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

Early end to England’s isolation rules is a: "perilous and politicised pandemic response"

Today the Government is expected to announce the end to all Covid restrictions, including ending self-isolation and free testing in the country. However, in an open letter to the UK's Chief Medical Officer and Chief Scientific Officer, the UK science and medical communities say this is a "HUGE mistake".
The open letter expresses concern about the Government plans to end testing, surveillance surveys and legal isolation of Covid-19 cases and asks the Government to clarify the scientific advice underpinning these policy decisions as they do not believe there is a solid scientific basis for the policy.

"It is almost certain to increase the circulation of the virus and remove the visibility of emerging variants of concern." 

"The emergence of new variants and a resultant wave of infections can occur very quickly, potentially within just several weeks. The ability to rapidly detect and characterise new variants and to scale up necessary responses (such as TTI and vaccinations) quickly will be very important. Considerations for future response preparedness and surveillance infrastructure should take this into account." 

"We believe humanity is in a race against the virus."

The letter goes on to say that some form of surveillance must be continued to ensure the situation is well understood and new variants of concern identified. Lack of testing is not only detrimental to controlling the spread of SARSCoV2 and detecting new variants, it also puts people who develop Long Covid at a great disadvantage by not having a confirmation of their infection, which is integral to the diagnosis, support and care they need to receive. For the 1 in 4 people in the UK who are clinically vulnerable, the current approach appears a perilous and politicised pandemic response.

The authors of the letter are asking members of the UK science and medical communities to sign the open letter.
Read the letter in full and sign here
Patient Safety Learning

Ministers warned getting rid of free Covid tests will lead to £500 ‘caring tax’

Abolishing free Covid tests for those who look after the vulnerable will amount to a “tax on caring” that would cost them more than £500 a year, ministers have been warned.
All remaining domestic Covid regulations that restrict public freedoms are ending, with Boris Johnson announing a move away from government intervention to “personal responsibility”. However, the scale of free testing to be retained is still being thrashed out within government.
Current data suggests that nearly 4 million people take regular Covid tests, including those who visit and help vulnerable relatives. That number also includes vulnerable people who work in settings that could put them at greater risk, where they have face-to-face contact with others.
Research based on the average cost of tests internationally, compiled by the Liberal Democrats, suggests that people who take two tests a week face an average bill of £534 a year. It comes after the government’s own scientific advisers have warned that removing free testing will “increase anxiety” and limit the “social participation outside the home” of those who are clinically vulnerable or who live with someone in that position.
“Charging people for the tests they need to safely see vulnerable loved ones is a tax on caring that risks leaving millions of people in lockdown by stealth,” said Ed Davey, the Lib Dem leader. “It means vulnerable people will see fewer loved ones and will be able to enjoy less of their lives. It is unfair and unjust. Ministers need to scrap these plans to stop a ‘cost of living with Covid’ crisis. Throughout the pandemic, people have been trying hard to do the right thing and keep others safe. The government should not be making that harder.”
Read full story
Source: The Guardian, 19 February 2022
Patient Safety Learning

USA: Covid infection increases risk of mental health disorders, study finds

Having Covid-19 puts people at a significantly increased chance of developing new mental health conditions, potentially adding to existing crises of suicide and overdoses, according to new research looking at millions of health records in the US over the course of a year.
The long-term effects of having Covid are still being discovered, and among them is an increased chance of being diagnosed with mental health disorders. They include depression, anxiety, stress and an increased risk of substance use disorders, cognitive decline, and sleep problems – a marked difference from others who also endured the stress of the pandemic but weren’t diagnosed with the virus.
“This is basically telling us that millions and millions of people in the US infected with Covid are developing mental health problems,” said Ziyad Al-Aly, chief of research and development at the VA St Louis Healthcare System and senior author of the paper. “That makes us a nation in distress.”
The higher risk of mental health disorders, including suicidal ideation and opioid use, is particularly concerning, he said.
“This is really almost a perfect storm that is brewing in front of our eyes – for another opioid epidemic two or three years down the road, for another suicide crisis two or three years down the road,” Al-Aly added.
These unfolding crises are “quite a big concern”, said James Jackson, director of behavioural health at Vanderbilt University’s ICU Recovery Center, who was not involved with this study. He is also seeing patients whose previous conditions, including anxiety, depression and opioid use disorder, worsened during the pandemic.
Read full story
Source: The Guardian, 18 February 2022
Patient Safety Learning

Netherlands: First Long Covid legal cases involve healthcare staff

At least five people in the Netherlands who developed Long Covid through their jobs are planning to sue their employers for financial and emotional damage, according to RTL Nieuws. But lawyers, unions, company doctors and academics expect many more cases will arise and say they could take years to reach a conclusion, RTL said.
One case involves a residential care nurse who was told to take care of a patient without protective clothing. It later transpired that the unit manager knew the patient may have had coronavirus. The nurse has been at home for almost two years with Long Covid, and her salary has been reduced in line with sick pay regulations.

Ambulance worker Lenny Wagemans is also holding her former employer responsible for her illness. She picked up coronavirus in March 2020 after a patient coughed all over during a trip to hospital. She too did not have a face mask or other protection. 
Dealing with work related illnesses is often complex and with Covid it is difficult to establish exactly where an infection took place, said Utrecht University researcher Marlou Overheul. ‘You might have picked up coronavirus somewhere else and that can have an impact on a damages claim,’ she said.

The Federation of Dutch Trade Unions said last month over 500 healthcare workers face losing their jobs because they are suffering from Long Covid and have been on sick pay for the regulation two years.

MPs have voted in favour of a motion which calls on the government to formally recognise Long Covid as an illness and which will ensure all nursing staff are entitled to invalidity benefits. The government has asked the national health council to make recommendations about how to deal with Long Covid which will be published in the first quarter of this year.

Read full story
Source: Dutch News, 20 February 2022
Patient Safety Learning

USA: Doctors are more likely to describe black patients as uncooperative, studies find

Medical records contain a plethora of information, from a patient’s diagnoses and treatments to marital status to drinking and exercise habits. They also note whether a patient has followed medical advice. A health provider may add a line stating that the patient is “noncompliant” or “non-adherent,” signalling that the patient has been uncooperative and may exhibit problematic behaviours.
Two large new studies in the US found that such terms, while not commonly used, are much more likely to appear in the medical records of Black patients than in those of other races.
The first study, published in Health Affairs, found that Black patients were two and a half times as likely as white patients to have at least one negative descriptive term used in their electronic health record. About 8% of all patients had one or more derogatory terms in their charts, the study found. The most common negative descriptive terms used in the records were “refused,” “not adherent,” “not compliant” and “agitated.”   The second study, published in JAMA Network Open, analysed the electronic health records of nearly 30,000 patients at a large urban academic medical centre between January and December 2018. The study looked for what researchers called “stigmatising language,” comparing the negative terms used to describe patients of different racial and ethnic backgrounds as well as those with three chronic diseases: diabetes, substance use disorders and chronic pain.   Overall, 2.5% of the notes contained terms like “nonadherence,” “noncompliance,” “failed” or “failure,” “refuses” or “refused,” and, on occasion, “combative” or “argumentative.” But while 2.6% of medical notes on white patients contained such terms, they were present in 3.15% of notes about Black patients.   Looking at some 8,700 notes about patients with diabetes, 6,100 notes about patients with substance use disorder and 5,100 notes about those with chronic pain, the researchers found that patients with diabetes — most of whom had type 2 diabetes, which is often associated with excess weight and called a “lifestyle” disease — were the most likely to be described in negative ways. Nearly 7% of patients with diabetes were said to be noncompliant with a treatment regimen, or to have “uncontrolled” disease, or to have “failed.” The labels have consequences, warns Dr. Schillinger, who directs the Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center. 
“Patients whose physicians tend to judge, blame or vilify them are much less likely to have trust in their doctors, and in the medical system overall,” Dr. Schillinger said. “Having health care providers who are trustworthy — who earn their patients’ trust by not judging them unfairly — is critical to ensuring optimal health and eliminating health disparities.”
Read full story (paywalled)
Source: The New York Times, 20 February 2022
Patient Safety Learning

Diabetic patient found dead on hospital roof after medics ejected him while he was in shock

A diabetic pensioner died on the roof of a hospital after staff physically ejected him despite being in a “confused” state.
Stephen McManus, a long-term Type 1 diabetes patient, had earlier been rushed to Charing Cross Hospital in west London while suffering a hypoglycaemic episode.
Despite colleagues having expressed concerns about his slurred speech and erratic behaviour, a junior doctor decided the 60-year-old had the mental capacity to go home.
He was wheeled out of the building by security guards, despite having no phone, money and being in his slippers. His family had not been contacted to inform them he was being discharged.
Some time later Mr McManus re-entered the building and managed to gain access to a construction area, somehow finding his way onto the roof.
He was found dead the next morning following a police search after his family reported him missing.
An inquest has begun trying to establish why Stephen was allowed to leave the hospital in the first place and how he was able to access a potentially dangerous zone.
Mr McManus’s family say the case raises profound questions about the treatment of diabetic patients in the NHS.
“My father was an extremely vulnerable patient and the nature of his removal from the hospital is inexplicable, Jonathan McManus, his son, told The Telegraph.
“Had he been kept in hospital he would no doubt be alive today.”
Read full story
Source: Yahoo News, 19 February 2022
Patient Safety Learning

Every hospital trust in England limiting visitors despite move towards ‘living with Covid’

Patients face limits on visitors in every hospital trust in England, The Telegraph has revealed, with restrictions set to continue even once the country moves to "living with Covid".
It comes as Boris Johnson announces that all Covid regulations including self-isolation will be abolished at the end of February. 
The health service supports keeping some visiting restrictions in place while Covid remains in circulation among the general population, it is understood.
A spokesman said: "The NHS regularly reminds hospitals that visits for patients should continue to go ahead as much as possible and extra measures should already be in place so that this can be done safely."
NHS England encourages trusts to facilitate visits "wherever possible, and to do so in a risk-managed way", but it is up to individual trusts to set their own policies based on UK Health Security Agency guidelines.
Analysis by The Telegraph found that at least 34 hospital trusts across England still have routine visits suspended, with exceptions such as those for patients receiving end-of-life care and people with dementia. All 125 trusts have some form of visiting restriction in place. The most common policy is to have one named visitor per patient for the entirety of a patient's stay, who can only visit for one hour once a day.
Helen Wildbore, the director of the Relatives and Residents Association, said limiting patients to one nominated visitor put pressure on families, leaving the carer "exhausted".
She added: "If you’re going into hospital and you're not able to have your family with you, you're going to come out worse." In some cases, patients who needed hospital care had chosen not to go because they were worried about being isolated from family, she said.
Caroline Abrahams, the Charity Director at Age UK, said it was "imperative that hospitals open their doors to visitors again as wide as they possibly can" as the pandemic eases.
Read full story (paywalled)
Source: The Telegraph, 18 February 2022
You may also be interested in reading: 
Visiting restrictions and the impact on patients and their families: a relative's perspective
Patient Safety Learning

Ovarian cancer symptoms are being ignored, UK charity warns

GPs and women are still ignoring key symptoms of ovarian cancer despite better awareness of the disease, a charity has warned, prompting fears that yet more patients will be diagnosed late and “die needlessly”.
Symptoms include frequently having a swollen tummy or feeling bloated; pain or tenderness in the tummy or the pelvis; having no appetite or feeling full quickly after eating, and an urgent need to pee or needing to pee more often, according to the NHS.
However, Target Ovarian Cancer is concerned that despite successful campaigns to boost awareness of the disease, many are still failing to act on the vital signs. “Key symptoms are being ignored – both by those experiencing them and their GPs,” a spokesperson said.
A poll of 1,000 women for the charity found 79% did not know that bloating was a symptom, while 68% were unaware abdominal pain was a sign, and 97% did not know feeling full was another. Most women (99%) did not know that needing to pee more urgently was also a sign, while evidence suggests women can often be told by their GP that their symptoms are more a symptom of irritable bowel syndrome (IBS), Target Ovarian Cancer said.
Ovarian cancer kills about a third of women with the disease in the first year after diagnosis, and is often diagnosed in the late stages. There are about 7,500 new ovarian cancer cases in the UK every year.
“These figures are incredibly disappointing,” said Annwen Jones, the chief executive of Target Ovarian Cancer. “We know we’ve shifted the dial in the past 10 years through the dedication of thousands of Target Ovarian Cancer’s campaigners, but it is not enough. Knowing the symptoms is crucial for everyone.
“We need to make sustained and large-scale government-backed symptoms campaigns a reality. Progress is possible. If we do this, fewer people will be diagnosed late, fewer will need invasive treatment, and, ultimately, fewer will die needlessly from ovarian cancer.”
Read full story
Source: The Guardian, 22 February 2022
Patient Safety Learning

"'I feel less safe without Covid measures"

Medically vulnerable people say the decision to end Covid restrictions means their freedoms being eroded.
Prime Minister Boris Johnson announced that legal requirements, including the need to self-isolate if you test positive, will end on Thursday.
Two clinically vulnerable women in the West say not knowing who is infected means it is now more dangerous for them to leave their homes.
"It doesn't feel safe," said Chloe Ball-Hopkins, from Gloucestershire.
"My friends and family will continue to try and keep me safe, my partner will keep me safe, they'll continue to test before they meet me," said the 25-year-old from Wotton-under-Edge.
Miss Ball-Hopkins has already had her fourth vaccine dose as she is considered extremely clinically vulnerable.
She has a rare form of muscular dystrophy called nemaline myopathy which affects her respiratory system, and contracted sepsis in 2019 which undermined her immune system further.
Miss Ball-Hopkins said that while the easing of restrictions would feel like freedom to much of the population, it meant the opposite for her.
"I'm supposed to go out and live my life normally yet now I won't know if someone next to me in a supermarket is literally breathing Covid down on me, as I'm in a wheelchair.
"I was actually probably safer in January when everyone was wearing masks than I will be in a week's time. That makes no sense," she said.
Read full story
Source: BBC News, 22 February 2022
Patient Safety Learning

Covid-19: Mexico City gave ivermectin kits to people with covid in “unethical” experiment

The government of Mexico City handed out nearly 200 000 “ivermectin based kits” last year to people who had tested positive for Covid-19, without telling them they were subjects in an experiment on the drug’s effectiveness.
The results of that experiment were then written up by public officials in an article placed on popular US preprint server SocArXiv. It became one of site’s most viewed articles, claiming that ivermectin had reduced hospital admissions by 52-76%.
But those officials have been under fire at home since SocArXiv withdrew the paper earlier this month, calling it “either very poor quality or else deliberately false and misleading.”
Opposition deputies in Mexico City’s Congress demanded hearings and said they would bring legal action against the paper’s lead author, José Merino, head of the city’s Digital Agency for Public Innovation.
Explaining the decision to withdraw the article—the first to be taken down by SocArXiv—the site’s steering committee wrote that it had responded “to a community groundswell beseeching us to act” in order “to prevent the paper from causing additional harm.”
The committee wrote, “The paper is spreading misinformation, promoting an unproved medical treatment in the midst of a global pandemic. The paper is part of, and justification for, a government programme that unethically dispenses (or did dispense) unproven medication apparently without proper consent or appropriate ethical protections.”
Read full story
Source: BMJ, 22 February 2022
Patient Safety Learning

NHS cuts to cover Covid costs may hit patient care, Labour warns

Patient care may suffer as a result of cuts to the NHS budget to fund the continuing costs of Covid, NHS leaders and Labour have said, after Sajid Javid refused to say where the axe would fall.
The Department of Health and Social Care (DHSC)  is trying to make savings from its budget to fund free lateral flow tests for elderly people, Covid surveillance studies and genomic sequencing, after the Treasury refused its request for £5bn in extra funding.
Although the government announced an end to most free mass testing and contract tracing on Monday, remaining Covid measures are expected to cost more than £1bn.
The Treasury and the DHSC refused to say exactly how much cash would be needed or which services would have to be cut back, prompting fears that the NHS could have to find savings at a time of a huge waiting list backlog.
It is understood that DHSC officials are working on identifying savings in the department’s £178.5bn budget for 2022-23, to fund the measures agreed on Monday, including maintaining a “baseline” testing capability that can be scaled up if necessary.
They have ruled out hitting Javid’s plan for tackling waiting lists, but a government source would not rule out any other areas being affected, saying a “significant amount of money” would have to be found by “reprioritising”.
Saffron Cordery, the deputy chief executive of NHS Providers, warned the government against abandoning its commitment to give the NHS “whatever it needs” to tackle Covid and called for transparency about “where the impact of these extra costs will fall”.
“Trust leaders are understandably anxious over reports that the ongoing and significant costs of living with Covid will be met by ‘reprioritising’ the NHS’s existing budget,” she said. “There is a very real risk of trade-offs affecting the quality of patient care – something no one wants to see.”
Read full story
Source: The Guardian, 23 February 2022
Patient Safety Learning

NHS to tackle 'unfair' maternity outcomes

A taskforce has been set up to tackle disparities in maternity care experienced by women belonging to ethnic minorities and those living in deprived areas.
Black women are 40% more likely to miscarry than white, studies suggest. Maternal death rates are also higher among black and Asian women.
Royal College of Obstetricians and Gynaecologists head Dr Edward Morris told BBC News implicit racial bias was affecting some women's care.
Patient Safety and Primary Care Minister Maria Caulfield said: "For too long disparities have persisted which mean women living in deprived areas or from ethnic minority backgrounds are less likely to get the care they need and, worse, lose their child.
"We must do better to understand and address the causes of this.
"The Maternity Disparities Taskforce will help level-up maternity care across the country, bringing together a wide range of experts to deliver real and ambitious change so we can improve care for all women - and I will be monitoring progress closely."
Chief midwifery officer Prof Jacqueline Dunkley-Bent, who will co-chair the taskforce, said: "The NHS's ambition is to be the safest place in the world to be pregnant, give birth and transition into parenthood - all women who use our maternity services should receive the best care possible."
The taskforce will meet every two months and focus on:
improving personalised care and support plans addressing how wider societal issues affect maternal health improving education and awareness of health when trying to conceive, such as taking supplements and maintaining a healthy weight increasing access to maternity care for all women and developing targeted support for those from the most vulnerable groups empowering women to make evidence-based decisions about their care. Read full story
Source: BBC News, 23 February 2022
Source: BBC News, 
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CQC should not ‘sit in an ivory tower’ when rating ICSs, says preferred chair

The Care Quality Commission (CQC) should not ‘sit in an ivory tower and dream up what it thinks good looks like’ when it starts rating integrated care systems, the proposed new chair for the regulator has told MPs.
Ian Dilks, the government’s preferred candidate to become the CQC’s new chair, was questioned by the health and social care committee on Tuesday. During the session the committee chair’s Jeremy Hunt asked how Mr Dilks would make the rating of systems “a success”.
Mr Hunt said: “We became the first healthcare system in the world to ‘Ofsted rate’ our hospitals. Under your leadership, assuming you take up this role, we will become the first healthcare system in the world to do the same for entire geographical regions of health systems.”
Mr Dilks responded: “I don’t think it is up to the CQC to sit in an ivory tower and dream up what it thinks good looks like.”
“It will not be in anybody’s interest if the CQC comes up with a whole bunch of ratings and ICSs say, ‘well I don’t know how you got there’.” He added: “I think involving all parties in the development process so that what emerges has a high degree of acceptance.”
He was also asked at the session about what he had learnt about improving patient safety while working at NHS Resolution.
Mr Dilks said: “I do not think the system is good at learning… it needs some help and encouragement to firstly really understand what’s gone wrong when you have an outcome that isn’t the correct one, and secondly how do you encourage and support the system to do better the next time around.”
Read full story (paywalled)
Source: HSJ, 23 February 2022
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Seven-week gap advised for elective surgery after Omicron

Despite a backlog of routine operations, NHS hospitals are being advised to delay elective surgical procedures by at least seven weeks if a patient has just had Omicron.
UK experts say it is a precaution since the first couple of months following infection is a riskier period, linked to poorer post-operative recovery.
In some circumstances the surgery may be urgent enough to go ahead, however. Patients should ideally have had all of their Covid vaccines too.
The advice has been issued by surgery and anaesthesia experts, including two Royal Colleges representing those professions.
The experts who drew up the recommendations say the desire to tackle waiting lists and backlogs must be balanced with delivering the safest care possible.
The latest expert guidance on routine operations recommends:
Elective surgery should not take place within 10 days of a confirmed Covid infection, mainly because the patient may be infectious which is a risk to staff and other patients. Operations that happen in the six-week period after an infection - even an asymptomatic one - carry a higher risk of serious complications for the patient, experience suggests. Dr Mike Nathanson, president of the Association of Anaesthetists, said: "The frustration felt by patients is immense and we - the healthcare professionals - want to do our jobs and provide these services when it is safe to do so and with the risks clear to all involved."
Read full story
Source: BBC News, 23 February 2022
Patient Safety Learning

'Bullying, unsafe practices and dysfunctional culture': Consultant speaks out on Shropshire maternity scandal

A former consultant gynaecologist has told how he raised concerns over bullying, unsafe practices and a "dysfunctional culture" ahead of a report into a maternity scandal.
Bernie Bentick, who worked at Shrewsbury and Telford Hospitals Trust (Sath) for almost 30 years, has spoken publicly about maternity care at the trust for the first time.
Sath is at the centre of the largest inquiry in the history of the NHS into maternity care, which is expected to report next month. An official investigation is examining the care that 1,862 families received.
Mr Bentick says he told senior management several times about a deteriorating culture at Sath.
“I was increasingly concerned about the level of bullying, of dysfunctional culture, of the imposition of changes in clinical practice that many clinicians felt was unsafe," Mr Bentick told BBC's Panorama.
"If the resources had been made available to employ adequate numbers, to provide safe levels of care in accordance with national guidelines, then the situation may have been profoundly different.”
Mr Bentick went on to say that though some “cursory” investigations were launched into his complaints, he believed the trust responded in a way that tried to “preserve the reputation of the organisation.”
Read full story
Source: Shropshire Star, 23 February 2022
Patient Safety Learning

NHS not ‘human’ enough to get greater role in social care, says government review

The NHS should not be given greater control of social care because it is ‘hierarchical, centralised and not person-centred’, according to a government-commissioned review which is repeatedly scathing about the health service.
The review was ordered by then health and social care secretary Matt Hancock in June 2020. Cross-bench peer, writer and former Number 10 adviser Baroness Camilla Cavendish was asked “to make recommendations for social care reform and integration with health in the wake of the Covid-19 pandemic, which could fit alongside the funding reforms planned by the department in the context of the NHS long-term plan.”
In her final report, Baroness Cavendish wrote that “one answer” to the problems facing the sector “would be to let the NHS take over social care. On paper, this would join up the care continuum.”
However, she rejected the idea because of the NHS’ “hierarchical” and “centralised” nature. Baroness Cavendish also suggested the NHS’ role should be limited because it is “still struggling to join up primary and secondary care”.
In contrast to the NHS, she claimed: “Social care is more innovative, more responsive and human.”
She added: “The culture of the NHS is still largely one of ‘doing to’ patients, and the NHS has much to learn from social care about how to be responsive and human facing.”
Referencing “recent attempts to import the successful [Buurtzorg] model of self-managing teams into the NHS”, the cross-bench peer said these “have foundered, because the NHS culture cannot seem to cope with giving staff the autonomy required”.
Read full story (paywalled)
Source: HSJ, 23 February 2022
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