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

Malaria booster vaccine could cut deaths in children, study suggests

A malaria vaccine created by Oxford researchers “is really exciting” and could contribute towards drastically reducing the number of children who die from the infection, experts suggest.
A new study reports on the effectiveness of a malaria booster vaccine which shows long-lasting high efficacy in African children, meeting the World Health Organisation (WHO) specified 75% efficacy goal.
The research found that a vaccine booster dose one year after children received three doses as their primary vaccination regime maintained high efficacy against malaria.
Adrian Hill, director of the Jenner Institute and Lakshmi Mittal and Family Professor of Vaccinology, University of Oxford, said: “We think these data are the best data yet.
“And very importantly, this is a vaccine that we think can be manufactured and deployed, very widely.”
He added that the vaccine could be produced for a few dollars a dose, and together with existing measures, like mosquito nets and sprays, could help save children’s lives.
Read full story
Source: The Independent, 8 September 2022
Patient Safety Learning

HRT medicine to be sold over the counter for first time

Previously offered as prescription only, estradiol tablets, sold under the brand name Gina10, will now be available to women over the age of 50 who have not had a period for more than a year, as part of hormone replacement therapy treatment (HRT).
Pharmacists have been offered training to identify who needs the tablets.
The Medicines and Healthcare products Regulatory Agency (MHRA) made the decision as part of a strategy to make menopause treatment more accessible for women.
Estradiol tablets treat vaginal symptoms caused by a lack of oestrogen, such as dryness, soreness, itching, burning and uncomfortable sex.
The product is inserted into the vagina rather than taken by mouth.
MHRA chief healthcare quality and access officer Dr Laura Squire called the move a "landmark reclassification for millions of women in the UK".
"In reaching this decision, we have seen positive support from a wide range of people, including many women aged 50 years and above who could benefit from this decision," she said.
The MHRA hopes the move will relieve pressure on front-line NHS services and give women more freedom in choosing treatments that work for them.
Read full story
Source: BBC News, 8 September 2022
Patient Safety Learning

Air pollution is the largest environmental health risk we face today - call for a Fossil Fuel Non-Proliferation Treaty

Every year, air pollution causes up to 36,000 deaths in the UK.  The World Health Organization and the UK Government recognise that air pollution is the largest environmental health risk we face today. 
Millions of people around the world breathe polluted air that puts their respiratory and cardiovascular health, and in some cases even their lives, at risk. Phasing out fossil fuels would be a major step in protecting health for current and future generations.
More than a thousand health professionals have already endorsed the call for a treaty. 
Add your name to endorse the call for a treaty.
Next week, the Global Climate and Health Alliance are planning a major press launch of the health community's letter calling for a Fossil Fuel Non-Proliferation Treaty and want to secure as many signatures as possible. They are encouraging healthcare professionals to help to build momentum by inviting two—or more—of your health colleagues to sign the health letter before the launch on 14 September.
Invite your colleagues to sign the health letter
By clicking the link above, you'll be taken to a form where you can send a short note of invitation to a colleague to sign the letter. They will be sent your note, as well as a link to some additional information about the Fossil Fuel Non-Proliferation Treaty. The form can only send one email at a time, but you use the form as many times as you wish.
Patient Safety Learning

Record 6.8m people waiting for hospital treatment in England

Liz Truss has received a stark insight into the dire state of the NHS after new figures showed millions of people in England were facing often record delays to access vital healthcare.
One leading NHS expert said the long waits for care, diagnostic tests and hospital beds showed that Britain’s new prime minister “inherits an NHS in critical condition”.
The total number of people in England waiting for hospital treatment rose again to a record high of 6.8 million at the end of July – almost one in eight of the population.
Patients are also facing long waits for accident and emergency care, cancer treatment, such as surgery or chemotherapy, and for an ambulance to arrive after a 999 call.
Of the 6.8 million people on NHS England’s “referral to treatment” waiting list, 2,665,004 had been waiting for more than 18 weeks, which is the supposed maximum waiting time for procedures such as a joint replacement, hernia repair or cataract removal.
In addition, 377,689 had been waiting more than a year to start their treatment, almost 22,000 more than a month before, according to the latest monthly performance data published by NHS England.
The data showed that ministers and NHS bosses had failed to fulfil their pledge to eradicate two-year waits by the end of July; 2,885 such cases had not been resolved by then, despite major efforts by hospitals to meet the target.
Read full story
Source: The Guardian, 8 September 2022
Patient Safety Learning

‘Overwhelmingly negative narrative must stop’

NHS England’s chief strategy officer has called for a “reset” of the current “overwhelmingly negative narrative” about the health service.
Chris Hopson said there was a collective responsibility to present a more balanced picture, while still being honest about problems.
The service should do more to emphasise successes, improvements and where there is good performance, he said.
He acknowledged there were too many instances where good quality care could not be delivered due to current pressures on the service. But they were being addressed and improvements being made.
“We need to make sure that our staff, our patients but also the taxpayers hear that more balanced narrative,” he said at the Ambulance Leadership Forum event on Wednesday. Ambulance services – whose response times have sky-rocketed, well beyond their targets, over the past 18 months – have been at the centre of much recent negative coverage.
Mr Hopson argued that the constantly negative narrative was having an impact on staff – whose work was not being recognised – and creating a sense that the NHS was broken.
“That narrative is partly being driven by opponents of the NHS and also [those] who want to attack the government,” Mr Hopson said, although he acknowledged that it also reflected genuine instances of staff and patient experience.
Read full story (paywalled)
Source: HSJ, 8 September 2022
Patient Safety Learning

Nurses liable for patient harm carried out under physicians' orders, North Carolina court rules

Nurses in North Carolina, USA, can now be sued for patient harm that results from them following physicians' orders, the state Supreme Court ruled last month. 
The 19 August ruling strikes down a 90-year-old precedent set by the 1932 case Byrd v. Marion General Hospital, which protected nurses from culpability for obeying and executing orders from a physician or surgeon, unless the order was obviously negligent. 
The North Carolina Supreme Court overturned this ruling in a 3-2 opinion as part of a separate case involving a young child who experienced permanent anoxic brain damage during an ablation procedure at a North Carolina hospital in 2010. The ruling means the certified registered nurse anaesthetist involved in the ablation could be held liable for the patient's harm. 
"Due to the evolution of the medical profession's recognition of the increased specialization and independence of nurses in the treatment of patients over the course of the ensuing ninety years since this Court's issuance of the Byrd opinion, we determine that it is timely and appropriate to overrule Byrd as it is applied to the facts of this case," Justice Michael Morgan wrote in the opinion. 
Read full story
Source: Becker's Hospital Review, 6 September 2022
Patient Safety Learning

NHS cuts 18-month waits but concerns over key target remain

NHS trusts again recorded a month-on-month reduction in the number of patients waiting over 78 weeks for treatment, although the flagship target to eliminate this cohort by March remains a tall order, with winter pressures set to crank up.
The overall waiting list rose from 6.7 to 6.8 million between June and July, a record high, with the number of those who have waited over a year rising from around 356,000 to around 378,000.
However, the 78-week breach figure fell from 53,911 in July from 51,838 in June. It had stood at nearly 60,000 in May.
This represents a significant achievement given the unprecedented pressures currently on the system.
Read full story (paywalled)
Source: HSJ, 8 September 2022
Patient Safety Learning

Self-sterilising plastic kills viruses like Covid

Scientists have developed a virus-killing plastic that could make it harder for bugs, including Covid, to spread in hospitals and care homes.
The team at Queen's University Belfast say their plastic film is cheap and could be fashioned into protective gear such as aprons.
It works by reacting with light to release chemicals that break the virus.
The study showed it could kill viruses by the million, even in tough species which linger on clothes and surfaces.
The research was accelerated as part of the UK's response to the Covid pandemic.
Studies had shown the Covid virus was able to survive for up to 72 hours on some surfaces, but that is nothing compared to sturdier species. Norovirus - known as the winter vomiting bug - can survive outside the body for two weeks while waiting for somebody new to infect. 
"This is the first time that anything like this has been developed," said Prof Andrew Mills, from the university's chemistry department.
He added: "This film could replace many of the disposable plastic films used in the healthcare industry as it has the added value of being self-sterilising at no real extra cost."
He said current personal protective equipment used in hospitals did a good job, but "infections can take place when you take off or put on the PPE, so this can help".
Read full story
Source: BBC News, 8 September 2022
Patient Safety Learning

NICE guidance for GPs to regularly review self-harming patients finalised

NICE has rubber-stamped guidance on self-harm that said GPs should ‘regularly review’ patients and offer a ‘specific CBT intervention’.
The guidance is the first to be drawn up in 11 years and emphasises the importance of referring patients to specialist mental health services but stresses that, for patients who are treated in primary care, continuity is crucial.
The final guideline mirrors the draft guidance in advising that self-harming patients, when treated in primary care, must receive:
regular follow-up appointments; regular reviews of self-harm behaviour; a regular medicines review. GPs must also provide care for co-existing mental health issues, including referral to mental health services where appropriate, as well as information, social care, voluntary and non-NHS sector support and self-help resources, it said.
The guidance said that referring people to mental health services would ‘ensure people are in the most appropriate setting’.
Read full story
Source: Pulse, 8 September 2022
Patient Safety Learning

Watchdog finds 'toxic' culture in Manx hospital A&E

There is a "toxic" culture of bullying and blame in the Isle of Man's emergency department at Noble's Hospital, an inspection has found.
The Care Quality Commission's report said it was a "significant concern" along with "ineffective" staff training and medicine storage systems.
It found a "significant disconnect" between nursing and medical staff had the potential to "cause or contribute to patient harm".
During inspectors' four-day visit in June, some staff said the attitude and behaviour of senior medics was "feral".
Manx Care's director of nursing Paul Moore said the understaffed department had been "really struggling" at times.
He warned efforts to change governance and culture would take time.
Mr Moore said on average the emergency department had about 50% of the required staff over a given month, and recruitment was the "number one priority" to help make lasting changes.
"The bottom line is I have to put staff in front of patients before other considerations, especially when we're short", he added.
Read full story
Source: BBC News, 8 September 2022
Patient Safety Learning

Doctors warn Truss over NHS ‘fantasy’

Liz Truss has been warned against “fantasy predictions” that the NHS can return to normal without radical change and was told that “unacceptable standards” are being normalised.
In a rare political intervention, the professional standards body for the UK’s 220,000 doctors agreed that the NHS was routinely letting down patients. The Academy of Medical Royal Colleges said politicians must be prepared for radical changes to save the health service. Closing smaller hospitals, accepting that routine dentistry cannot be free for everyone and a return of Covid volunteers to allow doctors to treat more patients were all suggested by the head of the academy.
The academy released a report that declared the NHS was in crisis, writing: “The system is providing increasing proportions of care or services which are sub-standard, threaten patient safety, and should not be acceptable in a country with the resources that we have in the United Kingdom. If we do not act with urgency, we risk permanently normalising the unacceptable standards we now witness daily.”
The report sets out a series of recommendations for reform, including boosting staff numbers, reforming social care and spending more on technology.
Helen Stokes-Lampard, the academy’s chairwoman, said patients were facing a “dismal winter” and that politicians must take difficult decisions. “If we don’t make changes it will inevitably deteriorate further,” she said. “The demand isn’t going away, the pressure isn’t going away, which is why the challenge for our government and for our whole society is to confront these issues and have a difficult conversation.”
Read full story (paywalled)
Source: The Times, 9 September 2022
Patient Safety Learning

NHS electric vehicles to help patients and the planet

The NHS is trialling a fleet of electric vehicles to help relieve pressure on ambulance services while also helping the NHS cut its carbon footprint.
The vehicles are part of a £2.1m investment as the NHS becomes the first health service in the world to commit to reaching net zero by 2040, said NHS England, with eight ambulance trusts trialling 21 zero-emission vehicles of various types.
Six of these new green vehicles are "dedicated to mental health response in the community", NHS England said. It emphasised that it hoped this development will "cut emergency response times for people with mental health needs and help reduce demand on traditional double-crewed ambulances".
The new dedicated mental health response vehicles differ in design from traditional ambulances by having fewer fluorescent markings and a much less clinical interior, to help put patients at ease. However, they still carry the equipment needed to respond to the most serious life-threatening emergencies.
NHS England highlighted that the all-electric vehicles can be deployed as a rapid response vehicle when someone is experiencing a mental health crisis, "providing a safe space for healthcare workers to support patients with mental health needs".
Claire Murdoch, national director for mental health, NHS England explained that the mental health response vehicles are an important addition to mental health care, and added: "we have a double win of being able to improve the experience of patients in crisis whilst also caring for the planet".
Read full story
Source: Medscape, 6 September 2022
Patient Safety Learning

Trusts turn to ‘aggressive accounting’ and large covid cash reserves to balance books

NHS trusts will draw on billions of pounds of cash reserves built up during the pandemic to help fund their costs this year, while using aggressive accounting treatments to stop the spending hitting the bottom line.
HSJ analysis reveals trusts’ balance sheets are in a far stronger position than before the pandemic, with cash levels reaching around £18bn – three times higher than in March 2020.
There have been increasing concerns around the financial outlook for the health service, with funding levels falling in real terms due to spiralling inflation.
NHS England has warned of service cuts being needed to balance the accounts, while local leaders have warned of “impossible choices” after being told to deliver “cost improvement plans” of around 5 per cent.
However, sources said the strong cash position offers significant headroom to avoid service cuts in the short term, by using the cash reserves built up during covid. But to avoid this impacting on the reported bottom line in the NHS accounts, which would risk a budget breach, they will deploy accounting treatments which reduce reported expenditure.
Read full story (paywalled)
Source: HSJ, 12 September 2022
Patient Safety Learning

Patient safety: Each UK nation needs overarching lead, report urges

A new patient safety chief should be appointed in each of the four UK nations to oversee health and social care and tackle the currently “fragmented and complex” system, experts have urged.
The Professional Standards Authority for Health and Social Care (the body that oversees the 10 statutory bodies that regulate health and social care professionals in the UK, including the General Medical Council) has called for what it described as a radical rethink to improve safety in care. In a report published last week, it recommended the appointment of an independent health and social care safety commissioner (or equivalent) for each UK country.
These commissioners would identify current and potential risks across the whole health and social care system, it said, and instigate necessary action across organisations. 
Read full story (paywalled)
Source: BMJ, 6 September 2022
Related reading
Working together to achieve safer care for all: a blog by Alan Clamp (chief executive of the Professional Standards Authority) Joining up a fragmented landscape: Reflections on the PSA report ‘Safer care for all’ (a blog from Patient Safety Learning
Patient Safety Learning

NHS ‘accused vaginal mesh victim of lying about pain and subjected her to surveillance’

The NHS accused vaginal mesh victims fighting for compensation of lying about pain, it has been claimed.
Women suing hospitals over harm they suffered following mesh operations are being subjected to “devastating” treatment, according to Robert Rose, the head of clinical negligence at law firm Lime Solicitors.
Campaign group Sling the Mesh, which represents thousands of patients, said it had received reports of those injured claiming they have been told their symptoms are psychosomatic, that their evidence is not convincing because of their mental state, or that they are lying about their pain.
It comes as MPs are set to hold an inquiry following up on the Independent Medicines and Medical Devices (IMMD) Safety Review, chaired by Baroness Cumberlege in 2020, which looked into cases of patients being harmed by mesh procedures, sodium valproate, and hormone pregnancy tests.
Lady Cumberlege called for the government to launch a redress scheme for patients in order to provide them with financial support without the need for them to go through clinical negligence battles.
Lisa, whose name has been changed to protect her identity, launched her claim in 2016, and it was settled this summer when a judge ruled in her favour.
Documents shared with The Independent reveal that NHS lawyers argued she was being “dishonest” about her injuries, and presented video surveillance. The judge subsequently ruled that she had not been dishonest.
Speaking about her ordeal, Lisa said: “Once they decided that I’d been dishonest, it changed from admitting liability to basically working out pain levels and stuff like that, and I had to prove that I wasn’t being dishonest. It was genuinely the worst thing I’ve ever gone through, ever. There’s not even a word that I can use to describe it, to say how it made me feel. The stress of it was just immense."
Read full story
Source: The Independent, 11 September 2022
Further reading
Doctors shocking comments to women harmed by mesh Specialist mesh centres are failing to offer adequate support to women harmed by mesh (Patient Safety Learning and Sling the Mesh) “There’s no problem with the mesh”: A personal account of the struggle to get vaginal mesh removal surgery
Patient Safety Learning

Millions of UK patients forced to go private amid record NHS waiting lists

Millions of patients are being forced to pay for private healthcare amid record NHS waiting lists and are having to cut spending, raid savings or get into debt to fund it, new research reveals.
One in 10 (10%) adults in the UK have turned to the private sector or independent healthcare in just the last 12 months, according to a survey commissioned by charity Engage Britain. Of those, almost two-thirds (63%) did so because they faced long delays or could not access treatment on the NHS.
The latest NHS England figures show the number of people in England waiting for routine hospital treatments has jumped to a record 6.8 million. Of those who have gone private, almost half (46%) were forced to reduce their spending in other areas, plunder savings they had been keeping for another purpose, or get into financial debt to pay for it.
Miriam Levin, health and care programme director at Engage Britain, said: “While the NHS still unites many of us with a feeling of pride, it’s clear more and more people feel forced to turn to private treatment.
“As people suffer through months of pain and discomfort after postponed appointments, or waste time and energy chasing up referrals, millions are feeling desperate enough to use savings or get into debt to help us get well again.”
Read full story
Source: The Guardian, 11 September 2022
Patient Safety Learning
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