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

Women in healthcare sector earn 24% less than men, international report finds

Women working in healthcare earn on average 24% less than their male peers and face a larger gender pay gap than in other economic sectors, a joint report by the International Labour Organization and the World Health Organization has found.
The analysis, which looked at data from 54 countries across all geographic and income regions, found a raw gender pay gap of around 20%, which jumped to 24% when factors such as age, education, and working time were considered. Gender pay gaps also tended to be wider in higher pay categories, where men were over-represented, while women were over-represented in the lower pay categories.
The authors said the findings highlighted that women, who accounted for 67% of the global health and care workforce in 2020, were underpaid and undervalued.
Read full story (paywalled)
Source: BMJ, 13 July 2022
Patient Safety Learning

More support needed for people with mental health difficulties at work

Being in a productive and supportive work environment is linked to better mental health. However, those experiencing mental health problems are often either excluded from the workplace or not supported appropriately when in work, according to new guidance from the Royal College of Psychiatrists.
As many as one in six people of working age are diagnosed with a mental health condition. Mental health problems are a leading cause of absence from work, but ‘good’ work can improve overall wellbeing. This is achieved by improving self-esteem, feeling useful, building a routine, and importantly, avoiding poverty, which adversely impacts health in many ways.
‘Good’ work should offer standard benefits such as job security, an appropriate wage, positive work/life balance, and opportunities for career progression as well as supportive mental health and wellbeing policies. These practices should support employees with existing mental health disorders while minimising the risk of developing issues with mental health and well-being.
This includes flexible working policies, use of appropriate reasonable adjustments to help people maintain employment and access to counselling and support services as needed.
The Royal College of Psychiatrists is calling for better support for people with mental health problems to find, return to, and remain in good work, and for employers and Government to recognise the valuable contribution these people make to the workforce.
Dr Adrian James, President of the Royal College of Psychiatrists, said:
“We all need to do more if the workplace is to consistently play a positive role in a person’s mental health and wellbeing. We know that issues such as insecure work and unemployment can have a disproportionate impact on the wellbeing of people with mental health conditions.
“Psychiatrists and occupational therapists can play a key role between employers and patients, ensuring staying in good work is seen as an important outcome of treatment. We must put in place better support for people with mental health problems to find, return to, and remain in good work and for employers and Government to recognise the valuable contribution these people make to the workforce.”
Read press release
Source: Royal College of Psychiatrists, 14 July 2022
Patient Safety Learning

UK skin cancer deaths higher in men than women

More men are dying from melanoma skin cancer than women in the UK, Cancer Research UK is warning as the country's heatwave continues.
Rates of the cancer, which can develop in sun-damaged skin, have been rising in both men and women in recent years.
Late diagnosis may be part of the reason why men are faring worse.
Melanoma is treatable if it is diagnosed early - the charity is urging people to take care in the sun and get any unusual skin changes checked.
Melanoma death rates have improved for women in the last 10 years, but not for men.
Michelle Mitchell, chief executive of Cancer Research, says the figures "drive home the importance of sun safety".
"We all need to take steps to protect ourselves from the sun's harmful UV rays. Getting sunburnt just once every two years can triple your risk of skin cancer," she adds.
Read full story
Source: BBC News, 15 July 2022
Patient Safety Learning

Ambulance services on fringe of collapse

Ambulance services are under intense pressure, with record numbers of callouts and the most urgent, category-one, calls last month.
BBC Two's Newsnight programme spent from 08:00 to 20:00 on Monday at six hospitals with the longest delays handing patients over from paramedics to accident and emergency staff.
This should take 15 minutes or less - but crews often wait many hours and sometimes whole 12-hour shifts, with ambulances queuing outside unable to respond to other emergency calls.
At Royal Cornwall, 25 ambulances were queuing by the afternoon, three for at least 10-and-a-half hours, at Derriford, in Plymouth, 20 were queuing up to 11 hours in an overflow car park and the longest wait at Heartlands was more than five hours.
"We're right on the fringe of collapse right now," a paramedic who has worked in emergency care for more than a decade said.
"People are phoning and being told that they're not going to get an ambulance for six or nine hours. And that's happening routinely - that is happening pretty much every shift."
"It would be wrong to say that there are times when I haven't shed a tear... for the people we haven't been able to help because it's been too late," the paramedic said. 
"They may have died anyway but there are definitely cases that I've been to where we should have been to them sooner and less harm would have come to them."
Read full story
Source: BBC News, 15 July 2022
Patient Safety Learning

Patients give up on 'difficult' appointments

Patients are increasingly avoiding seeing their GP because they find it too difficult to book an appointment, the latest data show.
Results from the 2022 GP Patient Survey also show that satisfaction with family doctors in England has dwindled since the previous year. The findings come as the Government and the NHS struggle to retain GPs and boost recruitment to meet rising patient demand and an ageing population.
The survey found that overall satisfaction ratings have declined over the past 2 years, although most patients who responded to a questionnaire reported a good overall experience with their GP practice, had confidence and trust in the healthcare professional who saw them, and considered they received good care and treatment.
The results also revealed an increase in the barriers patients faced in getting an appointment in the first place, with 55.4% who needed one in the last 12 months saying they had avoided making one – an increase of 13.1% since the last survey. The most common reason given was that they found it too difficult, cited by 26.5% of respondents, and a huge increase on last year's figure of 11.1%.
Commenting on the results, Beccy Baird, senior fellow at The King's Fund said: "For many of us, general practice is the front door to the NHS – these results show that patients are finding that door increasingly hard to push open.
"GPs are working harder than ever before, yet these findings show a dramatic fall in patients' experience of getting an appointment."
She said recruitment of GPs, nurses, and other professionals to meet rising levels of need was proving tough "because in many cases those staff simply don’t exist".
Read full story
Source: Medscape, 14 July 2022
Patient Safety Learning

Ambulance serious incidents triple

Serious incidents causing patient harm have increased steeply compared to previous years at an ambulance service whose nursing director still expects will “fail” next month under mounting service pressures.
There were 98 patient harm incidents at West Midlands Ambulance Service in June, official data obtained by HSJ suggests, up from 49 in the same month last year.
The figures show that from April-June this year, 262 harm incidents have been logged – a 240% on 77 in the same period in 2019 and a 71% on 153 last year.
Nursing director Mark Docherty, who previously warned the service was facing a “Titanic moment” and would “all fail” around a specific date of 17 August, said much of the increase can be attributed to worsening hospital handover delays. 
More than 700 people at one time waited for ambulances “that were not going to turn up” on Monday, according to Mr Docherty, who described the situation as a “really dangerous place to be”.
Mr Docherty explained how the harm incidents, including deaths, resulted from growing delays: ”You can’t underplay the risk. If you’ve got 750 patients like we did on Monday waiting, none of those patients have been assessed.
“Sadly, amongst them there will have been patients with stroke who won’t be treated because they’ve waited too long."
Read full story (paywalled)
Source: HSJ, 15 July 2022
Patient Safety Learning

Norfolk and Norwich Hospital unable to discharge 180 patients

A senior hospital nurse said she could not discharge 180 patients due to a lack of "care and support" at home.
Norfolk and Norwich University Hospital said among the people that did not need to be in hospital was a patient who had been there for 145 days.
Claire Fare, senior discharge matron, said delays "impact on the whole of the flow" of patients.
Norfolk County Council's social care department blamed the "national care crisis" for the problems.
In June, the hospital, which has about 1,200 beds, pleaded for family and friends to help look after fit patients to ease demand.
Melanie Syson, the hospital's discharge coordinator, said there was a person in the hospital ready for discharge that had been there for more than four months.
"She is medically fit to be discharged but we are waiting for support to be ready at home," she said.
Ms Syson added: "The length of stay of the patients seems to be getting longer."
To help cope with the delays, the hospital opened a "home-first unit" in January for patients who did not need acute care but it was unable to discharge. The unit focuses on rehabilitation to try to prevent the patients coming back into hospital or requiring more care at home.
Stephanie Ward, the ward sister, said it aimed to "give patients the time they need to do things themselves as much as they can".
Read full story
Source: BBC News, 15 July 2022
 
Patient Safety Learning

Surgeon branded bully faces review after patient, 17, dies

Catherine O’Connor, who was born with spina bifida and used a wheelchair all her life, was looking forward to the surgery to fix her twisted spine.
Tragically, after a catastrophic loss of blood, she died on the operating table at Salford Royal Hospital in Manchester.
She died in February 2007 but only now has an NHS-commissioned report concluded the “unacceptable and unjustifiable” actions of her surgeon, John Bradley Williamson, “directly contributed” to her death. Williamson pressed on with the surgery despite being explicitly told he needed a second consultant surgeon.
Her case is one of more than a hundred of Williamson’s being reviewed by Salford Royal Hospital amid allegations by whistleblowers of a cover-up by managers and a “toxic culture” within his surgery team.
An internal list produced by concerned clinicians as long ago as 2014 describes some of Williamson’s patients being left paralysed or in severe pain as a result of misplaced spinal screws and others being rushed back to theatre for life-saving surgery.
Separately, leaked minutes of a meeting between staff and the hospital’s new chief executive in December 2021 described a “snapshot” of five of Williamson’s patients which “clearly identified significant areas of clinical care, avoidable harm and avoidable death”. They added: “Concerns around Mr Williamson continue to be raised and remain unaddressed.”
Read full story (paywalled)
Source: The Times, 17 July 2022
Patient Safety Learning

Medical expert witnesses ‘should not scapegoat doctors’

Medical experts in cases involving doctors should have a mandatory duty to consider systems issues such as inadequate staffing levels to avoid them being scapegoated for wider failures, the Medical Protection Society (MPS) has said.
The MPS, which supports the the professional interests of more than 300,000 healthcare professionals around the world, says medical expert reports focus on scrutinising the actions of the individual doctor even when failings are a result of the setting in which they work.
Its report on the issue, shared with the Guardian before publication, points out that for doctors “adverse opinion can lead to loss of career or liberty”.
It references the case of Dr Hadiza Bawa-Garba who was convicted of gross negligence manslaughter in 2015 and handed a 24-month suspended sentence for her part in the death of six-year-old Jack Adcock from sepsis. She was later struck off by the General Medical Council before the court of appeal overturned the GMC’s decision.
Dr Rob Hendry, the MPS medical director, said: “In giving an opinion on whether or not the care provided by a doctor has fallen short of a reasonable standard, it would seem fair to the doctor that the medical expert considers all relevant circumstances. Any individual performance concerns must of course be addressed, but doctors should not be scapegoats for the failings of the settings in which they work. Sadly, we see this all too often in cases against doctors …
“Many expert reports focus solely on the actions of the individual without considering the wider context. In reality, patient harm arising from medical error is rarely attributable to the actions of a single individual. Inadequate staffing levels, lack of resources, or faulty IT systems are just some issues which can contribute to adverse incidents. Doctors confront these issues every day and have little influence over them.”
Read full story
Source: The Guardian, 18 July 2022
Patient Safety Learning

Hospital admits paper records putting patients at risk after man’s fatal cancer missed for 10 years

Patients are at risk of a missed cancer diagnosis due to a reliance on paper records, an NHS trust has admitted after a man died due to his tumour being overlooked.
Michael Lane, 50, from Shrewsbury, was “failed” by Shrewsbury and Telford Hospital Trust, his family has said after his cancer scan result was misplaced leaving him with a growing kidney tumour for 10 years.
The trust is yet to fully launch an electronic record system a year after an investigation into Mr Lane’s death warned other patients were at risk due to the gap in paper records.
Mr Lane went into Shrewsbury and Telford Hospital for a scan following a referral for suspected cancer in 2011. The radiographer flagged a small tumour but the scan was overlooked, placed within his paper records and never reported as being a concern.
In an investigation report carried out by the trust in May 2021, seen by The Independent, the hospital admitted that had his tumour been seen and operated on earlier he may have survived.
The report also admitted there were ongoing risks within the trust due to gaps in its electronic records system.
It said: “The implementation of an IT solution will not prevent sad cases such as that of Mr Lane where the scan report that was missed took place before the widespread availability of such systems, however, it is clear that until we have an electronic requesting and sign-off system we remain at risk of new cases of missed results and harm occurring as a result of the ongoing reliance of paper-based results.”
Read full story
Source: The Independent, 17 July 2022
Patient Safety Learning

Doctor struck off for falsely diagnosing children with cancer

A paediatrician has been struck off for falsely diagnosing children with cancer to scare their parents into paying for expensive private treatment.
Dr Mina Chowdhury, 45, caused "undue alarm" to the parents of three young patients - one aged 15 months - by making the "unjustified" diagnoses so his company could cash in by arranging tests and scans, a medical tribunal found.
Chowdhury, who worked as a full-time consultant in paediatrics and neonatology at NHS Forth Valley, provided private treatment at his Meras Healthcare clinic in Glasgow. But the clinic made losses, despite "significant" potential income from third-party investigations and referrals for treatment – with patients charged a mark up fee of up to three times the actual cost. In all three cases, Chowdhury gave a false cancer diagnosis, without proper investigation, before recommending “unnecessary and expensive” private tests and treatment in London.
Parents previously told the tribunal of their shock and upset at receiving Chowdhury’s diagnoses during consultations between March and August 2017. He told the parents of a 15-month-old girl - known as Patient C - that a lump attached to the bone in her leg was a "soft tissue sarcoma" and a second lump had developed. Chowdhury urged them to see a doctor in London who could arrange an ultrasound scan, a MRI scan and biopsy in a couple of days, saying: "If things are happening it is best to get on top of them early." He also warned that it would be "confusing" to return to the NHS for treatment. But the parents spoke to an A&E doctor and an ultrasound scan revealed that the lumps were likely fat necrosis.
Patient C later was discharged after her bloods tests came back as normal. The child’s mother told the tribunal that she and her husband had been "very upset" at Chowdhury’s diagnosis. She was also left "angry" after she later read Dr Chowdhury’s consultation notes and realised they were a "total falsification" of what was discussed.
Read full story
Source: Medscape, 18 July 2022
Patient Safety Learning

Serious concerns raised about senior NHS leaders’ approach to patient safety

Press release: London, UK, 18 July 2022
In a letter shared with Patient Safety Learning, Keith Conradi, outgoing Chief Investigator at the Healthcare Safety Investigation Branch (HSIB), has raised serious concerns with the Secretary of State about the lack of interest shown in the patient safety activities of HSIB at the highest levels of the Department of Health and Social Care and NHS England.
Keith Conradi states that successive leaders of NHS England have shown “little interest” in the work of HSIB. He also highlights concerns about NHS England’s engagement in several HSIB investigations delayed by the pandemic, stating that a lack of participation has “reduced the safety impact of their output”.
The letter calls for the Department of Health and Social Care to take a safety management system approach to safety, like other safety critical industries such as aviation. Keith Conradi notes that currently where patient safety is done well in the NHS, this is “because of the drive and enthusiasm of individuals rather than through a state organised structured approach”.
Commenting on this letter, Patient Safety Learning’s Chief Executive Helen Hughes said:
“We believe that HSIB can play an important role in improving patient safety in the NHS, but not without system-wide commitment and support for their work. It is disappointing to hear of this apparent lack of interest in their activities by NHS England.
We were also deeply alarmed by concerns about a lack of engagement by NHS England in HSIB safety investigations reducing their impact. This is simply not acceptable and flies in the face of the NHS Patient Safety Strategy’s vision of seeking to continuously improve patient safety.
We hope that NHS England will seriously rethink its approach to how it works with the national patient safety investigator, and that the new Secretary of State and incoming new Prime Minister seek to reset and re-invigorate our national approach to improving patient safety.”
Notes to editors
Patient Safety Learning is a charity and independent voice for improving patient safety. We harness the knowledge, enthusiasm and commitment of healthcare organisations, professionals and patients for system-wide change and the reduction of harm. We support safety improvement through policy, influencing and campaigning and the development of ‘how to’ resources such as the hub, our free award-winning platform to share learning for patient safety. HSIB is the independent national investigator for patient safety in England. It seeks to improve patient safety through professional safety investigations that do not apportion blame or liability.
Patient Safety Learning

‘Outrageous’ long A&E waits for mental health patients increase 150%

Mental health patients who arrive at emergency departments (ED) in crisis are increasingly facing ‘outrageous’ long waits for an inpatient bed, with some being forced to wait several days.
HSJ research suggests ED waits of more than 12 hours have ballooned in 2022, and are now around two-and-a-half times as high as pre-Covid levels.
Early intervention for patients in mental health crisis is deemed to be crucial in their care and recovery.
The Royal College of Emergency Medicine said the findings are a “massive concern”, while the Royal College of Psychiatrists described them as “unacceptable”.
RCEM president Katherine Henderson said the experience of mental health patients in accident and emergency departments “is not what it should be from a caring healthcare system”.
She said: “We have massive concern for this patient group. We feel they are getting a really poor deal at the moment.
“The bottom line is there are not enough mental health beds. There are not enough community mental health services to support patients and perhaps therefore prevent a crisis and the need for beds in the first place.
“Mental health crisis first responder teams work – a mental health practitioner working with the ambulance service can prevent the need for an ED visit.”
Read full story (paywalled)
Source: HSJ, 19 July 2022
Patient Safety Learning

GPs to give patients with learning disability and autism ‘priority appointments’

NHS England will ask GP practices to make ‘reasonable adjustments’ for patients with a learning disability or autism such as giving them ‘priority appointments’.
They could also be asked to provide ‘easy-read appointment letters’ to the group, the Department of Health and Social Care (DHSC) said yesterday in a new strategy on strengthening support for autistic people and those with a learning disability.
It said the measures aim to support Government plans to reduce reliance on mental health inpatient care, with a target to reduce the number of those with a learning disability or autism in specialist inpatient care by 50% by March 2024 compared with March 2015.
The policy paper said: ‘We know that people experience challenges accessing reasonably adjusted support which may prevent them from having their needs met.’
It added: ‘To make it easier for people with a learning disability and autistic people to use health services, there is work underway in NHS England to make sure that staff in health settings know if they need to make reasonable adjustments for people."
NHS England is also developing a ‘reasonable adjustments digital flag’ that will signal that a patient may need reasonable adjustments on their health record, it said.
It plans to make this flag, which is currently being tested, available across all NHS services, it added.
Read full story
Source: Pulse 15 July 2022
Patient Safety Learning

Hospitals ordered to take action to stop ambulances waiting longer than half an hour

Doctors’ leaders have reacted with incredulity to demands that all hospitals in England take “immediate steps” to find extra space for patients so that no ambulance waits longer than 30 minutes.
A letter from NHS England sent to the heads of NHS trusts, integrated care boards, and ambulance trusts acknowledged that this will not be easy “and that it may place additional burden on staff at an already challenging time.
The letter was sent on 15 July, in response to the increased pressure on ambulance services over the past year and in light of the current heatwave. It said, “All systems that are currently unable to offload ambulances within 30 minutes should now take further steps to create capacity within acute hospitals to ensure the rapid release of vehicles. This will require risk based decisions to be made about both the use of estate and deployment of clinical workforce.”
Vishal Sharma, chair of the consultants committee at the BMA, said, “The government should be ashamed that it has come to this. If hospitals had the space or the staff to allow them to care for these patients, they wouldn’t be waiting in ambulances at the hospital door in the first place. The sad fact is that after decades of underinvestment, our hospitals are under-resourced, under-bedded, and understaffed.”
 
Read full story
Source: BMJ, 18 July 2022
Patient Safety Learning

Are these Britain's most sexist surgeons? Offensive comments made to mesh surgery victims

Carole Davies and her partner, Malcolm, looked at each other in shocked silent horror as her surgeon spoke to them. 
Carole, 76, from Stevenage, Hertfordshire, had endured weeks of agony after an NHS surgeon had inserted a polypropylene mesh implant to treat a slight incontinence problem. The mesh was meant to act as a scaffold to support her leaking bladder.
Carole, then 60 and a recently retired personnel administrator, had returned to see the surgeon with her partner seven weeks after the surgery. She was in tears as she explained her debilitating pain.
'I told the surgeon that I could feel the mesh cutting into me, which was agonising,' Carole told Good Health.
'But he ignored this and said everything was OK. He told me: 'I just don't understand how you could be in pain. I will refer you to a psychiatrist.' Then he turned to Malcolm and said: 'I've made her nice and tight for you.' '
It was lewd and inappropriate but, as we can reveal, is shockingly by no means an isolated example — an insult, literally, not just to Carole but for many others, among the tens of thousands of British women who have suffered agonising complications from mesh-tape operations since they were first introduced in the late 1990s to treat incontinence or prolapse.
To add insult to injury, these women often struggled for years to have their complaints taken seriously, while surgeons dismissed the idea that there was anything wrong.
The Mail joined forces with campaigning group Sling The Mesh to highlight the issue, the Government set up an inquiry, led by Baroness Cumberlege, in July 2018.
This led initially to a pause in the use of surgical mesh for the treatment of urinary incontinence. The inquiry has since called for this pause to be extended until strict requirements on safety and recompense are met.
Nevertheless, an investigation by Good Health last month found that not only is mesh still being surgically implanted in women, but also that its use could well be on the rise again.
Sling The Mesh has received dozens of messages from women detailing similarly appalling responses, the majority in the past five years, that surgeons had made to deny, belittle and denigrate their agonising pain, emotional trauma and — in some cases — ruined sex lives.
You can read all the messages on the hub's community thread.
Read full story
Source: Mail Online, 18 July 2022
Further reading
Doctors’ shocking comments reveal institutional misogyny towards women harmed by pelvic mesh - a Patient Safety Learning blog
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