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

NHS has ‘broken’ its promise to the public over the ambulance service

The NHS has broken its “fundamental promise” to the public that life-saving emergency care will be available when they need it, a top NHS doctor has said, as ambulances continue to lose tens of thousands of hours waiting outside hospitals.
Katherine Henderson, the president of the Royal College of Emergency Medicine, said that what she described as the fundamental promise of the NHS to provide an ambulance in a real emergency has been “broken”.
Her comments come as the West Midlands Ambulance Service (WMAS) University NHS Trust predicted it would lose 48,000 ambulance hours waiting outside A&E departments in July. This would make it the worst month on record.
In papers published on Thursday, WMAS said the impact of handover delays means that patients are waiting longer than needed for an emergency response, including patients in category one, which includes those needing immediate life-saving care.
It added: “This means that patients who are immediately time-critical medical emergencies do not get the response they need and may suffer significant harm or death.”
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Source: The Independent, 26 July 2022
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UK doctors ‘less likely’ to resuscitate the most seriously ill patients since Covid

Doctors are less likely to resuscitate the most seriously ill patients in the wake of the pandemic, a survey suggests.
Covid-19 may have changed doctors’ decision-making regarding end of life, making them more willing not to resuscitate very sick or frail patients and raising the threshold for referral to intensive care, according to the results of the research published in the Journal of Medical Ethics.
However, the pandemic has not changed their views on euthanasia and doctor-assisted dying, with about a third of respondents still strongly opposed to these policies, the survey responses reveal.
The Covid-19 pandemic transformed many aspects of clinical medicine, including end-of-life care, prompted by millions more patients than usual requiring it around the world, say the researchers.
In respect of DNACPR, the decision not to attempt to restart a patient’s heart when it or breathing stops, more than half the respondents were more willing to do this than they had been previously.
Asked about the contributory factors, the most frequently cited were: “likely futility of CPR” (88% pre-pandemic, 91% now); coexisting conditions (89% both pre-pandemic and now); and patient wishes (83.5% pre-pandemic, 80.5% now). Advance care plans and “quality of life” after resuscitation were also commonly cited.
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Source: The Guardian, 25 July 2022
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‘Arrogance and bullying’ persist from ‘less understanding’ regulators, say trusts

NHS England and the Care Quality Commission are becoming less understanding of the pressures on trusts, their leaders report, with one CEO complaining “the arrogance and bullying continues to get worse”. 
This is the finding of a new survey of trust chiefs, chairs and directors by NHS Providers, shared with HSJ and published in a new report on regulation today.
It found two-thirds of trust leaders felt NHSE had a good understanding of “the pressures that NHS providers are facing” — down from 74% cent in a similar NHSP regulation survey in 2019, and 75% in 2018.
NHSP found: “Leaders from the acute sector were much more likely to say regulators understood the pressure they were under than those from the mental health or community sectors.”
One combined acute/community CEO said: “Not only have the number of requests increased but now they are coming from multiple levels, [integrated care system], regional and national.”
Meanwhile, most respondents welcomed regulators’ proposed changes to their approach – for example, by the CQC to a “risk based” approach, and NHSE towards collaboration – but many indicated they did not feel these were being put into practice.
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Source: HSJ, 26 July 2022
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Likely cause of mystery child hepatitis outbreak found

UK experts believe they have identified the cause of the recent spate of mysterious liver problems affecting young children around the world.
Investigations suggest two common viruses made a comeback after pandemic lockdowns ended - and triggered the rare but very serious hepatitis cases.
More than 1,000 children - many under the age of five - in 35 countries are thought to have been affected. Some, including 12 in the UK, have needed a lifesaving liver transplant.
The two teams of researchers, from London and Glasgow, say infants exposed later than normal - because of Covid restrictions - missed out on some early immunity to an adenovirus, which normally causes colds and stomach upsets, and adeno-associated virus 2.
Noah, three, who lives in Chelmsford, Essex, needed an urgent liver transplant after becoming dangerously ill with hepatitis. His mother, Rebecca Cameron-McIntosh, says the experience has been devastating.
"He'd previously had nothing wrong with him," she says. "And for it to suddenly go so quickly. I think that's what kind of took us by surprise.
"We've just assumed it was one little problem that will get easily sorted out - but actually it just kept on snowballing."
Noah's recovery has been good - but he will need to take immunosuppressant drugs fo life, to stop his body rejecting the new liver he received.
Rebecca says: "There is something really heartbreaking about that because you go along following the rules, do what you are supposed to do to protect people that are vulnerable and then, in some horrible roundabout way, your own child has become more vulnerable because you did what you were supposed to do."
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Source: BBC News, 26 July 2022
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Pre-eclampsia: Test change for pregnant women could save lives

A change in pre-eclampsia testing for pregnant women could help save lives.
The potentially-fatal condition affects around 6% of women, often during the second half of pregnancy.
The National Institute for Clinical Excellence (NICE) had recommended a test that could only rule out the condition, but now recommends more accurate tests that can diagnose cases.
The Welsh government welcomed the new guidance, but said routine screening had not been recommended.
Jeanette Kusel, director for scientific advice at NICE, said: "These tests represent a step change in the management and treatment of pre eclampsia.
"New evidence presented to the committee shows that these tests can help successfully diagnose pre eclampsia, alongside clinical information for decision-making, rather than just rule it out.
"This is extremely valuable to doctors and expectant mothers as now they can have increased confidence in their treatment plans and preparing for a safe birth"
Eleri Wyn Foxhall, 32, from Penygroes in Gwynedd had pre-eclampsia in 2020.
She welcomes the move, but called for women to be tested routinely.
She believes there is a general "lack of information" about pre-eclampsia, and wants more work to be done on early detection.
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Source: BBC News, 26 July 2022
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Londoners several times more likely to get life-saving treatment

The NHS and the Treasury need to make a renewed commitment to increasing the number of patients who benefit from thrombectomy, the Stroke Association has said, as it revealed the service was dependent on just 106 doctors in England.
New analysis due to be published by the charity later this week – and shared with HSJ  – also found only a quarter of thrombectomy units are open 24 hours, seven days a week, with 42% only operating during office hours and Monday to Friday.
Despite an NHS long-term plan target of treating 10% of strokes with a thrombectomy by this year, only 2.8% were benefitting in December 2021 – a smaller proportion than in the US or some other Western European nations. It means nearly 6,000 people who could benefit from thrombectomy are missing out, the charity has calculated.
The Stroke Association’s report also highlighted large apparent regional variation in the share of stroke patients receiving the treatment — with London patients several times more likely to receive the treatment than elsewhere.
Read full story (paywalled)
Source: HSJ, 27 July 2022
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Dental checkups to become less frequent in England and Wales

The decades-old routine of visiting an NHS dentist for a six-month checkup is being scrapped across England and Wales for most adults as part of changes designed to address the dire lack of access to dental care for many people.
Wales has announced that most adults now only need to see their dentist once a year, which the government in Cardiff says will free up NHS dentists’ time and allow them to take on more than 100,000 extra patients annually.
The Labour-controlled Welsh government also hinted it wanted to recruit disillusioned dentists from England by offering chances to develop skills such as carrying out more complex surgery within their practices.
Its announcement came after the UK government wrote to NHS dentists last week saying that under the first changes to the dental contract in 16 years, healthy people will only need a checkup every two years. It said this complied with guidance from the National Institute for Health and Care Excellence (Nice), which says dental teams should see patients for a checkup based on their health risk, which can be once every two years instead of every six months.
Both governments claimed the moves would allow more people to find NHS care but dentists’ representatives in England and Wales described the changes as “tinkering” and “marginal tweaks”.
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Source: The Guardian, 27 July 2022
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Hospital in meltdown over IT issues

A whistleblower has warned a London hospital is "literally in meltdown" after its IT system was knocked out during last week's heatwave.
Operations at Guy's and St Thomas' Hospital in Lambeth were cancelled after its IT servers broke down in 40C (104F) temperatures on 19 July.
A doctor told the BBC "poor planning" and "chronic underfunding" meant issues remained a week later.
A spokesperson for the hospital said IT issues were "having an ongoing impact".
Without a functioning IT system, staff have returned to paper notes, the doctor said.
The anonymous whistleblower, who works as a doctor at Guy's and St Thomas', said this meant "we see very worrying results, but we don't know where the patients are so we spend ages tracking them down".
"We cannot read any historical notes from patients. Names are being misspelt, so scans are not showing up.
"Each morning, someone hand-delivers a stack of test results to the ward. In there, we received several patient results that don't belong to our ward," the doctor said.
"If we don't recover our shared drives, we risk losing months of research data, if not years."
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Source: BBC News, 27 July 2022
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Barclay calls urgent ‘hackathons’ over ambulance crisis

The new health and social care secretary has asked officials to hastily organise several “hackathons” to try to address the crisis in ambulance performance.
The first, which was instigated just last week, will take place tomorrow (28 July), and a second is planned for August, sources told HSJ.
Messages from officials described the work as a “request from our new secretary of state” and explained the short notice by saying he was “pushing… quite strongly for something before the end of the month”.
The aim is said to be to examine what is driving poor performance, and the Department of Health and Social Care is “particularly interested in understanding which factors reduce risk to patients”, according to one message seen by HSJ.
Hackathons are short, time-limited collaborative design events, typically involving computer programmers and data scientists or analysts, which aim to result in working software or product on the chosen theme by the end.
Read full story (paywalled)
Source: HSJ, 27 July 2022
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Speaking up ‘still not business as usual’, national guardian warns

Whistleblowing is still not ‘business as usual’ and leaders must take action after an unusual drop in the proportion of staff viewing their organisation as having a positive speak up culture, the national guardian for freedom to speak up has said.
Speaking to HSJ, Jayne Chidgey-Clark highlighted some “really concerning” findings from the National Guardian’s Office’s most recent survey, both about speak up culture and the wellbeing of the freedom to speak up guardians.
The NGO survey found a 10 percentage point drop in freedom to speak up guardians agreeing senior leaders supported workers to speak up, dropping from around 80% to 70% between 2020 and 2021.
She also highlighted an increase in FTSU guardians reporting staff had experienced “detriment” for speaking up within their organisation.
Ms Chidgey-Clark, a nurse by background who took up the role last December, said it was the first time the National Guardian’s Office had seen a drop on this question since the survey began in 2017, and that it also “chimed” with the latest NHS staff survey.
She added: “Workers are saying the same thing, and that’s really concerning. And it will be even more concerning if we see a similar trend next year. It’s almost like an early warning sign to leaders."
Read full story (paywalled)
Source: HSJ, 28 July 2022
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NHS told to make better use of hospital passports to support patients

Hospital passports need to be more consistently used across the NHS to better support patients with communication difficulties, a learning disability nurse says.
Support for patients with communication needs and learning disabilities, as well as the nurses caring for them, is often ‘inconsistent’, according to RCN professional lead for learning disabilities Jonathan Beebee.
Coupled with the current system-wide pressure of patient backlogs and high staff vacancy rates it means patients often do not have their communication needs met.
A hospital passport, which contains vital information about a patient’s health condition, learning disability and communication needs, would help address this, Mr Beebee told Nursing Standard. 
"There has got to be better consistency in how we are identifying people with communication needs, how they are getting flagged and how nurses are being pointed to that from the second that someone is admitted to the ward," he said.
Mr Beebee says ensuring a standardised approach would improve patient experience and ultimately nurses’ relationship with patients.
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Source: Nursing Standard, 27 July 2022
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Jeremy Hunt calls contaminated-blood scandal a huge failing of democracy

Former Health Secretary Jeremy Hunt has told a public inquiry institutions and the state can sometimes "close ranks around a lie".
Giving evidence at the infected-blood inquiry, he said it could be seen as a "huge failing of democracy" that victims had waited so long for justice.
At least 5,000 people contracted HIV or hepatitis C in the 1970s and 80s, after being given contaminated blood products and transfusions on the NHS. More than 2,400 have died as a result.
Jenni Richards QC asked whether a 2012 briefing for new ministers in the health department - "almost certainly" not shown to Mr Hunt at the time - stating, under a heading "Key facts", hepatitis C and HIV (Human Immunodeficiency Virus) infection had been a problem in the 1970s and 80s, "before it was possible to screen donors and make products safer", suggested the contamination had been an "unavoidable problem".
Mr Hunt, health secretary for six years until July 2018, replied: "I mean, that briefing is wrong and it shouldn't say that.
"At the very least, ministers should be aware as politicians that this is contentious and disputed by families - but I'm afraid it tries to suggest the issue is closed when it is not."
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Source: BBC News, 27 July 2022
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Over 47,000 stroke patients to ‘miss out on a miracle treatment’

A new report by the Stroke Association released today warns that, if the thrombectomy rate stays at 2020/21 levels, 47,112 stroke patients in England would miss out on the game changing acute stroke treatment, mechanical thrombectomy, over the length of the newly revised NHS Long Term Plan. This year, NHS England missed its original target to make mechanical thrombectomy available to all patients for whom it would benefit – only delivering to 28% of all suitable patients by December 20212.
The Stroke Association’s ‘Saving Brains’ report calls for a 24/7 thrombectomy service, which could cost up to £400 million. But treating all suitable strokes with thrombectomy would save the NHS £73 million per year. Stroke professionals quoted in the report cite insufficient bi-plane suites, containing radiology equipment, as a barrier to a 24/7 service.
The Stroke Association is calling for:
The Treasury to provide urgent funding for thrombectomy in the Autumn Budget 2022, for infrastructure, equipment, workforce training and support, targeting both thrombectomy centres and referring stroke units. Department of Health and Social Care to develop a sustainable workforce plan to fill the gaps in qualified staff. NHS England to address challenges in transfer to and between hospitals in its upcoming Urgent & Emergency Care Plan. Putting innovation - such as artificial intelligence (AI) imaging software and video triage in ambulances - into practice. Juliet Bouverie, Chief Executive of the Stroke Association said: “Thrombectomy is a miracle treatment that pulls patients back from near-death and alleviates the worst effects of stroke. It’s shocking that so many patients are missing out and being saddled with unnecessary disability. Plus, the lack of understanding from government, the NHS and local health leaders about the brain saving potential thrombectomy is putting lives at risk. There are hard-working clinicians across the stroke pathway facing an uphill struggle to provide this treatment and it’s time they got the support they need to make this happen. It really is simple. Thrombectomy saves brains, saves money and changes lives; now is the time for real action, so that nobody has to live with avoidable disability ever again."
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Source: The Stroke Association, 28 July 2022
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Working women need greater menopause rights

Women going through menopause should be given greater rights and protection in the workplace, MPs say.
The Women and Equalities Committee said a lack of support in the UK was pushing women out of work.
The cross-party group wants menopause to become a protected characteristic like pregnancy, to give working women more rights.
Caroline Nokes, who chairs the committee said: "Stigma, shame and dismissive cultures can, and must, be dismantled."
The government, speaking on the issue for England as health issues is devolved to the national governments in Scotland, Wales and Northern Ireland, said the issue was a priority, highlighting it had recently appointed a women's health ambassador and set up a menopause taskforce to look into workplace support.
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Source: BBC News, 28 July 2022
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NHS leaders warn that social care workforce crisis risks patient safety

NHS leaders across England say staffing gaps and a lack of capacity in social care are putting the care and safety of patients in the NHS at risk.
Almost 250 NHS leaders responding to an NHS Confederation survey say that patients are being delayed in hospital much longer than they should, with the knock-on impact resulting in higher demand on A&E departments and longer ambulance response times.
More than 9 in 10 NHS leaders warn of a social care workforce crisis in their area which they expect will get worse this winter. Nearly all NHS leaders say the lack of capacity in social care is putting the care and safety of patients at risk. More than four in five warn that the absence of care packages for people to be able to return home or be moved into a care home is the main reason why medically fit patients are stuck in hospital longer than they should be. Almost all NHS leaders say that the most impactful solution would be better pay for social care staff and want the Government to increase investment in social care as a priority. An acute trust executive director in the South West accused the Government of presiding over a “national scandal.”
“If the social care capacity shortfall was solved then we would not be holding ambulances at all, we would have almost no problems with elective recovery and our emergency departments would not be crowded and unsafe,” they said.
Another acute trust chair in the East of England added: “The result of using nearly 20 per cent of our beds for patients who are medically fit but need packages of care to return home is an overcrowded A&E, twelve-hour trolley waits and much delayed ambulance handover times. The connection is very clear to us…Until we find a solution to social care staffing and funding, the situation can only get worse.”
Commenting on the survey results Lord Victor Adebowale, chair of the NHS Confederation, said:
“Decades of delay and inertia have left social care services chronically underfunded and in desperate need of more support.
“NHS leaders stand alongside their sister services in social care in wanting a rescue package for the sector. They are sounding the alarm and sending a clear message to Government that the social care system has not been ‘fixed’."
Read full story
Source: NHS Confederation, 28 July 2022
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CQC probes bullying allegations at national NHS agency

Bullying and harassment allegations made against leaders of the organisation that supplies blood to the NHS have prompted a Care Quality Commission (CQC) review, with staff claiming poor culture has exacerbated the crisis around low blood stocks.
HSJ has learned whistleblowers at NHS Blood and Transplant raised concerns with the CQC. As a result, the regulator has been carrying out a review of the organisation’s leadership.
Several current and former staff, who wished to remain anonymous, told HSJ there are widespread concerns about the organisation’s culture, which they claim has enabled bullying and harassment from senior employees, including some racist behaviours.
They said the culture has resulted in a significant number of staff being absent due to stress and anxiety, which alongside the latest wave of coronavirus, has contributed to an ongoing staffing crisis.
Read full story (paywalled)
Source: HSJ, 28 July 2022
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