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

MPs to question government on failures over use of epilepsy drug in pregnancy

Senior health officials are to face questioning over why pregnant women are still being prescribed sodium valproate despite its known risks as a cause of birth defects or developmental delays.
Campaigners for families affected by the drug will also give evidence to the Health and Social Care Committee in a one-off session later this month. Alongside campaigners on sodium valproate, the Committee will also hear from campaigners from Association for Children Damaged by Hormone Pregnancy Tests and on behalf of “Sling the Mesh” campaign.
MPs will examine government progress on recommendations made in the Independent Medicines and Medical Devices Safety (IMMDS) Review, which specifically looked into sodium valproate, hormone pregnancy tests and vaginal mesh. An update by Ministers on progress to implement the government’s response was due this summer.  A Minister from the Department of Health and Social Care has been invited to appear before the Committee.
The IMMDS Review’s report called for better communication to inform women of the risks of sodium valproate in pregnancy. Despite an NHS ‘valproate pregnancy prevention programme’, 247 women since April 2018 were found to have been prescribed the drug in a month in which they were pregnant, 25 as recently as April to September last year.
Health and Social Care Committee Chair Jeremy Hunt MP said:
“It is incredibly concerning to know that women of child-bearing age can still be prescribed the epilepsy drug sodium valproate despite its known risks as a cause of birth defects or developmental delays.
It has been two years since Baroness Cumberlege called for urgent action to prevent this happening. However, dozens of pregnant women were prescribed the drug last year while data published last month has shown that safety requirements were not being fully met.
We’re calling in a Minister and senior health officials as well as campaigners to address our concerns.”
Read full story
Source: UK Parliament, 2 September 2022
 
Patient Safety Learning

Forget the pandemic, NHS decline is ‘to blame for record waiting lists’

Record NHS waiting lists cannot be attributed to the pandemic as the health service has been “steadily declining” for a decade, a report says.
The number of people waiting for routine hospital treatment in England has almost tripled from 2.5 million in April 2012 to 6.78 million, after reaching 4.6 million in February 2020.
While Covid accelerated this trend, analysis suggests that even without the pandemic waiting lists for elective care would stand at 5.3 million.
The Quality Watch report, by the Nuffield Trust and Health Foundation think tanks, says the NHS was “already stretched beyond its limits” before Covid struck.
Analysis of performance figures show waiting times for scans, A&E and cancer care have been increasing for many years amid chronic staff shortages.
This deterioration means thousands of cancer patients each month face unacceptably long waits for treatment — damaging their survival chances.
The report found waiting times for 15 key diagnostic tests, such as MRI or CT scans, had also rocketed. In April 2012 632,236 patients were on waiting lists for these tests. This backlog increased to one million by February 2020 before hitting 1.6 million this year.
Read full story (paywalled)
Source: The Times, 5 September 2022
Patient Safety Learning

California approves bill to punish doctors who spread false information

Trying to strike a balance between free speech and public health, California’s Legislature on Monday approved a bill that would allow regulators to punish doctors for spreading false information about Covid-19 vaccinations and treatments.
The legislation, if signed by Gov. Gavin Newsom, would make the state the first to try to legislate a remedy to a problem that the American Medical Association, among other medical groups and experts, says has worsened the impact of the pandemic, resulting in thousands of unnecessary hospitalisations and deaths.
The law would designate spreading false or misleading medical information to patients as “unprofessional conduct,” subject to punishment by the agency that licenses doctors, the Medical Board of California. That could include suspending or revoking a doctor’s license to practice medicine in the state.
While the legislation has raised concerns over freedom of speech, the bill’s sponsors said the extensive harm caused by false information required holding incompetent or ill-intentioned doctors accountable.
“In order for a patient to give informed consent, they have to be well informed,” said State Senator Richard Pan, a Democrat from Sacramento and a co-author of the bill. A paediatrician himself and a prominent proponent of stronger vaccination requirements, he said the law was intended to address “the most egregious cases” of deliberately misleading patients.
Read full story (paywalled)
Source: New York Times, 29 August 2022
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London hospitals set to double up patients in wards to tackle winter crisis

NHS trusts across London are set to start moving patients from A&E onto wards “irrespective” of whether there are beds available, The Independent has learned.
The new model, which involves moving patients every two hours out of A&E and onto wards called acute medical units, has prompted concerns that patients could be “double lodged” on hospital wards.
The move follows the trial of a new system by North Bristol NHS Trust last month, which said it would be moving three patients every hour from A&E onto wards in a bid to address severe ambulance handover delays.
On Thursday, health secretary Steve Barclay said that the “number one” priority for the NHS currently is tackling ambulance handover delays, with a “small” number of trusts accounting for half of all delays.
In a memo seen by The Independent, NHS clinicians in one hospital were told that London trusts would be rolling out the North Bristol model at “pace” ahead of winter. The system involves moving one patient from A&E onto a ward every two hours “irrespective of bed availability”.
Speaking to The Independent, one NHS director said the move would lead to “double lodging” patients, which means squeezing more patients into wards, and that this could be “dangerous” for patients.
However, A&E doctors told The Independent that the move should be welcomed, as it spreads the crowding and risk for patients across hospital departments rather than confining it to A&E.
Read full story
Source: The Independent, 4 September 2022
Patient Safety Learning

Covid: Millions invited for booster jabs

Millions of people will be invited for their autumn Covid booster jab in England and Scotland, with care home residents the first to receive them.
Although infections are falling, health bosses are predicting a resurgence of Covid and flu this autumn and winter.
They are urging those eligible to protect themselves from serious illness by getting vaccines against both.
A recently approved vaccine against the Omicron variant will be used first.
However, there is not enough of Moderna's "bivalent" vaccine to protect everyone aged over 50 so health officials say people should take whichever booster they are offered. These will be the vaccines used in the spring.
The UK's Medicines and Healthcare products Regulatory Agency (MHRA) announced on Saturday that it had approved a second "bivalent" coronavirus vaccine from Pfizer/BioNTech for people aged 12 and over.
Read full story
Source: BBC News, 4 September 2022
Sam

Unfilled consultant posts pose key risk to patient safety - Irish Medical Council

Unfilled specialised medical consultant roles and an over-reliance on overworked, internationally trained graduates for non-consultant hospital doctors are among key risks to patient safety identified by the Irish Medical Council.
The council, which is the regulatory body for the medical profession, sets out the risks to healthcare for the first time in its workforce intelligence report that breaks down the make-up of the medical register and explains why doctors are leaving the health system.
More than a third of all clinically active doctors are on the general register, which is a key risk to patient safety because consultant and specialist roles are not being filled and “a considerable proportion” of non-consultant hospital doctors are required to perform the duties of consultants.
The report found that the majority of non-consultant hospital doctors are trained overseas and that the health system overly relied on these doctors who reported being “overworked, undervalued, experiencing discrimination and unable to access specialist training.”
“Aside from the individual impact on the doctors, the treatment of international medical graduates has serious implications for patient safety,” the council said.
In another risk identified by the regulatory body, more than a quarter of doctors reported working more than 48 hours a week, in breach of the European Working Time Directive.
This has further serious implications for patient safety,” the council said.
Read full story
Source: Irish Times, 1 September 2022
Patient Safety Learning

Truss move to cut management would ‘get in way’ of progress, says top CEO

Liz Truss’s desire to talk about cutting management in the NHS will get in the way of more important conversations about the future operating model of the health service, a respected system leader has said.
In an interview with HSJ, Rob Webster, chief executive of the West Yorkshire integrated care system, said NHS managers have been a “fundamental” part of the response to the pandemic and that they have a “good record of delivering” when backed by coherent plans.
His comments come after Ms Truss, who was confirmed as the new prime minister today, said during the Conservative Party leadership contest she was planning “fewer levels of management” in the NHS.
When asked about the comments made by Mrs Truss, as well as similar statements from health secretary Steve Barclay, Mr Webster said: “This is part of the reality of the NHS being a political issue, that you will get this sort of debate.
“And I think if you want to enter debate about the NHS being over-managed, you can look at any one of a number of independent publications that demonstrate that it’s not, from the Kings Fund, the Nuffield trust, and various others…"
Mr Webster said many patients in the NHS are still receiving good, safe and timely care, but at the same time many people are waiting too long to access services while staff have faced “incredible pressure” for an extended period.
“What we need to do is to work our way out of this,” he said. “And we can only do that with a coherent plan which is politically led nationally, politically owned locally, and led by people in the system collectively.”
Read full story (paywalled)
Source: HSJ, 6 September 2022
Patient Safety Learning

PM Truss appoints new health secretary

Thérèse Coffey has been appointed as the new health and social care secretary.
Ms Coffey, previously work and pensions secretary, has been appointed to the role by the new prime minister, Liz Truss.
A close ally of Ms Truss, Ms Coffey has also been appointed as her deputy prime minister. 
The new prime minister, in her first speech in the role, said that putting “our health service on a firm footing” was one of her “three early priorities”.
She pledged to improve access and build “hospitals”. 
Ms Coffey said this evening her priorities were “ABCD”, representing “ambulances, backlogs, care, doctors and dentists”.
 
Read full story (paywalled)
Source: HSJ, 6 September 2022
Patient Safety Learning

Nurse says she faced hours of racist abuse

A nurse who was racially abused at work has urged Health Minister Robin Swann to take action on racism towards healthcare staff.
Beverly Simpson, a nurse for more than 25 years, said she was subjected to hours of abuse while working last weekend.
The incident at the weekend took place in a private healthcare setting, Ms Simpson told BBC Radio Foyle.
She said she was called racist slurs by a patient for several hours.
"I want to do nursing, I have always been a nurse," she said. "I never realised that I would be placed in such a vulnerable position and I actually question myself if I should walk away."
Ms Simpson said she wanted to speak publicly to make sure "any other nurse from a black or minority ethic group did not feel alone".
"There is abuse going on, it's something that is happening," she said. "I felt, for the first time in a long while, about quitting. I asked myself: 'What is the point?'
"I understand that when people are sick their defences may be down, they're more vulnerable and they may say things they shouldn't, but there was a nastiness to it."
In a statement, the Department of Health said racism was not something that any colleague in Health and Social Care (HSC) should have to endure.
"We want to send a clear message, from the very top of our health and social care system, that such behaviour is totally unacceptable and will not be tolerated," the department said.
"We fully recognise and respect the hard work, commitment and dedication of HSC staff from within the BAME [black, Asian and minority ethnic] community."
Read full story
Source: BBC News, 6 September 2022
Patient Safety Learning

We need to find alternatives to 999 for care homes and falls

The NHS needs to do more to support care homes and people who have fallen with alternatives to ambulance calls and hospital admissions, the NHS England chief executive has said. 
Speaking at the Ambulance Leadership Forum, Amanda Pritchard acknowledged this winter would be a difficult one for the health service, saying: “The scale of the current and potential challenge mean that we do need to continue to look further for what else we can do… We need to pull out all the stops to make sure that they [patients] get that treatment as safely as possible and as quickly as possible.”
She added one area of focus should be making sure certain patient groups can access other – more appropriate – forms of care, rather than calling an ambulance by default and often resulting in hospital admission.
On care homes, she said: “Can we wrap around even more care for these care homes so they get to the point where they don’t need to call for help at all or, if they do, there are alternatives pathways [to the emergency department]?”
She suggested another area where responses could be made more consistent was for patients who had fallen but without serious injuries, which she said made up a “really significant part of activity”. These patients took a long time to reach and, if admitted to hospital, risked long admissions, she said.
Some areas were working to find other ways of responding to non-injury falls patients and trying to keep them away from hospital, she said.
Read full story (paywalled)
Source: HSJ, 6 September 2022
Patient Safety Learning

50 new surgical hubs set to open across England

Over 50 new surgical hubs will open across the country to help bust the Covid-19 backlogs and offer hundreds of thousands more patients quicker access to vital procedures, Steve Barclay, has announced.
These hubs will provide at least 100 more operating theatres and over 1,000 beds so people get the surgery they need.
And they will deliver almost two million extra routine operations to reduce waiting lists over the next three years, backed by £1.5billion in government funding.
They will focus mainly on providing high-volume, low-complexity surgery, as previously recommended by the Royal College of Surgeons of England, with particular emphasis on ophthalmology, general surgery, trauma and orthopaedics, gynaecology, ear nose and throat, and urology.
Located on existing hospital sites, the surgical hubs will bring together skills and expertise of staff under one roof – reducing waiting times for some of the most-common procedures such as cataract surgeries and hip replacements.
Improving quality and efficiency will mean patients have shorter waits for surgery, will be more likely to go home on the same day, and will be less likely to need additional treatment.
And, as the hubs are separated from emergency services, surgical beds are kept free for patients waiting for planned operations, reducing the risk of short-notice cancellations and improving infection control.
Read full story
Source: Building Better Healthcare, 5 September 2022
Patient Safety Learning

Excess deaths continue to soar despite Covid deaths decreasing

Excess deaths in the UK have continued to soar, as Covid deaths decreased for fourth week in a row, the latest data shows.
A total of 10,942 deaths from all causes were registered in England and Wales in the week to 26 August, according to the Office for National Statistics.
This is 16.6%above the five-year average, the equivalent of 1,556 “excess deaths” during this week.
However, new figures show a continued downward trend in deaths involving Covid-19, which have fallen to the lowest level since the beginning of July.
A total of 453 deaths registered in the seven days to August 26 mentioned coronavirus on the death certificate, according to the Office for National Statistics (ONS) – down 18 per cent on the previous week.
Stuart Macdonald, from the Covid-19 actuaries’ response group, wrote: “There have been around 5,300 deaths with Covid-19 mentioned on the death certificate in the last ten weeks. Covid was the underlying cause for 3,400 of these and may also have contributed to others. Since Covid does not explain all the recent excess we need to look at other causes.”
Mr Macdonald outlined a number of potential drivers of excess deaths which included increased risk of heart failure in people following Covid-19 infection, delays for urgent treatment within the NHS and missed or delayed diagnoses earlier in the pandemic.
Read full story
Source: The Independent, 6 September 2022
Patient Safety Learning

Long-wait cancer patient list grows again

The backlog of urgent cancer referral patients who have waited 104 days or more for treatment has increased month-on-month again, internal NHS data reveals.
Data obtained by HSJ shows the total backlog of NHS patients waiting over three months for their first treatment since referral grew by 10% month-on-month, from 10,361 as of 26 June, to 11,212 by 28 August.
There are now nearly 341,000 patients are waiting to start their cancer treatment after being referred, the internal data also reveals.
Under current NHS rules, the 104-day point marks a “backstop” – beyond which any patient waiting longer than this for treatment should be reviewed for potential harm. The NHS has not achieved this target since 2014.
Read full story (paywalled)
Source: HSJ, 7 September 2022
Patient Safety Learning

Anger at plans to roll back Covid vaccines to under-11s in England

The decision to reduce the number of children who are offered Covid jabs has prompted outcry from parent groups and academics.
The UK Health Security Agency (UKHSA) said children who had not turned 5 by the end of last month would not be offered a vaccination, in line with advice published by the UK’s Joint Committee on Vaccination and Immunisation (JCVI) in February 2022. UKHSA said the offer of Covid jabs to healthy 5 to 11-year-olds was always meant to be temporary.
UKHSA’s Green Book, which provides information on the vaccine rollout for public health professionals, states: “This one-off programme applies to those aged 5 to 11 years, including those who turn 5 years of age before the end of August 2022".
“Subject to further clarification, on-going eligibility in 2022/23, after the one off-programme, is expected to be for children in the academic years where children are aged 11 or 12 years.”
However, Prof Christina Pagel, of University College London, criticised the move.
“JCVI itself considered there to be a benefit to young children to be vaccinated – even if most of them had already been infected,” she said.
“There is also the additional benefit to children of providing additional protection from developing long Covid, missing school during the acute illness and reducing transmission to household members, other children and teachers.”
Pagel said that at least one serious Covid wave was expected later this year, but that many children about to start school would now have to wait six years for vaccination, with likely relatively frequent infections in that time.
“When we know there is a safe and effective vaccine available this seems unjustifiable to me,” said Pagel, adding that – while rare – children had died from Covid.
Read full story
Source: The Guardian, 6 September 2022
Patient Safety Learning

Billionaire-backed group steps up hunt for Long Covid treatment

A group of top researchers, clinicians and patients have stepped up efforts to combat Long Covid, launching a new billionaire-backed initiative to search for drivers of the poorly understood condition and ultimately find treatments to help the millions of people around the world living with the disease.
The Long Covid Research Initiative (LCRI) hopes to accelerate efforts to understand and treat Long Covid, a sometimes disabling condition that lingers for months or years after infection with SARS-CoV-2, the virus that causes Covid-19.
The group’s first goal—supported by $15 million dollars in funding from Balvi, a scientific investment fund led by crypto billionaire and Ethereum co-founder Vitalik Buterin—will be to investigate the causes Long Covid, with a particular focus on whether the virus stubbornly persists in the body after initial infection.
Dr. Amy Proal, a microbiologist at the PolyBio Research Foundation and LCRI’s chief scientific officer, told Forbes the research is not just geared towards identifying the presence of the virus in the body but is also aimed at understanding the downstream impact it has on things like blood clotting and the immune system.
Proal said another key aim of LCRI’s research program is to identify measurable features of Long Covid that could form the backbone of clinical trials and help develop much-needed treatments for the condition.
LCRI has already secured a commitment for further funding from the Chan Soon-Shiong Family Foundation, led by biotech billionaire Dr. Patrick Soon-Shiong (the final amount has yet to be settled), and Scott-Green said the group is aiming to raise $100 million in order to help patients as soon as possible.
Read full story
Source: Forbes, 8 September 2022
Patient Safety Learning

GPs warn of ‘tsunami of demand’ this winter as patient contacts surge 200%

GPs have warned of a ‘tsunami of demand’ this winter as patient contacts surged 200% during the pandemic.
One of the largest GP providers in the UK, Modality Partnership, told The Independent it received 4.8 million calls from patients in one year alone with around a quarter going unanswered every day.
The provider, which covers 500,000 patients across the country, said its practices were now working above “safe levels” with 50 appointments a day per GP, far higher than the 35 advised by the British Medical Association.
Speaking with The Independent, Vincent Sai, chief executive and partner at Modality said the new health secretary Therese Coffey must “not point fingers” and “not find a scapegoat” as “every part of the system is under pressure. Every player in the health system is under the cosh.”
Dr Sai said: “We believe patient contacts have increased 200 per cent, over the last few years. The expectation is that GP practices have maybe four to five patient contacts per year, but if you just look at just the number of phone calls alone, it’s showing that it’s much more now.
“So something is broken somewhere...there’s more work, there are fewer people. People say I can’t get access to my GP and the hypothesis is they’re just lazy and not working, but it’s not the case.”
Read full story
Source: The Independent, 7 September 2022
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