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

NHS staff shortages are ‘biggest’ sepsis risk this winter, charity warns

The looming NHS staffing crisis could lead to more patients dying from sepsis, a major UK charity has warned.
Doctors have told the UK Sepsis Trust that staff shortages and high numbers of patients to treat are two of the most common factors preventing them from following national sepsis guidance.
The chief executive of the UK Sepsis Trust, Dr Ron Daniels, warned that the NHS was in a “fragile” state and said workforce shortages were some of the “biggest potential causes of harm” in the context of diagnosing the condition.
In a report by the trust, shared with The Independent, 65 out of 100 doctors in the UK warned that they had missed cases of sepsis.
The most common reason for this was staff shortages alongside “high patient caseloads”, they said.
Dr Daniels warned that staff might find it increasingly difficult to spot sepsis in the coming months as the staffing crisis intensifies.
He told The Independent: “The NHS is in a fragile state after the pandemic... and staff absence is a fact of life within the NHS at the moment. That’s partly because staff have left, it is partly because we have high caseloads, but it is also because staff are still off sick".
“It is my view that staff shortages are one of the biggest potential causes of harm that our public face in the context of developing sepsis, and we need to urgently address it.”
Read full story
Source: The Independent, 26 September 2022
Patient Safety Learning

IHPN launch “refresh” of medical governance framework for independent providers

The Independent Healthcare Providers Network (IHPN) have today launched a “refresh” of its Medical Practitioners Assurance Framework (MPAF), designed to further improve the safety and quality of care independent providers deliver to patients.
Initially launched in October 2019, the MPAF – led by former National NHS Medical Director Sir Bruce Keogh – contains key principles to strengthen and build upon the medical governance systems already in place in the sector and sets out expected practice in a number of key areas.
Care Quality Commission (CQC) now uses the framework’s principles in assessing how well-led an independent service is, with the framework a requirement of the NHS’ 2022/23 Standard Contract which all independent sector providers of NHS-funded care must adhere to.
The MPAF was always designed to be a “live document” and today’s refresh strengthens the framework to ensure it remains in-keeping with current best practice in the health system. This includes taking into account recommendations from the Bishop of Norwich’s inquiry into Ian Paterson, as well as Baroness Cumberlege’s Independent Medicines and Medical Devices Safety Review (IMMDS). Key areas strengthened in the refresh include giving more prominence to expectations around patient consent, and the need to have greater transparency around conflict of interest declarations.
New initiatives such as the Learn from Patient Safety Events (LFPSE) service are also reflected in the refreshed framework, as well as an IHPN Development Plan which sets how the network will support providers to continue to implement the MPAF.
 David Hare, Chief Executive of the Independent Healthcare Providers Network (IHPN) said:
 “IHPN are delighted to be launching today a new refresh of our Medical Practitioners Assurance Framework (MPAF), reflecting the independent health sector’s commitment to continuously improving the safety and quality of care they deliver to millions of patients every year.
“Since the MPAF was launched in 2019, independent healthcare providers – with the support of CQC and NHS England –  have really embraced the framework, using it to review and update their practices to further raise the bar in medical leadership in the sector.
“With a continued focus amongst the entire healthcare system around improving patient safety and quality, this framework ensures providers adhere to the latest medical governance practices.
“This will not only ensure greater consistency around how clinicians work across the independent sector and NHS, but also give confidence to patients that independent healthcare providers are committed to delivering the safest possible care”.
Read press release
Source: Independent Healthcare Providers Network, 26 September 2022
Patient Safety Learning

Republican abortion bans in the US restrict women’s access to other essential medicine

Many pharmacies and physicians are forced to deny patients access to drugs, such as methotrexate, that can be used to help induce an abortion
A few weeks after the supreme court’s 24 June decision to overturn the nationwide abortion rights established by Roe v Wade, the pharmacy chain Walgreens sent Annie England Noblin a message, informing her that her monthly prescription of methotrexate was held up.
Noblin, a 40-year-old college instructor in rural Missouri, never had trouble getting her monthly prescription of methotrexate for her rheumatoid arthritis. So she went to her local Walgreens to figure out why, standing in line with other customers as she waited for an explanation.
When it was finally her turn, a pharmacist informed Noblin – in front of the other customers behind her – that she could not release the medication until she received confirmation from Noblin’s doctor that Noblin would not use it to have an abortion.
Since the supreme court’s elimination of federal abortion rights, many states have been enacting laws which highly restrict access to abortion, affecting not only pregnant women but also other patients as well as healthcare providers.
As a result, many pharmacies and physicians have been forced to deny and delay patients’ access to essential medications – such as methotrexate – that can be used to help induce an abortion.
Noblin is one of the 5 million methotrexate users across the US and one of the country’s many autoimmune patients. Although she was eventually given her prescription, Noblin and other patients are now forced to grapple both with a monthly invasion of privacy at pharmacies that ask them about their reproductive choices as well as the possibility of being wholly denied the medication in the future due to restrictive laws.
Read full story
Source: The Guardian, 26 September 2022
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Coffey accused of leaving NHS 'in limbo' on A&E target

The four-hour emergency care target is “not the right answer” long term, but services have been left “in limbo” by Therese Coffey’s promise that it will no longer be scrapped, the president of the Royal College of Emergency Medicine has said.
Katherine Henderson said RCEM was “delighted” there could be more focus on the four-hour target in the short term following the health and social care secretary’s surprise comment last week, as emergency care has been “in a performance policy vacuum since before the pandemic”.
But Dr Henderson said that in the long term there should be performance metrics that account for the “journey” of the most acutely unwell patients, and should be a further review of NHS England’s clinical review of standards – which proposed a suite of new measures to replace the totemic four-hour target. She added that more than a dozen A&Es which are involved in trialling the new measures have been “left in limbo”.
Dr Henderson, whose term as RCEM president ends in October, said plans to use virtual wards and urgent community response teams to improve patient flow and prevent emergency admissions would have limited impact this winter due to a lack of staff.
Read full story (paywalled)
Source: HSJ, 26 September 2022
Patient Safety Learning

Almost 6,000 people harmed by prescription errors in NHS last year

A pregnant woman who died after being given the wrong dosage of drugs was one of almost 6,000 people harmed and 29 killed following prescription errors in the NHS in England last year.
Figures from NHS England show that 98 hospital trusts experienced an increase in the number of prescription errors reported in 2021, including cases where patients were given the wrong drug, wrong dosage or were not given medicine when needed. Meanwhile, the number of errors fell at 105 trusts.
Leeds Community healthcare trust had a sixfold increase in prescription errors – with 111 errors, up from just 17 in 2020. At the Royal National Orthopaedic hospital errors rose from 60 to 193, while Herefordshire partnership university NHS trust had 55 errors, up from 20 in 2020.
The NHS said that some trusts still did not have a fully funded plan to introduce electronic prescribing, meaning they are still run at least partially using paper notes.
Peter Walsh, the chief executive of Action against Medical Accidents, said: “These are very disappointing statistics and behind every one there is a story of personal suffering or tragedy. What is particularly frustrating is that prescription errors are probably easier to avoid than many things that go wrong in healthcare".
“We are particularly concerned about vulnerable people such as elderly or disabled people in care homes, who may be more at risk because they may be less able to check for themselves and because they tend to get a less personalised service than the average patient.”
Read full story
Source: The Guardian, 26 September 2022
Patient Safety Learning

‘Four-hour rush’ continuing at top A&Es

Hospital trusts are still treating many patients just before the four-hour A&E target deadline, whose proposed abolition was reversed by government last week, HSJ analysis has revealed. 
Several of those still treating large proportions of attenders in the 10 minutes before the cut-off are among the top performers on the target.
NHS England’s 2019 clinical review of standards had proposed to scrap the four-hour target, claiming it was no longer the most appropriate or effective measure. NHSE had planned to replace it with a new bundle of measures, such as the average time spent in emergency departments. It has been trialling these at 14 trusts for more than two years, with enforcement of the four-hour target by NHSE being substantially wound down.
The move to end use of the four-hour target was never officially endorsed by government, but both Matt Hancock and Sajid Javid indicated they backed the idea. However, their successor as health and social care secretary, Therese Coffey, announced that she would not be abolishing it.
Royal College of Emergency Medicine president elect Adrian Boyle warned this “target-associated” patient flow could be “diverting clinicians away from more sick cases to people with lower acuity”. He added “the scrutiny and managerial grip that used to go with [the target]” has been “taken away”.
Read full story (paywalled)
Source: HSJ, 27 September 2022
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NHS eating disorder services forced to ‘exclude’ patients and ‘ration care’

Patients are being excluded from life-saving eating disorder treatment as services are severely underfunded, experts have warned.
Adult eating disorder services are so severely underfunded and understaffed that they are having to employ rationing measures and turn away patients, leading psychiatrist Dr Agnes Ayton told The Independent.
In their research, Dr Ayton and 22 other psychiatrists found that in 2019-20, just 31% of eating disorder services accepted all patients, regardless of the level of illness.
The researchers warned that the situation had become more serious following the pandemic, which had driven a “worsening of the demand and capacity” crisis across the services.
Experts have called for emergency funding to meet the needs of adult patients with eating disorders, and say that these services should be receiving at least £7m per million population each year to meet standards.
Dr Ayton warned that patients who are “literally on death’s door” are not getting care when they need it.
Read full story
Source: The Independent, 25 September 2022
Patient Safety Learning

Flu poses 'significant threat' in Wales this winter, officials warn

Flu could pose a "significant" threat this winter for the first time since the Covid pandemic, public health expert have warned.
There are concerns the flu season may start earlier and affect more people, as other respiratory viruses re-emerge following Covid restrictions.
Public Health Wales is urging adults and children who are eligible for a free flu jab to take up the offer. The announcement comes as cases of flu have already been detected in Wales.
All children between two and 16 are eligible for a free flu vaccine - although only certain groups of children over five are eligible for Covid-19 boosters.
The warning comes after Australia experienced its highest number of flu cases in five years, with its season starting early.
Experts fear Wales and the UK could see similar levels this winter.
Read full story
Source: BBC News, 27 September 2022
Patient Safety Learning

Doctors in Ebola zone strike over safety fears

Trainee medics battling Ebola in Uganda's virus epicentre accuse the government of putting their lives at risk.
"Most times you come into contact with a patient and you use your bare hands," one worker told the BBC anonymously.
All trainees at Mubende's regional hospital say they are on strike and are demanding to be moved somewhere safer.
But Ugandan health ministry spokesman Emmanuel Ainebyoona told the BBC there was "no strike at the hospital".
Yet all 34 of the hospital's interns - including doctors, pharmacists and nurses - have announced their decision to strike in a joint statement. They say they are being put at undue risk because they lack appropriate safety kit, risk allowances and health insurance.
Six interns at the hospital have already been exposed to the virus, and are awaiting their test results in isolation.
Read full story
Source: BBC News, 26 September 2022
Patient Safety Learning

Anger after NHS Trust says it has no plans to publish 'independent' review into deaths of three young people

Families have blasted a NHS Trust after it said it did not intend to publish an independent review into their loved ones deaths. Three young people died in nine months at the same mental health unit.
A Coroner was told last week that the review will be "ready" this month. Rowan Thompson, 18, died while a patient at the unit, based in the former Prestwich Hospital, Bury, in October 2020, followed by Charlie Millers, 17, in December that year, and Ania Sohail, 21, in June last year.
Earlier this year, Greater Manchester Mental Health NHS Foundation Trust (GMMH), which runs the hospital, commissioned an 'external report' into the deaths. A pre-inquest hearing into the death of Rowan - who used the pronoun 'they' - heard that the full report would be available for the coroner to read 'on or around September 30'.
Asked by the Manchester Evening News if the review would be published a spokesperson for the Trust said the Trust "always act on the wishes of the family regarding publication of reports," adding "and so in line with this we have no immediate plans to make the report public."
But the parents of both Rowan Thompson and Charlie Mllers said they wanted the report publishing. Charlie's mother, Sam, said: "We want it published. It needs to be put out there, otherwise there is no point in having it. We are hoping they (The Trust) will learn lessons. We want answers but it should also be published for the benefit of the wider public - and the parents of other young people who are being treated in that unit."
Read full story
Source: The Manchester News, 13 September 2022
Sam

NHS trusts in England offered extra funding to recruit overseas nurses

Health service trusts in England are to be given additional funding to recruit nurses from overseas amid record staff shortages and increased demands.
For nurses recruited between 1 January and 31 March 2023, trusts will be able to claim £7,000 per overseas nurse from NHS England. This is up to £4,000 higher than the financial support on offer during 2021-22.
The move was unveiled by NHS Employers on its website last week and confirmed to Nursing Times by NHS England.
NHS Employers said the additional funding reflected the rising costs of flights, accommodation and preparation costs for the nursing and midwifery objective structured clinical examination (OSCE).
The OSCE forms part two of the Nursing and Midwifery Council’s test of competence and is a practical exam in which overseas nurses and midwives are tested on their clinical and communication skills.
Responding to the move, Unison’s head of health, Sara Gorton, said: “Extra cash to tackle the chronic staffing shortages in the NHS is essential.”
She warned that, until NHS staff vacancies ware addressed, there “will be a need for overseas recruitment”. “But it has to be done in the best interests of the individual workers,” she added.
Ms Gorton highlighted ongoing concerns about unethical recruitment of nurses from overseas and the poor treatment many report facing.
“Sadly, overseas nurses are still being exploited by unscrupulous care and health employers,” she said. “This is no way to treat those who come to offer the UK their help.”
Read full story (paywalled)
Source: Nursing Times, 27 September 2022
Patient Safety Learning

UK children’s doctors given advice on how to help families in poverty

Children’s doctors plan to help poor families cope with the cost of living crisis and its feared impact on health, amid concern that cold homes this winter will lead to serious ill health.
In an unusual move, the Royal College of Paediatrics and Child Health (RCPCH) is issuing the UK’s paediatricians with detailed advice on how they can help households in poverty.
It has drawn up a series of resources, including advice for doctors treating children to use appointments to talk sensitively to their parents about issues that can have a big impact on their offspring’s health. These include diet, local pollution levels, socio-economic circumstances and difficulties at home or school, which are closely linked to children’s risk of being overweight, asthmatic or stressed.
“Don’t shy away from it,” the RCPCH’s 17-page manual says. “If we aren’t asking families about things which may impact on their children’s health, we are short-changing the children themselves.”
However, it adds that paediatricians should “pick your timing carefully [as] parents can feel alienated if we are perceived as jumping in with two feet to ask about smoking when they are stressed about an acutely unwell child with pneumonia.”
Read full story
Source: The Guardian, 22 September 2022
Sam

Women's symptoms ignored by GPs

Too many women feel fobbed off or not listened to when they raise concerns about their health, according to a women's health campaign group.
The Women's Health Wales coalition says women are often misdiagnosed or have to push for a diagnosis.
The theme has emerged repeatedly during BBC Wales interviews with women.
The Welsh government said it had set out what's expected of the NHS on women's health, and a full plan is due to be published this autumn.
"From the moment I went to my GP about my symptoms in my late teens, I have always felt dismissed," said Jessica Ricketts, 35, who was diagnosed with endometriosis.
But the feeling of being fobbed off has cropped up in countless conversations with women whether it be in relation to a heart attack, UTI, stroke, autism or even brain tumour.
Patients have told us that clinicians thought they were having a panic attack rather than a heart attack," said Gemma Roberts, policy and public affairs manager at British Heart Foundation Cymru, and co-chair of the Women's Health Wales coalition.
"We hear from patients and from clinicians that women have to see their GPs multiple times before they get a diagnosis. Women often aren't listened to.
"They are told that pain is a normal part of the female experience but actually that isn't the case. I think we need to be listening to women more about what's going on with their own bodies."
The coalition wants:
Greater focus on women's health from the very beginning of medical training. Health data to be broken down by protected characteristics because "the stories of women with those backgrounds goes untold". Equitable access to healthcare, including specialist care, regardless of where women live in Wales. Read full story
Source: BBC News, 28 September 2022
Related blogs on the hub
‘Women are being dismissed, disbelieved and shut out’ The normalisation of women’s pain Gender bias: A threat to women’s health
Patient Safety Learning

Centre has ‘lost the narrative’ over NHSE merger

The NHS should reduce the number of different electronic patient records (EPRs) used by trusts and instead rely on a smaller set of suppliers with nationally agreed prices, according to the CEO of NHS Digital.
Simon Bolton, who is also NHS England’s interim chief information officer, also said NHSD and NHSE had “lost the narrative a little bit” over their forthcoming merger, due to a “fixation” with reducing NHSE staff numbers by a third; and that the centre of the NHS remained too “autocratic and authoritarian”.
Mr Bolton said there were “too many” different EPRs used in the health service and said no private sector organisation would allow such variability for so long.
His comments come amid a national drive to improve the uptake and quality of EPRs across NHS providers, following new technology targets set by the government earlier this year.
Read full story (paywalled)
Source: HSJ, 28 September 2022
Patient Safety Learning

Contacting the Patient Safety Commissioner for England

Dr Henrietta Hughes was appointed as the first ever Patient Safety Commissioner for England in July. She began her role on 12 September.
Dr Hughes is an independent point of contact for patients so that patients’ voices are heard and acted upon. She will use patients’ insight to help the government and the healthcare system in England listen and respond to patients’ views and promote patient safety, specifically with regard to medicines and medical devices.
For more information on the role of the Patient Safety Commissioner see the fact sheet and the government’s response to a consultation regarding the post.
The privacy notice sets out how the Patient Safety Commissioner collects and uses personal data to fulfil the role.
Please contact the Patient Safety Commissioner at [email protected].
Source: Department of Health and Social Care, 28 September 2022
Patient Safety Learning

Superbug ‘pandemic’ stalks India as antibiotic resistance jumps 10% in a year

India faces a “pandemic” of superbugs, the country’s top public health experts have warned, as resistance to common antibiotics has jumped by 10% in just one year
In the fifth edition of its annual report on antimicrobial resistance (AMR), the Indian Council of Medical Research warned that urgent action is needed to prevent a major health crisis caused by the rampant misuse of antibiotics.
“The resistance level is increasing to five to ten per cent every year for broad spectrum antimicrobials, which are highly misused,” said Dr Kamini Walia, who led the ICMR’s report.
“Antibiotic resistance has the potential of taking the form of a pandemic in the near future if corrective measures are not taken immediately.”
The report warned that only 43% of pneumonia infections in India could be treated with first line antibiotics in 2021 – down from 65% in 2016.
“We could absolutely see a pandemic driven by AMR infections in India,” said Ramanan Laxminarayan, director of the One Health Trust, a global public health think tank. “It is certainly within the realms of possibility, it could be next year or over the next two decades.
“Bacterial infections were the biggest killers in the early 20th Century and we risk going back to that time where there are no effective antibiotics and infections can spread rapidly,” he added.
Read full story (paywalled)
Source: The Telegraph, 16 September 2022
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