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

Talking about death better than ‘giving aggressive treatments to prolong life’

Death has become “over medicalised” and the public should be encouraged to discuss dying and grief, experts have said.
There's a call for shift in attitude towards palliative care, with more emphasis on compassion and less on giving medication that may prolong pain.
According to a new Lancet commission, an overemphasis on aggressive treatments to prolong life, global inequities in palliative care access, and high end-of-life medical costs have led to millions of people suffering unnecessarily at the end of their life.
The authors also note that the pandemic has made death and dying more prominent in daily life, while health systems have been “overwhelmed” when trying to care for those dying.
People often died alone, with families unable to say goodbye to loved ones or grieve together, the commission said – the effects of which will “resonate for years to come”.
The researchers argue that many people, mainly in low- and middle-income countries, have no access to end-of-life care, and particularly to opioids, while those in high-income countries may be overtreated.
Attitudes towards death and dying should be “rebalanced”, the authors conclude, away from a medicalised approach towards a “compassionate community model”, where families work with health and social care services to care for those dying.
Read full story (paywalled)
Source: The Telegraph, 31 January 2022
Sam

New research hints at 4 factors that may increase chances of Long Covid

It is one of many mysteries about Long Covid: Who is more prone to developing it? Are some people more likely than others to experience physical, neurological or cognitive symptoms that can emerge, or linger for, months after their coronavirus infections have cleared?
Now, a team of researchers who followed more than 200 patients for two to three months after their Covid diagnoses report that they have identified biological factors that might help predict if a person will develop long Covid.
The study, published by the journal Cell, found four factors that could be identified early in a person’s coronavirus infection that appeared to correlate with increased risk of having lasting symptoms weeks later:
The level of coronavirus RNA in the blood early in the infection, an indicator of viral load. The presence of certain autoantibodies — antibodies that mistakenly attack tissues in the body as they do in conditions like lupus and rheumatoid arthritis. The reactivation of Epstein-Barr virus, a virus that infects most people, often when they are young, and then usually becomes dormant. Having Type 2 diabetes, although the researchers and other experts said that in studies involving larger numbers of patients, it might turn out that diabetes is only one of several medical conditions that increase the risk of Long Covid. The researchers said they had found that there was an association between these factors and Long Covid whether the initial infection was serious or mild. They said that the findings might suggest ways to prevent or treat some cases of Long Covid, including the possibility of giving people antiviral medications soon after an infection has been diagnosed.
“I think this research stresses the importance of doing measurements early in the disease course to figure out how to treat patients, even if we don’t really know how we’re going to use all that information yet,” said Jim Heath, the principal investigator of the study.
However, the study authors and other experts cautioned that the findings were exploratory and would need to be verified by considerably more research.
Read full story (paywalled)
Source: The New York Times, 25 January 2022
Patient Safety Learning

Government writes off £8.7bn of pandemic PPE

The government has written off £8.7bn it spent on protective equipment bought during the pandemic, accounts show.
The Department for Health and Social Care documents show items costing £673m were unusable, while £750m of equipment was not used before its expiry date.
The largest write-off - £4.7bn - was because the government paid more for it than it is currently worth, now that global supplies have recovered.
No 10 said the purchases were justified - with 97% of items suitable for use.
A further £2.6bn of equipment was judged to be unsuitable for use in the NHS, the 2020/21 accounts show, but the Department of Health and Social Care (DHSC) believes it could still be sold or given to charities.
At the start of the pandemic, countries around the world were clamouring for personal protective equipment (PPE), sending prices soaring.
No 10 said "we stand by the decision to purchase the items that we did", saying the approach was "justified" to get PPE to the front line. And the government was now able to "mitigate" similar problems in the future by "massively increasing our onshore-based PPE production".
Read full story
Source: BBC News, 1 February 2022
Patient Safety Learning

Trust CEO ‘behaved poorly’ and chair was ‘complicit’, NHS England review concludes

An NHS England review into the behaviour of high-profile senior leaders who took over a Midlands trust has concluded that the interim CEO “behaved poorly and inappropriately” while its chair was “complicit with” and failed to address problems.
NHS England had commissioned an independent probe into allegations about the behaviour of new executives, who had recently been appointed to the board of Walsall Healthcare Trust.
David Loughton and Professor Steve Field, who hold the same roles at the Royal Wolverhampton Trust, were brought in as interim chief executive and chair respectively in spring 2021.
Walsall has faced care quality concerns for some years and it was hoped the pair from neighbouring Wolverhampton would bring improvements. 
Dr McLean wrote in her review: “Leadership changes can, understandably, represent a period of anxiety for those affected but this can be minimised if changes are made in line with appropriate values and processes. 
“Whilst I conclude that the joint chair and interim CEO were motivated to act in the best interests of patients, I was saddened by much of what I heard.
”In the narratives I heard, there was a consistent lack of compassion or respect for people.”
She concluded: “The interim CEO, while motivated by the safety and care of patients, has behaved poorly and inappropriately … the joint chair has been complicit with and failed to address this behaviour.”
Read full story (paywalled)
Source: HSJ, 2 February 2022
Patient Safety Learning

Hormone replacement therapy could be made available over the counter

Hormone replacement therapy (HRT) could be made available to buy over the counter.
Health watchdogs are proposing a re-classification of the medication so women would be able to buy it in pharmacies without a prescription, it’s claimed.
HRT is mainly used to treat menopause symptoms but it is not yet known which version of the medication will be a part of the proposal, the Daily Telegraph reports.
Symptoms can include hot flushes, reduced sex drive and mood swings and usually pass after a few years.
More than one million women a year are believed to suffer each year but treatment is currently only available after consultation with a GP or a specialist.
A spokesperson for the Department of Health and Social Care said: "We understand that for some women menopause symptoms can have a significant impact on their quality of life, and we are committed to improving the care and support they receive.
"That’s why we’re developing the first ever government-led Women’s Health Strategy, informed by women’s lived experience. Menopause, including improving access to Hormone Replacement Therapy, will be a priority under the Strategy."
Read full story
Source: The Independent, 2 February 2022
Sam

NHS 'riddled with racism' against ethnic minority doctors

The NHS is "riddled with racism", the chair of the British Medical Association's council has told the BBC.
Dr Chaand Nagpaul has spoken out in response to a survey by the BMA, shared exclusively with BBC News.
At least 75% of ethnic minority doctors experienced racism more than once in the last two years, while 17.4% said they regularly faced racism at work, the survey said.
NHS England said it takes a "zero-tolerance approach" to racism.
Racism affects patients as well as doctors' wellbeing, by stopping talented people from progressing fairly and affecting doctors' mental health, Dr Nagpaul warned.
"This is about a moral right for anyone who works for the NHS to be treated fairly," he said.
Around 40% of the NHS's 123,000 doctors are from minority backgrounds, compared to about 13.8% of the general population. But despite this diversity, doctors told the BBC that there was a toxic "us versus them" culture in NHS trusts across the UK.
They said they had faced bogus or disproportionate complaints from colleagues, racist comments from superiors, and even physical assault in the workplace. Some said they had tried to lodge complaints which were then ignored or dismissed without investigation.
One consultant, from a black African background, told the BMA that after reporting previous incidents "no action was taken... I feel uncomfortable and anxious of reprisals".
Read full story
Source: BBC News, 2 February 2022
Sam

Dr Ted Baker announced as the new Chair of HSSIB

Dr Ted Baker has been formally appointed as the new chair of the Health Services Safety Investigations Body (HSSIB).
The Secretary of State for Health and Social Care, Rt Hon Steve Barclay MP, made the announcement today (1 December 2022).
Dr Baker is a retired consultant paediatric cardiologist, and most recently was Chief Inspector of Hospitals at the Care Quality Commission (CQC) between 2017 and 2022.
Dr Baker says: “I am delighted to be joining such a ground-breaking organisation. I have been impressed by the quality of the work coming from the HSIB and I am excited to be joining the organisation at such an important time in its history."
Source: HSIB, 1 December 2022
Patient Safety Learning

Electronic decision support ‘to be the norm for all clinicians’ under NHSE plan

Electronic systems and clinical decision support software must become “the norm” for all NHS clinicians, under plans being drawn up by NHS England’s new transformation directorate, HSJ has revealed.
The massive increase in clinicians’ use of technology forms a major part of the draft plans, seen by HSJ, with the new directorate set to launch ambitious targets for the health service.
Other targets include every integrated care system creating virtual wards which are the equivalent size of a district general hospital — around 500 beds each — and installing electronic patient records at every NHS trust.
The proposals are led by former US healthcare chief Tim Ferris, NHSE’s new transformation director, who was appointed last year.
According to the plans, NHSE’s ambition is to increase the “safe and effective use” of computer assisted processes and clinical decision support so it becomes the “expected norm for all clinicians”.
NHS leaders have welcomed the use of virtual wards to improve home care and reduce hospital occupancy, but clinicians have warned of safety issues within virtual wards, with some prominent doctors calling for a careful implementation of the policy.
Read full story (paywalled)
Source: HSJ, 2 February 2022
Patient Safety Learning

Long waits at Scotland's A&E 'putting patients at serious risk'

Long waits at accident and emergency (A&E) departments in Scotland continue to put patient safety at “serious risk”, the Royal College of Emergency Medicine has warned.
New figures from Public Health Scotland show 78 per cent of patients visiting A&E in the week to January 23 were seen and admitted, transferred or discharged within four hours.
This is an increase on the previous week, but still below the Scottish Government target of 95%
It comes as the number of planned operations across NHS Scotland dropped 13% from November to December, to 17,835.
Dr John Thomson, vice-president of the Royal College of Emergency Medicine in Scotland, said the college was concerned poor A&E performance times are becoming the “status quo”.
“With fewer attendances performance has plateaued, but be in no doubt that the health service and its staff in Scotland remain under unprecedented pressure and increasing burnout,” he said.
Dr Thomson added: “The impact of this continued poor performance is distress and moral injury to staff and serious discomfort and risk to the safety of patients.
Read full story
Source: The Scotsman, 2 February 2022
Patient Safety Learning

“Injured people will suffer twice” – furious reaction to clinical negligence fixed costs

Those harmed by the NHS will “have to pay again by losing access to justice” as a result of government plans to introduce fixed costs, campaigners have claimed.
The Department of Health & Social Care has published long-awaited proposals for fixed recoverable costs for fast-track cases, and significantly chose to set the fees at levels recommended by defendant representatives, rather than higher ones proposed by the claimant side.
Peter Walsh, chief executive of Action against Medical Accidents (AvMA), noted that the government consulted on similar proposals in 2017 and received a thumbs down from the majority of respondents.
He said: “It is shocking that the government is still pushing to bring in these illogical and potentially unfair proposals rather than looking at the root causes of high costs and addressing them…
“The government seems to have ignored the fact that the likely effect of these proposals would be that many people whose lives have been devastated by perfectly avoidable, negligent treatment will not be able to challenge denials or get access to justice.
“In effect, the very people that the NHS has harmed through lapses in patient safety will have to pay again by losing access to justice. If lawyers are unable to claim for time they spend overcoming denials of liability, injured people will not be able to get legal representation.”
Mr Walsh argued that the best way to save the NHS money was to improve patient safety to prevent these incidents in the first place, “and when mistakes do happen investigate them properly and make early, fair and appropriate offers of compensation without costly litigation”.
Read full story
Source: Legal Futures, 1 February 2022
Patient Safety Learning

Thousands of children are falling through the cracks in youth addiction services

Thousands of children are falling through the cracks in youth addiction services owing to Covid, staff shortages and funding cuts, psychiatrists have said, as figures suggest the number able to get help has fallen to the lowest on record.
Analysis of data from the National Drug Treatment Monitoring System (NDTMS) found that 11,013 under-18s were in treatment for drug and alcohol dependency in England in 2020-21, which was 3,278 fewer (23% less) than in 2019-20. It was the sharpest annual fall since records began, and means 13,481 fewer children were being treated than at a peak in 2008-09.
The vast majority of children in treatment (89%, or 9,832) had a problem with cannabis and 41% (4,459) had a problem with alcohol. About 12% (1,333) were struggling with ecstasy use and 9% (976) reported a problem with powder cocaine.
The Royal College of Psychiatrists, which analysed the data, said the pandemic, together with “drastic” historical funding cuts, was preventing young people from accessing the drug and alcohol treatment they need, potentially condemning them to a life of addiction.
Dr Emily Finch, the vice-chair of the addictions faculty at the Royal College of Psychiatrists, said: “Children and their families up and down the country are having their lives blighted by drug and alcohol use due to drastic cuts, workforce shortages and the impact of the pandemic.
“Addiction is a treatable health condition. Intervening early will mean many kids won’t go on to have an addiction in their adulthood, keeping them out of the criminal justice system and helping them to live full lives. It’s now time for the government to act on their promise and deliver the multimillion-pound investment into drug services.”
Read full story
Source: The Guardian, 3 February 2022
Sam

NHS Nightingale hubs cost £11m to build ... only to treat seven patients

The Nightingale surge hubs cost more than £10.6 million to set up but have admitted roughly seven patients, it has emerged.
Eight temporary sites were built at hospitals across the country during the height of the omicron wave, with the capacity to house about 100 patients each. However, it has now been revealed that the hubs cost £10,672,088 to build and only one has admitted a handful of patients.
Announcing the hubs in December, NHS England said they would be used if “the record number of Covid-19 infections leads to a surge in admissions and outstrips existing capacity”.
However, as of Jan 30, there were 1,285 daily admissions, an eight per cent decrease on the previous week.
The chief executive of the William Harvey Hospital, in Ashford, Kent – the location of one of the eight omicron hubs – has expressed concerns that the structure “may adversely impact” other services and never be used.
The cost of the hubs was revealed in response to a written question submitted by Damian Green, the Conservative MP Mr Green said that the temporary sites were an “insurance policy” and added “it looks like they won’t be needed”. He called on ministers to assess if they could be repurposed to help clear the backlog of patients waiting for treatment.
Read full story (paywalled)
Source: The Telegraph, 2 February 2022
Sam

Health charities warn women with UTIs are “patronised” and “not believed” when seeking medical help as new research reveals “medical misogyny”

Research by Garmin finds 40% of young women say they have been accused of over-exaggerating symptoms of UTIs.     
While it’s clear that already strained services and a lack of funding contributed to the impact of the pandemic on the healthcare system, health inequality isn’t something that’s unique to Covid-19.
Instead, it’s often the result of commonly misunderstood, misrepresented and mistreated conditions that disproportionately affect women, such as polycystic ovary syndrome (PCOS), endometriosis and urinary tract infections (UTIs).
New research from fitness company Garmin, published by The Independent, found that 40% of young women say they have been accused of over-exaggerating symptoms of UTIs or being “overdramatic” about their wellbeing when seeing a doctor. 45% also said they’ve had their UTI symptoms written off as “part of being a woman”.
According to the Chronic Urinary Tract Infection Campaign (CUTIC), 50% of all women will suffer at least one UTI episode in their lifetime, one third of these by the age of 24. 
“Statistics show that UTI is the most common infection seen by GPs,” says CUTIC. “In fact, doctors are so familiar with UTIs that they are frequently dismissed as merely a woman’s problem, rooted in the ‘flawed female anatomy’.
“With little training in UTI management, GPs and urologists rely heavily on discredited laboratory tests which miss up to 60% of infections."
“The medical training for UTI diagnosis is inadequate and most doctors are not aware of the complexity of this illness. They are trained to accept the test results and look no further,” CUTIC suggests.
“It is clear from the recent government probe into menopause that women’s health has not been an area of priority. Conditions which primarily affect women are underfunded and under researched – this includes UTIs. Women are frequently patronised and not believed when they describe symptoms relating to UTIs, peri-menopause, menopause and vaginal atrophy. Medical training fails to include proper diagnosis and effective treatment for such conditions. Change is needed now.”
Read full story
Source: The Stylist, 2 February 2022
Have you attempted to access treatment for a urinary tract infection (UTI), or recurrent UTIs? We'd love you to share your experiences with us? Share your experience on the hub.
Sam

An amputee's wife had to "carry him to the toilet" after her husband was sent home from hospital without a care plan

An amputee's wife having to "carry him to the toilet" after her husband was sent home from hospital without a care plan was just one of many findings in a report into vascular services at Betsi Cadwaladr University Health Board in north Wales.
The critical report by the Royal College of Surgeons England makes five urgent recommendations "to address patient safety risks".
Part one of the report, published last summer, made nine urgent recommendations and raised issues including too many patient transfers to the centralised hub, a lack of vascular beds and frequent delays in transfers.
The final part of the report, published on 3 February, focussed on the clinical records of 44 patients dating from 2014 - five years before centralisation - to July 2021, two years after the Ysbyty Glan Clwyd hub opened.
Assessors were "extremely concerned" about the case of a man where a decision was made to "amputate the foot rather than proceed to a below-the-knee amputation as the primary procedure".
The report adds: "The review team also noted that the patient had been discharged without a care plan and that the patient's wife was having to 'carry him to the toilet'."
It also highlights an "inappropriate" decision to offer a patient an "unnecessary and futile" amputation when "palliation and conservative therapy should have been considered instead".
Referring to that case, the report added that the risk from "major amputation was extremely high".
Read full story
Source: BBC News, 3 February 2022
Sam

Pfizer and BioNTech seek emergency use authorisation of the first coronavirus vaccine for children under 5 in the US

Pfizer and BioNTech said Tuesday that they were seeking emergency-use authorisation for the first coronavirus vaccine for children younger than 5 in the US and have begun submitting data on the safety and efficacy of the first two doses of a planned three-dose regimen.
The Food and Drug Administration asked the companies to apply for authorization of their vaccine, and in an email, FDA spokeswoman Stephanie Caccomo said the omicron surge had generated new data “impacting the potential benefit-risk profile of a vaccine for the youngest children.”
In December, Pfizer and BioNTech announced that the immune response generated by the vaccine in children between 2 and 4 years old was not sufficiently robust. But the companies said the vaccine had provoked a strong enough response in children 6 months to 2 years old. A third shot was added to the trial to increase the immune response.
An earlier vaccine trial in children 5 to 11 years old was also focused on showing that those children had adequate immune responses after vaccination. In addition, there were enough cases of illness in that study population to determine that the vaccine was 91% effective in preventing symptomatic illness.
The companies said Tuesday that the FDA requested they move forward with an application because of the “urgent public health need in this population,” noting that 1.6 million children under the age of 4 have tested positive for the coronavirus.
“The need for a safe and effective vaccine for our youngest children is significant, particularly given the rapid spread of the omicron variant, the notable rise in the number of hospitalizations in young children with severe disease, and the possibility that future variants could cause severe disease in those who are unvaccinated,” Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, said in a statement.
Read full story
Source: The Washington Post, 1 February 2022
Sam

Substantial fall in diabetic health checks as GPs reprioritised during pandemic

The proportion of patients with type 2 diabetes who have had recommended health checks has fallen substantially, provisional data from 2021 suggests, as have the numbers hitting key disease control targets.
In response, primary care experts have called for GP practices to receive targeted investment to focus on the checks, which they had to deprioritise as the vaccination programme was introduced.
There are now 3.24 million people with a diagnosis of type 2 diabetes in England, the data across all GP practices shows.
National Diabetes Audit figures for England from January to September 2021 showed that:
74% of patients had received a HbA1c check and 70% a blood pressure check compared with 93% and 95% respectively in 2019/20. In the first nine months of last year, 61.9% of patients had an HbA1c under 58 mmol/mol, compared with around 66% in previous years. The proportion of patients with blood pressure targets of under 140/80 was 66.5% in the latest figures compared with around 73-74% during 2015 to 2020. Speaking with Pulse, Professor Partha Kar, NHS England national specialty advisor for diabetes said while this was not the final data, a drop off had been expected for a range of reasons outside GPs control.
‘What we have seen is that there was a massive drop off in wave one. Then around the middle of 2020 it started to pick up again but then it’s dropping off again so irrespective of data cleaning, I suspect you will see a massive drop off compared to where things have been over the last four or five years.
‘We need to be very clear its not because anyone was twiddling their thumbs, it’s because primary care was asked to do something else.
‘We can’t go back to primary care again for the vaccines because they are being taken away from the thing that they’re amazing at which is delivering long-term conditions at scale.’
Read full story
Source: Pulse, 2 February 2022
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