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

All women must be able to access to safe abortion services, says WHO

The World Health Organization has published new guidelines on abortion aimed at tackling the unsafe care that leads to up to 39 000 maternal deaths and millions of women being admitted to hospital with complications every year.
When carried out using a method recommended by WHO, abortion is a safe procedure. Tragically, however, only half of all abortions take place under such conditions, with unsafe abortions causing around 39 000 deaths globally. Most of these deaths are in lower-income countries – with over 60% in Africa and 30% in Asia – and among those living in the most vulnerable situations.
“Being able to obtain safe abortion is a crucial part of health care,” said Craig Lissner, acting Director for Sexual and Reproductive Health and Research at WHO. “Nearly every death and injury that results from unsafe abortion is entirely preventable. That’s why we recommend women and girls can access abortion and family planning services when they need them.”
Evidence shows that restricting access to abortions does not reduce the number of abortions that take place. In fact, restrictions are more likely to drive women and girls towards unsafe procedures. In countries where abortion is most restricted, only 1 in 4 abortions are safe, compared to nearly 9 in 10 in countries where the procedure is broadly legal. 
“It’s vital that an abortion is safe in medical terms,” said Dr Bela Ganatra, Head of WHO’s Prevention of Unsafe Abortion Unit. “But that’s not enough on its own. As with any other health services, abortion care needs to respect the decisions and needs of women and girls, ensuring that they are treated with dignity and without stigma or judgement. No one should be exposed to abuse or harms like being reported to the police or put in jail because they have sought or provided abortion care." 
“The evidence is clear – if you want to prevent unintended pregnancies and unsafe abortions, you need to provide women and girls with a comprehensive package of sexuality education, accurate family planning information and services, and access to quality abortion care,” Dr Ganatra added.
Read full story (paywalled)
Source: BMJ. 9 March 2022
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'He was there four hours begging for help'

An 86-year-old man died after lying in the road waiting more than four hours for an ambulance, his family have said.
George Ian Stevenson was hit by a car near his home in Johnstown, Wrexham county, last Wednesday. His family said the first 999 call was made at 19:31 GMT, and the ambulance did not arrive until 23:37 GMT.
The Welsh Ambulance Service is looking into the incident, but said that at the time of the call, all its vehicles were already committed to other patients.
Two off-duty paramedics stopped to help, but were reluctant to move him in case they caused further injury.
Mr Stevenson's granddaughter, Ellie Williams said on the night of the accident it was raining, freezing and foggy.
She said: "Left there for four hours, begging for help, waiting for help. And that makes us so sad.
"A hard-working man who has paid his taxes all his life and paid into the system has been let down when he's needed them the most, and I just can't quite comprehend what has happened to him."
Read full story
Source: BBC News, 8 March 2022
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USA: Covid long-haulers face grueling fights for disability benefits

Deepa Singh, 30, of Louisville, USA, has been seriously ill for two years, racked with extreme fatigue, racing heartbeat and memory problems from Long covid that she says prevent her from working. Adding to her distress, she says, has been a grueling — and so far unsuccessful — battle for disability payments.
Singh, who worked as a project manager, is among a cohort of Long Covid patients who have been denied disability benefits, either by private insurance companies, which operate benefit plans offered by employers, or by the Social Security Administration, which manages government disability benefits.
Tasked with sorting legitimate health claims from fraudulent or marginal ones, these gatekeepers now face a novel challenge as the coronavirus pandemic drags on: a flood of claims citing a post-infection syndrome that is poorly understood by the medical community and difficult to measure.
Patients cite a litany of symptoms that defy verification through basic medical tests. They become exhausted at the merest exertion. They can’t remember simple words. Their hearts feel like they are fluttering. Yet neurological exams, ECGs and chest X-rays come back clean.
Doctors said in interviews they are treating Long Covid patients who are clearly too sick to work but who have difficulty meeting the evidence threshold insurers demand: objective medical test results showing an inability to perform work.
Specialized tests can measure a few Long Covid-related problems, such as a central nervous system disorder called dysautonomia, which affects the body’s ability to regulate itself. But there are months-long waiting lists for the tests, doctors and patients said.
The challenges are similar to those faced for years by people claiming disabilities based on chronic fatigue syndrome. But the pandemic has given rise to such claims on a far greater scale.
Read full story (paywalled)
Source: The Washington Post, 8 March 2022
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‘Angry’ NHSE pressures prestigious trust to make ‘public apology’

NHS England is trying to force a prestigious cancer trust to publicly apologise to a group of whistleblowers, after being ‘shocked’ by the way it responded to a review into their concerns.
As HSJ reported in January, an external review into The Christie Foundation Trust supported multiple concerns which had been raised by staff about a major research project with pharma giant Roche.
The review had also noted how 20 current and former employees, some of whom were “long-standing, loyal, senior staff”, had described bullying behaviours and felt they had suffered detriment because they spoke out.
In response to the review, trust chair Christine Outram and chief executive Roger Spencer issued a bullish report listing numerous “inaccuracies” and characterised the concerns as being limited to a “small number of staff who are dissatisfied or aggrieved”.
It did not thank the staff for raising the issues, nor apologise for the experiences they had. However, HSJ has now learned that NHSE is trying to ensure the trust issues a public apology.
At a meeting with some of the whistleblowers on 11 February, David Levy, medical director for NHSE North West, said he was “shocked” and “frankly a bit angry” at the trust’s response, saying it reflected badly on the organisation, HSJ understands.
Read full story (paywalled)
Source: HSJ, 9 March 2022
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British Sign Language to be used in NHS mental health service

The charity SignHealth has been awarded a national contract with NHS England to supply the mental health service Talking Therapies in British Sign Language.
The new specialist service will help to support deaf people who are experiencing anxiety, depression and other mental health issues.
This marks the first time NHS England have granted a national contract to a deaf specialist service and will hope to bridge the gap and tackle the health inequalities recognised after a recent freedom of information (FOI) request found that around 100 NHS trusts do not comply with accessible information standards (AIS).
Prior to the contract, deaf people experiencing mental health related issues would have to rely on funding from their Clinical Commissioning Group (CCG) to approve additional communication assistance on an individual basis.
Waiting for approval of the funding for British Sign Language (BSL) therapy services meant that many deaf patients were having to wait considerably longer than their able hearing counterparts.
Many CCGs do not grant additional funding and would not offer these kinds of services to deaf people, often resulting in ‘postcode lottery’.
Dr Sarah Powell, Clinical Lead at SignHealth, said: "Deaf people are twice as likely to experience mental health challenges such as depression and anxiety compared to hearing people. This is a serious and sometimes life-threatening health inequality. Therapy delivered in sign language has been proven to have higher recovery rates and we are delighted that this contract removes the funding barrier so that more Deaf people are able to access life-changing treatment."
Read full story
Source: NHE, 9 March 2022
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'Urgent action' needed on hospital waiting times in Ireland

Urgent action is required to tackle hospital waiting times on both sides of the Irish border, according to the Economic and Social Research Institute (ESRI).
A report into the primary healthcare systems of Ireland and Northern Ireland found that both jurisdictions are experiencing similar problems.
These include workforce shortages and increasing expenditure.
On hospital waiting times the problem is worse in Northern Ireland. 
The proportion of people on the waiting list in Northern Ireland for more than one year increased from 20% to 60%. In the Republic of Ireland, during the same period between 2017 and 2021, the figure increased from 12% to 20%.
A key distinction between the healthcare systems is the absence of a universal healthcare system in Ireland, write the authors.
That means in Northern Ireland, all residents are entitled to a wide range of free health care services, while in Ireland, the majority pay to see their GP and for other services.
But despite this key difference, both systems are currently facing similar challenges, including shortages in key areas of the workforce and long waits for a range of healthcare services.
Cross-border collaboration in healthcare across the island is an interesting but contentious issue. At present, according to the ESRI report, that work is relatively limited.
It points to a 2011 report which identified the potential benefits to be gained from increased co-operation in healthcare including collaboration in cystic fibrosis, ear, nose and throat surgery, paediatric cardiac surgery and acute mental health services.
However, this 2022 report concludes that despite some notable exceptions such as the Congenital Heart Disease Network and the North West Cancer Centre at Altnagelvin Hospital in Londonderry, "collaboration has been relatively limited".
Read full story
Source: BBC News, 10 March 2022
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British women are facing a quiet crisis in contraceptive care

Delays in being able to get contraception and abortions can wreck women’s lives. It’s time women ignored the stigma and started complaining more loudly, writes Nell Frizzell in the Guardian. 
"When a friend recently told me that there was a 10-week waiting list to have a copper coil fitted, my shock turned quickly into anger. Ten weeks is a hell of a long time to wait for adequate, hormone-free, affordable contraception.
We are experiencing a quiet crisis in contraceptive care in this country. 
According to a report by the Advisory Group on Contraception: “Going into lockdown, services had faced years of budget cuts by the government, leading to an 18% decrease in real-terms contraception spend since 2015.”
The same report points out that there has also been a huge reduction in sites commissioned to deliver contraception (26% of local authorities cut sites in 2018-2019), meaning people are having to travel further to get the medical help they need, simply not to have an unplanned, unwanted, unaffordable or unsafe pregnancy.
Unfortunately, the stigma still attached to contraception and reproductive health means people are less willing to complain publicly about the huge waiting times, the travel costs and the difficulty they face in accessing contraception and abortion. Subtly and overtly, we are told that this is our lot and we must bear it.
Read full story
Source: The Guardian, 9 March 2022
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Antipsychotics are increasingly prescribed for personality disorder, against NICE guidelines, researchers find

Antipsychotics have been frequently and increasingly prescribed for extended periods to people with recorded personality disorder but no history of severe mental illness, a study looking at UK general practice data has found.
Researchers from University College London looked at 46 210 people who had had personality disorder recorded in their GP record between January 2000 and 31 December 2016. Of these, 15 562 (34%) had been prescribed antipsychotics.
The study, published in BMJ Open, also found that 36 875 people with a record of personality disorder had no record of severe mental illness.
An urgent review of clinical practice is warranted, including the effectiveness of such prescribing and the need to monitor for adverse effects, including metabolic complications.
Read full story (paywalled)
Source: BMJ, 10 March 2022
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‘Lack of respect’ for children at ‘inadequate’ hospital

Staff failed to provide kind and compassionate care and did not treat children with respect at a private hospital downgraded from ‘good’ to ‘inadequate’, a report by health inspectors has revealed.
Huntercombe Hospital Stafford was placed in special measures in 2016, but was rated “good” by the Care Quality Commission two years later.
Now, its first inspection under provider Huntercombe Young People Ltd in October 2021 has exposed a raft of safety concerns and instances of poor care. Huntercombe Young People Ltd took over the service in February 2021. 
Heavy reliance on agency staff, workers spotted with their “eyes closed” on observations, and staff not respecting young people’s pronouns were among concerns inspectors flagged.
Staff observation of patients was also found to be “undermined” by a blind spot where people could self-harm unseen, the CQC report, published today, said.
Children also told the CQC they felt staff did not always understand their mental health condition or know how to support them, particularly those on the psychiatric intensive care ward with eating disorders or autism.
Read full story (paywalled)
Source: HSJ, 10 March 2022
Sam

NHS England to replace cancer targets

The two-week wait cancer target should be scrapped and replaced with a different measure, as part of an overhaul of cancer standards, NHS England has said.
After piloting a new measure which aims to see 75% of patients given the all-clear or a diagnosis within 28 days of referral, NHS England has recommended .The new “faster diagnosis target” would replace the current ‘two-week wait’ target, which is for 93% to have seen a specialist within two weeks, but not necessarily had a diagnosis.
This proposal, and other changes to the way cancer waiting time targets are organised, will be consulted on until 6 April.
The nine current cancer targets were created in 2000. The current headline measure along with the two-week wait — a two-month wait from urgent GP referral to first treatment — has not been hit since December 2015.
The document containing the proposals said the current two-week standard saw some patients given an appointment at which no test was taken, purely to hit the target. For some suspected cancers, “many trusts… offer outpatient appointments to ensure they hit the target”, without improving diagnosis.
The move to scrap the two-week wait was welcomed – with significant caveats — by Cancer Research UK
Cancer Research UK chief executive Michelle Mitchell said: “The new Faster Diagnosis Standard is a more meaningful target than the current two-week wait that will hopefully improve early diagnosis. If all trusts met the 75 per cent target, it would be an improvement to where we are now. However, in the long-term to improve cancer survival, we’d like to see a 95 per cent target originally proposed in the 2015 cancer strategy in Sajid Javid’s upcoming 10-year plan for cancer.
“We recognise the target was set lower because of a shortage of cancer specialists, critical to diagnosing cancer across the NHS. The government must provide the extra investment they have promised to grow the NHS workforce. Every moment of delay risks more people waiting for diagnosis and treatment.”
Read full story (paywalled)
Source: HSJ, 10 March 2022
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UK Covid inquiry draft terms of reference set out

The draft terms of reference for the UK public inquiry into the government's handling of the Covid-19 pandemic have been published.
The inquiry, due to start in the spring, will play a key role in "learning lessons" from the pandemic and for the future, it said. 
The terms of reference were published after a consultation with inquiry chairwoman and former High Court judge Baroness Hallett, and with ministers in the devolved nations.
The Scottish government has already published the terms of reference for its own Covid-19 inquiry, to be led by Judge Lady Poole.
The UK-wide inquiry proposes examining a broad range of issues including:
the UK's preparedness for the pandemic the use of lockdowns and other 'non-pharmaceutical' interventions such as social distancing and the use of face coverings the management of the pandemic in hospitals and care homes the procurement and provision of equipment like personal protective equipment and ventilators support for businesses and jobs, including the furlough scheme, as well as benefits and sick pay. The inquiry aims to produce "a factual, narrative account" covering decision-making at all levels of government and the response of the health and care sector as well as identifying the "lessons to be learned".
Becky Kummer, spokesperson for Covid-19 Bereaved Families for Justice, said the publication was a "huge step forward" and the organisation looked forward to contributing to the consultation on the terms.
Chris Hopson, chief executive of NHS Providers, which represents hospital trusts, said there was much the NHS did well during the pandemic but: "It is right the inquiry looks at areas where there were major challenges - such as infection prevention and control, access to PPE, testing, and robust epidemiological modelling."
Read full story
Source: BBC News, 11 March 2022
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Midwife struck off over Shropshire baby's death

A midwife found guilty of misconduct over the death of a baby six years ago is to be struck off.
Claire Roberts was investigated by the Nursing and Midwifery Council (NMC) for failures in the care she gave to Pippa Griffiths - who died a day after being born at home in Myddle, Shropshire.
An independent disciplinary panel described the midwife as "a danger to patients and colleagues".
Ms Roberts and fellow midwife Joanna Young failed to realise the "urgency" of medical attention needed, following the birth, the panel said. They had failed to carry out a triage assessment, after Pippa's mother called staff for help because she was worried about her daughter's condition.
The panel concluded Ms Roberts's fitness to practise was impaired.
Inaccurate record-keeping by Ms Roberts represented "serious dishonesty", panel chair David Evans said, adding she had carried it out "in order to protect herself from disciplinary action".
Her failures had represented a "significant departure from standards expected by a registered midwife," he added.
Her colleague Ms Young, whose case was also heard by the panel, faced strong criticism on Wednesday, but was told she would face no sanction after the hearing concluded she had shown remorse and undergone extra training since 2016.
Kayleigh Griffiths said she and her husband welcomed the findings and sanctions.
"We're really relieved that one of the midwives has been struck off and actually we're also relieved to find that the other midwife has learnt and feels significant remorse for the event that took place," she said.
"We realise people do make mistakes and I think how you deal with those mistakes is really important.
"All we do ask is that learning was made from those and I think in one of the instances it did occur and in the other it didn't - so I think the right outcome has been found."
Read full story
Source: BBC News, 10 March 2022
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WHO Foundation chief ‘very concerned’ over UK dismantling Covid testing as pandemic ‘isn’t over’

A leading figure in the World Health Organisation Foundation has criticised the UK’s move to dismantle its Covid testing programme as the disease surges in other parts of the world.
Mr Anil Soni, chief executive of the WHO Foundation, said in an interview with The Independent that maintaining surveillance over Covid-19 was “incredibly important” and the “dismantling of the testing infrastructure here strikes me as very worrying.”
The WHO Foundation chief warned people were “looking the other way” from counties where there is low vaccine coverage to maintain the hope that Covid is over.
He warned low vaccine coverage is a “petri dish” for future variants to breed and that the acute phase of the pandemic could not be over until this is addressed.
When asked about the UK’s plans to end its NHS Test and Trace programme Mr Soni said: “I’m very concerned about it.
“What we’ve seen is, it’s incredibly important to maintain surveillance, and countries in southern Africa should be applauded for detecting Omicron as quickly as they did. Those surveillance systems need to be in place around the world.
“We also want to make sure that testing is widely available so that people, when they become infectious, can be aware of their status and keep others safe. For testing not to be available and for us to be moving too quickly to normalcy creates risk.”
Mr Soni said the world’s position with Covid was “precarious” and highlighted the surge being seen in Hong Kong, where “health centres are at the verge of collapse, because of how many people are sick”.
Read full story
Source: The Independent, 10 March 2022
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NHS gender identity service for children can’t cope with demand, review finds

The only NHS gender identity service for children in England and Wales is under unsustainable pressure as the demand for the service outstrips capacity, a review has found.
The interim report of the Cass Review, commissioned by NHS England in 2020, recommends that a network of regional hubs be created to provide care and support to young people with gender incongruence or dysphoria, arguing their care is “everyone’s business”.
Led by the paediatrician Hilary Cass, the interim report explains that the significant rise in referrals to the Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS foundation trust in London has resulted in overwhelmed staff and waiting lists of up to two years that leave young people “at considerable risk” of distress and deteriorating mental health. 
Last spring, the Care Quality Commission demanded monthly updates on numbers on waiting lists and actions to reduce them in a highly critical report on GIDS.
Differing views and lack of open discussion about the nature of gender incongruence in childhood and adolescence – and whether transition is always the best option – means that patients can experience a “clinician lottery”, says the new review, which carried out extensive interviews with professionals and those with lived experience.
It notes that the clinical approach used by GIDS “has not been subjected to some of the usual control measures” typically applied with new treatments.
Another significant issue raised with the review team was that of “diagnostic overshadowing”, whereby once a young person is identified as having gender-related distress, other complex needs – such as neurodiversity or a mental health problem that would normally be managed by local services – can be overlooked.
Read full story
Source: The Guardian, 10 March 2022
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Seven billion items of pandemic PPE 'not fit for purpose'

Nearly one in five items of personal protective equipment (PPE) the government bought during the pandemic are not fit for purpose and cannot be used by the NHS, it has been revealed – including 1.2 billion items that cannot be used at all.
As of December, almost 7 billion items of personal protective equipment bought for frontline services – 19.1% of the 36.4 billion items bought since February 2020 – had been marked “do not supply” to the NHS by the Department of Health and Social Care.
The number is more than three times the figure quoted last September, when health minister Lord Bethell admitted 1.9 billion items worth £2.8bn were in the “do not supply” category – 6.2% of the PPE bought up to that point.
The not-fit-for-purpose stock includes 1.2 billion units of PPE that cannot be used in any setting.
This "wastage" – which accounts for 3.3% of pandemic PPE – includes around 800m aprons that DHSC is now looking to recycle, permanent secretary Sir Chris Wormald said in a letter to the Public Accounts Committee.
The revelation comes as a consultation opens on the terms of reference for the public inquiry into the government's response to Covid. The inquiry will look at pandemic preparedness and the healthcare response, among other things.
Read full story
Source: Civil Service World, 11 March 2022
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National robotic assisted surgery programme to be established in Wales

A national robotic-assisted surgery programme allowing surgeons to perform complex procedures with more precision and control is being introduced in Wales, the Health Minister has announced.
The All-Wales Robotic Assisted Surgery Network, developed by health boards, the Life Sciences Hub Wales and the Moondance Cancer Initiative, will provide less invasive surgery for thousands of cancer patients across the country.
The surgery involves the use of highly advanced robotic surgical instruments under the control of a surgeon. It will initially be used in Wales for some Colorectal, Upper Gastrointestinal, Urological and Gynaecological cancers.
The Welsh Government will support the network with funding of £4.2m over five years, alongside £13.35m provided by health boards over 10 years.
Health and Social Services Minister Eluned Morgan said: "The All-Wales Robotic Assisted Surgery Network is an ambitious and important programme helping to improve outcomes for patients and the NHS in Wales. It will put Wales at the forefront of international research for the use of robotic surgical techniques. This pioneering service will also encourage specialist staff to come to Wales to train and practice".
It will initially be provided in the Betsi Cadwaladr University Health Board area, with the first patient expected to receive treatment in June. Once fully established, patients in north Wales will no longer need to travel to England to receive robotic-assisted surgery.
Read full story
Source: Welsh Government, 14 March 2022
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