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

Child deaths expose mental health unit pressures

Deaths, staff shortages and a culture of life-threatening self-harm are exposing deep fears about the quality of mental health care in hospitals for children and young people.
Since 2019, at least 20 patients aged 18 or under have died in NHS or privately-run units, the BBC has found.
A further 26 have died within a year of leaving units, amid claims of a lack of ongoing community support.
The NHS said it had "invested record amounts... to meet record demand".
Child and Adolescent Mental Health Services (CAMHS) units look after about 4,000 patients with many different diagnoses each year. The aim is to help them recover over a period of weeks or months through specialist care. Some patients are in and out of the units for years.
The BBC has also heard serious claims regarding the unsafe discharge of patients sent home from CAMHS hospitals.
Several former patients told the BBC they had serious self-harm incidents or tried to take their own life within days of returning home.
Parents have described being on "suicide watch" 24 hours a day, to ensure their child's safety.
Read full story
Source: BBC News, 9 August 2022
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One in 25 heart attack deaths in north-east of England ‘preventable in London’

One in 25 people who die of a heart attack in the north-east of England could have survived if the average cardiologist effectiveness was raised to the London level, research shows.
The research, undertaken by the Institute for Fiscal Studies (IFS), looked at the record of over 500,000 NHS patients in the UK, over 13 years. It highlights the stark “postcode lottery” of how people living in some parts of the country have access to lower quality healthcare.
The results found that while cardiologists treating patients in London and the south-east had the best survival rates among heart attack patients, patients being treated in the north-east and east of England had the worst.
Among 100 otherwise identical patients, an additional six patients living in the north-east and east of England would have survived for at least a year if they had instead been treated by a similar doctor in London.
Furthermore, if the effectiveness of doctors treating heart attacks in these areas of the country were just as effective as the cardiologists in London, an additional 80 people a year in each region would survive a heart attack.
The research also revealed a divide between rural and urban areas of England, with patients living in the former typically receiving treatment from less effective doctors compared with those in more urban areas.
Read full story
Source: The Guardian, 9 August 2022
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Patients to wait longer for routine checks so NHS can clear record backlogs

NHS patients will wait longer for routine checks as part of a national drive to clear record backlogs.
Health officials have instructed hospitals to “repurpose” resources to focus on those waiting the longest, who are yet to have their first appointment. 
Today the NHS claimed it had “virtually eliminated” two year waits, with less than 3,000 people enduring such delays, down from 22,500 at the end of January.
Hospitals are being urged to prioritise those waiting 18 months or more, with pledges to get rid of such waits by April next year.
NHS chiefs have instructed hospitals to focus on outpatient first appointments, rather than patients who have already had treatment, and are waiting for follow-up checks.
Senior officials have said many such appointments are a “a waste of time” saying there should be more use of systems where routine slots are scrapped, and patients instead told to contact their medical team if they have particular concerns. 
The drive - which health chiefs dubbed “Super September” - will see priority given to tackling the longest waits. 
Read full story (paywalled)
Source: The Telegraph, 9 August 2022
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US doctor issues warning of many undiagnosed polio cases

A health official in New York State has told the BBC there could be hundreds or even thousands of undiagnosed cases of polio there.
It follows an announcement last month that an unvaccinated man had been paralysed by the virus in Rockland County, New York. His case has been linked genetically to traces of polio virus found in sewage in London and Jerusalem.
Developed countries have been warned to boost vaccination rates.
Dr Patricia Schnabel Ruppert, health commissioner for Rockland County, said she was worried about polio circulating in her state undetected.
"There isn't just one case of polio if you see a paralytic case. The incidence of paralytic polio is less than 1%," she said.
"Most cases are asymptomatic or mildly symptomatic, and those symptoms are often missed. So there are hundreds, perhaps even thousands of cases that have occurred in order for us to see a paralytic case."
"This is a very serious issue for our global world - it's not just about New York. We all need to make sure all our populations are properly vaccinated," she said.
Read full story
Source: BBC News, 9 August 2022
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Virtual outpatient drive at heart of effort to end 78-week waits, says Mackey

Patients at trusts with long waiting lists should no longer think ‘they have to go to their local hospital’ for outpatient appointments, but should instead be offered virtual consultations elsewhere in the country where there is greater capacity, Sir Jim Mackey has told HSJ.
The NHS England elective chief said recent efforts to abolish two-year waiters by July had meant a “very big” surgical focus. However, the next phase of the elective recovery plan would see a major shift of emphasis onto reducing the wait for outpatient appointments.
Sir Jim said: “Providers have been split into tiers again with tier one having national oversight and tier two, regional oversight. Behind that we will be pairing up organisations so that organisations with capacity can help those with the biggest challenges from a virtual outpatient perspective.
He added: “There still is a lot to work through [on virtual outpatients], we’re going to be testing the concept… We need to work through how all the wiring and plumbing needs to work. For example, what happens if the patient needs a diagnostic locally, having seen a clinician virtually in another part of the country?
“It would be great also to try and stimulate more of a consumer drive on this – encouraging patients to ask about virtual outpatients when the waits locally may be too long, so they don’t just think they have to go to their local hospital. I think this could really help shift the model if we can get it right.”
Read full story (paywalled)
Source: HSJ, 9 August 2022
 
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Hospital asking nurses to clean wards ‘risky’ and shows ‘little respect’ for staff

Specialist nurses at an NHS hospital have been told they may be taken off clinical shifts to help clean wards, it has emerged.
Bedfordshire Hospitals NHS Foundation Trust has said it asked nursing staff to help clean wards as the hospital faced the “most challenging circumstances” it has ever faced.
Clinical specialist nurses, who are advanced nurses and can usually have hundreds of patients under their care, were among those asked to spend entire shifts helping other wards “cleaning”, “tidying” and “decluttering”.
The news has prompted criticism from unions, however, multiple nurses have reported that the requests happen “often” during winter.
Alison Leary professor of healthcare and workforce at South Bank University warned that asking specialist nurses to drop their work was “very risky”.
She said: “This problem keeps cropping up-as soon as there is pressure on wards they are expected to abandon their patients. It usually happens in winter and so it’s concerning that it has now started to happen in summer.
“This also shows very little respect for nursing generally and will not help retention. Trusts need to plan workforces accordingly and should ensure they have the right amount of cleaning, administrative and housekeeping staff-all staff groups which contribute to patient safety and care quality."
Read full story
Source: The Independent, 8 August 2022
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Doctors declare ‘lack of confidence’ in trust board

The medical body at Norfolk and Suffolk Foundation Trust has written to the trust’s chair saying that it is unable to provide safe care and expressing a lack of confidence in the board.
The letter, which has been seen by HSJ, is signed by 140 of doctors at the mental health provider. It claims the trust’s “clinical services are unable to provide good basic care and are unsafe”.
Significant criticism is reserved for the trust’s senior management, with the letter stating “there is a general dysfunction with perpetual changes of key staff in executive posts and ever increasing layers of management” and that “major decisions are frequently made by a handful of people at an executive level without clinical consultation”.
The letter continues: “Doctors are by and large used as clinical workhorses. Many carrying huge workloads and holding unacceptable clinical risks”.
The letter, first revealed by BBC Look East, asks for an urgent meeting with the chair and states that the medical body “lacks confidence in the executive board to resolve the plight of NSFT”.
Read full story (paywalled)
Source: HSJ, 10 August 2022
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Birmingham: 'Action not reports' needed on healthcare racism

Action rather than reports is needed to tackle healthcare inequalities faced by black people in Birmingham, a charity says.
It follows a report which found people from black communities continued to face racism and discrimination when accessing treatment.
The city's director of public health said he was "horrified" by the finding. Dr Justin Varney said the system must be adapted to meet the needs of all.
Charity The First Class Foundation wants to see implementation of changes and says among the healthcare problems in need of tackling are "microaggressions" faced by communities.
The publication of the Birmingham and Lewisham African Health Inequalities Review followed an 18-month study commissioned by the areas' local authorities.
It found disadvantages among the communities in housing, pollution and availability of green space had "all contributed to worse health".
The report additionally highlighted how the communities were "exposed to structural racism and discrimination which leads to... chronic stress and trauma".
Read full story
Source: BBC News, 10 August 2022
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Just four out of 1,100 lone worker alarms being used by trust workforce

A trust which rented 1,100 lone worker alarms has found just four were in use after a year.
Sussex Partnership Foundation Trust rented the system for five years, with the contract starting in early 2021. But a year later only 51 of the units were assigned to a user, and just four were being used.
Most of the users had not completed their training and 19 had not even logged into the system to set up a profile, according to an annual health and safety report covering 2021-22.
The health and safety report said: “Unfortunately the system has yet to demonstrate value for money as the uptake within services across the trust is very poor, despite the extensive work by the health and safety team to encourage uptake.” This had included demonstrating the system at multiple meetings and trying to raise awareness.
A spokesperson from Sussex Partnership Foundation Trust said: “The lone worker system is one of the ways we ensure the safety of our staff who work alone. It has taken time to embed the new system due to the changes in working practices during the pandemic. However, in recent months we have seen the number of staff actively using the system increasing."
“There is more we are doing to ensure wider take-up and implementation, through a programme of engagement and training.”
Read full story (paywalled)
Source: HSJ, 9 August 2022
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Half of UK adults ‘don’t contact GP within six months of finding cancer symptom’

Half of UK adults with a possible cancer symptom do not contact their GP within six months, despite spotting changes to their body, research suggests.
A YouGov poll of 2,468 people for Cancer Research UK found that just 48% of those who had experienced a red flag symptom – including coughing up blood, unexplained weight loss and a new or unusual lump – contacted their GP within half a year.
Not telling a doctor about unusual health changes or possible cancer symptoms reduces the chances of an early cancer diagnosis, leading to potentially devastating outcomes.
Cancer Research UK’s chief executive Michelle Mitchell said: “Spotting cancer early is vital if more people are to survive, and the first step in that process is getting help for a possible cancer symptom.
“It’s really worrying to see such a large gap in accessing services between the UK’s most and least deprived groups.
“Earlier this year, the Government announced among its top priorities were improving early diagnosis of cancer and tackling health disparities.
“Cancer must remain a top priority and with the upcoming Health Disparities White Paper and 10-Year Plan for England, the new Health and Social Care Secretary has a huge opportunity to transform cancer survival with a clear and strong plan that works for all.”
Read full story
Source: The Independent, 10 August 2022
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Obese patients ‘being weight-shamed by doctors and nurses’

Doctors and nurses often “weight-shame” people who are overweight or obese, leaving them feeling anxious, depressed and wrongly blaming themselves for their condition, research has found.
Such behaviour, although usually the result of “unconscious weight bias”, leads to people not attending medical appointments, feeling humiliated and being more likely to put on weight.
Dr Anastasia Kalea and colleagues at University College London analysed 25 previous studies about “weight stigma”, undertaken in different countries, involving 3,554 health professionals. They found “extensive evidence [of] strong weight bias” among a wide range of health staff, including doctors, nurses, dieticians, psychologists and even obesity specialists.
Their analysis found that a number of health professionals “believe their patients are lazy, lack self-control, overindulge, are hostile, dishonest, have poor hygiene and do not follow guidance”, said Kalea, an associate professor in UCL’s division of medicine.
She added: “Sadly, healthcare, including general practice, is one of the most common settings for weight stigmatisation and we know this acts as a barrier to the services and treatments that can help people manage weight.
“An example is a GP that will unconsciously show that they do not believe that the patient complies with their eat less/exercise more regime they were asked to follow as they are not losing weight."
“The result is that patients are not coming back or they delay their follow-up appointments, they avoid healthcare prevention services or cancel appointments due to concerns of being stigmatised due to their weight.”
Read full story
Source: The Guardian, 10 August 2022
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USA: The GOP blocked an insulin price cap - what it means for diabetics

The Senate passed a sweeping budget package Sunday intended to bring financial relief to Americans, but not before Republican senators voted to strip a proposal that would have capped the price of insulin at $35 per month for many patients.
A proposal that limits the monthly cost of insulin to $35 for Medicare patients was left untouched. But using a parliamentary rule, GOP lawmakers were able to jettison the part of the proposal that would apply to privately insured patients.
Lowering the price of drugs such as insulin, which is used by diabetics to manage their blood sugar levels, is broadly popular with voters, polling shows. Senate Democrats denounced Republicans for voting against relief for Americans struggling to pay for the lifesaving drug.
More than 30 million Americans have diabetes, and about 7 million require insulin daily to manage their blood sugar levels.
The insulin price cap, part of a larger package of proposals to cut prescription drug and other health-care costs, was intended to limit out-of-pocket monthly insulin costs to $35 for most Americans who use insulin.
More than 1 in 5 insulin users on private medical insurance pay more than $35 per month for the medicine, according to a recent analysis from the Kaiser Family Foundation. The same analysis found that the median monthly savings for those people would range from $19 to $27, depending on their type of insurance market.
A Yale University study found insulin is an “extreme financial burden” for more than 14% of Americans who use it. These people are spending more than 40% of their income after food and housing costs on the medicine.
Read full story (paywalled)
Source: The Washington Post, 8 August 2022
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Urgent polio boosters for London children

All children aged one to nine and living in Greater London will be offered a polio vaccine after the virus was detected in sewage.
The virus, which can cause paralysis, has been found 116 times in London's wastewater since February.
The urgent immunisation campaign will see nearly a million children offered the vaccine - including those already up to date with their jabs.
Parents and carers will be contacted by their GP within the next month.
Polio is seen as a disease of the past in the UK after the whole of Europe was declared polio-free in 2003.
Dr Vanessa Saliba, a consultant epidemiologist at UKHSA, said: "All children aged one to nine years in London need to have a dose of polio vaccine now - whether it's an extra booster dose or just to catch up with their routine vaccinations."
She said the risk for the majority of the population who are vaccinated remains "low" but said it was "vital" parents ensure their children are fully vaccinated.
Read full story
Source: BBC News, 10 August 2022
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New capital fund to boost beds and A&E capacity

England’s mental health inpatient system is “running very hot” and operating well above recommended occupancy levels, HSJ has been told, as new funding to address the problem is revealed.
The move was announced by NHS England mental health director Claire Murdoch in an exclusive interview with HSJ. 
It comes amid a steep rise in mental health patients waiting more than 12 hours in accident and emergency. Last month, an HSJ investigation revealed 12-hour waits for people in crisis had ballooned by 150% in 2022 compared to pre-pandemic levels. Problems finding specialist beds have been cited by experts as one of the root causes of A&E breaches.
Ms Murdoch told HSJ the funds would not come from ”within the mental health service budget” and that they would be used to “help address any pressures where we think the answer is more of either beds or other urgent and emergency care which has a capital need.”
NHSE is now working with the 42 integrated care systems to determine where the money can best be used. Ms Murdoch said the money would be spent ”where there is a particular need” and that there was “no blanket approach” to its allocation. 
Read full story (paywalled)
Source: HSJ, 10 August 2022
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Cyber attack: NHS staff unable to access patient notes for three weeks

A cyber attack that has caused a major outage of NHS IT systems is expected to last for more than three weeks, leaving doctors unable to see patients’ notes, The Independent has learned.
Mental health trusts across the country will be left unable to access patient notes for weeks, and possibly months.
Oxford Health Foundation Trust has declared a critical incident over the outage, which is believed to affect dozens of trusts, and has told staff it is putting emergency plans in place.
One NHS trust chief said the situation could possibly last for “months” with several mental health trusts, and there was concern among leaders that the problem is not being prioritised.
In an email to staff, Oxford Health Foundation Trust chief executive Nick Broughton, said: “The cyber attack targeted systems used to refer patients for care, including ambulances being dispatched, out-of-hours appointment bookings, triage, out-of-hours care, emergency prescriptions and safety alerts. It also targeted the finance system used by the Trust."
The NHS director said: “The whole thing is down. It’s really alarming…we’re carrying a lot of risk as a result of it because you can’t get records and details of assessments, prescribing, key observations, medical mental health act observations. You can’t see any of it…Staff are going to have to write everything down and input it later.”
They added: “There is increased risk to patients. We’re finding hard to discharge people, for example to housing providers, because we can’t access records.”
Read full story
Source: The Independent, 11 August 2022
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