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

Is nitrous oxide a climate risk? Yes, but doctors say effective pain relief in childbirth should be the priority

Greenpeace and obstetricians have questioned a scientific report warning pregnant women to consider alternatives to nitrous oxide as pain relief during childbirth because of the environmental impact of its emissions.
A report in Australasian Anaesthesia notes that while nitrous oxide – known as laughing gas when used as an anaesthetic – is an effective method of pain relief during labour, the gas represents 7% of global emissions, according to the World Meteorological Organization. 
Using nitrous oxide as pain relief during a four-hour labour creates a carbon footprint equivalent to driving an average car for 1,500km, the report’s authors found, whereas an epidural is equivalent to driving 6km.
The report explores methods to capture and destroy waste from the nitrous oxide, and suggests that pregnant women consider alternatives, such as epidurals, as well as acupuncture, massaging and hypnobirthing to manage their pain during labour.
“While it may be innocuous for the pregnant woman and unborn baby, that is certainly not the case for the environment,” the report states, noting its use should ultimately continue in some capacity due to its convenience and safety.
A Greenpeace spokesperson said that the health sector accounts for about 7% of Australia’s emissions, and that while it was important for all industries to assess their climate impact, the focus should be on the worst polluters such as the energy sector.
Associate Prof Gino Pecoraro, president of Australia’s National Association of Specialist Obstetricians and Gynaecologists, said that while some pregnant women might be concerned about the environmental impact of their childbirth, alternative pain relief such as epidurals are not available at every hospital, especially outside of capital cities.
He added that nitrous oxide can be a more attractive pain relief option as it doesn’t restrict walking or movement ability to the extent epidurals do.
“If you’re in rip-roaring pain during labour, carbon footprint might not be the thing you most want to discuss,” Pecoraro said. 
Pecoraro said that ultimately it was important to offer as many different options for pain relief during labour as possible, as different methods are effective for different women.
Read full story
Source: The Guardian, 31 May 2022
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‘Overdiagnosis’: some breast cancer treatments may have been unnecessary, study suggests

When Jenny* had a mastectomy after being diagnosed with breast cancer, she believed the major surgery to remove her breast, although traumatic, had saved her life.
She described feeling “rage” when at a follow-up appointment three years later, she said to her surgeon, “I would probably be dead by now” if she had not received the surgery, to which he replied: “Probably not.”
It was only then, after she had already undergone invasive and life-changing treatment, that Jenny learned about “overdiagnosis”.
While breast cancer screening programs are essential and save lives, sometimes they also detect lumps that may never go on to cause harm in a woman’s lifetime, leading to overtreatment, and psychological and financial suffering.
Jenny is 1 of 12 women from the UK, US, Canada and Australia whose stories were published in the medical journal BMJ Open. It is the first study to interview breast cancer patients who believe they may have received unnecessary and harmful treatment, highlighting the effect this has had on their lives.
“The usual story of breast cancer screening is ‘screening saves lives’,” an author of the study and a professor of public health at the University of Sydney in Australia, Alexandra Barratt, said.
“This study reports the other side of the story – how breast cancer screening can cause harm through overdiagnosis and overtreatment.”
Read full story
Source: The Guardian, 8 June 2022
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Duty of all NHS staff in England to fight discrimination, review says

All the NHS’s 1.5m staff in England should tackle discrimination against disadvantaged groups, not just bosses and specialist diversity teams, a major review has concluded.
NHS trusts will need fewer equality, diversity and inclusion (EDI) teams if action against discrimination does become “the responsibility of all”, according to the report.
The review of NHS leadership said the health service should adopt a different approach to equality issues in order to overcome the widely recognised disadvantages faced by certain groups of its own staff, which include lower pay and chances of promotion among Black and ethnic minority doctors compared with white medics and low BAME representation in senior managerial ranks.
The inquiry, undertaken by Genl Sir Gordon Messenger and Dame Linda Pollard, was commissioned last year by Sajid Javid, the health secretary.
The report concluded that: “Most critically, we advocate a step-change in the way the principles of equality, diversity and inclusion are embedded as the personal responsibility of every leader and every member of staff.
“Although good practice is by no means rare, there is widespread evidence of considerable inequity in experience and opportunity for those with protected characteristics, of which we would call out race and disability as the most starkly disadvantaged.
“The only way to tackle this effectively is to mainstream it as the responsibility of all, to demand from everyone awareness of its realities and to sanction those that don’t meet expectations.”
Read full story
Source: The Guardian, 8 June 2022
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Patients unwashed ‘for three days’ at trust under ‘extreme pressure’

The Care Quality Commission (CQC) has issued a trust with a warning notice following an inspection that found wards did not have enough staff to care for patients.
Staff at York hospital told inspectors they were not able to interact with individual patients and cater to their needs, with one saying: “We have to choose, do we turn, check, and make sure all patients are not soiled, or do we fully wash ten? Some of these patients haven’t been washed for two to three days.” 
York and Scarborough Teaching Hospitals CEO Simon Morritt said: “Many of the issues raised by the CQC were known to us, and reflect the extreme pressures facing the trust, the demands of covid and associated staff absence, and the well-documented recruitment challenges. The report demonstrates that, when faced with these pressures, it is not always possible to give the standard of care we would want for all of our patients all of the time.”
The CQC said there were “significant safety concerns about fundamental standards of patient care” at the hospital. 
“The service didn’t have enough nursing staff with the right skills, training and experience to keep patients safe and to provide the right care and treatment,” said Sarah Dronsfield, the CQC’s head of hospital inspection. “It was disappointing that managers didn’t regularly review the situation and change the staffing arrangements to accommodate this.”
Read full story (paywalled)
Source: HSJ, 9 June 2022
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Doctors' concern over reduced mention of women in NHS advice

Leading doctors say they have concerns about the NHS reducing mentions of the word "women" in ovarian cancer guidance.
They say "it may cause confusion" and create barriers to care.
But NHS Digital, which writes the online advice, said they wanted to make it relevant for everyone who needs it.
The updated guidance now says that people with ovaries, such as trans men, can also be affected.
Until February, the NHS guidance began by explaining ovarian cancer was "one of the most common types of cancer for women". Now, the only specific mention of women comes on the third page with the explanation that ovarian cancer can affect "women, trans men, non-binary people and intersex people with ovaries".
NHS Digital said the changes were introduced to make the advice more relevant and inclusive. 
The Royal College of Obstetricians and Gynaecologists, which represents thousands of women's health specialists and pregnancy doctors, said the language used "does need to be appropriate, inclusive and sensitive to the needs of individuals whose gender identity does not align with the sex they were assigned at birth".
But it added: "Limiting the term 'woman' to one mention may cause confusion and create further barriers for some women and people trying to make an informed choice about their care.
"We would therefore support the use of the word 'woman' alongside inclusive language."
Read full story
Source: BBC News, 8 June 2022
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Experts predict increase in Covid hospital admissions and another wave

Admissions of people to hospital with Covid in England have begun to grow again, new data from the NHS shows, as fears were raised over a new wave.
Analysis by John Roberts of the Covid Actuaries group, set up in response to the pandemic, showed hospital admissions had stopped falling after a period of decline.
Figures on Tuesday showed weekly admissions increased by 4% across England as of 5 June and were up by 33% in the North East and Yorkshire.
When asked if the UK was heading into another wave, Mr Roberts told The Independent: “Yes we could be but...how big that wave and how serious it will be in terms of admissions and deaths is very, very difficult to judge at this stage.”
His comments come after experts in Europe warned there will be a new wave driven by the growth of the BA.5 and BA.4 Covid variants.
The figures, which cover hospitals in England only, show the weekly average of admissions for patients in hospital with Covid stood at 531 as of 5 June.
Read full story
Source: The Independent, 9 June 2022
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Northern Ireland: Forming an Executive is vital to protect patients

Nursing leaders are to write to Northern Ireland's Secretary of State Brandon Lewis over the failure to establish an Executive and the risk this poses to patients.
The Royal College of Nursing (RCN) congress has passed a motion calling for all political parties and the UK Government to commit to the immediate formation of a fully functioning Executive and Assembly.
Fiona Devlin, chair of the RCN Northern Ireland board, brought the matter to the congress and said the move represents the deep level of concern in the profession.
“There is a responsibility to speak up when patients are coming to harm,” she said.
“The health service is about to completely tip over the edge. We felt we did everything we could to communicate our concerns before the elections, and since then, nothing has changed.
“The system is crumbling minute by minute, we have the worst waiting lists in the UK, our emergency departments are completely overstretched, primary care and the independent sector are in crisis.
“Patients can’t be decanted out of ambulances into emergency departments because there’s no room in the hospitals and they’re dying in the back of ambulances.
Read full story
Source: Belfast Times, 8 June 2022
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US healthcare workers sound alarm on staffing shortage

Concerned healthcare workers in Illinois and Indiana are calling on The Joint Commission to add a safe staffing standard to its accreditation process.
Yolanda Stewart, a patient care technician at Northwestern Memorial Hospital, once injured her back so badly on the job that she couldn’t work for six months. But when she talks about that time, she doesn’t mention her own pain. Instead, she talks about the patient she’d been trying to help, recalling his extreme discomfort.
Because the unit was short-staffed, Stewart lifted and turned the patient on her own. The move helped the patient but cost Stewart. Many healthcare workers have similar stories, she says, adding, “Working short-staffed is a safety issue for workers and patients.”
In fact, reports show that lack of staff in hospitals leads to higher patient infection and death rates. 
Covid-19 has greatly worsened the healthcare staffing shortage, with 1 in 5 hospital employees — from environmental services workers to nurses — leaving the field. Hospitals have grappled with staffing issues since before the pandemic, but Covid-19 highlighted the challenges — and exacerbated them.
Now, concerned healthcare workers throughout Illinois and Indiana are sounding the alarm. They’re calling on The Joint Commission — the third-party agency that accredits 22,000 US healthcare organisations — to add a safe staffing standard to its accreditation process, similar to student-to-teacher ratio requirements that many states have.
“We have all kinds of rules to make sure that hospitals are safe: We make sure that healthcare workers wash their hands before procedures, that they wear gloves and protective equipment, that bed sheets are changed between patients. Yet there are no statewide regulations about hospital staffing levels,” said Service Employees International Union (SEIU) Healthcare Illinois President Greg Kelley at a demonstration in early June. 
Read full story
Source: Chicago Health, 8 June 2022
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Hospitals defy NHS chiefs by telling patients to keep wearing face masks

A number of hospitals are insisting that patients keep wearing masks despite instructions from NHS chiefs to drop the rules.
National coronavirus guidance which insisted on face coverings has now been scrapped, with health officials leaving it to local organisations to draft their own policies.
However, several hospitals have called on patients and staff to continue to wear masks and face coverings on their sites.
Sajid Javid, the Health Secretary, has repeatedly called on NHS trusts to drop restrictions in hospitals which are limiting operational capacity. Last month, he threatened to name and shame hospitals that do not lift social distancing measures and restrictions on visitors.
A letter from health chiefs said that patients visiting accident and emergency (A&E) departments, hospital outpatient appointments and GP surgeries no longer needed to wear masks “unless this is a personal preference”.
Hospitals have now begun issuing guidance for their local communities, with a number saying they intend to keep insisting on people wearing masks.
The Sheffield Teaching Hospitals NHS trust issued a notice to patients and staff saying: “We are still asking patients, visitors, staff and anyone working at one of our hospital or community sites to continue to wear a mask, gel hands and social distance while in our buildings despite the lifting of national restrictions."
“This is to keep vulnerable people as safe as possible.”
Read full story (paywalled)
Source: The Telegraph, 8 June 2022
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Messenger at odds with Javid over NHS diversity jobs

Sajid Javid’s claim that the number of NHS roles dedicated to promoting equality and diversity should be cut is incorrect and not what the government-commissioned review into NHS management recommended, according to its author.
The review by General Sir Gordon Messenger and Leeds Teaching Hospital chair Dame Linda Pollard was published Wednesday.
Speaking to the Daily Telegraph on Tuesday evening, the health secretary said: “In my view, there are already too many working in roles focused solely on diversity and inclusion, and at a time when our constituents are facing real pressures around cost of living, we must spend every penny on patients’ priorities.
“As this report sets out, it should be the responsibility of everyone to encourage fairness and equality of opportunity which is why we must reduce the number of these roles.”
Speaking later to HSJ, Mr Javid was asked if there was any area of NHS management cuts should be made.
He said: “I would like to see fewer managers in terms of diversity managers and things, because I think it should actually be done by all management and all leadership, and not contracted out as some kind of tick-box exercise.”
However, when HSJ spoke to General Messenger he said: “The report does not recommend the reduction of EDI (equality, diversity and inclusion) professionals.
“What it does say though, is that if one successfully inculcates equality, diversity and inclusion to every leadership’s responsibilities then that becomes an accepted, instinctive, understood part of being a leader and a manager at every level then the requirement for dedicated EDI professionals should reduce over time."
Read full story (paywalled)
Source: HSJ, 8 June 2022
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NHS waiting lists: Women, low earners and ethnic minorities worst affected

Women, low earners and ethnic minorities are faring worse on NHS waiting lists, according to research.
Healthwatch, a patient watchdog, warned there was a risk that those with “more demands on their lives” such as long hours or caring responsibilities could end up at the back of the queue.
It urged hospitals to be proactive in managing waiting lists and communicate with patients who might otherwise be left in limbo.
The Healthwatch survey found 54% of women had waited more than four months for treatment, compared with 42% of men.
They were also more likely to have had treatment delayed or cancelled, and to feel that a delay to treatment had made an impact on their ability to work.
Some 54% of people on lower incomes had been waiting more than four months for hospital care, compared with 34% of higher wealth individuals. They reported a greater impact on their mental health and their ability to work.
And 57% of respondents from ethnic minorities had faced a delay to or cancellation of hospital treatment, compared with 42 per cent of white British people.
Louise Ansari, Healthwatch England’s national director, said the factors could have a “layering effect” that meant people had a much poorer experience, calling for “an additional specific focus on those groups” so that they do not end up “in worse and worse health”.
Read full story (paywalled)
Source: The Times, 8 June 2022
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Trust failed for months to give vital medication to vulnerable inmate

A troubled NHS trust failed for months to give vital medication to a prison inmate who had a long-standing diagnosis of HIV, an inquest has found.
A jury at Essex Coroner’s Court concluded that a series of failures and neglect by Essex Partnership University Trust (EPUT) contributed to the death of Thokozani Shiri in April 2019.
The 21-year-old spent two spells as a prisoner at HMP Chelmsford, where EPUT provided some services at the time.
He was considered vulnerable due to a long-standing diagnosis of HIV for which he was receiving treatment before he went to prison, and the trust was aware he had HIV throughout both stays, the inquest heard.
The inquest jury identified that five separate failings had “probably caused” Mr Shiri’s death. These included: a failure to provide antiretroviral medication to Mr Shiri during both periods of imprisonment; a failure to refer him to an HIV clinic; the absence of an appropriate care plan and engagement with a multidisciplinary team; and inadequate management of records.
Each failing on behalf of the trust was considered by the jury to have amounted to neglect.
Read full story (paywalled)
Source: HSJ, 9 June 2022
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Cost of living: Soaring bills damaging people's health, say medics

Rises in the cost of living are already having a negative impact of people's health, health professionals warn.
BBC News has been told of people skipping meals or cutting back on medication, because of money worries.
The Royal College of Nursing says people are having to make heart-wrenching choices that compromise their health and wellbeing. Along with GPs and hospital doctors, they warn health inequalities between rich and poor risk becoming worse.
Laura Brant, 28, has already had to make some tough choices about a treatment keeping her alive.
Having lived with kidney disease since the age of seven, she has already had two kidney transplants - and now needs another.
Laura is dependent on a dialysis machine to carry out the filtering process usually performed by the kidneys. Without it, she could be dead in a week.
Laura was having dialysis at home - but the machine used so much electricity and water the bills started to mount rapidly.
"I'd say that it's the straw that broke the camel's back, really, with the cost of running the dialysis machine, the water it uses, the electric," she says.
"And it was adding to my anxiety, like, 'How am I going to pay to do this treatment every month?'"
Royal College of Physicians president Dr Andrew Goddard says some of his respiratory-medicine colleagues are hearing of patients choosing to turn off oxygen supplies to save money.
"Respiratory disease disproportionately affects those least able to afford to improve their social circumstances," he says.
"It seems likely the cost of living crisis will widen this disparity further."
Read full story
Source: BBC News, 9 June 2022
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Law change to let pharmacists sign people off sick

Pharmacists and some other healthcare professionals, rather than just GPs, will soon be able to sign people off sick from work, under new rules.
The law change will take effect in July and apply across England, Wales and Scotland. The aim is to free up family doctors' time.
People off work for more than seven consecutive days because of illness may need to show a note from a healthcare professional to their employer.
When the new legislation is passed, nurses, occupational therapists, pharmacists (working in hospitals and GP practices) and physiotherapists will be able to provide the notes, in addition to GPs.
Health and Social Care Secretary Sajid Javid said: "I know how important it is for people to be able to see their GP speedily and in the way they want.
"That's why we are slashing bureaucracy to reduce GPs workloads, so they can focus on seeing patients and giving people the care they urgently need.
Read full story
Source: BBC News, 9 June 2022
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CEOs of covid-ravaged trusts call for more action on shared waiting lists

Coordination of waiting lists and elective treatment across health systems and regions should be ‘far more systematic’, and could have happened earlier, chief executives of some of the hardest hit trusts have told HSJ.
In interviews for the HSJ Health Check podcast, the CEOs of King’s, Croydon, Chester and Sandwell and West Birmingham hospital trusts spoke about their experience in the pandemic and what could be learned from it.
These included the need for faster decision making; resources for deprived and diverse areas, which are often hardest hit; the need for basic staff facilities such as parking and eating areas for staff; longer-term attention to the wellbeing of staff who were most affected; and to give time for trusts to recover.
On elective care, the CEOs highlighted how the length of lists and waits, and the NHS’s ability to keep up, are now much worse in some areas than others. Some of those with the longest waits and lists at present – such as Countess of Chester and Birmingham – were also heavily hit by Covid; for others this is not the case.
There were moves, particularly later in the pandemic, for patients who were on the elective waiting list of one trust to be treated at another, for example if they needed urgent treatment and faced harm if delayed, while other hospitals were still able to treat less urgent cases. Combining lists, often known as “shared patient tracking (or treatment) lists”, could also mean capacity being managed more efficiently across providers. 
Read full story (paywalled)
Source: HSJ, 10 June 2022
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Home menopause tests are waste of time and money, say doctors

Women are wasting their time and money buying do-at-home menopause testing kits, doctors have warned.
The urine tests are not predictive enough to tell whether a woman is going through the phase when her periods will stop, doctors have told the BBC.
The tests, which give a result within minutes, accurately measure levels of follicle-stimulating hormone (FSH), which helps manage the menstrual cycle. But experts say it is not a reliable marker of the menopause or perimenopause.
Dr Annice Mukherjee, a leading menopause and hormone doctor from the Society of Endocrinology, told the BBC the FSH urine tests were “another example of exploitation of midlife women by the commercial menopause industry, who have financial conflicts of interest”.
“It’s not helpful for women to access [FSH] directly,” she said. “It is not a reliable marker of perimenopause and can cause more confusion among women taking the test. At worst, misinterpretation of results can cause harm.”
The Royal College of Obstetricians and Gynaecologists (RCOG), along with other leading experts in women’s health, said the tests could be unhelpful and potentially misleading.
Read full story
Source: The Guardian, 10 June 2022
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