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

Scientists link ‘severe’ Covid-19 to long-term mental health problems

People who suffer from severe Covid-19 symptoms are more likely to have long-term mental health problems, a new study suggests.
Higher rates of depression and anxiety have been found in people who were “bedridden” with Covid-19 for more than seven days last year, according to a study published in the Lancet.
Scientists, drawing on data from 247,249 people across the UK, Denmark, Estonia, Iceland, Norway and Sweden, found that people with coronavirus who were not admitted to hospital were more likely to experience symptoms of depression up to 16 months after diagnosis, compared to those never infected.
However, over 16 months, patients who were bedridden for seven days or more were between 50 and 60% more likely to experience higher levels of depression and anxiety compared to people never infected during the study period, the researchers found.
Overall, people diagnosed with Covid-19 had a higher prevalence of depression and poorer sleep quality compared with individuals who were never diagnosed – 20% of those in the former group experienced symptoms of depression, versus 11% in the latter group.
Researchers suggested patients who spent longer in bed or had higher depression or anxiety rates could be suffering from ill health due to a combination of worrying about long-term health effects and Covid symptoms persisting.
Patients with severe Covid often experience inflammation, which has previously been linked to chronic mental illness, particularly depression.
Read full story
Source: The Independent, 15 March 2022
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Pregnant women should be asked how much they drink

Pregnant women should be asked how much alcohol they are drinking and the answer recorded in their medical notes, new "priority advice" for the NHS says.
The advice, from the National Institute for Health and Care Excellence (NICE), is designed to help spot problem drinking that can harm babies.
Infants with foetal alcohol spectrum disorder (FASD) can be left with lifelong problems. The safest approach during pregnancy is to abstain from alcohol completely.
The more someone drinks while pregnant, the higher the chance of FASD - and there is no proven "safe" level of alcohol.
But the risk of harming the baby is "likely to be low if you have drunk only small amounts of alcohol before you knew you were pregnant or during pregnancy", the Department of Health says.
An earlier draft of the recommendations for NHS staff in England and Wales suggested transferring data on a woman's alcohol intake to her child's medical notes - but this has now been dropped, following concern women who needed help might hide their drinking.
The Royal College of Midwives spokeswoman Lia Brigante said: "As there is no known safe level of alcohol consumption during pregnancy, the RCM believes it is appropriate and important to advise women that the safest approach is to avoid drinking alcohol during pregnancy and advocates for this.
"We are pleased to see that the recommendation to record alcohol consumption and to then transfer this to a child's record has been reconsidered.
"This had the potential to disrupt or prevent the development of a trusting relationship between a woman and her midwife."
Read full story
Source: BBC News, 16 March 2022
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Government overseen years of decline in NHS

The government has overseen years of decline in cancer care and non-urgent hospital services in England, MPs say.
The House of Commons Public Accounts Committee said services had started deteriorating long before the pandemic. It pointed out key targets had not been met since 2016 and the pandemic had just exacerbated the problems.
But ministers said they were investing extra money and creating more capacity to treat patients, to address the backlog that had now developed.
More than six million people are currently on a hospital waiting list - one in nine of the population - the highest figure on record. This includes people waiting for operations such as knee and hip replacements.
Meanwhile, just two-thirds of urgent cancer patients start treatment within the target time of 62 days. And the number of referrals for cancer care has dropped by between 240,000 and 740,000 since the pandemic started.
The MPs said people would face serious health consequences because of delays in cancer treatment, with some dying earlier.
The government is also accused of failing to recognise staffing the health service remains its biggest problem.
The MPs said the workforce was crippled by shortages and exhausted by two years of the pandemic.
Read full story
Source: BBC News, 15 March 2022
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Javid ‘unconcerned’ as Covid admissions rise 46% in a fortnight

Admissions of covid positive patients to English hospitals are once again rising steadily across England.
The seven day total of new confirmed covid cases in hospitals on 12 March (the latest data available) stood at 9,642. This is 46% higher than the seven day total of 6,612 recorded on 25 February, the day before the current rise began.
Asked on Radio 4’s Today programme yesterday about the rise in Covid infections, health and social care secretary Sajid Javid said there was “nothing in the [covid] data that gives us any cause for concern”.
The Covid admissions figures used include patients who are already covid-positive when admitted, are diagnosed on admission, or are diagnosed while in hospital, so in some cases have caught Covid while in hospital.
Read full story (paywalled)
Source: HSJ, 15 May 2022
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Surgery and cancer care in England will have long delays for years

Patients waiting for surgery and cancer care in England will face long delays for years to come, MPs have warned in a new report that is highly critical of both ministers and NHS bosses.
The already-record 6.1 million-strong waiting list for vital treatment will keep growing and officials are “too optimistic” that plans to tackle it will succeed, the public accounts committee (PAC) said in a report on Wednesday.
“For the next few years it is likely that waiting time performance for cancer and elective care will remain poor and the waiting list for elective care will continue to grow,” it said.
The committee of MPs, which monitors spending across Whitehall, acknowledges Covid-19’s role in contributing to the ballooning backlog and lengthening waiting times. But it singled out years of inaction by the Department of Health and Social Care (DHSC) for particular blame.
Patients waiting for surgery and cancer care in England will face long delays for years to come, MPs have warned in a new report that is highly critical of both ministers and NHS bosses.
The already-record 6.1 million-strong waiting list for vital treatment will keep growing and officials are “too optimistic” that plans to tackle it will succeed, the public accounts committee (PAC) said in a report on Wednesday.
“For the next few years it is likely that waiting time performance for cancer and elective care will remain poor and the waiting list for elective care will continue to grow,” it said.
The committee of MPs, which monitors spending across Whitehall, acknowledges Covid-19’s role in contributing to the ballooning backlog and lengthening waiting times. But it singled out years of inaction by the Department of Health and Social Care (DHSC) for particular blame.
Read full story
Source: The Guardian, 16 March 2022
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IHI's Patient Safety Awareness Week

This week is Patient Safety Awareness Week (13-19 March) and is an annual recognition event intended to encourage everyone to learn more about healthcare safety. During this week, the US Institute for Healthcare Improvement (IHI) seeks to advance important discussions locally and globally, and inspire action to improve the safety of the health care system — for patients and the workforce.
Patient Safety Awareness Week serves as a dedicated time and platform for growing awareness about patient safety and recognising the work already being done.
Find out more here.
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NHSE director calls out trust over ‘speak English’ rule

An ‘outstanding’ London trust has come under fire for asking staff to communicate ‘only in English’ when around other people.
A document published under the ‘trust values’ section of Homerton University Hospital Foundation Trust’s website, says: “I will only communicate in English in the presence of others.”
The document has been widely shared on social media in the last 24 hours, with many criticising the trust for its wording. The document itself is dated 2014, but was reposted by the trust in 2019, and remained on its website as of midday today.
NHS England’s director of equality – medical workforce, Partha Kar, who is also NHSE’s diabetes lead, questioned the document on Twitter. He also said: “I am not aware of any NHS England ‘diktat’ suggesting we must all only speak in English to uphold NHS values.”
It follows a separate notice being posted on Twitter yesterday signed simply by “Matron”, by a doctor who claimed her friend saw it at her “hospital placement”. It seemingly threatened staff with “disciplinary action” if they spoke any other language other than English.
It reads: “English is the only language to be spoken in the ward area – this includes the kitchen. Disciplinary action will be taken against staff who do not comply, including agency and bank.”
The documents have prompted a backlash on Twitter, with many criticising them and raising concerns about racism and inclusivity of staff. NHSE’s chief nursing officer, Ruth May, has publicly queried where the document is from.
Read full story (paywalled)
Source: HSJ, 16 March 2022
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Dying patients living longer than expected lose NHS funds

More than 1,300 patients a year are having NHS funding for their palliative care withdrawn after living longer than expected, BBC analysis shows.
Terminally ill or rapidly-declining patients are given fast-track support, allowing them to live outside hospital.
From 2018 to 2021, a total of 9,037 people had this funding reviewed in England and Wales, with 47% of them losing all support.
A further 15% of patients had their continuing healthcare support replaced with the more limited NHS-funded nursing care.
Sandra Hanson was referred to the fast-track pathway of the NHS continuing healthcare scheme in mid-2020, after her needs were judged by a clinician to be "end of life".
She was diagnosed with end-stage dementia, and had been in hospital eight times in the previous year following multiple falls and bouts of pneumonia.
The funding covered the costs of a nursing home, where she suffered fewer falls. But in March 2021, this funding was reviewed by her local Clinical Commissioning Group (CCG).
These assessments, usually undertaken by a multi-disciplinary team including health and social care professionals, consider the severity of a person's needs in areas such as mobility, cognition and behaviour.
Sandra's daughter, Charlotte Gurney, said the family was represented by a social worker they had not previously met, and describes the meeting as "traumatic" as she tried to explain her mum's needs.
"We just felt not listened to... we were treated as if we were trying to swindle the system.
Sandra's support was withdrawn, and she had to be moved to a new nursing home, financed by her husband Malcolm.
Shortly afterwards, she broke her wrist following a fall and injured her face. The family believe had the review correctly identified Sandra's needs and risks, this could have been avoided.
Read full story
Source: BBC News, 17 March 2022
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Is the CQC giving the NHS an easy ride?

The purpose of Care Quality Commission (CQC) ratings has been a hotly contested question since the creation of the four category classifications in the last decade.
The original idea was to give the public a sense of how good their local hospital was, as well as providing commissioners, system managers and government with an idea of whether the local, regional or national health services they had responsibility for were getting better or worse.
The practicality of the first aim was always questionable given the public’s inability and unwillingness, in most cases, to take their custom elsewhere. The second ran into the lack of desire and/or courage on behalf of most commissioners to challenge their local provider, but it did seem to have traction at the top of the shop.
Jeremy Hunt, told HSJ, once they had been dished out across the sector, that their CQC classification now mattered much more then whether or not it had achieved foundation status or not.
Another function, whether intended or not, was that by splashing “inadequate” and unsafe care on the front pages, in the wake of the Francis report, CQC ratings fuelled a drive to put more staff on the wards (forcing the Treasury to pay for the consequent agency bills and deficits, and curtailing Simon Stevens’ transformation funds).
Whatever your take on their purpose, however, they only make sense if they accurately reflect the state of the service. And the latest data suggests that may not be the case.
Read full story (paywalled)
Source: HSJ, 17 March 2022
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‘Cinderella’ postnatal care leaves women ‘forgotten’ after birth

Women and NHS staff have warned that mothers are being “forgotten” after giving birth, with a staff crisis only making matters worse.
Kate, a 32-year-old from Leeds, says she has been left in “excruciating” pain for nine years after horrifying postnatal care.
Other women have told The Independent stories of care ranging from “disjointed” to “disastrous”.
It comes as midwives warn there are “horrendous” shortages in community services, which have prevented women from accessing adequate antenatal and postnatal care.
Mary Ross-Davie, the Royal College of Midwives’ director for professional midwifery, said that with each Covid wave midwifery staffing has been hit worse than the last.
To provide safe care during labour, antenatal and postnatal care, teams are sent into wards putting “huge pressure on care”.
She said this could mean clinicians end up “missing things”, such as women struggling emotionally after birth.
The warnings over poor antenatal and postnatal care come after experts at the University of Oxford said in November there were “stark” gaps in postnatal care, despite the highest number of deaths being recorded in the postnatal period.
Dr Sunita Sharma, lead consultant for postnatal care at Chelsea and Westminster Trust, said that when NHS maternity inpatient staffing overall is in crisis “often the first place staff are moved from is the postnatal ward, which is clinically very appropriate, but it can come at a cost of putting more pressure on postnatal care for other mothers”.
Dr Sharma said postnatal teams were doing their best to improve services but need national drivers and funding to sustain improvement.
Read full story
Source: The Independent, 16 March 2022
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Somerset care home staff continue working with Covid

Some care homes have "no choice" but to allow workers who have Covid to deliver care, a public health official said.
According to Public Health England cases are rising the fastest in Somerset.
As a result, care homes in the county are struggling to safely staff their services and schools are seeing a rise in staff sickness.
Somerset Council said ensuring vulnerable residents received care was "lower risk" than them being infected.
Health officials advised care workers to continue working only if they wore PPE and felt well enough.
Council public health consultant Alison Bell said: "In some cases, we have no choice but to have people who are testing positive delivering care to people in Somerset.
"That risk is actually less than that person not receiving care."
She said the Omicron variant was more transmissible and people were getting re-infected with it, some within a matter of weeks.
Read full story
Source: BBC News, 16 March 2022
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Ban on home abortions increases risks to women, Government told

Banning home abortions could increase risks to women and waste NHS resources, leading doctors have warned.
The “pills by post” system is set to be dismantled in England by September, having been introduced as a temporary measure at the start of the pandemic.
However, the plans, disclosed by The Telegraph last month, have sparked outrage from medical organisations and women’s groups.
The decision by ministers to return to pre-pandemic abortion systems in England has sparked fierce debate and could be subject to a vote in Parliament on Wednesday.
Writing for The Telegraph, the leaders of the Academy of Medical Royal Colleges, the British Medical Association and the Royal College of Obstetricians and Gynaecologists have urged ministers to reconsider their intentions.
They said that the current system has meant terminations take place earlier in the pregnancy, reducing the risk of complications, and that the most vulnerable women, including domestic abuse victims, are able to get help.
Baroness Sugg of Coldharbour, a former operations chief to David Cameron, said that the UK should “stand strongly against the rollback of women’s rights”. She has also tabled an amendment to the Health and Care Bill seeking to maintain the current system in England.
Read full story (paywalled)
Source: The Telegraph, 15 March 2022
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Focus on acutes has left mental health facing ‘significant uncertainties’ say trust leaders

A large mental health trust has highlighted a lack of additional funding for the sector, in contrast to the £8bn earmarked for acute providers to tackle elective waiting lists.
Tees, Esk and Wear Valleys Foundation Trust expects demand for its services to be 20% higher than pre-covid levels, but says uncertainties around funding could “impede” progress and “wider service sustainability”.
In an interview with HSJ last week, TEWV’s chief executive Brent Kilmurray said: “Quite often, we are facing the challenge of trying to find beds and meet demand. What we’ve seen is an increase in occupancy and an increase in length of stay. And we are relating that to an increase in acuity.
“We really welcome the investment that goes into the long-term plans on the specialist services that are coming through. [But] what we want to do with our work is give greater transparency to the backlogs that have developed and some of the additional pressures.
Asked about the trust’s actions to address multiple concerns around safety and quality, Mr Kilmurray said staffing had improved in forensics, although the vacancy rate is still higher than the trust average, and that a leadership development programme is aiming to improve the culture of the organisation. He said he hopes the CQC “would see significant improvement” when they are inspected again.
He added that “a lot has changed” since the high-profile deaths of two teenagers under the care of the trust, which are subject to an ongoing inquiry
He said: “We will be able to build on the legacy of those young women in terms of the learning that we want to embed within the organisation.”
Read full story (paywalled)
Source: HSJ, 16 December 2022
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USA: Dentist found guilty of damaging patients’ teeth to boost profits

A Wisconsin dentist was found guilty of healthcare fraud and other charges after he intentionally damaged his patients’ teeth to boost profits, raking in millions from his scheme.
Scott Charmoli, 61, was convicted of five counts of healthcare fraud and two counts of making false claims about his clients’ treatment last Thursday, according to the Milwaukee Journal Sentinel.
With his sentencing scheduled for June, Charmoli faces up to 10 years for each healthcare fraud charge and a maximum of five years for each of the two other charges.
Prosecutors say that Charmoli had routinely drilled or broken his clients’ teeth on purpose, charging them for additional treatment services to fix the damage he had just done. As a result, Charmoli’s profits ballooned, with the dentist going from making $1.4m and installing 434 crowns in 2014 to $2.5m in 2015, installing over 1,000 crowns, reported the Washington Post.
According to prosecutors, in 2015, Charmoli began pressuring his clients into getting unnecessary crowns, a dental procedure where a tooth-shaped cap is placed on a damaged tooth. Charmoli would drill or break his client’s teeth and send X-rays of the intentional damage to insurance as “before” photos to justify the crown procedures.
One client, Todd Tedeschi, testified that Charmoli pressured him into getting two crowns in one appointment, despite Tedeschi believing that his teeth were fine.
“It seemed excessive, but I didn’t know any better,” said Tedeschi. “He was the professional. I just trusted him.”
Some of the patients that Charmoli badgered into unnecessary procedures were also vulnerable, said prosecutors.
Read full story
Source: The Guardian, 16 March 2022
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Care homes ‘could face widespread closures’ under social care reforms

Hundreds of England’s care homes could be closed and care rationed because the government has “seriously underestimated” the costs of a shake-up, experts are warning.
Widespread closures would leave hundreds of thousands of elderly and vulnerable residents homeless.
Those in the southeast, the east and the southwest would be hardest hit, according to a new study.
Under a package of social care reforms announced in September, ministers are aiming to make care fees fairer between private and state fee payers.
At the moment, residents who self-fund all their care pay up to 40% more on average than those eligible for state support, for whom their local authority arranges care, and care homes charge councils lower rates.
Read full story
Source: The Independent, 18 March 2022
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Covid-19: Evusheld is approved in UK for prophylaxis in immunocompromised people

The UK’s drug regulator has approved a combination of two monoclonal antibodies to prevent Covid-19 in people who are unlikely to mount an immune response from vaccination or for whom vaccination is not recommended.
Evusheld, a combination of the two long acting antibodies tixagevimab and cilgavimab, is authorised for Covid-19 prevention by the Medicines and Healthcare products Regulatory Agency (MHRA). The government’s independent advisory body, the Commission on Human Medicines, endorsed the approval after independently reviewing the evidence.
Almost 500 000 people in the UK are immunocompromised, including people with blood cancers, those taking immunosuppressive drugs after an organ transplant, or those with conditions such as multiple sclerosis and rheumatoid arthritis. The treatment could offer this group of patients, many of whom are still shielding, protection against Covid-19 and help them feel more confident about returning to a normal life.
June Raine, MHRA chief executive, said, “While Covid-19 vaccines continue to be the first line of defence, we know that some people may not respond adequately to these vaccines and for a small number they may not be recommended. For these people, Evusheld could provide effective protection against Covid-19.”
Penny Ward, an independent pharmaceutical physician and visiting professor in pharmaceutical medicine at King’s College London, said, “This treatment could be a good way to protect patients who are not able to respond normally to vaccination. Many of these people are continuing to shield while Covid is still circulating in the community and this agent could help them feel more confident to return to a more normal life.”
Read full story
Source: BMJ, 17 March 2022
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