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Keep up to date with the latest news, research and activity in patient safety.
On 24 June the US Supreme Court overturned Roe v Wade, the 1973 decision that legalised abortion and left the regulation of abortion to the states.4 At present, about half of the 50 states ban or severely limit abortions, but the picture is changing daily as century old bans go into place in some states, bans are challenged in courts, and state legislatures debate changes to their laws.
The American College of Obstetricians and Gynecologists (ACOG) said, “Each piece of legislation is different, using different language and rationales. State legislators are taking it upon themselves to define complex medical concepts without reference to medical evidence. Some of the penalties for violating these vague, unscientific laws include criminal sentences.”
Doctors report being confused and fearful about how they can continue to practise in states where abortion laws are changing day by day and sometimes hour by hour.
Katie McHugh, an obstetrician and gynaecologist in Indianapolis, where abortion until 20 weeks is legal for the moment, told The BMJ about a patient who arrived from another state (around 200 miles away) with a miscarriage.
“A fetal heartbeat could still be detected. The local hospital sent her home and told her to come back if she became very sick.” Instead she travelled two and a half hours by car to McHugh.
“I don’t blame the physicians in [the other state]. I don’t know if abortion is legal now a trigger law is in effect. They could face lawsuits. As a physician, it’s unacceptable to have to watch the news to know what’s legal and how to practise,” said McHugh.
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Source: BMJ, 1 August 2022
Ministers have admitted a key NHS pledge to ensure that everyone who has been waiting at least two years for hospital care would be treated by last month has not been met.
The then health secretary Sajid Javid made the promise in February when launching the NHS’s “elective recovery plan”. It was intended to tackle what is now a record 6.6 million-patient backlog in England for those awaiting a procedure such as a joint replacement or cataract removal and included a series of treatment milestones the health service had to hit.
“No one will wait longer than two years by July,” Javid said. However, the Department of Health and Social Care has now admitted that it will miss that target and that “a small number of patients” will have remained untreated by that deadline.
The health minister Maria Caulfield told Wes Streeting, the shadow health secretary, in a written parliamentary answer on 18 July that while “no formal estimate has been made … engagement with the National Health Service suggests a small number of patients with complex cases will have waited longer than two years for NHS treatment by the end of July 2022”.
Streeting said the admission was a further example of the government not backing up rhetoric on the NHS with concrete action. “It is unacceptable for anyone to be left waiting more than one year for healthcare, let alone two,” he said. “Once again the Conservatives have overpromised, [and] undelivered, and patients are paying the price.”
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Source: The Guardian, 3 August 2022
More than 100,000 doses of the monkeypox vaccine have been acquired in order to combat the spread of the virus, the government has said.
Last month the NHS stepped up its monkeypox vaccination programme in England as infections rose.
Vaccines minister Maggie Throup said the majority of vaccines were being made available in London, with about 75% of confirmed cases in the capital.
But she urged people to wait to be invited to receive their jabs.
While anyone can get monkeypox, the majority of those with the virus are gay, bisexual and other men who have sex with men.
The latest figures show that nationally there have been 2,436 confirmed cases, with 1,778 of those in London.
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Source: BBC News, 3 August 2022
Fresh concerns have been raised about the treatment of whistleblowers by managers at a trust recently embroiled in a high-profile bullying scandal, the hospital’s workforce director has disclosed.
A series of further accusations have been made against managers at West Suffolk Foundation Trust, where executives were recently judged to have led an “intimidating, flawed” hunt for a whistleblower, prompting a series of high-profile departures.
The trust’s executive director for workforce detailed in a paper for the hospital’s July board meeting how managers had been hunting to identify staff who had raised concerns through supposedly confidential channels.
The report, by executive director of workforce and communications, Jeremy Over, said: “Feedback has been given indicating that some people have had a poor experience when speaking up.
“In two separate cases, where people spoke up in confidence, it was reported that the managers were then asking and wishing to find out who had spoken up making the individuals very uncomfortable.
“Another case reported that the individual was ‘told off’ by their manager for ‘going about their heads’ [sic] and another where staff felt discouraged from raising any points or suggestions as these were taken [as] a personal offence [by] the senior staff. In a further case, the person speaking up was criticised [for] doing so.”
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Source: HSJ, 3 August 2022
NHS England patients with Type 1 diabetes will now be eligible for life-changing continuous glucose monitors after the health service secured a new cut-price deal.
The wearable arm gadget sends information to a mobile app and allows diabetes patients to keep track of their glucose levels at all times without having to scan or take a finger prick test.
Traditionally, continuous glucose monitors are more expensive than their flash monitor counterparts – which record glucose levels by scanning a sensor – but thanks to the NHS agreeing on a new cost-effective deal with manufacturers DEXCOM, they will now be available for NHS patients on prescription at a similar price.
The monitor, called Dexcom ONE Real Time-Continuous Glucose Monitoring, uses a sensor no bigger than a bottle cap that attaches to the arm for up to 10 days and measures glucose levels from just under the skin.
Patients will receive their starter pack – which will include information on the product and usage, a sensor and transmitter – from the hospital or GP surgery once prescribed, after which they can go to the pharmacy for their repeat prescription.
Dr Partha Kar, national speciality advisor for diabetes and obesity said: “This is a huge step forward for Type 1 diabetes care and these monitors will be life-changing for anyone with the illness – giving them more choice to manage their condition in the most convenient way possible – as well as the best chance at living healthier lives, reducing their risk of hospitalisation and illnesses associated with diabetes, which in turn reduces pressure on wider NHS services.
“The new deal also delivers on our commitment to get patients the latest cutting-edge medical technology at the best value for taxpayer money – saving the NHS millions over the coming years”.
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Source: NHS England, 2 August 2022
You may also be interested in:
“I felt lucky to get out alive”: why we must improve hospital safety for people with diabetes Peer support makes a big difference to living with type 1 diabetes Improving safety for diabetic inpatients: 4 key steps - Interview with Dr Partha Kar
Sam
Russell-Cooke personal injury and clinical negligence partner Grant Incles recently represented Mrs Karen Preater in a clinical negligence case over vaginal mesh surgery performed on her at a hospital in north Wales in 2014. 
Wrexham County Court found in favour of Mrs Preater, and roundly dismissed allegations made by the defendant in this case, the Betsi Cadwaladr University Health Board, that the claimant had lied in the presentation of her case, as part of a Fundamental Dishonesty defence. 
Mrs Preater underwent vaginal mesh surgery in January 2014 - to which she had not been properly consented. The surgery itself was performed negligently and as a result she suffered a life-changing chronic pain condition. In late 2020, the defendant carried out intrusive video surveillance of Mrs Preater and trawled through her life on social media, proceeding to launch a defence of Fundamental Dishonesty pursuant to S.57 of the Criminal Justice and Courts Act 2015.
The defendant alleged that the claimant was seeking to lie to the Court about her ability to work and need for care and assistance which, if found to be correct by the Court, would have meant that Mrs Preater would have lost all of her claimed compensation, and which may well have led to an application by the defendant to have her committed to prison for her alleged dishonesty.
The case was fought to trial over seven days in July 2022. HHJ Howells found that Mrs Preater had not sought to deceive any party at any time and should be fully compensated for her grave suffering since being injured over eight years ago. 
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Source: Russell-Cooke, 4 August 2022
Court judgement:
22081101.Preater v BCUHB approved judgment dated 4 August 2022.pdf
The chief executive of a trust trialling the new emergency care standards being considered by the government has called for a new six-hour target to either move patients out of accident and emergency, or for them to receive treatment.
North Tees and Hartlepool Foundation Trust chief executive Julie Gillon told HSJ  a new target should be set as a “body of evidence” indicates patients are at risk of deterioration following A&E waits of six hours or more.
The proposal is likely to be broadly welcomed by many clinicians, but could prove controversial in some quarters. NHS England did not include a six-hour target in the bundle of new A&E metrics being piloted, and the proposal could be interpreted by some as a watered-down version of the existing four-hour standard.
However, Ms Gillon cited analysis by the Royal College of Emergency Medicine last year which revealed thousands of excess deaths resulting from overcrowding and long stays in A&Es.
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Source: HSJ, 4 August 2022
Private and NHS ambulance services are reviewing safety procedures after the Care Quality Commission identified a series of risks to mental health patients being transported by non-emergency providers.
The care watchdog wrote to all providers of non-emergency patient transport earlier in the summer, warning of concerns identified at recent inspections about use of restraints, sexual safety, physical health needs, vehicle and equipment safety standards, and unsafe recruitment practices.
The letter, seen by HSJ, stated: “We know there are many independent ambulance providers providing a good standard of care. Unfortunately, our recent inspections suggest that this is not always the case."
“We expect providers to deliver on their commitment to provide safe, high-quality care and we will do everything within our powers to ensure this happens.”
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Source: HSJ, 4 August 2022
Midwife numbers are reaching a dangerous level which could put lives at risk, as records show more staff leaving than joining the profession for the first time in a decade.
As a record number suffer burnout and leave, the figures from NHS Digital for 2021/22 show almost 300 more staff abandoned midwifery than joined the service, with 3,440 leaving and only 3,144 coming in.
Analysis of the data showed a record 551 resigned in 2021 because of a lack of work-life balance.
Midwives working in NHS trust maternity units typically work 12-hour shifts, but many work longer for no additional pay to cover staff shortages and to keep services running.
The Royal College of Midwives (RCM) says members are "at the end of their tether' and 'physically and emotionally burnt out"
Joeli Brearley, chief executive of campaign group Pregnant Then Screwed, said: "We don't have enough midwives, and those we do have are underpaid, undervalued and overworked."
"This is a problem that has been communicated to the Government repeatedly for years. It is putting the lives of women and their babies in danger and causing untold damage to their mental and physical health. The Government needs to get a grip of the situation urgently before there are more tragedies."
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Source: Daily Mail, 1 August 2022
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Mobile apps to track patients' health are keeping them out of hospital and could cut waiting times, experts have said.
It follows a trial of a new app which heart patients are using through their mobile phones. The trial allows clinicians to change treatments quickly and uses video consultations, avoiding unnecessary hospital visits.
Rhodri Griffiths is the innovation adoption director at Life Sciences Hub Wales, and is looking for more ways to introduce similar technology. He believes the pandemic accelerated the use and acceptance of digital solutions in healthcare, by patients and clinicians.
"We really are looking at a big digital revolution within healthcare and there are an amazing myriad of things coming through," he said.
He explained data collected by smartphones and watches can help predict who is likely to have a heart attack.
"We can avoid that happening. So prevention is key but it's also looking at how some of this can impact on waiting lists," he said.
"So, looking at how theatres are used, which patients can be prioritised?
"In social care it's looking at how pain is managed by face recognition."
Mr Griffiths said he believed the data collected could also identify wider problems: "It's combining these digital solutions with our genetic information - bringing big data together on a population level we can start spotting trends".
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Source: BBC News, 4 August 2022
A 65-year-old man died after doctors failed to notice serious abnormalities on his X-ray, an investigation by the Parliamentary and Health Service Ombudsman (PHSO) has revealed.  
The investigation comes a year after a landmark report by the Ombudsman highlighted failings in how X-rays and scans are reported and followed up in the NHS.  
Mr B, who was admitted to University Hospitals Birmingham NHS Foundation Trust in May 2019, had been unwell for several days. He was admitted to hospital suffering from abdominal pain and vomiting. An X-ray of his abdomen was taken, which two doctors said did not show any apparent abnormalities.
The following day the man’s condition deteriorated. He suffered a heart attack and died. A PHSO investigation found the Trust failed to notice a blockage in his intestine on the X-ray. Because of this failure, Mr B did not receive treatment that could have saved his life. 
Speaking on this case Ombudsman Rob Behrens said:  
“The case of Mr B highlights the devastating impact mistakes like this can have. If the Trust had picked up the abnormalities on his X-ray sooner, Mr B could still be with his family today. 
“As the NHS faces the challenge of rebuilding after the pandemic, it must not lose momentum in improving the way X-rays and scans are handled during a patient’s care.”  
Progress has been made by the NHS in implementing recommendations made by the Ombudsman in the report; however, Rob Behrens has said more needs to be done to protect patients from serious harm. 
“Attention and buy-in from the NHS’s senior leaders is crucial if we want to see sustained and meaningful change in how X-rays and scans are managed during a patient’s care. We need more collaboration across clinical specialties, looking at the whole patient journey once a scan has been carried out.
"I want to see the NHS treating complaints as a source of insight to drive improvements in patient care. Not learning from mistakes will mean missed opportunities to diagnose patients earlier. In the most serious cases, like that of Mr B, it will mean a death which should never have happened.”
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Source: PHSO, 20 July 2022
NHS England has called for a “deep dive” into local evacuation and shelter arrangements, amid ongoing concerns about outdated and unsafe estate.
NHS England’s director of emergency preparedness, resilience and response Stephen Groves wrote to trusts: “Following the publication of the updated evacuation and shelter guidance for the NHS in England, and recent work driven by the heightened risk associated with reinforced autoclaved aerated concrete (RAAC), the 2022-23 EPRR annual deep dive will focus on local evacuation and shelter arrangements.”
The letter, sent at the end of last week, comes amid growing concerns about NHS estate, including RAAC planks which were used in constructing public sector buildings in the 1960s, 70s and 80s. 
Areas to be examined in the deep dive vary by type of organisation. However, according to a self-assessment tool referenced in the letter, questions for providers include: whether they have “a process in place to triage patients in the event of an incident requiring evacuation and/or shelter of patients”; whether there are “effective arrangements in place to support partners in a community evacuation, where the population of a large area may need to be displaced”; and whether “evacuation and shelter arrangements include resilient mechanisms to communicate with staff, patients, their families and the public, pre, peri and post evacuation”. 
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Source: HSJ, 5 August 2022
The NHS in England is increasingly reliant on doctors and nurses recruited from outside the UK and EU, analysis has found.
Some 34% of doctors joining the health service last year came from overseas, a rise from 18% in 2014.
The government said overseas recruitment had always been part of its strategy, but unions have warned it is an unsustainable way of recruiting in the long-term.
Patricia Marquis, Royal College of Nursing (RCN) director for England, said ministers must do more to reduce the "disproportionate reliance" on international recruits.
The government is funding an additional 1,500 undergraduate medical school places each year for domestic students in England - a 25% increase over three years.
However, last week a report by MPs concluded the large number of unfilled NHS job vacancies, about 110,000 in total, was posing a serious risk to patient safety.
Danny Mortimer, chief executive of NHS Employers, said it was "high time for the government to commit to a fully-funded, long-term workforce plan for the NHS" to tackle "chronic workforce shortages".
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Source: BBC News, 5 August 2022
Sexual health charities and LGBT groups are calling for the government to step up efforts to control the monkeypox outbreak in the UK.
In an open letter to Health Secretary Steven Barclay, they say that without a quicker and wider vaccine rollout, the virus could become "endemic".
There have been more than 2,600 cases of monkeypox in the UK so far, mostly among men who have sex with men.
The Department of Health & Social Care (DHSC) says it is working "rapidly" to vaccinate those at risk.
The Terrence Higgins Trust, which co-wrote the letter, says the rollout needs to be speeded up across the UK to help combat "fear and anxiety" within the LGBT community.
Trust head of policy Ceri Smith told BBC News: "We need to see far better co-ordination, increased vaccine procurement, improved delivery and a cash injection to sexual health services to treat monkeypox."
The letter reads: "Without urgent action, we risk monkeypox becoming endemic in the UK. This poses a serious risk to health and will exacerbate the health inequalities already experienced by gay and bisexual men and other men who have sex with men.
"Vaccinating those most at risk of monkeypox must be a priority if we are to stand a chance of preventing the virus from becoming endemic in the UK."
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Source: BBC News, 5 August 2022
Prescribing potentially harmful antipsychotic drugs to people with dementia has increased by more than 50% on average in care homes during the pandemic, new research suggests.
It found that the number of people with dementia receiving these prescriptions had soared from 18% to 28% since 2018 – with prescription rates of over 50% in a third of care homes.
Professor Clive Ballard, who was part of a national campaign in 2009 to reduce antipsychotic prescribing by half, said: “Covid-19 put tremendous pressure on care homes, and the majority of them must be applauded for maintaining relatively low antipsychotic prescribing levels amid incredibly difficult circumstances."
“However, there were very significant rises in antipsychotic prescribing in one third of care homes and we urgently need to find ways to prioritise support to prevent people with dementia being exposed to significant harms.”
Antipsychotic drugs are used to treat some of the more distressing behavioural and psychological symptoms of dementia, such as agitation and psychotic episodes. They have only very limited, short-term benefits in treating psychiatric symptoms in people with dementia – but significantly increase the risk of serious side effects, including stroke, accelerated decline and death.
Dr Richard Oakley, from the Alzheimer’s Society, added: “This study shows the shocking and dangerous scale of the use of antipsychotic drugs to treat people with dementia in care homes.
“Alzheimer’s Society has been campaigning for a move away from the model of ‘medicate first’ and funded research into alternatives to antipsychotic prescriptions, focused on putting people living with dementia at the centre of their own care.
“This drug-free, tailored care can help avoid the loss of lives associated with the harmful side effects of antipsychotic medications.”
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Source: The Independent, 4 August 2022
One in eight Covid-19 patients (12.7%) is likely to experience long term symptoms, a study from the Netherlands has reported.
Using digital questionnaires, researchers collected data on the frequency of 23 symptoms commonly associated with Covid in an uninfected population and in people who had had a Covid diagnosis.
The findings, published in the Lancet, found that 21.4% of adults who had had Covid experienced at least one new or severely increased symptom three to five months after infection when compared with before. This compared with only 8.7% of uninfected people followed over the same period.
The core Long Covid symptoms highlighted by the researchers include chest pain, difficulties breathing, pain when breathing, painful muscles, loss of taste and smell, tingling extremities, lump in throat, feeling hot and cold, heavy arms or legs, and general tiredness.
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Source: BMJ, 4 August 2022
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