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

Half of Covid-hospitalised still symptomatic two years on, study finds

More than half of people hospitalised with Covid-19 still have at least one symptom two years after they were first infected, according to the longest follow-up study of its kind.
While physical and mental health generally improve over time, the analysis suggests that coronavirus patients discharged from hospital still tend to experience poorer health and quality of life than the general population. The research was published in the Lancet Respiratory Medicine.
“Our findings indicate that for a certain proportion of hospitalised Covid-19 survivors, while they may have cleared the initial infection, more than two years is needed to recover fully,” said the lead author, Prof Bin Cao, of the China-Japan Friendship hospital in China.
Until now, the long-term health effects of Covid-19 have remained largely unknown, as the longest follow-up studies to date have spanned about a year. The absence of pre-Covid-19 health status data and comparisons with the general population in most studies also made it difficult to determine how well patients with Covid-19 have recovered.
“Ongoing follow-up of Covid-19 survivors, particularly those with symptoms of long Covid, is essential to understand the longer course of the illness, as is further exploration of the benefits of rehabilitation programmes for recovery,” said Cao. “There is a clear need to provide continued support to a significant proportion of people who’ve had Covid-19, and to understand how vaccines, emerging treatments and variants affect long-term health outcomes.”
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Source: The Guardian, 11 May 2022
Sam

Secret stats show A&E crisis four times worse than reported

New figures leaked to HSJ show the true volume of 12-hour waiters in emergency departments is more than four times higher than official statistics suggest.
Internal NHS England figures for February and March show around one in five admissions through ED waited more than 12 hours from arriving until being admitted to a ward – equating to around 158,000 cases.
The official stats published by NHSE record a slightly different, and shorter, time period, from ‘decision to admit’ to admission. There were around 39,000 of these cases in the same two months, which equates to 4 per cent of admissions through ED, and 5.4 per cent of total emergency admissions.
The Royal College of Emergency Medicine has long called for the official stats to reflect the total time spent from arrival in ED (as per the internal data), and for trusts to be measured and regulated on this.
Senior medics have for some time been warning about the patient safety risks of long waiting in EDs and have appealed to NHS England and the government for plans to tackle the crisis.
Adrian Boyle, vice president of RCEM, said: “This data show the scale of long waiting times in emergency departments and the scale of the patient safety crisis. Performance continues to deteriorate across multiple metrics meaning we are documenting a failing urgent and emergency care system without any system transformation or improvement."
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Source: HSJ, 13 May 2022
Sam

Jeremy Hunt ‘ignored’ NHS staff shortages while health secretary

Jeremy Hunt has been accused of ignoring serious NHS staff shortages for years and driving medics out of the profession while health secretary after he intervened this weekend to warn of a workforce crisis.
Promoting his new book, 'Zero: Eliminating Unnecessary Deaths in a Post-Pandemic NHS', Hunt said tackling the “chronic failure of workforce planning” was the most important task in relieving pressure on frontline services. Now the chair of the health and social care committee, he said the situation was “very, very serious”, with doctors and nurses “run ragged by the intensity of work”.
But his comments drew sharp criticism from healthcare staff, who said Hunt – the longest-serving health secretary in the 74-year history of the NHS – failed to take sufficient action to boost recruitment while in the top job between 2012 and 2018. Instead, critics said, his tenure saw health workers quit the NHS in droves for jobs abroad or new careers outside medicine. There are now 100,000 vacancies in the NHS, and the waiting list for treatment has soared to 6.4 million.
“There’s an avalanche of pressure bearing down on the NHS. But for years Jeremy Hunt and other ministers ignored the staffing crisis,” said Sara Gorton, the head of health at Unison, the UK’s largest health union. “The pandemic has amplified the consequences of that failure. Experienced employees are leaving at faster rates than new ones can be recruited.”
“Hunt has recently been an articulate analyst of current issues, particularly workforce shortages, but these haven’t come out of the blue,” said Dr Colin Hutchinson, the chair of Doctors for the NHS. “At the time he could have made the greatest impact, his response was muted. We have to ask: was the service people were receiving from the NHS better, or worse, at the end of his time in office? At the time when it most mattered, he was found wanting.”
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Source: The Guardian, 15 May 2022
Patient Safety Learning

Thousands miss out on treatment as physiotherapists are taken off UK register

Thousands of patients have been left without vital healthcare after nearly 1 in 10 physiotherapists was prevented from practising after their regulator removed them from its register.
Exactly 5,311 physiotherapists were deregistered by the Health and Care Professions Council (HCPC) on 1 May because they had not renewed their registration after the HCPC decided not to send out reminder letters.
Ash James, director of practice and development at the Chartered Society of Physiotherapy (CSP), said its helpline had been swamped with calls from distressed physiotherapists, concerned for their patients and worried about dramatic losses in income.
“In one of the trusts in Liverpool, 23 physios were sent home in one day, and obviously the implication for patients is huge,” he said.
“At a time when the workforce is stretched by the Covid backlog, it’s obviously not ideal that we’ve lost 9% of the workforce overnight.”
Physiotherapists have many roles but play a crucial part in helping people leave hospital after long stays, because lengthy bed rest leads to muscle wastage that leaves patients needing physiotherapy to learn to walk again.
So far, only about 2,300 physios have been re-registered. With most practitioners seeing at least five patients a day, the number of cancelled NHS and private appointments in the past two weeks could range between 50,000 to 100,000.
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Source: The Guardian, 14 May 2022
Patient Safety Learning

Sharp rise in child development issues in wake of covid

Families are being ‘left without the support they need’, as overstretched services struggle to handle ‘a significant and growing minority’ of children not developing as expected.
Figures published by the Office for Health Improvement and Disparities earlier this month show 79.6% of children who received a two-to-two-and-a-half year review with an ages and stages questionnaire during quarter three of 2021-22 met the expected level in all five areas of development measured.
The five areas assessed by the screening questionnaire are communication skills, gross motor skills, fine motor skills, problem solving, and personal-social. A lower-than-expected score in any of the five areas will likely mean some sort of intervention, which may include further monitoring from health visitors or referral to a specialist service. However, health visitor numbers are declining. ber 2015.
Alison Morton, Institute of Health Visiting executive director, said: “The latest national child development data highlight a worrying picture with fewer children at or above the expected level of development at two-to-two-and-a-half years. While the majority of children are developing as expected, a significant and growing minority are not.
“The pandemic and its impacts are not over. In many areas, despite health visitors’ best efforts, they are now struggling to meet growing levels of need and vulnerability and a backlog of children who need support. In our survey, health visitors reported soaring rates of domestic abuse, mental health problems, child behaviour and development problems, poverty, and child safeguarding.
“In addition, onward referral services like speech and language therapy, and mental health services, also have long waiting lists and families are left without the support that they need.”
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Source: HSJ, 16 May 2022
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Scandal-hit heart surgery unit warned for third time over ‘toxic’ culture

Junior doctors have been prevented from returning to scandal hit heart surgery unit previously criticised over “toxic” culture, The Independent has learned.
A coroner defended cardiac surgery at St George’s University Hospital, criticising an NHS-commissioned review into 67 deaths that warned of poor care.
However, The Independent has learned the unit received a critical report from Health Education England (HEE), the body responsible for healthcare training, just last year.
The NHS authority was so concerned about culture problems and “inappropriate behaviour” within the unit that it took away the junior doctors working there.
This is the third time HEE has intervened since 2018, when the unit was criticised in an independent review for having a “toxic” culture.
In a statement, Professor Geeta Menon, postgraduate dean for South London at Health Education England, said: “HEE carried out a review of cardiac surgery at St George’s University Hospital in July 2021 and concluded that further improvements were required to create a suitable learning environment for doctors in training.
"Unfounded’ NHS criticism and investigation caused unnecessary deaths at London heart surgery unit
“We continue to work closely with the trust to implement our requirements and recommendations and will reassess their progress this summer. HEE is committed to ensuring high quality patient care and the best possible learning environment for postgraduate doctors at St George’s.”
The Independent understands that a report issued in December, following the HEE visit, identified problems of “inappropriate behaviour”, poor team working from consultants and raised concerns the culture problems previously identified at the unit persisted.
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Source: The Independent, 14 May 2022
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Tens of thousands waiting too long for 999 calls to be answered in England

Tens of thousands of emergency calls are taking more than two minutes to be answered in England amid a crisis in the ambulance service, The Independent has learned.
More than 37,000 emergency calls took more than two minutes to answer in April 2022 – 24 times the 1,500 that took that long in April 2021, according to a leaked staff message.
April’s figures were slightly down compared to March, The Independent understands, when 44,000 calls took more than two minutes to answer.
The deterioration in 999 calls being answered within the 60-second goal comes as ambulance services across the UK have been placed under huge pressures.
The latest NHS data showed long delays in response times for ambulance services with stroke or suspected heart attack patients waiting more than 50 minutes on average. Response times are being driven by ambulances being held up outside of A&Es because emergency departments are unable to take patients.
In March, there were likely to have been more than 4,000 instances of severe harm caused to patients as a result of ambulances being delayed by more than 60 minutes.
Martin Flaherty, managing director of AACE said: “It is no secret that UK ambulance services and their staff are under intense pressure, which is further evidence of the need to secure more funding for ambulance services as soon as possible, continue to find more ways to protect and care for our staff, prevent the depletion of our workforce and above all, eradicate hospital handover delays.
“AACE believes that whilst reasons such as overall demand and increasing acuity of patients are certainly contributory factors, the most significant problem causing these pressures remains hospital handover delays. These have increased exponentially and the numbers of hours lost to ambulance services is now unprecedented. For example, in some regions in March, ambulance trusts were losing up to one third of all the ambulance hours they were capable of producing due to hospital handover delays.”
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Source: The Independent, 15 May 2022
Patient Safety Learning

Ex-nurse convicted of injecting patient with wrong drug gets probation

RaDonda Vaught, a former nurse in Tennessee who was convicted on felony charges for fatally injecting a patient with an incorrect drug, was sentenced to probation Friday in a case that became a rallying cry for health-care workers fearful that medical mistakes would be criminalised.
Vaught, who worked at Vanderbilt University Medical Center in Nashville, faced up to eight years in prison for giving 75-year-old Charlene Murphey a fatal dose of the wrong medication in December 2017. Prosecutors said that instead of giving Murphey a dose of the sedative Versed, Vaught injected the patient with the powerful muscle relaxant vecuronium, which left her unable to breathe. Vaught, 38, was convicted in March of criminally negligent homicide and gross neglect of an impaired adult.
Davidson County Criminal Court Judge Jennifer Smith ruled Friday that Vaught would be granted a judicial diversion, meaning the conviction would be expunged from the records if she completed a three-year probation.
“Ms. Vaught is well aware of the seriousness of the offense,” Smith said, according to NPR, noting that the Murphey family had suffered a “terrible loss.” “She credibly expressed remorse in this courtroom.”
The judge added that Vaught, who was shaking and had broken into tears as the order was read, had no previous criminal record and would never be a nurse again.
Vaught, who took responsibility for her actions immediately, had apologized to the Murphey family in court, saying she’d “be forever haunted by my role in her untimely passing.”
The judge’s sentencing Vaught to probation instead of prison ends a case that has galvanised healthcare workers who have spoken out against poor working conditions that have only been exacerbated during the coronavirus pandemic.
Medical errors, including those that result in death, are usually dealt with by state medical boards. Lawsuits against those involved in fatal medical mistakes are almost never prosecuted in criminal court, which made Vaught’s case a matter of national interest in recent months.
Read full story  (paywalled)
Source: Washington Post, 14 May 2022
Patient Safety Learning

NICE sets out steps NHS must take to implement ME/CFS guidelines

The National Institute for Health and Care Excellence has issued an unprecedented implementation statement1 setting out the practical steps needed for its updated guideline on the diagnosis and management of myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome (ME/CFS)2 to be implemented by the NHS.
Such statements are only issued when a guideline is expected to have a “substantial” impact on NHS resources, and this is thought to be the first. It outlines the additional infrastructure and training that will be needed in both secondary and primary care to ensure that the updated ME/CFS guideline, published in October 2021, can be implemented.
The statement is necessary because the 2021 guideline completely reversed the original 2007 guideline recommendations that people with mild or moderate ME/CFS be treated with cognitive behavioural therapy (CBT) and graded exercise therapy (GET). Instead the guideline recommends that any physical activity or exercise programmes should only be considered for people with ME/CFS in specific circumstances and should begin by establishing the person’s physical activity capability at a level that does not worsen their symptoms. It also says a physical activity or exercise programme should only be offered on the basis that it is delivered or overseen by a physiotherapist in an ME/CFS specialist team and is regularly reviewed.
Although cognitive behavioural therapy (CBT) has sometimes been assumed to be a cure for ME/CFS, the guideline recommends it should only be offered to support people who live with ME/CFS to manage their symptoms, improve their functioning and reduce the distress associated with having a chronic illness.
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Source: BMJ, 16 May 2022
Patient Safety Learning

Patient waited 24 hours in ambulance for A&E

Nearly 600 patients waited 10 hours or more in the back of an ambulance to be transferred into emergency departments last month – with one taking 24 hours, HSJ can reveal.
The 24-hour wait was the longest handover delay recorded in the past year, and probably ever, according to information released by ambulance trust chief executives.
In May last year the longest recorded rate was seven hours. This has risen steadily during the year to hit 24 hours in April. In March a patient in the West Midlands had to wait 23 hours.
The figures also show 11,000 patients waited more than three hours for handover last month, with 7,000 of them taking more than four hours and 4,000 over five hours. Some 599 waited more than 10 hours.
The Association of Ambulance Chief Executives estimates 35,000 patients were potentially at risk of harm from delayed handovers last month, with just under 4,000 of those risking severe harm. This is based on work it did looking at patients waiting more than 60 minutes in 2021 and was a slight fall on March. They are based only on handover delays and do not include harm from patients left waiting for an ambulance response.
Hours lost to ambulance handover delays restrict ambulance trusts’ ability to reach other patients waiting for an ambulance in the community.
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Source: HSJ, 16 May 2022
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NHS prescription charges in England to be frozen

NHS prescription charges in England are to be frozen for the first time in 12 years, the government has confirmed.
Single prescription charges, which the Department of Health said would normally rise "in line with inflation", will remain at £9.35 until next year.
Health Secretary Sajid Javid said freezing the costs would "put money back in people's pockets".
Faith Angwet, a single mother of two, said she had to choose between paying for prescriptions to treat for her high blood pressure, or using that money to feed her children.
She said the price freeze "won't go far" because "it's not necessarily the outgoings affecting me, everything is going up in price and I'm not able to afford everything I use to be, including my prescription".
Claire Anderson, of the Royal Pharmaceutical Society, said people who do not qualify for free prescriptions because of their income, age, or medication type, often had to make decisions about which medicines they need.
"Those medicines are prescribed for a reason because that patient needs that treatment," she told the BBC.
And Laura Cockram, chairwoman of the Prescription Charges Coalition, who welcomed the freeze, said the government should review the list of those who qualified for free prescriptions.
She said the prescription exemption charge list was put together more than 50 years ago, when conditions like HIV "didn't even exist" and at a time there "weren't life saving treatments for things like asthma, Parkinson's and MS".
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Source: BBC News, 16 May 2022
Patient Safety Learning

Probe after man wrongly diagnosed with Alzheimer's disease

A hospital trust is investigating after a patient was incorrectly diagnosed and treated for Alzheimer's disease for seven years.
Alex Preston, from Anstey, Leicestershire, was 54 at the time and said the diagnosis completely destroyed his life and made him feel suicidal.
Mr Preston said he was having problems concentrating at work in 2014. "The doctor thought I had low mood and anxiety," he said.
Mr Preston, now 62, was sent to the Bradgate Mental Health Unit where he underwent a series of tests and was diagnosed with Alzheimer's disease.
"That's when my life was completely destroyed. "As soon as we were told that diagnosis, everything me and Susan had planned just went," he said.
He was then re-examined in the pandemic and told that diagnosis was a mistake.
Leicestershire Partnership NHS Trust (LPT) said it was undertaking an independent review of the case.
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Source: BBC News, 16 May 2022
Patient Safety Learning

Funding overhaul for mental health beds revealed

National NHS officials have proposed a major shift in the funding model for inpatient mental health beds for children and young people, information seen by HSJ reveals.
A report on child and adolescent mental health services by Getting it Right First Time (GIRFT), an NHS England national programme, recommends a move away from the current ‘payment per bed day’ model to a system which funds particular outcomes or “therapeutic models”.
It appears the proposal in the GIRFT recommendations seen by HSJ would apply to both NHS and independent provision, although some NHS providers are already less likely to receive funding on a ”per bed day” basis.
Ananta Dave, consultant CAMHS psychiatrist at Lincolnshire Partnership Foundation Trust, told HSJ that having agreed therapy and outcome measures as recommended by the report would not only boost patient experience but also lead to better results.
“One inpatient bed can actually be the equivalent of 100 young people being looked after in the community. So these are precious resources we are talking about, hence the quality of inpatient units is really important.
“It should not just be a tick-box exercise that a bed exists. Instead, it is about the quality of that service. If you simply go by the number of bed days, you’re unlikely to meet your target or meet your ambition of reducing the spend on inpatient services.”
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Source: HSJ, 16 May 2022
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NHS is 'dangerously over-reliant' on China amid fears supplies could be 'weaponised'

The NHS has become 'dangerously over-reliant' on China for vital medicines and supplies, a report has warned.
One in six medical items used in UK hospitals — including needles, bandages and oxygen — are shipped from the communist state.
Thinktank Civitas found that overall NHS dependency on Chinese supply chains has trebled since 2019, with the UK now sending £6.2billion a year to Beijing for medical gear.
Security experts are now calling for an 'NHS Security Act' to wean Britain off Chinese medical items and start manufacturing more domestically.
Civitas looked at 228 medical items on the Government's disaster relief list — which include drugs, tests, medical devices and personal protective equipment (PPE). The team found that 17% came from China in 2020, up from 6% before the pandemic. 
The report found up to a third of tests and diagnostic equipment and 30% of PPE used in the health service now come from China.
Almost all paper masks used by medics in hospitals come from China (90%), more than half of all gloves (54%) and almost 80% of bandages. And 42% of emergency trolleys and wheelchairs are Chinese-made.
Robert Clark, head of defence and security at Civitas, said: 'Things like gloves, monitors, wheelchairs and bandages all largely come from China rather than the UK. We are dangerously over-reliant on China."
"Let's not be naïve about China. This is an urgent issue for health bosses with the risk that future geo-political spats could lead to the Chinese switching off critical medical supplies destined for the NHS."
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Source: Mail Online,17 May 2022
Patient Safety Learning

"A backward step for patient safety": US Medical groups respond to RaDonda Vaught sentencing

RaDonda Vaught was sentenced to three years of supervised probation on the 13 May for a fatal medication error she made in 2017 while working as a nurse at the Vanderbilt University Medical Center in the USA.
In remarks made during the sentencing hearing, Ms. Vaught expressed concerns over what her case means for clinicians and patient safety reporting. 
"This sentencing is bound to have an effect on how [nurses] proceed both in reporting medical errors, medication errors, raising concerns if they see something they feel needs to be brought to someone's attention," she said. "I worry this is going to have a deep impact on patient safety." 
Numerous medical organisations expressed similar concerns in statements circulated after Ms. Vaught's sentencing. 
"To achieve our goal of zero patient harm and death from preventable medical errors, we need to foster a culture where leadership of hospitals and healthcare organizations support healthcare workers and encourage them to share near misses," the Patient Safety Movement Foundation said in a statement. "Healthcare workers are human and healthcare systems need to ensure there are appropriate processes in place to provide their staff with a safe and reliable working environment so they can provide their patients with the best care. Only by identifying potential problems and learning from them can change occur."
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Source: Becker's Hospital Review, 16 May 2022
Patient Safety Learning

NHS risks losing GPs to ‘nonsensical’ immigration rules, Priti Patel told

Hundreds of overseas-born trainee GPs are at risk of deportation because of “nonsensical” immigration rules, the profession’s leader has warned Priti Patel.
The NHS risks losing much-needed family doctors unless visa regulations are overhauled to allow young medics to stay in Britain at the end of their GP training, Prof Martin Marshall said.
Marshall, the chair of the Royal College of GPs, has written to Patel, the home secretary, demanding that she scrap “bureaucratic” hurdles affecting would-be GPs from abroad.
He told the Guardian: “At a time when general practice is experiencing the most severe workload pressures it has ever known, it is nonsensical that the NHS is going to the expense of training hundreds of GPs each year who then face potential deportation by the Home Office because of an entirely avoidable visa issue.
“We cannot afford to lose this expertise and willingness to work in the NHS, delivering care to patients, due to red tape.”
The threat to foreign-born GP trainees has arisen because current immigration rules state that “international medical graduates” (IMGs) can be given indefinite leave to remain only after they have been in the country for five years, but GP training lasts for only three years.
Read full story
Source: The Guardian, 17 May 2022
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