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

Non-compliant online STI tests put patients at risk, experts warn

Patients are being put at risk in the UK because very few sexually transmitted infection (STI) tests offered online meet official standards, experts have warned.
The NHS provides free in-person tests for STIs via its network of sexual health and genitourinary medicine clinics. Patients can also order tests via the internet from both NHS-commissioned and private providers, a practice that has become increasingly popular during the pandemic.
However, new research in the Sexually Transmitted Infections journal published by the BMJ found that few online STI test services meet national recommended standards, with independent sector providers the least likely to be compliant.
Online tests involve the user ordering a kit and either self-sampling by posting the specimen for laboratory analysis, or self-testing by interpreting the test themselves.
The research found that the commercial self-sample providers, which advertised to those with symptoms, did not differentiate by STI symptom severity, and eight – seven private and one NHS-commissioned provider – offered no advice on accessing preventive treatment after exposure to HIV as recommended.
Self-test providers did not appear to offer any form of order of treatment for patients and five offered tests that were intended for professional use only.
The research concluded: “Regulatory change is required to ensure that the standard of care received online meets national guidelines to protect patients and the wider population from the repercussions of underperforming or inappropriate tests."
“If we do not act now, patients will continue to receive suboptimal care with potentially significant adverse personal, clinical and public health implications.”
Read full story
Source: The Guardian, 12 April 2022
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GP telephone first system 'here to stay' in Northern Ireland

A phone first system adopted by most GP surgeries at the start of the pandemic is "here to stay", the Royal College of GPs (RCGPs) in Northern Ireland has said.
However, the RCGP has also accepted patient access needs to improve.
The system was introduced in spring 2020. According to GPs, the move, which came without either consultation or prior information, was necessary to minimise the risk of infection of Covid-19.
Two years on, there is concern among some members of the public that the system is not working.
Speaking to BBC News NI, Dr Ursula Mason accepted that the system wasn't working but said there were not enough GPs to see people.
She added that the telephone system, which was being "refined" and "improved" was the best way to manage "growing demand" and to "prioritise the sickest patients to be seen first".
"The telephone system allows us to see many more patients, to deal with demand in a better way so I think the telephone system is here to stay," added Dr Mason.
"There will be some changes to upgrade it, but it will form a significant part of how we manage demand."
Patient Safety Learning

Nurses reveal shocking abuse from patients as backlog rises

Nurses have spoken of the shocking abuse they face from patients as the NHS struggles to cope with a rise in demand for care.
Both patients and staff are becoming increasingly frustrated with the situation the NHS is in, with staff shortages and a patient backlog of six million people causing already stretched services extra strain.
"As we are the faces that the public see we do get the brunt of a lot of their anger as they are becoming increasingly frustrated with the situation that the NHS is in," one nurse wrote on Nursing Standard’s Facebook page. "Staff are equally frustrated with the whole situation and knackered from working long hours and covering for the many staff still absent."
Nurses given the task of conveying ‘unwelcome messages about the limitations of resources’
Another said: "Working in an ED abuse occurs on a daily basis… it is not acceptable but even when you Datix these incidents nothing gets done, staff are reduced to tears and frightened to walk into patient waiting areas, it is not acceptable."
It comes as former chief inspector of social services Lord Herbert Laming accused health service managers of putting nursing staff in the public firing line during a House of Lords debate on reducing abuse of nurses in the NHS.
Read full story
Source: 12 April 2022, Nursing Standard
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Huge drop in midwives’ morale amid Ockenden fallout

There has been a dramatic fall in morale among midwives across multiple measures within the NHS staff survey.
Although general morale deteriorated among most staffing groups in 2021, the results for midwives across numerous key measures have worsened to a far greater degree than average.
It comes amid the final Ockenden report into the maternity care scandal at Shrewsbury and Telford Hospitals Trust, which raised serious concerns about short staffing and people wanting to leave the profession.
The survey results, published on 31 March, suggest 52% of midwives are thinking about leaving their organisation, up 16 percentage points on the previous year. In comparison, the number of general nurses thinking of leaving was 33%, up just 5 percentage points.
Chris Graham, chief executive of healthcare charity the Picker Institute, which coordinates the staff survey, described the midwifery profession as an “outlier” in the 2021 results, in terms of how their experiences compare to other groups and how their responses have changed over time.
“Not only do midwives report worse experiences in many areas, but there is evidence of particularly sharp declines in some key measures,” Mr Graham said. “It appears likely that staffing shortages are a major factor here.”
Read full story (paywalled)
Source: HSJ, 13 April 2022
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Government publishes report that will shape Women's Health Strategy

In an ongoing effort to improve care and support for elderly women and women’s health satisfaction and outcomes in general, the government have published their report summarising written responses from 436 organisations and experts from the Women’s Health Strategy call for evidence.
The organisations that contributed to the report included participants from the charity sector, academia, professional bodies, clinicians, royal colleges and other general experts in women’s health.
The topics highlighted in the report include:
Menstrual health and gynaecological conditions, including the impact of premenstrual syndrome on someone’s quality of life. Fertility, pregnancy, pregnancy loss and maternal health, including women not feeling listened to during and after pregnancy and the provision of bereavement support services. Menopause, including suggestions for improvements in training and guidelines for healthcare professionals. Gynaecological and other cancers, including barriers to accessing high-quality, up to date information on risk factors for female cancers. Mental health, including its interaction with other health conditions across women’s life course. Healthy ageing, including the need to increase focus on the health needs of older women and emphasise women may experience the same conditions as men in different ways. Violence against women and girls, including the complications associated with hymenoplasty and barriers to accessing healthcare support for those who’ve been subject to years of violence and abuse. Minister for Women’s Health Maria Caulfield said: “For generations, women have lived in a healthcare system primarily designed by men, for men. We are committed to tackling the gender health gap, and the publication of our strategy later this year will mark a significant step forward.”
She added: “I want to thank the expert individuals and organisations who took the time to respond to our call for evidence. The insights you have provided have been stark and sobering but will be pivotal to ensuring our strategy represents the first-hand experiences of the health care system.”
Read full story
Source: NHE, 13 April 2022
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Trust board backs medical director who wrongly dismissed whistleblower

A trust board has backed the medical director who oversaw the dismissal of a whistleblower in a case linked to patient deaths.
Portsmouth Hospitals University Trust told HSJ John Knighton had the full support of the organisation when asked if he faced any censure over the wrongful dismissal of a consultant who raised the alarm about a surgical technique.
Jasna Macanovic last month won her employment tribunal against the trust with the judge calling its conduct “very one-sided, reflecting a determination to remove [her] as the source of the problem”.
The judgment found that the disciplinary process Dr Knighton oversaw was “a foregone conclusion” and as such had broken employment rules. The nephrologist was twice offered the opportunity to resign with a good reference, once during her disciplinary hearing and again on the day the outcome of that hearing was delivered.
The trust told HSJ nothing in the judgment suggested Dr Knighton should face any action about his conduct and none had been taken. It said there were no reasons to doubt his credibility or probity.
The trust did not respond when asked if any apology had been offered to Dr Macanovic.
A spokesperson said: “We are committed to supporting colleagues raising concerns, so they are treated fairly with compassion and respect.”
Read full story (paywalled)
Source: HSJ, 13 April 2022
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NHS faces an Easter 'as bad as any winter'

NHS leaders are warning that the health service is facing the "brutal reality" of an Easter as bad as most winters.
Latest data shows record waits for planned surgery and in A&E, as staff plough through a backlog fuelled by Covid. The government says there is hope on the horizon.
Jean Shepherd, 87, had a stroke in April last year, leaving her severely disabled and requiring round-the-clock care.
At the end of February there was an outbreak of sickness at her nursing home and she needed hospital treatment. She had to wait in a wheelchair for more than 9 hours until an ambulance arrived to take her to A&E. She then spent 31 hours on a trolley between the emergency department and a secondary-care unit.
"She was very distressed because she doesn't like hospitals at the best of time," says her son, Andy Shepherd. "Since the stroke, because of her cognitive ability, she doesn't understand what's happening around her."
Mrs Shepherd was eventually moved to a bed in a main hospital ward, where her family says she later contracted Covid, before recovering and being discharged back to her care home two weeks later.
"I appreciate that A&E departments have always been busy, but I just wasn't prepared for what greeted me at the hospital," says her son.
"There were patients on ambulance trolleys literally everywhere and the staff were absolutely rushed off their feet. I remember thinking at the time that this is not sustainable."
Read full story
Source: BBC News, 14 April 2022
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Johnson & Johnson ordered to pay $302M in pelvic mesh case

A California appeals court has upheld a lower court ruling that Johnson & Johnson must pay penalties to the state for deceptively marketing pelvic mesh implants for women, but reduced the amount by $42 million to $302 million.
Johnson & Johnson had appealed in 2020 after Superior Court Judge Eddie Sturgeon assessed the $344 million in penalties against Johnson & Johnson subsidiary Ethicon.
Sturgeon found after a non-jury trial that the company made misleading and potentially harmful statements in hundreds of thousands of advertisements and instructional brochures for nearly two decades.
The instructions for use in all of the company’s pelvic mesh implant packages "falsified or omitted the full range, severity, duration, and cause of complications associated with Ethicon’s pelvic mesh products, as well as the potential irreversibility and catastrophic consequences," Presiding Justice Judith McConnell of the appeals court said in a 3-0 ruling upholding the $302 million in penalties.
The products, also called transvaginal mesh, are synthetic and surgically implanted through the vagina of women whose pelvic organs have sagged or who suffered from stress urinary incontinence when they cough, sneeze or lift heavy objects.
Many women have sued the New Jersey-based company alleging that the mesh caused severe pain, bleeding, infections, discomfort during intercourse and the need for removal surgery.
Read full story
Source: Fox News, 12 April 2022
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USA: ‘Burnt out and tired’: nurses at leading California hospitals prepare to strike

Five thousand nurses at Stanford and Lucile Packard children’s hospital in Stanford, California, are preparing to strike in demand of wage increases, mental health and wellness support, better healthcare benefits, and a focus on hiring and retaining nurse staff.
The union has set a strike date for 25 April.
Stanford hospital at Stanford University in California has been consistently ranked among the top hospitals in the US by US News, but nurses say high turnover rates, understaffing, and inadequate proposed wage increases and benefits have contributed to high burnout rates. In a survey of union members, 45% of nurses reporting said they intend to leave their job within the next five years.
Kathy Stormberg, a nurse in the radiology department at Stanford hospital for 19 years and vice-president of the Committee for Recognition of Nursing Achievement (Crona), blamed the strike on the hospitals’ continued reliance on contractors and its policy of pushing nurses to work overtime amid staff shortages, unfilled vacancies, and difficulties retaining enough nursing staff.
“That is not sustainable,” said Stormberg. “Nurses have an overwhelming sense of guilt to work overtime when they are getting texts requesting nurses to come in every four hours on their days off.”
In January 2022, a nurse on a contract at Stanford hospital walked out of their shift and killed themself, highlighting the need for better mental health and wellness support services and for improvements to the poor working conditions that nurses have faced through the Covid-19 pandemic.
“The working conditions that we have now are just no longer sustainable,” said Leah McFadden, a nurse in Stanford’s surgical trauma unit since October 2019. “Over the last two years, we’re starting to run on empty, we aren’t having a chance to decompress, or even just get away from the hospital as much as we should.”
Read full story
Source: The Guardian, 13 April 2022
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Covid disruption to NHS in England wreaks havoc with surgery backlog

Operations are being cancelled across England as Covid causes “major disruption” inside the NHS, the country’s top surgeon has said, as doctors and health leaders say the government’s backlog targets look increasingly unachievable.
Six million people are on the waiting list for NHS hospital care, including more than 23,000 who have waited more than two years.
Boris Johnson said in February that he had launched “the biggest catch-up programme in the history of the health service”, but in the same month he dropped every domestic Covid restriction. Now record-high Covid rates are wreaking havoc with the ability of the NHS to catch up with surgery that was delayed or cancelled before and during the pandemic.
More than 28,000 staff are off work every day due to Covid, recent figures show, while more than 20,000 patients are in hospital with Covid, which has dramatically reduced the number of beds and space available for planned surgery patients.
“Unfortunately, Covid-19 continues to cause major disruption in the NHS, with high staff absences in recent weeks,” Prof Neil Mortensen, the president of the Royal College of Surgeons of England, told the Guardian.
“We have heard that planned surgery is being cancelled again in different parts of the country due to staff being off sick with the virus. This is understandably frustrating for surgical teams who want to help their patients by getting planned surgery up and running again. It’s also very distressing for patients who need a planned operation.”
Read full story
Source: The Guardian, 14 April 2022
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CEO describes anger at ‘disrespectful’ staff

The chief executive of a mental health trust grappling with care quality failures has described his anger at ‘disrespectful’ staff who have ‘now had to leave the organisation’.
In a message to staff, seen by HSJ, Brent Kilmurray, chief executive of Tees Esk and Wear Valleys Foundation Trust, said a number of staff had “stepped away from our values”.
HSJ has heard reports of 12 staff members within the trust’s forensic secure inpatient services being suspended in recent weeks, and some dismissed, after being caught sleeping on shifts and using electronic devices while meant to be observing patients.
The reports are unconfirmed, but appear to be referenced in a message sent by Brent Kilmurray on 14 March, which said: “I’m sorry to say, there’s been a handful of people who have stepped away from our values and in doing so have now had to leave the organisation."
Mr Kilmurray said the staff were in a “minority” and that when the trust investigated these matters “we have found far more excellent caring practice”. He added the trust is working with service leaders “to ensure that they understand their accountabilities for ensuring that services are safe”.
Read full story (paywalled)
Source: HSJ, 14 April 2022
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GP sexually abused 48 patients over 35 years

A doctor from North Lanarkshire has been found guilty of 54 sex offence charges against women over 35 years.
Krishna Singh, 72, kissed, groped, gave inappropriate examinations and made sleazy comments to 48 patients during appointments in various medical settings.
Prosecutors described how the sexual predator was "hiding in plain sight" over nearly four decades.
The offences mainly occurred at medical practices in North Lanarkshire, but also at a hospital accident and emergency department, a police station and during visits to patients' homes.
An investigation was launched into his behaviour when one woman reported him to authorities in 2018. A letter was then sent to all patients at the practice to see if they could help in the police inquiry.
Many women became so uncomfortable going to see the GP that they brought a friend or relative to appointments.
One woman tried to make her medication last longer to delay having to go back and see him.
Prosecutor Angela Gray told the jury during the trial that Singh had been in a routine of abusing his position to offend against women.
She said: "Sexual offending was part of his working life. Access to women as and when the situation arose and taking the chances when he could."
Read full story
Source: BBC News, 14 April 2022
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End ‘natural birth’ bias in midwife job ads, hospitals told

NHS bosses have written to hospitals telling them to stop using language that implies a bias against caesarean sections when advertising jobs in maternity services.
A recent report into an NHS maternity scandal found that a focus on “normal birth” had played a key role in babies dying or being born disabled. Women at the Shrewsbury and Telford trust were forced to undergo traumatic natural births when they should have been offered surgical intervention. 
However, even since its publication, trusts have published job adverts looking for a member of staff “to help us promote normality” or saying that they are “proud of our commitment to normal birth”.
In a letter sent, Dr Matthew Jolly, NHS clinical director for maternity, and Professor Jacqueline Dunkley-Bent, chief midwifery officer, ask maternity services “to review the language that they are using about their services, in job adverts, and any other information designed to support decision-making on pregnancy and birth choices”.
The letter continues: “There have been a number of concerns raised about the language used in some NHS trust maternity service job adverts and materials — phrases that suggest bias toward one mode of birth.
“The NHS has a duty to provide safe and personalised care to women and families according to best practice guidance informed by evidence and the changes that are taking place in society, midwifery, maternity, and neonatal care services.
“It is a fundamental requirement of a maternity multidisciplinary team to inform and listen to every woman, respect their views and help them to try and achieve the type of birth they aspire to.”
Read full story (paywalled)
Source: The Times, 15 April 2022
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A&E patients waiting more than two days for a bed, warns leaked letter

A clinical director and several senior managers have written to a trust CEO warning that patients are routinely waiting more than 60 hours to be admitted to a ward from accident and emergency, leaving staff “crying with frustration and anger”.
In a letter to executives at Lancashire Teaching Hospitals Foundation Trust, seen by HSJ, the managers say they lack support from the rest of the trust, and claim the emergency department at Royal Preston Hospital has a “never-ending elasticity in the eyes of others”.
The letter, dated 30 March, is signed by clinical director Graham Ellis, two unit managers, the specialty business manager, and the matron.
It says: “Whilst we have documented our concerns previously the current situation is worse than it has ever been…Our situation is increasingly precarious…
“For the past few months we have on a regular basis had more than 50 patients waiting for a bed and that wait being in excess of 60 hours.
“This means that at most times there is limited or no space to accommodate newly acutely ill patients causing ambulance handover delays of over four hours and delay in treatment.”
Clinicians at Preston have been raising safety concerns about the ED for several years, but the letter is the first time concerns of senior managers have been made public.
The letter references research which suggests patients die as a “direct result from long waits in ED”, and says there has been an increase in clinical incidents, pressure sores, detrimental outcomes, and occasions where patients “die without the dignity of privacy”.
Read full story (paywalled)
Source: HSJ, 4 April 2022
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Focus will shift from trust ratings to services

Trusts leaders can expect more emphasis on inspection ratings for individual services in future — as opposed to overall organisational ratings — the chief executive of the Care Quality Commission has said.
In an interview with HSJ, Ian Trenholm discussed the future of the inspection regime, his views on prosecuting trusts, and how integrated care systems could be regulated.
Asked about the future of inspections, Mr Trenholm said he did not believe trust leaders would be satisfied with just looking at their overall rating.
He said: “My appeal to chief executives would be look at the broader suite of services that you’ve got in front of you.
“In [the] future, I think there’ll be much more emphasis on individual ratings of individual services. Exactly what the detail will look like I think remains to be seen…”
It follows questions about the accuracy of NHS acute trust ratings now, with the CQC having carried out fewer thorough inspections during the pandemic. There is now only one trust rated “inadequate”, despite huge concerns about service failings, particularly in acute care.
He said the “intention over the next few months” is to create a new CQC single assessment framework which incorporates inspection findings for health systems, as well as individual providers."
Read full story
Source: HSJ, 19 April 2022
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Mums-to-be still being given unsafe epilepsy drug

The moment her newborn son Sebastian was handed to her, Catherine McNamara knew something was terribly wrong. His tiny hands were deformed, unnaturally twisted and facing in the wrong direction. One was missing a thumb.
A few days later, the couple were devastated as doctors told them Sebastian’s deformities were permanent — and had been caused by the drug McNamara had been taking to control her epilepsy.
Like thousands of women, McNamara had been told her epilepsy medicine, sodium valproate, was safe to take during pregnancy. “They told me everything would be fine,” she said.
Sodium valproate, which was given to women with epilepsy for decades without proper warnings, has caused autism, learning difficulties and physical deformities in up to 20,000 babies in Britain.
Yet despite a 2020 report that criticised the failure over four decades to inform women about the dangers, doctors are still not properly warning women of the risks. According to the latest data, published in March, sodium valproate was prescribed to 247 pregnant women between April 2018 and September 2021.
An investigation by The Sunday Times has found that the drug is still being handed out to women in plain packets with the information leaflets missing, or with stickers over the warnings.
The government is refusing to offer any compensation to those affected by sodium valproate, despite an independent review by Baroness Cumberlege concluding in 2020 that families should be given financial redress.
The former health secretary Jeremy Hunt says doctors should now be banned from prescribing the drug to pregnant women — and that the families affected by it must be properly compensated.
He has compared the case to the scandal of the anti-morning-sickness drug thalidomide, which caused deformities in thousands of babies after it was licensed in the UK in the 1950s.
Read full story (paywalled)
Source: The Sunday Times, 16 April 2022
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