of Compensation report,” said Mr Forster.
Patients who took part in the research cite mounting debt; uncertainty about their future health; isolation; abandoned careers; relationship breakdowns; and loss of independence, as some of the many far-reaching side effects of injuries sustained through failures in care.
“Patients are devastated to have trusted the NHS with their health and then have to live with the pain and suffering of an injury which should have been avoided,” said Mr Forster. “This report provides new insight on how compensation can help rebuild their lives.”
“None of them relish having to make a claim for compensation. I cannot stress enough that the money is never, ever a ‘windfall’ for an injured patient,” he went on.
“It is obvious that full and fair compensation is critical for injured patients. It should go without saying that the cost of compensation would be cut if the harm were not caused in the first place. But it is critical that when things go wrong, injured people are cared for properly and have the chance to get back on track.”
Read press release
Source: APIL, 12 January 2022
Sam

Growing number of trusts defy system leaders on FFP3 guidance

Over 30 trusts are now mandating FFP3 masks are used beyond settings stipulated in national rules, amid calls for system leaders to clarify the national position on the key staff and patient safety issue.
Fresh Air NHS, a group of frontline staff who campaign for better protection against Covid-19, said it now knows of 32 trusts which have already introduced enhanced infection prevention control policies that mandate FFP3 use beyond national guidance.
News that a growing number of trusts are mandating more stringent PPE use comes amid fresh confusion around the national guidance after small but potentially significant alterations were made last week. A new line has been added to guidance which says:: “FFP3 respirator or equivalent must be worn by staff when caring for patients with a suspected or confirmed infection spread by the airborne route.”
David Tomlinson, consultant cardiologist and also a member of Fresh Air NHS, said NHS trusts were “in fear of going beyond the guidance and allowing non-ICU staff to wear FFP3 respirators”.
“The guidance doesn’t mandate respirators for staff in highest risk of transmission areas, for example, medical wards housing symptomatic patients at a time in their disease when they are releasing greatest amounts of infectious aerosols,” Dr Tomlinson said. “Real world data has consistently shown far greater rates of SARS2 infection comparing non-ICU healthcare workers to those on ICU.”
Alison Leary, chair of healthcare and workforce modelling at London Southbank University, said: “Trusts choosing to implement evidence based safety interventions is a positive move towards workforce safety.”
Read full story
Source: HSJ, 27 January 2022
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