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

US pediatricians’ group moves to ban race-based medical guidance

The American Academy of Pediatrics is attempting to ban race-based medical guidance which the organisation attributes to long-standing inequities in healthcare.
In a statement on Monday, the AAP said: “Race is a historically-derived social construct that has no place as a biologic proxy. Over the years, the medical field has inaccurately applied race correction or race adjustment factors in its work, resulting in differential approaches to disease management and disparate clinical outcomes.”
“Although it will continue to be important to collect clinical data disaggregated by race and ethnicity to help characterize the differential lived experiences of our patients, unwinding the roots of race-based medicine, debunking the fallacy of race as a biologic proxy, and replacing this flawed science with legitimate measures of the impact of racism and social determinants on health outcomes is necessary and long overdue,” the academy added.
A re-examination of AAP treatment recommendations that began before George Floyd’s 2020 murder by police in Minneapolis, and intensified after it and the resulting nationwide protests, has doctors concerned that Black youngsters have been under-treated and overlooked, said Joseph Wright, lead author of the new policy and chief health equity officer at the University of Maryland medical system, a network of hospitals.
According to Wright, the academy has begun to scrutinise its “entire catalog,” including guidelines, educational materials, textbooks and newsletter articles.
The academy went on to recommend a series of policies to medical societies, institutions and pediatricians. “All professional organizations and medical specialty societies should advocate for the elimination of race-based medicine in any form,” it said.
It urged institutions to collaborate with learner-facing organizations such as the Accreditation Council on Continuing Medical Education to expose more people to health equity content with a “specific focus on the elimination of race-based medicine”.
Read full story
Source: The Guardian, 2 May 2022
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Few staff using wellbeing hubs despite rise in sick days

Only 53,500 staff have used a flagship NHS staff wellbeing initiative in its first year of operation, HSJ can reveal, while separate analysis finds mental health sick days have soared in the last five years. 
Figures obtained via Freedom of Information requests reveal the NHS’s staff mental health and wellbeing hubs, set up in February 2021 in response to covid pressures, received 53,549 contacts from NHS and social care staff between then and January 2022.
It is the first time such data has been published and it comes as HSJ’s analysis of separate figures shows mental health sick days taken across acute and specialist NHS trusts have risen sharply in the past five years (see box below). 
The total number accessing the hubs, which is inclusive of social care staff, equates to less than 4 per cent of the NHS workforce as of January 2022. 
Sean Duggan, mental health chief executive at NHS Confederation, said: “Given what we know about the pandemic and the toll it has paid on NHS staff, I would have expected bigger numbers.
“We need to encourage more people to come forward. To me, this number says we certainly need to sustain the hubs with funding for years to come.”
Read full story (paywalled)
Source: HSJ, 3 May 2022
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Trusts failing on waiting list ask told to ‘get act together’

Trusts have been told to ‘get their act together’ on health inequalities, after HSJ research suggested only a small minority have so far published data on disparities in waiting times between different patient groups.
Planning guidance issued by NHS England in September 2021 said trusts’ board performance reports should include a disaggregation of waiting lists by ethnicity and deprivation group.
Through freedom of information and media requests, HSJ attempted to obtain such data from the 20 trusts with the largest waiting lists, but only three currently appear to have met the requirement in full.
The remainder either said they were still undertaking the work, were thinking about how to publish it, or failed to respond.
Roger Kline, an academic researcher and former director of NHSE’s workforce race equality standard, said trusts should have been collecting and publishing the data for years.
He said: “We know there are issues around health and healthcare of some groups of people, most notably in poor working class communities and black and minority ethnic communities. It shouldn’t be seen as an optional extra, this should be part of good public health work and good equitable healthcare provision."
“This data should be on the trust website. It should be an active part of the conversations with local communities. Well done to the trusts that are pushing this forward. The ones that are not need to get their act together.”
Read full story (paywalled)
Source: HSJ, 3 May 2022
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When the NHS spends billions on personal injury cases, it’s the public that loses

Hunt’s radical plan to reform compensation for clinical negligence is “completely unacceptable” says the Association of Personal Injury Lawyers, which includes some of the kinds of firms that urge people to sue the NHS, soliciting online, in TV ads or posters in waiting rooms.
Damages paid by the NHS as a result of medical negligence claims have soared exponentially over the last decade, up from £900m to £2.2bn now. Yet despite horror stories of deaths and life-changing damage in badly run maternity wards, the National Audit Office (NAO) finds no evidence of more injuries, only that the number of claims and sums awarded by courts are shooting up. The NAO found that “the claimant’s legal costs exceeded the damages awarded in 61% of claims settled”. Though the lawyers in the clinical compensation business protest vigorously that they defend patients’ rights, the Hunt committee demolishes any justification for the present system.
The report quotes Sir Ian Kennedy QC, the chair of many inquiries and emeritus professor of health law and ethics at University College London, who wrote in 2021 that clinical negligence was an “outdated, arbitrary and scandalously expensive system” with a “stranglehold that lawyers exert over a system that should be putting the interests and needs of patients first”.
What injured patients need is an independent authority to conduct a speedy and transparent investigation of what went wrong, with everyone free to speak openly, ending in reasonable compensation and a pledge to prevent anyone else being put at risk by the same error. Peter Walsh, the chief executive of Action Against Medical Accidents, told the committee that litigation was often “a last-gasp attempt to get a sense of justice and to get to the bottom of what has actually happened after people have experienced denial after denial”.
Instead of a system of delays and denials that frustrates grieving families and terrorises doctors as lawyers seek to pin personal blame on someone, the committee proposes a system closer to those used in New Zealand and Scandinavia. An independent administrative body would investigate a patient’s case to see if the harm done was avoidable and if so, to fix fair compensation briskly within six months. The priority would be openness and learning from mistakes to protect future patients. Not needing to find a person to blame makes it easier for patients to get compensation – but the payout would be far lower. Some warn this lower burden of proof would encourage a flood of claims, but New Zealand found a similar system ended up halving the sums paid out. 
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Source: The Guardian, 3 May 2022
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‘40,000 put at risk last month’ while waiting in ambulance

More than 38,000 patients were put at risk of harm during March – more than 4,000 of them seriously – while they waited in an ambulance outside hospital, according to estimates shared with HSJ.
The number of hour-plus delays to handing over patients from ambulances to emergency departments in March was the highest ever recorded, following steep increases since last summer.
Figures collected by the Association of Ambulance Chief Executives (AACE), and shared with HSJ, reveal that one trust recorded a delay of 23 hours during March. 
Based on its detailed information about the length of handover delays, AACE has produced an estimate of the likely number of patients harmed while waiting to he handed over, using a model initially developed in research published last year. This found 85 per cent of those who waited more than an hour could have suffered potential harm.
The AACE report said that patients who waited the longest were at greatest risk of some level of harm and the risk of severe harm tripled for those waiting for more than four hours compared with waiting for 60 to 90 minutes.
AACE managing director Martin Flaherty told HSJ: “We expect the situation to be no better when we collate our figures for April.
“The most significant problem remains hospital handover delays which continue to increase exponentially, with tens of thousands of ambulance hours being lost due to hospital handover delays, causing enormous knock-on effects out in the community, where delays in people receiving the ambulance resource they need are the obvious result.
“However, the human cost, in terms of direct harm that is being caused to patients through these combined delays at hospitals and in the community, as well as to the health and wellbeing of our ambulance crews, is substantial."
Read full story (paywalled)
Source: HSJ, 29 April 2022
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Leaked NHS report warns GPs face ‘shocking levels’ of racism

GPs face “appalling and systemic” racism from patients and colleagues, a leaked NHS report has revealed.
The first Health Education England report for London of its kind says racism and discrimination are widespread within primary care across the capital, and GPs in other parts of the country have raised similar concerns.
Doctors speaking with The Independent have told stories of being called derogatory and racist names, of staff leaving due to the bigotry they’ve faced, and of patients asking to see a “white” or “English” GP.
Senior GPs have warned patients will ultimately suffer as a result, as experienced doctors leave practices to avoid such abuse.
Professor Simon Gregory, deputy medical director for Health Education England, said: “There is considerable evidence that the UK is systemically racist, and that the NHS is a systemically racist workplace.
“This report is shocking evidence of terrible, indeed appalling, levels of discrimination across protected characteristics and with much intersectionality, but especially shocking levels of racial discrimination.”
“The awful and painful narratives of so many colleagues over so many years cannot be ignored but thanks to London’s primary care educational leaders we now have firm evidence. Evidence that cannot be ignored.”
Read full story
Source: The Independent, 4 May 2022
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Patient watchdog chair quits and tells Javid funding cuts are endangering ‘its vital role’

Sir Robert Francis has announced he is to step down as chair of Healthwatch England 20 months early, claiming funding cuts mean the patient watchdog could soon struggle “to fulfil its vital role”.
The prominent QC has also announced he will quit his position as a non-executive director of the Care Quality Commission on November 15 2022.
In a letter to Mr Javid, Sir Robert said it had been an “honour and a privilege” to serve on the CQC’s board and a “great pleasure” to support Healthwatch England. He added: “I believe [Healthwatch England] has proved its worth to your department and the system more generally and is now in an ideal position to help you take forward your agenda for improving the patient’s voice.
“However, if I have one regret about my time as chair[man], it is that we have been unable as yet to find a way of reversing the alarming decline in the resources available to Healthwatch – I am afraid there is a growing risk the network will be unable to fulfil its vital role unless urgent attention is paid to this issue.”
Sir Robert has chaired a number of independent inquiries involving the NHS, most notably the inquiry into poor care and high mortality rates at Stafford Hospital – which was published in February 2013.
Last June, Sir Robert was appointed by the government to undertake an independent study into a framework for compensation for victims of the infected blood scandal.
Read full story (paywalled)
Source: HSJ, 3 May 2022
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Empowering and investing in midwives could save millions of lives each year

Ms. Martinez is a midwifery student in Tulancingo, Mexico, working in an underserved community. “There is a health care house, but there are no permanent staff,” she explained. “In my community there are many youth pregnancies, and there are no dedicated health staff who could care for women or take care of teenagers.”
This shortage is partly due to a widely held misconception that midwifery is an antiquated profession, she indicated. “I met with doctors and nurses who questioned me: Why was I studying this midwife career? They didn't see room for that.”
Thursday is the International Day of the Midwife, a moment to recognise the enormous contributions of midwives to health care around the world. 
“Not only do their capable hands bring new life into the world, they are champions of sexual and reproductive health and rights, providing voluntary contraception and other essential services, while supporting childbearing women emotionally,” said Dr. Natalia Kanem, UNFPA’s Executive Director, in her statement marking the day.
Yet continued lack of recognition hinders not only the success of midwives but also the health and well-being of whole societies. “We will not achieve universal health coverage without them,” said Dr. Kanem, “or realize our aspirations to reduce maternal and newborn deaths, as agreed in the Sustainable Development Goals.”
Read full story
Source: United Nations Population Fund, 4 May 2022
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Hospital robots are helping combat a wave of nurse burnout in the US

Since February, the nurses at Mary Washington Hospital in Fredericksburg, Virginia, USA, have had an extra assistant on their shifts: Moxi, a 4-foot-tall robot that ferries medication, supplies, lab samples, and personal items through the halls, from floor to floor. After two years of battling Covid-19 and related burnout, nurses say it’s been a welcome relief.
“There's two levels of burnout: There's ‘we’re short this weekend’ burnout, and then there's pandemic burnout, which our care teams are experiencing right now,” says Abigail Hamilton, a former ICU and emergency room nurse that manages nursing staff support programmes at the hospital.
Moxi is one of several specialised delivery robots that has been developed in recent years to ease the strain on healthcare workers. Even before the pandemic, nearly half of US nurses felt that their workplace lacked adequate work–life balance. The emotional toll of seeing patients die and colleagues infected at such a large scale—and fear of bringing Covid-19 home to family—has made feelings of burnout worse. Studies also found that burnout can have long-term consequences for nurses, including cognitive impacts and insomnia years after the exhaustion of their early careers. The world already had a nurse shortage going into the pandemic; now, roughly two out of three nurses in the US say they have considered leaving the profession, according to a survey from the National Nurses United union.
Moxi has spent the pandemic rolling down the halls of some of the largest hospitals in the country, carrying objects like a smartphone or beloved teddy bear to patients in emergency rooms when Covid-19 protocol kept family members from bedsides.
Read full story
Source: Wired, 19 April 2022
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Obesity ‘epidemic’ leading to 1.2m deaths a year in Europe, says WHO

Obesity has reached “epidemic proportions” in Europe, the World Health Organization says, as a major report shows the disease is causing 200,000 cancer cases and 1.2 million deaths a year.
In the first such study for 15 years, the WHO said overweight and obesity rates had hit deadly levels and were “still escalating”. No country in the region was on track to meet the WHO global noncommunicable disease (NCD) target of halting the rise of obesity by 2025, it said.
Across Europe, 59% of adults are overweight or obese as well as 8% of children under five and one in three children of school age. Obesity prevalence in Europe is higher than in any other part of the world except the Americas, according to the report presented at the European Congress on Obesity.
Obesity is linked to a string of other diseases, including musculoskeletal complications, type 2 diabetes, heart disease and at least 13 types of cancer. The report said excess body fat led to premature death and was a leading risk factor for disability.
“Across the WHO European region, obesity is likely to be directly responsible for at least 200,000 new cancer cases annually, with this figure projected to rise in the coming decades,” the report said. “For some countries within the region, it is predicted that obesity will overtake smoking as the main risk factor for preventable cancer.”
Dr Hans Kluge, the WHO regional director for Europe, said reversing the obesity epidemic in Europe was still possible. “By creating environments that are more enabling, promoting investment and innovation in health, and developing strong and resilient health systems, we can change the trajectory of obesity in the region.”
Read full story
Source: The Guardian, 3 May 2022
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GPs won’t see us unless it’s ‘life or death’, complain pensioners

A 94-year-old man has said his GP refuses to see him “unless it’s life or death”.

Dennis Baker, from North Hampshire, said he felt “put off” by his doctor's surgery, which is a three-minute walk from his house.

The pensioner, who lives with his wife who has advanced dementia and is bed-bound, said he found it “quite difficult to carry on a conversation with a doctor” and cannot get one to visit him at home.

“The chances are [the receptionist] will say… ‘you're not dying, a doctor will phone you at some stage today’, that’s the usual response,” he told BBC Radio 4’s World at One.
It comes as the president of the Royal College of GPs (RCGP) said family doctors should start “saying no” to extra work to tackle the crisis in primary care.

Speaking at Pulse Live last week, Professor Dame Clare Gerada said the workload crisis was not the fault of GPs and they “cannot innovate [their] way out”.
“When you’re in debates and people are saying to you 'you’ve got to work harder and smarter' - no, the rest of the system has to adapt,” she told the conference.

“You have to start saying no.”
Read full story (paywalled)
Source: The Telegraph, 3 May 2022
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Officials sound alarm on ambulance stroke response times

National NHS officials have called for ambulance response times for stroke cases to be “urgently reviewed”.
A report on stroke services by Getting it Right First Time – an NHS England national programme – recommends modelling the impact of a change to the categorisation by ambulance services of suspected strokes.
The GIRFT report notes that the time between symptom onset and arrival at hospital has increased by 41 minutes over the last seven years, yet faster access to emergency stroke care gives a better chance of survival and reduces the impact on quality of life for survivors.
Strokes are currently treated as “category two” incidents, meaning they should get a response within 18 minutes.
However, patients are currently experiencing much longer waits, as average response times were more than three times this in March. Since the introduction of the current system of categorisation in 2017-18, the 18 minute target for category two calls was only ever hit for a few months, at the height of the covid pandemic, when call-outs were abnormally low.
However, when asked about the issue, Janette Turner, the academic who led research on the last official review of ambulance response times, warned that moving all suspected strokes to category one could lead to longer responses for the most serious calls.
Read full story (paywalled)
Source: HSJ, 4 May 2022
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Baby death mother 'was not seen by obstetrician'

A woman whose baby died after sustaining severe brain damage during labour was not seen by an obstetrician during her pregnancy, an inquest heard. It meant his mother Eileen McCarthy was unable to discuss her birthing options.
Walter German was starved of oxygen during a long labour at the Royal Sussex County Hospital in Brighton.
Lawyers at Fieldfisher are pursuing a civil negligence case, claiming a C-section should have been offered due to a previous third-degree tear.
Walter was born in December 2020. His life-support was turned off after nine days, as his injuries were unrecoverable.
Recording a narrative verdict, coroner Sarah Clarke said Walter died as a result of his brain being starved of oxygen, likely due in part to an umbilical cord obstruction.
She said: "Walter's mother was not seen by an obstetrician during her pregnancy and this led to her being unable to discuss birth options regarding delivery given her previous third degree tear.
"Walter's mother was in the advanced stages of labour for a prolonged period of time with an indication for an earlier obstetric review being apparent."
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Source: BBC News, 4 May 2022
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Maternity scandal review chair resigns after pressure from families

The newly appointed chair of a major review into poor maternity care in Nottingham has resigned following mounting pressure from families.
Julie Dent was appointed by the NHS just two weeks ago to lead a review into hundreds of cases of alleged poor care at Nottingham University Hospitals NHS Trust.
On 7 April, more than 100 families called for Ms Dent to decline the offer after they had previously urged NHS England to appoint Donna Ockenden, who chaired the Shrewsbury and Telford maternity inquiry.
In a letter to families on Wednesday, the chief operating officer of NHS England and NHS Improvement, David Sloman, said: “After careful consideration and further conversations with her family, Julie Dent has, for personal reasons, decided not to proceed as chair of the independent review of maternity services at Nottingham University Hospitals NHS Trust.”
The letter said that NHS England and NHS Improvement would still have “oversight” of the independent review, and that a new review process was being established.
Mr Sloman said he would write to families to inform them of the next stage in the review “shortly”.
The Nottingham independent maternity review was launched in July last year, and since then more than 500 families have come forward, the majority in the last two months.
Read full story
Source: The Independent, 4 May 2022
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Struggling system asks NHSE for help with ambulance handovers

Health leaders in Lincolnshire have admitted they do not have a ‘robust’ response to managing the risks posed by ambulance handover delays and poor response times.
The system’s acute provider, United Lincolnshire Hospitals Trust (ULHT), was consistently among the trusts accounting for the highest proportion of ambulance delays over winter.
In a document submitted to NHS England, the county’s integrated care system said: “While the system has good visibility of the level of risk across the system, and there are discussions about this on daily system calls, it is recognised that the system doesn’t currently have a robust response approach to ambulance handover delays.
“A request has been made to regional NHSE/I team for support in developing a Lincolnshire system risk and response approach to ambulance handover delays.”
ULHT’s board has recently noted “increasing concerns” from regulators. Its board papers have described capacity outside the acute sector as key, but there was “currently… not a sense of collective impact to scale and scope that would make a difference to reach the trajectory described”.
Read full story (paywalled)
Source: HSJ, 5 May 2022
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Remdesivir has “small effect” against death or progression to ventilation, WHO trial finds

Remdesivir has no significant effect on patients with Covid-19 who are already being ventilated but has a small effect against death or progression to ventilation among other patients admitted to hospital, the World Health Organization’s Solidarity trial has found.
This appears to be a change from findings reported in February 2021, when preliminary trial data suggested that remdesivir “had little or no effect on patients admitted to hospital with Covid-19.”
The updated results, published in the Lancet, reported that overall 14.5% of patients assigned to remdesivir died compared with 15.6% assigned to the control group.
The release of these results has prompted questions about why it has taken so long to publish these data, especially considering WHO’s recommendation against the use of remdesivir in patients with Covid-19.
Read full story
Source: BMJ, 4 May 2022
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