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

Australia: New guidelines helping stem the tide of serious allergies in children

The rising rate at which Australian children are being admitted to hospital for serious food allergies has flattened since infant feeding guidelines were changed, new research shows.
The rate of hospitalisation for food anaphylaxis has increased in Australia in recent decades – but data suggests that changes to allergy prevention and infant feeding guidelines in 2008 and 2016 have helped to stem the rise in young children and teenagers.
In 2008, the Australasian Society of Clinical Immunology and Allergy guidelines were changed to recommend that allergenic solid foods should no longer be delayed, and in 2016 they were again updated to suggest such foods should be introduced in the first year of life.
Study co-author Prof Mimi Tang, an immunologist at the Murdoch Children’s Research Institute, said the greatest benefit of the updated guidelines was in children aged one to four.
Tang said there had been important changes to allergy prevention advice in the last 15 years. “Prior to 2008, all of the food allergy … prevention guidelines around the world were advising to delay the introduction of allergenic foods such as egg, milk and peanut until the ages of somewhere between two and four, depending on the food,” she said.
“The reason these recommendations were in place was based on theoretical concerns that the gut barrier was perhaps not as strong in young babies.”
But a growing body of evidence showed that delaying allergenic foods was associated with an increased risk of developing food allergies.
In the new study, published in the Journal of Allergy and Clinical Immunology, Tang and her colleagues noted an ongoing increase in anaphylaxis hospitalisation rates in teenagers aged 15 and older at the time the research was completed. People in this age group were born before the 2008 changes to the Australian guidelines.
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Source: The Guardian, 24 February 2022
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‘Living with Covid plan’ will hamper NHS patient care, doctors warn as restrictions lift

Senior doctors say the government’s “Living with Covid” plan will hamper the ability of the NHS to provide care.
Michelle Drage, chief executive of the Londonwide Local Medical Committee, which represents the majority of practices in the city, has said the government’s changes may discourage vulnerable patients to seek care when they need it, while David Nicholl, a neurologist and spokesperson for Doctors’ Association UK, said it could exacerbate health inequalities.
It comes as the legal requirement to isolate after testing positive is lifted from Thursday, while free Covid testing ends on 1 April.
NHS England sent a letter to all healthcare providers confirming workers would have to continue with current rules and not come into work after testing positive.
Staff were told they should continue to carrying out regular testing, and access this through national routes until 31 March, but were not given guidance on testing requirements beyond this.
Dr Drage said the changes in isolation and testing rules could put off vulnerable patients.
“We may well see people not being able to access the services they need to because they’re afraid to attend,” she said.
“Then to make people pay for those tests for what looks like a fiver a pop, when the people that can least afford it and the people who can least afford to take time off... suggests to me we’re increasing the risk of inappropriate transmission.”
“It’s a perfect storm that could be brewing that will have a further impact on the ability of patients to be properly cared for… It feels like, yet again, the government gambling with people’s health to sustain the economy.”
Read full story
Source: The Independent, 25 February 2022
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Why a year is 'long term' for vaccine safety

"We don't know the long-term side effects of Covid vaccines." That's a claim that's still common to see shared online.
But a year is actually considered relatively "long term" when it comes to vaccine safety.
This week marks the anniversary of the first delivery of Covid-19 vaccines under the Covax scheme - as well as being more than 14 months since the first dose was given.
And scientists explain that's enough time for all but the rarest side effects to have emerged.
Read full story
Source: BBC News, 25 February 2022
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CDC is asked to release race and gender data on Long Covid

Lawmakers say minorities may disproportionately suffer from long-term symptoms of coronavirus infection.
A pair of Democratic House members asked the Centers for Disease Control and Prevention (CDC) in a letter Tuesday to release data on the number of Americans who suffer lingering symptoms of coronavirus infection, including breakdowns along race, gender and age.
The National Institutes of Health and the CDC have launched detailed studies of Long Covid, but those examinations are expected to take years. In the meantime, policymakers lack good information about how many people in the United States and worldwide suffer from long-term, debilitating effects of the disease.
“People suffering from Long Covid have been ignored and overlooked for far too long. Collecting and publishing robust, disaggregated demographic data will help us better understand this illness and ensure that we are targeting lifesaving resources to those who need them most,” said Rep. Ayanna Pressley, who co-signed the letter Tuesday to the CDC.“We’re calling on the CDC to publicly report this data because that which gets measured gets done — and we can’t have an equitable recovery from this pandemic without it.”
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Source: The Washington Post, 25 January 2022
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Face-to-face GP appointments fall despite plea to ‘restore routine service’

Face-to-face GP appointments have continued to fall, despite a rallying cry for doctors to restore normal services.
The proportion of GP appointments held in person fell for the third month in a row to 60.3% in January, latest data show.
Data published by NHS Digital on Thursday show about 25.6 million appointments were carried out in January. Of these, some 15.4 million were face-to-face. The last time it fell below this level was August 2021, when just 57.6% of appointments were face-to-face. 
Pre-pandemic, the proportion of GP appointments held in person was about 80%.
Dr Nikki Kanani, NHS England’s medical director of primary care, told doctors last month to “restore routine service” following the successful rollout of the booster jab campaign.
Writing to GPs, she said: “It is now important that all services across the NHS, including in primary care, are able to restore routine services where these were paused in line with the Prime Minister’s request to focus all available resource on the omicron national mission.”
But patient groups say the “situation hasn’t improved” and patients are still struggling to see their doctor in person.
Dennis Reed, from patient group Silver Voices, said the figures were “worrying” but not surprising.
“I'm still getting complaints on a daily basis that people are struggling to see their GP,” he said.
Read full story
Source: The Telegraph, 24 February 2022
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Stressed NHS staff in England quit at record 400 a week, fuelling fears over care quality

A record number of more than 400 workers in England have left the NHS every week to restore their work-life balance over the last year, according to a new analysis of the workforce crisis hitting the health service.
The flood of departures comes with staff complaining of burnout and cases of post-traumatic stress disorder following two years of battling the Covid pandemic. There are now concerns that the exodus is impacting the quality of care, with more than a quarter of adults saying they or an immediate family member had received poor care as a result of the workforce problems.
The findings emerged in an assessment of the health service compiled by John Hall, a former strategy director at the Department of Health and Social Care, for the Engage Britain charity. Concerns over the state of the workforce came top of its list as it investigated the public’s attitude towards health and social care services, which remain under pressure in the wake of the pandemic.
“The workforce crisis in the NHS has clearly penetrated the public consciousness,” Hall writes. “The UK has long had significantly lower numbers of doctors and nurses per capita than comparable systems … More recently, the impact of working conditions is showing an increasing impact on the ability of the NHS to retain staff. Around 50 in every 10,000 staff working in hospital and community health services in June 2021 left the service within the next three months, citing work-life balance as the reason. This was a new record.”
Julian McCrae, Engage Britain’s director, said frontline health and care workers were now “running on empty” and a plan for boosting the workforce was overdue. “NHS workers across the country have spoken to us about feeling overstretched, undervalued and struggling to get support in a chaotic system,” he said. “We can’t allow staff to burn out, while putting patients at risk of mistakes or spiralling downwards as they wait months for treatment. The government must act quickly to expand its promise of reform, based on listening to the people who use or work in the system every day. Only answers rooted in real experiences can deliver health and care that works for us all.”
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Source: BBC News, 26 February 2022
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Pregnancy risk tool cuts baby loss in black and Asian women

A new pregnancy screening tool cuts the risk of baby loss among women from black, Asian and ethnic minority backgrounds to the same level as white women, research suggests.
The app calculates a woman's individual risk of pregnancy problems.
In a study of 20,000 pregnant women, baby death rates in ethnic groups were three times lower than normal when the tool was used.
Experts say the new approach can help reduce health inequalities.
The screening tool is already in use at St George's Hospital in London and is being tried out at three other maternity units in England, with hopes it could be rolled out to 20 centres within two years.
Researchers from Tommy's National Centre for Maternity Improvement, led by the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives, developed the new tool.
Professor Basky Thilaganathan, who led the research team at St George's Hospital, said the new approach could "almost eliminate a large source of the healthcare inequality facing black, Asian and minority ethnic pregnant women".
"We can personalise care for you and reduce the chances of having a small baby, pre-eclampsia and losing your baby," he said.
The current system of a tick-box checklist to assess pregnancy risk has been around for 70 years, and is limited.
The new digital tool, which uses an algorithm to calculate a woman's personal risk, can detect high-risk women more accurately and prevent complications in pregnancy, the researchers say.
Both pregnant women and maternity staff can upload information on their pregnancy and how they are feeling to the app during antenatal appointments and at other times.
Dr Edward Morris, president of the Royal College of Obstetricians and Gynaecologists, said it was "unacceptable" that black, Asian and minority ethnic women faced huge inequalities on maternity outcomes.
"The digital tool provides a practical way to support women with personalised care during pregnancy and make informed decisions about birth.
Read full story 
Read Tommy's press release
Source: BBC News, 28 February 2022
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A&E bookings via 111 fall ‘far short of aspiration’

NHS England’s plan to make the 111 service a ‘primary route’ into emergency departments has fallen ‘far short of aspiration’, with only a small fraction of attendances being booked through it.
NHSE began recording the numbers of ED appointments booked via 111 in August 2020, as it aimed to reduce unnecessary attendances and demand on emergency services, via the programme known as “111 First”.
Planning guidance for 2021-22 told local systems to “promote the use of NHS 111 as a primary route into all urgent care services”. It added that at least 70% of patients referred to ED by 111 services should receive a booked time slot to attend. 
Pilots experimented with making it harder for people who had not called 111 to attend A&E, although proposals to direct those people away were rejected.
Data published by NHSE shows the number of ED attendances that were booked through 111, but not those referred to ED without a booking.
Jacob Lant, head of policy and research at Healthwatch England, said: “Sadly, it’s clear from these figures that implementation across the country is lagging behind where we would have hoped.
“Obviously this has to be seen in the context of the massive pressures on A&E departments at the moment as a result of the pandemic, but there is also a need for the NHS to really step up efforts to tell people about this new way of accessing care.”
Read full story (paywalled)
Source: 25 February 2022
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Campaigners call for action over UK’s ‘shameful’ lung health

The UK has the highest death rate for lung conditions in western Europe, research reveals, prompting calls from health leaders for urgent action to tackle the “national scandal”.
More than 100,000 people in the UK die from conditions including asthma attacks, bronchitis, chronic obstructive pulmonary disease (COPD) and pneumonia every year, according to data analysis by the charity Asthma and Lung UK.
Across Europe, only Turkey has a higher respiratory death rate than the UK, analysis of data up to 2018 shows.
It described the UK figures as “shameful”, and said that lung conditions had for too long been treated like the “poor relation compared with other major illnesses like cancer and heart disease”.
Even before the pandemic, significant numbers of lung patients were not receiving “basic care” from their GP services such as medicine checks and help using their inhalers, the charity said. Over the past two years, the health of thousands more has deteriorated while they waited for respiratory care, and diagnosis rates have fallen.
Katy Brown, 64, a retired nursery nurse from Bristol, who was diagnosed with COPD in February 2021, said she was shocked by the lack of medical support she has received, and the poor general awareness of her condition.
“I spent two years struggling to breathe and with constant chest infections, before I finally got a diagnosis of COPD,” she said. “Even now, over a year after my diagnosis, I’m still waiting for a test that will show how bad my condition is, and further treatment.
“There is a lack of awareness about how serious lung conditions are and how terrifying it is to struggle to breathe. It’s like having an elephant sitting on your chest. If I’d been diagnosed with another serious condition like a heart problem, I believe my treatment and the way I was dealt with would have been completely different.”
Read full story
Source: The Guardian, 28 February 2022
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Police investigating death of young girl at mental health hospital

The police are investigating the death of a young person at a mental health hospital, The Independent can reveal.
Police are investigating the death of a young girl at The Huntercombe Maidenhead mental health hospital in February.
In a statement to The Independent: Thames Valley Police, said: “Thames Valley Police is conducting an investigation after the death of a girl following an incident at Huntercombe Hospital in Maidenhead on Saturday 12 February. The girl’s next of kin have been informed and our officers are supporting them. Our thoughts remain with them at this very difficult time. An investigation is ongoing to understand the circumstances around this tragic incident.”
The Care Quality Commission has also said it was notified of the young girls death. The care regulator said it could not comment further.
The NHS confirmed to The Independent admissions to one of the hospital’s wards have been suspended.
The 60-bed hospital was rated Inadequate and placed in special measures by the CQC in February 2021 following serious concerns over care of patients.
Read full story
Source: The Independent, 26 February 2022
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End-of-life care will become a legal right

Dying people will be given an explicit legal right to healthcare for the first time in NHS history, requiring every part of England to provide specialist palliative care.
New analysis from the charity Marie Curie shows that about 215,000 people a year miss out on end-of-life care and that without intervention this could rise to 300,000 within 20 years.
The government will back an amendment to the Health and Care Bill in the House of Lords.
Baroness Finlay of Llandaff, a professor of palliative care medicine and supporter of the amendment, said: “This change is incredibly important. For the first time the NHS will be required to make sure that there are services to meet the palliative care needs of everyone for whom they have responsibility in an area. People need help early, when they need it, seven days a week — disease does not respect the clock or the calendar.”
She told the Lords that although “general basic palliative care should be a skill of every clinician”, specialist palliative care was a “relatively new specialty, which is why it was not included in the early NHS legislation”.
The government amendment will introduce a specific requirement for “services or facilities for palliative care” to be commissioned by integrated care boards, responsible for local services under the government’s NHS reforms, in every part of England.
Matthew Reed, chief executive of Marie Curie, said: “If you need palliative and end-of-life care today, the chances of you getting the pain relief, symptom control and support for your family that you need depend largely on where you live, your ethnicity, gender and on what condition you have. This is wrong.
“We welcome the news coming out of the Department of Health and Social Care. The impact of this legal requirement to provide appropriate care to dying people could be transformative — it is one of the biggest developments in end-of-life care since the inception of the NHS. This change has the potential to end the current postcode lottery and make end-of-life care fair for all."
Read full story (paywalled)
Source: The Times, 25 February 2022
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Ambulance staff experiencing ‘horrific’ abuse and attacks, NHS warns

Ambulance staff are experiencing “horrific” abuse from the public as attacks on workers increased by 23% in the wake of the pandemic.
Assaults against female ambulance staff have risen by 48% in the last five years, according to a new report from the Association of Ambulance Chief Executives (AACE).
In response to rising attacks, the NHS has launched a #workwithoutfear campaign to prevent abuse of ambulance staff. Last year there were 11,749 attacks against ambulance staff, equating to 32 workers being abused or attacked every day.
AACE said incidents included kicking, slapping, headbutting and verbal abuse, and ranged from common assault to serious attacks involving knives and weapons.
Daren Mochrie, chair of AACE and chief executive of North West Ambulance Service said ambulance staff “face the possibility of violence, assault and aggression” on every shift.
“When they occur, these attacks have a significant and lasting impact on the team member, affecting every aspect of their life."
Read full story
Source: The Independent, 28 February 2022
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Patients will be endangered by flaws in health bill, says NHS ombudsman

Patient safety will be harmed and victims of medical negligence denied justice because of flaws in the government’s health and care bill, the NHS ombudsman has told the Guardian.
Rob Behrens, the parliamentary and health service ombudsman, fears he and his staff will not be able to get to the bottom of clinical blunders because under the bill he will be denied potentially vital information collected by the NHS’s Healthcare Safety Investigation Branch (HSIB).
The ombudsman said the legislation would allow the HSIB to “operate behind a curtain of secrecy” and undermine his own investigations into lapses in patient safety and could deny grieving families the full truth about why a loved one died.
Behrens has spoken out because he is concerned about government plans for NHS staff involved in an incident to give evidence about mistakes privately in a “safe space” to the HSIB, which cannot be shared with anyone else except coroners. His exclusion from seeing material gathered in that way could force him to take the agency to the high court to access it, he said.
“If the ‘safe space’ provisions become law as drafted there is a real risk to patient safety and to justice for those who deserve it. This is a crisis of accountability and scrutiny,” he said.
Julia Neuberger, a crossbench peer who chairs University College hospitals NHS trust, has tabled an amendment to the bill in the House of Lords seeking to give the ombudsman access to information obtained via “safe space” processes.
Unless ministers rethink the plan “there could be serious consequences for members of the public who use the ombudsman service”, she recently told a Lords debate. “If the ombudsman is unable to investigate robustly all aspects of complaints about the NHS, except with the permission of the high court, patients may find it harder to get access to justice. The NHS may well become less accountable for its system failings,” she said.
Peter Walsh, chief executive of patient safety charity Action Against Medical Accidents, backed Behrens. “The so-called safe space is a red herring with serious unintended consequences. There is no evidence staff do not take part in investigations for fear of information being known. It is bullying employers and over-zealous regulators that staff fear. Denying people their right to have the ombudsman investigate properly does nothing to address that.”
Read full story
Source: The Guardian, 28 February 2022
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Covid-19: Incomplete lists of vulnerable patients left many unprotected, desperate, and afraid

Up-to-date registers of clinically vulnerable patients must be created to ensure that those who are most at risk during Covid-19 and any future pandemics are protected and can access the support they need, a report from the All-Party Parliamentary Group (APPG) on Vulnerable Groups to Pandemics has recommended.
The report considered vulnerable people’s experiences during the pandemic and makes 16 recommendations on what the government and the health service can do better to plan and prioritise extremely vulnerable patients during further Covid-19 outbreaks and future pandemics.
These tackle the format and content of information and guidance; access to medical services such as mental health support to help people deal with anxiety, fear, and isolation; provision of practical support such as food and finance when isolating; and the need for more research into how medical conditions make people more vulnerable to a threat and vaccines less protective.
At the launch of the report representatives of charities and patient groups described how the pandemic had left clinically vulnerable people feeling anxious, afraid, lonely, trapped, and desperate. They also described the “not on the list” scenario many had had to contend with, meaning they could not access priority services such as testing or support to isolate.
There were still patients whose doctors recognised that they should be on the list fighting to get their condition recognised, said Susan Walsh, chief executive of Immunodeficiency UK. This means that, under the government’s Living with Covid plans, they will no longer be able to access free testing. Lord Mendelsohn, co-chair of the APPG on Vulnerable Groups to Pandemics, said, “We should be more willing to allow the medical practitioners responsible for these patients to be able to overhaul computerised systems and find ways to make that happen.”
Read full story
Source: BMJ, 28 February 2022
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Sussex woman forced to sleep in wheelchair due to lack of care staff

A woman has been left to sleep in her wheelchair several nights a week and remain in bed for the rest of it due to a lack of social care in her local area.
Mandy Page, 53, who lives alone in Hove, has difficulty getting into and out of bed on her own and previously had carers to provide support in the morning and evenings.
However, since before Christmas she has had no care support in the evenings after the MyLife East Sussex agency told her it was no longer covering her care, and that the agency believed her care was now being provided by her local authority.
Page receives dialysis three times a week at Royal Sussex county hospital, and on those days arrives home, by hospital transport, after 6pm. This means that without help getting out of her wheelchair and into bed she must sleep in the wheelchair.
“It’s very stressful, because at the moment I’m in bed every day. I can’t get up without help, and I can’t get back to bed on a dialysis day,” Page said. “On a dialysis day, I go to dialysis and I’m in my wheelchair. Every other day, I’m in bed all day and all night. That’s no life.
Page’s situation exemplifies the crisis in social care. England has faced chronic shortages of care workers, with a survey by Care England finding that 95% of care providers struggle to recruit and retain staff. In 2020/21, there were around 105,000 vacancies at any one time in the social care sector, and more than a third of the sector’s staff left their jobs during the year.
Page says the lack of adequate social care has taken a negative toll on her quality of life, and has meant she hasn’t been able to undertake everyday tasks.
Rob Persey, the executive director for health and adult social care at Brighton and Hove council, said the council had not been able to source a new provider for Page since her earlier care was withdrawn.
“This is a national as well as a local problem as there are insufficient home care staff to meet demands. Various local initiatives, including additional funding, have been taken to increase the home care workforce, but so far they have only had a limited impact."
“We recognise Mandy does not want respite care, and acknowledge this is a completely unacceptable situation for her,” he said.
Read full story
Source: The Guardian, 28 February 2022
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Record demand for mental health services as new mothers are left ‘isolated’ in pandemic

Tens of thousands of new mothers have been left feeling “hopeless” and “isolated” during the pandemic, with the NHS seeing record numbers of referrals to mental health services.
Requests for help from new, expectant and bereaved mothers jumped by 40% in 2021 compared with 2019, analysis by The Independent has revealed.
NHS data shows mental health referrals hit an all-time high of 23,673 in November last year, with average monthly referrals for the whole of 2021 running 21% higher than the year before, jumping from 17,226 to 21,990.
Among those affected when support systems were “suddenly” removed in March 2020 was Leanne, a woman who had her second child just before the pandemic and experienced a mental health crisis. She told The Independent how she had struggled following the first lockdown.
“I just thought, Oh God, my recovery is going to stop, how am I going to get better now because I’ve got no support – I’m on my own with it,” she said.
“I was [also] anticipating the lockdown … in addition to the nursery closing, and I was getting quite anxious about that, and feeling quite hopeless. The pressure piled on me was enormous, and I had no one who could see me or support me."
Dr Rosena Allin-Khan MP, the shadow minister for mental health, said the figures uncovered by The Independent were “extremely concerning” and that pregnant women had been “forgotten about through the pandemic”.
The Royal College of Psychiatrists’ lead for perinatal mental health services, Dr Joanne Black, said the NHS pandemic recovery plan had lost sight of women in pregnancy and children under two years old, who have been “disproportionately affected”.
Read full story
Source: The Independent, 28 February 2022
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