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

NHS England ends covid ‘command and control’ measures

The NHS threat level in response to Covid-19 has been downgraded following drops in community cases and hospital inpatient numbers, NHS England chiefs have announced.
The threat level to the health service has been dropped from a “level four” incident, which requires NHSE to “command and control” NHS resources in response to the pandemic, to a “level three” incident, which requires a response by a number of trusts within an NHS region.
A letter from NHSE chief executive Amanda Pritchard and chief operating officer Sir David Sloman, published today, said local systems “need to ensure their resilience and capability to re-establish full incident responses” if needed. At NHSE’s board meeting she stressed that covid was still impacting the service.
Trusts have also been reminded to relax visiting restrictions. The letter said all healthcare settings “should now begin transitioning back towards their own pre-pandemic [or better] policies on inpatient visiting and patients being accompanied in outpatient and [urgent and emergency care] services”.
The default position for trusts should be “no patient having to be alone unless through their choice,” the letter said.
It comes as some trusts have resisted pressure from government and NHSE to relax visiting restrictions.
Read full story (paywalled)
Source: HSJ, 19 May 2022
Patient Safety Learning

Wrong surgery and jabs among hundreds of NHS ‘never events’

A woman who had her ovaries removed by mistake was one victim of the hundreds of “never events” that occurred in the NHS over the past year.
Between April 2021 and March 2022 more than 400 patients in England’s hospitals suffered errors so serious that they should never have happened according to data released by NHS England. They include the wrong hips, legs, eyes and knees being operated on, and diabetic patients being given too much insulin.
Foreign objects were left inside 98 patients after operations, including gauzes, swabs, drill guides, scalpel blades and needles. Vaginal swabs were left in patients 32 times and surgical swabs were left 21 times. Other objects left inside patients included part of a pair of wire cutters, part of a scalpel blade, and the bolt from surgical forceps. On three separate occasions part of a drill bit was left in a patient.
“Wrong-site surgery” was carried out on 171 patients and six patients had injections to the wrong eye. The wrong hip implant was put in 12 times, a wrong knee implant was performed 11 times, and patients were connected to air instead of oxygen 13 times. Seven patients were given the wrong type of blood during a transfusion.
Some patients were given doses of drugs that were far too high, including the immunosuppressant methotrexate, which is used for severe arthritis, psoriasis and leukaemia. There were 11 overdoses of insulin.
Read full story (paywalled)
Source: The Times, 19 May 2022
 
Patient Safety Learning

What is monkeypox and how do you catch it?

Cases of monkeypox are being investigated in European countries, including the UK as well as the US, Canada and Australia.
Monkeypox is caused by the monkeypox virus, a member of the same family of viruses as smallpox, although it is much less severe and experts say chances of infection are low.
It occurs mostly in remote parts of central and west African countries, near tropical rainforests.
There are two main strains of virus - west African and central African.
Two of the infected patients in the UK travelled from Nigeria, so it is likely that they are suffering from the West African strain of the virus, which is generally mild, but this is as yet unconfirmed.
Another case was a healthcare worker who picked up the virus from one of the patients.
More recent cases do not have any known links with each other, or any history of travel. It appears they caught it in the UK from spread in the community.
The UKHSA says anyone with concerns that they could be infected should see a health professional, but make contact with the clinic or surgery ahead of a visit.
Initial symptoms include fever, headaches, swellings, back pain, aching muscles and a general listlessness.
Once the fever breaks a rash can develop, often beginning on the face, then spreading to other parts of the body, most commonly the palms of the hands and soles of the feet.
The infection usually clears up on its own and lasts between 14 and 21 days.
Experts say we are not on the brink of a national outbreak and, according to Public Health England, the risk to the public is low.
Prof Jonathan Ball, professor of molecular virology, University of Nottingham, said: "The fact that only one of the 50 contacts of the initial monkeypox-infected patient has been infected shows how poorly infectious the virus is.
"It is wrong to think that we are on the brink of a nationwide outbreak."
Read full story
Source: BBC News, 20 May 2022
Sam

Birmingham Children's Hospital worker held on suspicion of poisoning child

A health worker has been arrested on suspicion of administering poison with intent to endanger life after a child died at Birmingham Children's Hospital.
The 27-year-old woman was arrested on Thursday and has been suspended from her role at the hospital.
The child was being treated in the Paediatric Intensive Care Unit, a spokesperson for the hospital said.
Police said the woman had been released while investigations continued and forensic tests were being examined.
A spokesperson for Birmingham Women's and Children's NHS Foundation Trust said it was "supporting the infant's family at this distressing time and ask that privacy is respected during this process".
"Following the death of an infant at our Paediatric Intensive Care Unit at Birmingham Children's Hospital, we have asked West Midlands Police to examine what has happened, in line with our own safeguarding policy," it added.
"The staff member involved has been suspended by the Trust following the national process on the sudden unexpected death of a child."
Read full story
Source: BBC News, 23 May 2022
Patient Safety Learning

NHS ambulance service doctored documents to cover up truth about deaths

Quinn Evie Beadle died in 2018. Her parents later found out that the “kind, caring” 17-year-old had been failed by a paramedic at the scene of her death — and that the ambulance service altered documents to try to stop them finding out the truth.
The teenager, who dreamt of becoming a medic but suffered poor mental health, was found after she hanged herself near her home in Shildon, Co Durham, on the evening of 9 December 2018. The paramedic who attended the scene made basic mistakes, and made no effort to clear her airway or continue with basic life support — despite the fact her heart was still active.
But instead of attempting to learn lessons, bosses at the North East Ambulance Trust (NEAS) set out to prevent the family learning what happened.
They changed a key witness statement given to the coroner at her first inquest, removing references to mistakes the paramedic had made and inserting the claim that any life support offered would “not have had a positive outcome”. They also withheld from the coroner a key piece of evidence — a reading from a heart monitor — which demonstrated Quinn’s heart activity.
It is thought Quinn’s death could be one of more than 90 cases in the past three years in which the NEAS failed to provide families with the whole truth about how their relatives died.
Senior managers repeatedly withheld key evidence from coroners about deaths linked to service failures, an internal report shows. In some cases, bosses doctored or suppressed evidence to cover up failures by staff.
An independent report into a small number of the cases, including Quinn’s, raised by whistleblowers found that, as in her case, statements were changed or suppressed and pieces of key evidence not disclosed.
Read full story (paywalled)
Source: The Sunday Times, 22 May 2022
Patient Safety Learning

One in five patients leave some A&E departments in England without treatment

More than one in five patients at some hospitals are leaving accident and emergency departments before completing treatment, and in some cases before being seen for assessment at all, with the rate across England trebling since before the pandemic.
Experts told the Observer that the increase was probably driven by a combination of long A&E waiting times and by difficulties accessing NHS facilities such as GPs, community health services and NHS 111.
The figures apply to patients who left A&E before an initial assessment; after an assessment but before treatment started; or before treatment was completed. They include patients who left to find treatment elsewhere.
David Maguire, a senior analyst with the King’s Fund health thinktank, linked the rise to patients having difficulty accessing other parts of the NHS and going to A&E instead.
“We’re probably talking about things that won’t require an admission, but it’s important that you get seen by someone,” he said. “So for example, somebody’s got a chest pain, somebody’s got some sort of adverse indication that you would want to seek attention for. It’s a perfectly rational thing to do. But it’s a struggle to access at other points [in the NHS], so you default towards A&E.”
He added that staff shortages and social care capacity were also contributing factors.
“I think it’s a lot of the NHS not functioning properly. Pre-pandemic, there was a certain amount of flex in the system – even with the problems that we were seeing around performance – that meant you could come to A&E with some of these issues. That flex in the system has gone – the capacity has been absorbed by other issues.”
Read full story
Source: The Observer, 21 May 2022
Patient Safety Learning

New GP crisis as struggling hospital trusts reject specialist referrals for hundreds of thousands of patients

Hundreds of thousands of patients referred to specialists by their GPs are being rejected by hospitals and left to deteriorate because there are no appointments available.
NHS waiting lists are already buckling under record-high backlogs and now delays are being compounded as local doctors struggle to even get their patients to outpatient services.
Patients’ referrals are rejected by hospital trusts if there are no appointment slots available, meaning they get bounced back to the GP who is unable to help with their complex needs, leaving them without the care they desperately need.
Clare Rayner, 54, from Manchester, has been left distraught by delays which have hampered the treatment she needs for complex spinal problems. She is still waiting to find out if an upcoming appointment with a neurologist is going ahead after a request for an urgent review from her GP was ignored five times.
Outpatient referrals are typically classed as having an “appointment slot issue” (ASI) when no booking slot is available within a specific time frame, under the NHS e-Referral system.
According to experts, the situation varies between specialities, but is reportedly particularly bad in areas such as mental health and neurology.
Ms Rayner, a former medical teacher who had to retire because of ill health, said: “I’ve been sent all around the country for neurosurgery over the last few years so have been directly affected by being bounced back to my GP."
“A unit in London rejected me because they said I lived too far away, which was ridiculous as they take people from all over the UK, and a local consultant just never replied to my GP’s email.
Ms Rayner said she has endured “massive delays” to her care which had left her intensely frustrated. “It’s left me with significant deterioration with my spinal problems and that’s been very distressing,” she said.
Helen Hughes, chief executive of charity and campaign group Patient Safety Learning, said: “NHS England needs to urgently investigate, quantify the scale of the problem and take action if we are to prevent these capacity problems resulting in avoidable harm for patients.”
A target for providers to reduce ASIs to a rate of 4% or less of their total outpatient activity was set by NHS England in 2019. Guidance in subsequent years has seen a move towards the requirement for providers to implement “innovative pathways” to support prevention of ill health.
Read full story
Source: iNews, 22 May 2022
Related blogs on the hub:
Rejected outpatient referrals are putting patients at risk and increasing workload pressure on GPs A child left waiting for ‘urgent’ surgery, a blog by Clare Rayner  
Patient Safety Learning

New US Surgeon General Advisory sounds alarm on health worker burnout and resignation

The United States Surgeon General Dr. Vivek Murthy issued a new Surgeon General’s Advisory highlighting the urgent need to address the health worker burnout crisis across the country. Health workers, including physicians, nurses, community and public health workers, nurse aides, among others, have long faced systemic challenges in the health care system even before the COVID-19 pandemic, leading to crisis levels of burnout. The pandemic further exacerbated burnout for health workers, with many risking and sacrificing their own lives in the service of others while responding to a public health crisis. Promoting the mental health and well-being of our nation’s frontline health workers is a priority for the Biden-Harris Administration and a core objective of President Biden’s national mental health strategy, within his Unity Agenda.  
The Surgeon General’s Advisory Addressing Health Worker Burnout lays out recommendations that the whole-of-society can take to address the factors underpinning burnout, improve health worker well-being, and strengthen the nation’s public health infrastructure.   
“At the height of the COVID-19 pandemic, and time and time again since, we’ve turned to our health workers to keep us safe, to comfort us, and to help us heal,” said Secretary of Health and Human Services Xavier Becerra. “We owe all health workers – from doctors to hospital custodial staff – an enormous debt. And as we can clearly see and hear throughout this Surgeon General’s Advisory, they’re telling us what our gratitude needs to look like: real support and systemic change that allows them to continue serving to the best of their abilities. I’m grateful to Surgeon General Murthy for amplifying their voices today. As the Secretary of Health and Human Services, I am working across the department and the U.S. government at-large to use available authorities and resources to provide direct help to alleviate this crisis.”
“The nation’s health depends on the well-being of our health workforce. Confronting the long-standing drivers of burnout among our health workers must be a top national priority,” said Surgeon General Vivek Murthy. “COVID-19 has been a uniquely traumatic experience for the health workforce and for their families, pushing them past their breaking point. Now, we owe them a debt of gratitude and action. And if we fail to act, we will place our nation’s health at risk. This Surgeon General’s Advisory outlines how we can all help heal those who have sacrificed so much to help us heal.”   
Read full story
Source: HHS, 23 May 2022
Patient Safety Learning

'I was repeatedly ignored' - report finds maternity racism

Black and Asian women are being harmed by racial discrimination in maternity care, according to an inquiry.
The year-long investigation into "racial injustice" was conducted by the charity Birthrights.
Women reported feeling unsafe, being denied pain relief, facing racial stereotyping about their pain tolerance, and microaggressions.
The government has set up a taskforce to tackle racial disparities in maternity care.
Hiral Varsani says she was traumatised by her treatment during the birth of her first child.
The 31-year-old from north London developed sepsis - a potentially life-threatening reaction to an infection - after her labour was induced, which she says was only spotted after a long delay.
"I was shivering, my whole body was aching, my heart was beating really fast and I felt terrible. But everyone kept saying everything was normal," she says. "It was almost 24 hours later before a doctor took my bloods for the first time and realised I was seriously ill."
She believes her race played a role in her care: "I experienced microaggressions and was stereotyped because of the colour of my skin.
"I was repeatedly ignored, they just thought I was a weak little Indian girl, who was unable to take pain."
While death in pregnancy or childbirth is very rare in the UK, there are stark racial disparities in maternal mortality rates. Black women are more than four times more likely to die in pregnancy or childbirth than white women in the UK, while women from Asian backgrounds face almost twice the risk.
Read full story
Source: BBC News, 23 May 2022
Patient Safety Learning

Mortuary abuse inquiry suggests contractors’ criminal checks could be shared with trusts

Contractors could be required to provide trusts with the findings of criminal records checks on their employees, an update from Michael inquiry into mortuary security has suggested.
The independent inquiry, chaired by Sir Jonathan Michael, was set up to examine the implications of the sexual assaults on the bodies of women and children in hospital mortuaries by maintenance supervisor and convicted murderer David Fuller.
A progress report published this month by the inquiry highlighted “responsibilities between trusts and contractors” as an area of concern.
The report said expectations around information sharing should be made clear in policy and, if sharing is deemed necessary, consideration should be given to what checks and evidence is needed to show this is taking place.
HSJ understands that Mr Fuller did not declare previous convictions for burglary when he was first employed at the Kent and Sussex Hospital in Tunbridge Wells in 1989.
Other issues flagged to NHS England by the inquiry included how access to “high-risk areas” is monitored and who requires access to these areas. It added that consideration should be given to monitoring access, involving a review of CCTV and swipe card use.
Read full story (paywalled)
Source: HSJ, 20 May 2022
Sam

Intensive care units for children not meeting standards, says NHSE report

Three intensive care units for children are not meeting standards for co-located services, a national report has found.
Royal Stoke University Hospital, Royal Brompton Hospital in London and Freeman Hospital in Newcastle, which all have “level three” paediatric intensive care beds for the most seriously ill patients, do not offer specialised paediatric surgery, according to a report from NHS England’s Getting it Right First Time (GIRFT) programme.
The report, released in April, said specialised paediatric surgery “should be co-located on the same site” as a paediatric intensive care unit with level three beds and be “immediately available” to meet quality standards set by the Paediatric Intensive Care Society.
The report also found the units do not offer services such as trauma, neurosurgery and bone marrow transplantation, which it says is a reflection of the variability and “the poor alignment” of specialised paediatric services at PICUs.
Read full story (paywalled)
Source: HSJ, 23 May 2022
Patient Safety Learning

Record 420,000 children a month in England treated for mental health problems

More than 400,000 children and young people a month are being treated for mental health problems – the highest number on record – prompting warnings of an unprecedented crisis in the wellbeing of under-18s.
Experts say Covid-19 has seriously exacerbated problems such as anxiety, depression and self-harm among school-age children and that the “relentless and unsustainable” ongoing rise in their need for help could overwhelm already stretched NHS services.
The latest NHS figures show “open referrals” – troubled children and young people in England undergoing treatment or waiting to start care – reached 420,314 in February, the highest number since records began in 2016.
The total has risen by 147,853 since February 2020, a 54% increase, and by 80,096 over the last year alone, a jump of 24%. January’s tally of 411,132 cases was the first time the figure had topped 400,000.
Mental health charities welcomed the fact that an all-time high number of young people are receiving psychological support. But they fear the figures are the tip of the iceberg of the true number of people who need care, and that many more under-18s in distress are being denied help by arbitrary eligibility criteria.
Read full story
Source: The Guardian, 22 May 2022
Patient Safety Learning

NHS doctors to stop issuing prescriptions for 35 minor medical conditions

THE NHS has announced plans to scrap prescriptions for 35 conditions in a bid to save the money it spends on drugs available over-the-counter (OTC). The body said it will no longer issue treatments for a range of minor conditions, such as diarrhoea, oral thrush and ailments associated with pain.
The health body will no longer prescribe drugs for 35 conditions listed below, which patients will have to purchase from their local pharmacy or supermarket going forward. The plan to dial back on prescriptions was devised with the aim of allocating funds to treatments for more serious conditions, according to the health body. Many of the conditions are able to resolve on their own, but prescriptions may still be issued if an exemption applies.
Acute sore throat Conjunctivitis Coughs, colds, and nasal congestion Cradle cap Dandruff Diarrhoea Dry eyes / sore tired eyes Earwax Excessive sweating Haemorrhoids Head live Indigestion and heartburn Infant colic Infrequent cold sores of the lip Infrequent constipation Infrequent migraine Insect bites and stings Mild acne Mild burns and scalds Mild cystitis Mild dry skin Mild irritant dermatitis Mild to moderate hay fever Minor conditions associated with pain, discomfort and fever (e.g. aches and pain, headache, period pain, back pain) Mouth ulcers Nappy rash Oral thrush Prevention of tooth decay Ringworm/athlete’s foot Sunburn Sun protection Teething / mild toothache Threadworms Travel sickness Warts and verrucae Read full story
Source: Express, 20 May 2022
Patient Safety Learning

Fears of Long Covid crisis as demand for rehabilitation services surges

Health officials are calling for urgent intervention from the government to meet the steep surge in demand for occupational therapy in the wake of the Covid-19 pandemic.
According to healthcare professionals from both the NHS and the private care system, demand for occupational-therapy-led rehabilitation services in Britain has increased by a staggering 82 per cent over the past six months alone.
Swelling pressure on already “overloaded” rehabilitation services has stirred up stark warnings from members of the Royal College of Occupational Therapists (RCOT), who say the level of demand for the service they provide “isn’t sustainable” as there isn’t a large enough workforce to meet the need.
A revealing survey carried out by the college has raised grave questions about the prospect of providing timely rehabilitation for people recovering from short and long-term illnesses who need urgent support to enable them to carry out their daily activities.
The survey of of 550 occupational therapists working in the UK found that 84 per cent are now supporting people whose needs have become more complex because of delays in treatment brought about by the pandemic.
As a result of this, coupled with a wider increase in the number of people requiring help, 71 per cent of the RCOT’s respondents felt there were not enough occupational therapists to meet the demand.
Read full story (paywalled)
Source: The Independent, 22 May 2022
Patient Safety Learning

North East Ambulance Service: Cover-up claims to be probed by government

The government is to investigate claims an ambulance service covered up details of the deaths of patients following mistakes by paramedics.
It follows the Sunday Times report that North East Ambulance Service (NEAS) withheld information from coroners.
Labour's shadow health secretary Wes Streeting described the alleged cover-up as "a national disgrace".
Health minister Maria Caulfield said she was "horrified" and there would be a further investigation.
The newspaper reported that concerns were raised about more than 90 cases and whistleblowers believed NEAS had prevented full disclosure to relatives of people who died in 2018 and 2019.
Speaking in the House of Commons, Mr Streeting asked why the regulator - the Care Quality Commission (CQC) - had failed to take action.
Ms Caulfield said that while both the NEAS and the CQC had both reviewed the allegations, further investigation was required.
The minister said non-disclosure agreements have "no place in the NHS", adding: "Reputation management is never more important than patient safety."
Read full story
Source: BBC News, 23 May 2022
Patient Safety Learning

‘One woman took out 13 of her own teeth’: the terrifying truth about Britain’s dental crisis

In England, only a third of adults – and half of children – now have access to an NHS dentist. As those in pain turn to charity-run clinics for help, can anything stop the rot?
It is over an hour before the emergency dental clinic is due to open, but Jodie Manning is taking no chances. She hasn’t been able to eat for four days – “I can’t physically bite down any more” – and is determined to get an appointment. 
Aged 19, she has been to hospital with severe toothache “three-and-a-half times” in the previous year. The half is when they sent her home without treatment; on the other occasions, she was kept in overnight after collapsing from pain and dehydration, when even drinking liquids hurt her swollen mouth. Morphine has become her crutch: she fell asleep in college recently after taking the powerful painkiller. Like many of those waiting grimly in line, she has been struck off by her NHS dentist after not attending for two years, even though surgeries were shut to all but emergency cases during Covid.
The same desperation can be seen across England, particularly in the north and east. Only a third of adults – and less than half of English children – now have access to an NHS dentist, according to the Association of Dental Groups (ADG). At the same time, three million people suffer from oral pain and two million have undertaken a round trip of 40 miles for treatment, the ADG calculated recently, calling dentistry “the forgotten healthcare service”. Tooth extraction is now the most common reason for a child to be admitted to hospital, costing the NHS £50m a year.
The decline of NHS dentistry has deep roots. Years of underfunding and the current government contract, blamed for problems with burnout, recruitment and retention. Dentists are paid a flat fee for services regardless of how long a treatment takes (they get the same amount if they extract one tooth or five, for example). Covid exacerbated existing challenges, with the airborne disease posing a health risk for dentists peering into strangers’ mouths all day.
As the British Dental Association put it in its most recent briefing: “NHS dentistry is facing an existential threat and patients face a growing crisis in access, with the service hanging by a thread.”
Read full story
Source: The Guardian, 24 May 2022
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