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

Leak reveals management consultants’ role in recovery plans

Consultants will set strategy, provide analytics and help lead the creation of integrated care systems’ elective recovery plans, a leaked document reveals.
HSJ reported that seven management consultancy firms would be paid up to £21m to “support” every ICS design its elective recovery plans by April. According to internal NHS documents, leaked to HSJ, the firms will provide “tailored skills and expertise” to help ICS teams develop their plans.
The document, shared with ICS and regional chiefs in a presentation by NHS elective care chief Sir Jim Mackey, states the consultancies will work alongside ICS teams to “ensure” the ICS plans achieve many objectives.
These objectives include:
Delivering or exceeding the expected performance ambitions… and are “triangulated across activity, finance and workforce capacity”; Making “full use of transformational opportunities” to manage demand, increase capacity or improve productivity;  Having a clear link to the health inequalities agenda; and Maximising elective activity through all available options including making use of the available independent sector capacity.  Read full story (paywalled)
Source: HSJ, 10 February 2022
Patient Safety Learning

Role of NHS national and regional teams under review as ICSs develop, says Confed chief

The role of the centre and region of NHS England is under review because trusts will increasingly be accountable to and challenged by their integrated care systems, the NHS Confederation chief executive has said. 
Matthew Taylor, CEO of Confed, also told HSJ people should “guard against scepticism” about the emerging ICSs, which are a “bold experiment” and need to be given time.
Speaking about the respective roles of ICSs and NHS England’s national and regional teams, Mr Taylor said: “One of the challenges for ICSs is that [while] they will be about convening, they’ll be about developing collaboration, they will be developing a shared vision, there will be an element of challenge as well.
“If things go wrong and ICSs and [integrated care boards] are in place, then ICBs will need demonstrate they can tackle those things.”
He added: What we don’t want is another layer [in addition to the] centre and region. I’ve spoken to quite a lot of acute leaders over the last few months about ICBs and ICSs, and when I say to them, ‘do you want another level of accountability that you’ve got to report to?’ They say ‘no’.
“But when I say, ‘what if it replaced - and you had less regulation from - the centre and from the regions, and more from the system level, would that be okay?’ And they say, ‘that’ll be fine, that will be good’.
“Because I think they would feel a level of engagement then. Nobody wants to see more regulation - it’s a question of trying to make sure that challenge function primarily takes place at system level.”
Read full story (paywalled)
Source: HSJ, 10 February 2022
Patient Safety Learning

Lack of hospital beds makes Covid spread 'inevitable'

A lack of beds in Welsh hospitals meant it was "inevitable" Covid patients would come into contact with others, a doctor has said.
"Seeing patients in bed at the time of admission is becoming a rarity," Dr Nicky Leopold said.
Some patients, including those with Covid, have had to spend nights on chairs in A&E due to a lack of beds.
The Welsh government said it aimed to deliver 12,000 more staff by 2024-25.
Health Minister Eluned Morgan and the chief executive of the Welsh NHS are due to give evidence to the Senedd's health committee on winter pressures..
Dr Leopold, a consultant geriatrician, who is a member of the BMA union in Wales, said there had been recent improvements since the number of NHS staff testing positive for Covid fell, but the flow of patients through hospital was still a problem.
She said: "So many patients are stranded in hospital and that's very difficult and frustrating. There just aren't the staff in the community to support the increased level of need."
Outpatient appointments had also been affected by shortages, she added. A lot of patients were in "dire need" and staff were "desperately" trying to keep clinics running.
Read full story
Source: BBC News, 10 February 2022
Patient Safety Learning

Doctors warn NHS private sector plans risk patient safety

Healthcare leaders have been warned by nearly 200 doctors that plans to give more work to private hospitals will “drain” money and staff away from NHS services, leaving the most ill patients at risk.
In a letter, seen by The Independent, almost 200 ophthalmologists urged NHS leaders to rethink plans to contact cataract services to private sector hospitals as it “drains money away from patient care into private pockets as well as poaching staff trained in the NHS.”
The doctors have called for “urgent action” to stop a new contract from being released which would allow private sector hospitals to take over more cataract services.
They raised concerns NHS ophthalmology services would fall into the same crisis at NHS dentistry which would have “blinding consequences” for patients.
One of the lead authors of the letter told The Independent the plans would mean there are not enough NHS staff available to carry out more complex surgeries where patients are at risk of losing their eyesight.
Read full story
Source: The Independent, 10 February 2022
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Record levels of self-harm found at Derbyshire women’s prison

Inmates held in a women’s prison are making 1,000 calls a month to Samaritans amid record levels of self-harm, increased violence and low safety levels usually only seen in men’s facilities, a damning report has found.
Nearly a third of women held at Foston Hall in Derbyshire, which holds 272 residents, told inspectors they felt unsafe, while the use of force in the prison has doubled over nearly three years and is the highest on the women’s prison’s estate.
The women’s prison and youth offender institute is the first to be given a score of “poor” – the lowest – for the safety of female prisoners, since HM Inspectorate of Prisons developed its current framework more than a decade ago.
Charlie Taylor, HM chief inspector of prisons, said the rating of “poor” for safety levels was a “rare and unexpected finding” in a women’s prison.
Recorded levels of self-harm were also the highest in the women’s estate and two prisoners had taken their own lives since the last official inspection in February 2019, he said.
“As an indicator of the level of distress, women were making 1,000 calls a month to Samaritans. The prison had no strategy to reduce self-harm or improve the care for those in crisis,” Taylor said.
The response to women in crisis was too reactive, uncaring and often punitive, Taylor observed. “This, taken with other safety metrics and observation, meant it was no surprise that in our survey nearly a third of women told us they felt unsafe,” he said.
The report also found that the majority of women who harmed themselves did not have enough support or activity and faced daily frustration in getting the help they needed. 
Read full story
Source: The Guardian, 9 February 2022
Patient Safety Learning

Organ donation: Change to Northern Ireland law passes final hurdle

Campaigners have welcomed the "life-saving" legislation to bring opt-out organ donation to Northern Ireland.
The legislation, which will align Northern Ireland with the rest of the UK, passed its final stage in the assembly on Tuesday. It means people will automatically become donors unless they specifically state otherwise.
Máirtín MacGabhann, whose son Dáithí is waiting on a heart transplant, said it was "phenomenal".
The bill is to be known as 'Dáithí's Law' after the five-year-old whose family have campaigned for the law change.
Mr MacGabhann said it was an emotional day for them.
He told BBC NI's Evening Extra programme: "The most important thing, regardless of the name, is that it's passed its final stage and that life-saving legislation will go through."
Read full story
Source: BBC News, 9 February 2022
Patient Safety Learning

Soaring trolley waits spark warnings A&E pressures getting ‘worse and worse’

The number of 12-hour waits in accident and emergency departments rose by 27% in one month to reach record levels in January amid warnings overcrowding is harming an increasing number of patients.
Official monthly performance data prompted the Royal College of Emergency Medicine’s president to warn that the problems facing emergency departments were getting “worse and worse”, while pointing out the real number of 12-hour A&E breaches is likely higher than official data records. 
The figures also revealed the waiting list had hit a new high of 6.1 million, while the number of two-year breaches also rose a record level.
Trusts recorded 16,558 patients last month waited 12 hours or more in an emergency department from decision to admit to being discharged or admitted. This was up from 12,986 in December.
RCEM president Katherine Henderson warned on Twitter: “This is [decision to admit] plus 12 – a concept which must be retired as a performance metric. We should have 0-12 hour data. You cannot fix a problem if you [are] unwilling to face up to what it actually is. We estimate reality is 20 x more. This is getting worse and worse.”
Read full story (paywalled)
Source: HSJ, 10 February 2022
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CDC proposes new guidelines in the US for treating pain, including opioid use

The federal government on Thursday proposed new guidelines for prescribing opioid painkillers that remove its previous recommended ceilings on doses for chronic pain patients and instead encourage doctors to use their best judgment.
But the overall thrust of the recommendations was that doctors should first turn to “nonopioid therapies” for both chronic and acute pain, including prescription medications like gabapentin and over-the-counter ones like ibuprofen, as well as physical therapy, massage and acupuncture.
Though still in draft form, the 12 recommendations, issued by the Centers for Disease Control and Prevention (CDC), are the first comprehensive revisions of the agency’s opioid prescribing guidelines since 2016. They walk a fine line between embracing the need for doctors to prescribe opioids to alleviate some cases of severe pain while guarding against exposing patients to the well-documented perils of opioids.
“We are welcoming comments from patients who are living with pain every day and from their caregivers and providers,” said Christopher Jones, a co-author of the draft and acting director of the National Center for Injury Prevention and Control, the arm of the CDC that released the new guidelines.
Read full story (paywalled)
Source: The New York Times, 10 February 2022
Patient Safety Learning

7,469 research nurses and midwives across the UK and Ireland, new census reveals

There are at least 7,469 research nurses and midwives across the UK and Ireland working within all areas of healthcare, reveals a landmark new census initiated by a group of NIHR 70@70 Senior Nurse & Midwife Research Leaders.
The census, incorporating responses from research nurses and midwives across all four UK nations and the Republic of Ireland, reveals nurses and midwives are working at every level in healthcare from Bands 5 – 9 in the UK, and from staff nurse to Directors of Nursing or Midwifery in the Republic of Ireland. This suggests there are opportunities to join the profession at every level, with continued potential for career progression. Clinical research nurses and midwives are a specialist workforce, with knowledge, skills and expertise in both clinical practice and research delivery.
The census shows that:
33.7% reported working in joint posts, for example as a clinical research nurse for part of their role as well as a clinical nurse specialist; 72% are working within a single disease/area specialism;  28% reported covering multiple disease areas.  NIHR Director of Nursing & Midwifery Professor Ruth Endacott said: “This census reveals the true breadth and depth of our research nursing and midwifery community. We know there are scores of people working incredibly hard day and night helping to bring us new treatments and medicine alongside their healthcare colleagues but we now have a much clearer idea of the size of the workforce. Research nurses and midwives are making a difference to the health of people across the UK and Ireland."
Read full story
Source: National Institute for Health Research, 9 February 2022
Patient Safety Learning

Doctors repeatedly told a woman stress was causing her symptoms. Then they pulled out a volleyball-size tumor.

Again and again, Hannah Catton told doctors something was wrong with her body. Again and again, she said, the doctors dismissed her concerns.
They didn’t listen in late 2018 when she told them about her frequent urinary tract infections. They didn’t listen months later when she returned to tell them she was having irregular periods. And they didn’t listen when she complained of bloating, constipation, diarrhea and extreme pain.
Catton was telling them her body was in rebellion. Almost a dozen physicians told her otherwise: She was young and healthy, so it was probably nothing — just a little too much stress. One told her she was overweight and losing a few pounds might ease her symptoms.
Almost three years passed after Catton’s symptoms first emerged, during which she saw about 10 doctors. Then, in October, she collapsed in pain and took herself to the emergency room. From one of her ovaries, surgeons pulled a cancerous blob weighing roughly 4½ pounds and stretching nearly eight inches — about the size of a volleyball.
After her years-long crusade to be heard, Catton, now 24, wants other women and doctors to learn from her experience. Women should learn the warning signs of ovarian cancer and forcefully advocate for themselves, she said, while doctors need to become better versed in recognizing the symptoms. More importantly, Catton said, physicians need to listen to patients instead of dismissing them.
Catton knew early on that something was wrong, that it wasn’t just stress. Despite that, she acquiesced to the doctors because she didn’t “want to be a patient that wastes time.”
She’s not alone, clinical psychologist Bella Grossman told Northwell Health’s Katz Institute for Women’s Health in the article “Gaslighting in women’s health: No, it’s not just in your head.” Men tend to be more persistent with their doctors when they have concerns about their health, Grossman said.
Read full story (paywalled)
Source: Washington Post, 9 February 2022
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NHS hospital doctor arrested on suspicion of sexual assault

Two NHS hospital trusts are working with police after a doctor was arrested on suspicion of sexual assault.
Staffordshire Police has launched a major incident review of the doctor's work at hospitals in Dudley, West Midlands, and Stoke-on-Trent, The Sunday Times reported.
The force said the 34-year-old man from the West Midlands was arrested in December and released on bail.
It is reviewing an investigation into the same suspect it undertook in 2018.
The doctor was suspended from seeing patients at the Royal Stoke University Hospital in Staffordshire when the parents of a vulnerable female raised concerns about his examination of her, the Sunday Times reported.
The case was referred to police in 2018 who said there was "insufficient evidence to take further action" at the time.
The Staffordshire force has now reported itself to the Independent Office for Police Conduct.
University Hospitals of North Midlands NHS Trust, which runs the Royal Stoke, said it was working with police and had set up a helpline for any patient and guardian who may have concerns.
Read full story
Source: BBC News, 13 February 2022
Patient Safety Learning

Staff on prolonged leave with long covid could be dismissed, says NHSE

Staff on prolonged sick leave due to long covid could be dismissed if ‘redeployment is not an option’ and they are unable to fulfil their contract, new NHS England guidance says.
The advice was set out in guidance published this month and follows the government’s temporary, non-contractual guidance that was issued in response to the coronavirus pandemic during its first waves.
The government’s advice aimed to provide a temporary enhancement of covid sick pay and meant that staff who were absent with covid would remain on full pay, therefore, did not feel pressured to return.
However, NHSE’s guidance warned that “while this provision is still available, it is possible that it may change”.
The move has been seen as an inevitable step as the guidance was brought in as an emergency measure, while some employers may have been holding off dismissing staff with long covid or covid-related absences due to guidelines in place.
NHSE’s new Guidelines for supporting our NHS people affected by long covid said: “According to [the] guidance, periods of covid-19 sick pay would not be counted towards a colleague’s normal sickness entitlements.
“However, if a colleague is approaching long-term sickness (for a period of 12 months or more), the employing organisation would be expected to complete a review at 12 months to understand the ongoing need and potential challenges with a return to work.
It adds: “Consideration of dismissal due to the colleague being unable to fulfil their contract should only be considered if redeployment is not an option.”
Read full story (paywalled)
Source: HSJ, 11 February 2022
Patient Safety Learning

Radical action needed to tackle racial health inequality in NHS, says damning report

Radical action is needed urgently to tackle “overwhelming” minority ethnic health inequalities in the NHS, leading experts have said, after a damning study found the “vast” and “widespread” inequity in every aspect of healthcare it reviewed was harming the health of millions of patients.
Racism, racial discrimination, barriers to accessing healthcare and woeful ethnicity data collection have “negatively impacted” the health of black, Asian and minority ethnic people in England for years, according to the review, commissioned by the NHS Race and Health Observatory, which reveals the true scale of health inequalities faced by ethnic minorities for the first time.
“Ethnic inequalities in health outcomes are evident at every stage throughout the life course, from birth to death,” says the review, the largest of its kind. Yet despite “clear”, “convincing” and “persistent” evidence that ethnic minorities are being failed, and repeated pledges of action, no “significant change” has yet been made in the NHS, it adds.
From mental health to maternity care, the sweeping review led by the University of Manchester paints a devastating picture of a healthcare system still failing minority ethnic patients despite concerns previously raised about the harm being caused.
“By drawing together the evidence, and plugging the gaps where we find them, we have made a clear and overwhelming case for radical action on race inequity in our healthcare system,” said Habib Naqvi, the director of the NHS Race and Health Observatory, an independent body established by the NHS in 2020 to investigate health inequalities in England.
Read full story
Source: The Guardian, 13 February 2022
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Vulnerable women are being failed by maternity services, report finds

Current models of maternity care in the UK are failing to reach pregnant women living in adverse social circumstances, research commissioned by the Royal College of Obstetricians and Gynaecologists has found.
Georgina Jones, one of the report’s authors and professor of health psychology at Leeds Beckett University, told The BMJ, “Women are often living in a tangled web of complex inequalities that is beyond their control, and this impacts on the care they receive and the outcomes of that care . . .We’ve really been letting down these women in the way that our maternity and reproductive health services are currently delivered, and strategies and care pathways need to be identified and put in place to remedy this.”
A number of recommendations have been made in the paper including:
Understanding it is the vulnerable, minoritised and disadvantaged women in society that have an increased risk of maternal death. These women are often living in an entangled web of complex inequalities that is beyond their control, which impacts on the care they receive and the outcomes of that care. Strategies and care pathways need to be identified and put in place to improve their situation. These women have been let down in the way that our maternity and reproductive health services are currently delivered. We need to find a better way of recording social determinant data. The current way of doing this is inadequate and not fit for purpose, and it doesn’t provide us with enough information to really understand how the complex circumstances of the woman impacts on her maternal outcomes. The research shows current models of care are still failing pregnant women who have lived in adverse social circumstances prior to, during and after pregnancy. Maternal outcomes are particularly poor for socially disadvantaged women affected by pre-existing physical or mental health problems; those who misuse substances; those who have a lower level of education; those who are overweight, undernourished or poorly sheltered; and those who are at increased risk due to the threat of abusive and unsupportive partners, families and peers. Read full story (paywalled)
Source: BMJ, 10 February 2022
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Heart-disease risk soars after COVID — even with a mild case

Even a mild case of COVID-19 can increase a person’s risk of cardiovascular problems for at least a year after diagnosis, a new study1 shows. Researchers found that rates of many conditions, such as heart failure and stroke, were substantially higher in people who had recovered from COVID-19 than in similar people who hadn’t had the disease.
What’s more, the risk was elevated even for those who were under 65 years of age and lacked risk factors, such as obesity or diabetes.
“It doesn’t matter if you are young or old, it doesn’t matter if you smoked, or you didn’t,” says study co-author Ziyad Al-Aly at Washington University in St. Louis, Missouri, and the chief of research and development for the Veterans Affairs (VA) St. Louis Health Care System. “The risk was there.”
People who had recovered from COVID-19 showed stark increases in 20 cardiovascular problems over the year after infection. For example, they were 52% more likely to have had a stroke than the contemporary control group, meaning that, out of every 1,000 people studied, there were around 4 more people in the COVID-19 group than in the control group who experienced stroke.
The risk of heart failure increased by 72%, or around 12 more people in the COVID-19 group per 1,000 studied. Hospitalization increased the likelihood of future cardiovascular complications, but even people who avoided hospitalization were at higher risk for many conditions.
“I am actually surprised by these findings that cardiovascular complications of COVID can last so long,” Hossein Ardehali, a cardiologist at Northwestern University in Chicago, Illinois, wrote in an e-mail to Nature. Because severe disease increased the risk of complications much more than mild disease, Ardehali wrote, “it is important that those who are not vaccinated get their vaccine immediately”.
Read full story
Source: Nature, 10 February 2022
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Delayed diagnoses and self-imposed lockdown: Australians living with cancer during Covid

Two years of the pandemic have meant drops in essential screening and detection in Australia, while cancer patients undergo treatments alone and isolate to avoid Covid risks.
When Claire Simpson turned 50 in early 2020, she received a letter telling her to get a mammogram. Then the pandemic hit, and Victoria went into lockdown.
“Like many people, I put it off until we were coming out of that lockdown, but by then it was September and I couldn’t get an appointment until December,” she says.
In February 2021 she was diagnosed with breast cancer and had a mastectomy. Tests showed she was positive for the aggressive HER2 receptor, so she began 12 weeks of chemotherapy as well as a treatment called Herceptin, which she received an IV infusion of every three weeks.
Simpson says the delay in screening “really, really delayed diagnosis for me, by a good six months”.
“I can’t help but feel that [an earlier screening] could have probably saved me from having to have chemotherapy and this Herceptin infusion therapy that I’m having,” she says.
Her last Herceptin treatment was last Wednesday. She has been living in self-imposed lockdown, terrified as the Omicron wave built that she would have to isolate due to Covid and disrupt her treatment. That self-imposed isolation will continue until her final surgery, an elective operation scheduled for mid-year.
Cancer screening dropped by 10% in Victoria alone in the first year of the pandemic. In 2021, referrals to the Peter MacCallum Cancer Centre, a leading treatment and research facility in Melbourne, were down 40%.
“That is certainly going to bounce back at some point,” says Prof Sherene Loi, an oncologist and researcher at Peter MacCallum. “It is potentially going to be a real problem in a few years’ time. At the moment we have a lot of very young cancer diagnoses, a lot of breast cancer … we are just flat chat.”
Read full
Source: The Guardian, 13 February 2022
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