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

Give all women a menopause check at 45, MPs told

Women should be invited for a menopause check-up when they turn 45, a report for MPs says, criticising the current support as completely inadequate.
The Menopause All-Party Parliamentary Group says it has listened carefully to women's experiences, including difficulties getting a diagnosis and accessing hormone-replacement therapy (HRT).
Many had long waits or were offered antidepressants, against guidelines.
The report covers a year-long inquiry.
It says action is needed to improve the situation for those going through the menopause, and the families, friends and colleagues affected by it.
And a health check offered to all women in their mid-40s, as they approach the perimenopause - when hormones decline and menopausal symptoms, such as hot flushes and night sweats, can begin - should help ensure the necessary support and care as early as possible.
The inquiry heard a 39-year-old who suspected she was perimenopausal was turned away by her GP and told to "wait and see".
Some 18 months later, she was "almost at the verge of collapsing, struggling to keep my usually happy marriage on track and not functioning well physically or mentally".
The report also warns a socio-economic divide is emerging between women able to access the right treatment and those who lose out in the postcode lottery and do not have the financial means to seek treatment elsewhere.
Read full story
Source: BBC News, 12 October 2022
Patient Safety Learning

IT failure disrupts patient care ‘at number of trusts’

An IT failure has left clinicians at ‘a number of trusts’ which use the Cerner Millennium system unable to access patient records or write discharge summaries, according to an internal trust email seen by HSJ.
The email, sent to staff at Barts Health Trust this afternoon, said there was a “performance issue” with Cerner PowerChart which was affecting “a number of other trusts”.
The Powerchart programme is the part of the Cerner Millennium electronic patient record system used by clinicians to process document notes, request tests, view blood tests and scan reports.
At least 13 trusts in the English NHS are known to use the Cerner Millennium system but it is not yet clear how many trusts aside from Barts have been affected.
One clinician told HSJ the outage was “overwhelmingly unsafe” for patients.
Read full story (paywalled)
Source: HSJ, 11 October 2022
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NHS declares first-ever ‘amber alert’ over critically low blood supplies

The NHS has declared its first-ever amber alert over blood supplies, which have fallen to critically low levels.
The alert means some non-urgent operations that require blood are likely to be impacted, with hospitals advised to swap in other surgeries which do not require blood.
A letter is due to go out to hospitals on Wednesday, The Independent was told.
Hospitals will be asked to make individual decisions over whether to postpone surgeries such as hip replacements but will continue to carry out urgent surgeries and blood transfusions for those with long term conditions.
The “amber-alert” will last for four weeks initially, NHS Blood and Transplant has said.
Wendy Clark, interim chief of NHS Blood and Transplant said: “Asking hospitals to limit their use of blood is not a step we take lightly. This is a vital measure to protect patients who need blood the most.
“Patients are our focus. I sincerely apologise to those patients who may see their surgery postponed because of this."
“With the support of hospitals and the measures we are taking to scale up collection capacity, we hope to be able to build stocks back to a more sustainable footing."
Read full story
Source: The Independent, 12 October 2022
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Buffer zone to be set up outside Bournemouth abortion clinic

An extensive buffer zone is being put in place around a clinic in Dorset in order to prevent anti-abortion campaigners harassing service users and staff.
The zone will cover six streets around the British Pregnancy Advice Service clinic in Bournemouth and will be in force for 12 hours a day, five days a week for the next three years.
Anyone caught protesting, harassing, intimidating or photographing visitors or staff could incur a fixed penalty notice of £100 or be liable for conviction at a magistrates court.
Women have complained of being followed into the clinic or accosted when they leave. They have reported being told “the baby loves them” or asked whether they know they “murder babies” inside the building.
One worker told the Guardian she has witnessed “many distressed clients”, including one who injured herself trying to climb a wall to avoid walking past the protesters.
In another serious incident, an individual dressed in a monk’s cassock followed a staff member along the street in the dark while recording her.
One service user said: “It was really intimidating. You’re in a really vulnerable situation and you have all these people shouting at you and saying you’re going to hell.”
Read full story
Source: The Guardian, 11 October 2022
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WHO chief urges immediate action to tackle ‘devastating’ Long Covid

Long Covid is “devastating” the lives and livelihoods of tens of millions of people, and wreaking havoc on health systems and economies, the head of the World Health Organization (WHO) has warned as he urged countries to launch “immediate” and “sustained” efforts to tackle the “very serious” crisis.
The world has never been in a better position to end the Covid-19 pandemic, but it is also “very clear” that many of those infected by the virus, which first emerged in China in late 2019, are still experiencing “prolonged suffering”, the WHO director general, Dr Tedros Adhanom Ghebreyesus, said.
With the absence of evidence about how best to treat it, Long Covid is turning people’s lives upside down, and many face “often lengthy” and “frustrating” waits for support or guidance, Tedros said. The large numbers of those cruelly affected by the long tail of Covid is also having a dangerous impact on health systems and economies still reeling from waves of infections.
“While the pandemic has changed dramatically due to the introduction of many lifesaving tools, and there is light at the end of the tunnel, the impact of long Covid for all countries is very serious and needs immediate and sustained action equivalent to its scale,” Tedros said, writing for the Guardian.
Countries must now “seriously ramp up” both research into the condition and access to care for those affected if they are to “minimise the suffering” of their populations and protect their health systems and workforces.
Read full story
Source: The Guardian, 12 October 2022
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USA: Breast Implant Illness - Statement from President of BAAPS, Marc Pacifico

Breast implant illness (BII) is an umbrella term that has been used by some women who have breast implants to describe a wide array of systemic (affecting their whole body rather than a single body part) symptoms experienced by them. The symptoms frequently include tiredness, joint ache, brain fog, memory loss and headaches but many other symptoms have also been described.
The WHO (World Health Organisation) does not recognise “BII” as a medical diagnosis as it has not fulfilled the criteria to be classified as a disease. No scientific link between breast implants and these symptoms has yet been identified, however, many women who identify as having these symptoms experience varying degrees of relief after their implants are removed.
A huge amount of research has been done on this, and most notably, in the last few months 3 incredibly high level and well-designed research studies* have been published on this topic.
President of BAAPS, Marc Pacifico, said "My main advice is that firstly if you have implants and experience any symptoms (such as tiredness, joint ache, brain fog, memory loss etc), please do not first assume they are related to your implants. It is crucial that you see your GP to exclude other medical causes, that could range from medical diseases, infections, menopausal reasons or a host of other reasons that need to be excluded first. Secondly if undergoing implant checks, ensure that you are seeing an appropriately qualified surgeon on the GMC specialist register in either plastic surgery or general surgery with a special interest in breast surgery. Finally, you should be aware that there is no scientific evidence to support the benefit of undergoing the riskier so-called “en-bloc” capsulectomy (total intact capsulectomy) compared to other capsulectomy techniques when it comes to relieving systemic symptoms thought to be linked to breast implants or BII. This should not be presented to you as the only possible solution to your symptoms.”
Read full story 
Source: BAAPS, 12 October 2022
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NHSE plans 24-hour target for new hospital discharge service

NHS England is developing plans for a new universal ‘community recovery service’ with a 24-hour target to provide ‘step down care’ once a patient is deemed ready to leave hospital, HSJ has revealed.
Slides presented to an NHS England webinar reveal it is seeking to pilot “one single intermediate care step-down service [organised] at place through one lead commissioner”.
It would include a target, or standard, requiring that when patients no longer meet the “criteria to reside in hospital”, they enter the new community recovery service within 24 hours. NHSE’s “vision” is that this 24-hour standard is met for all acute hospital patients within five years, the slides seen by HSJ reveal. The documents do not specify whether they would also be discharged within 24 hours.
Delayed discharges have been a problem for many years, but have caused particularly huge difficulties in the past 18 months, leading to emergency department overcrowding and ambulance handover delays. In August, one in seven patients in acute hospitals were medically ready to be discharged, NHSE figures suggest. 
According to the documents seen by HSJ, key objectives for the new service also include reducing long-term care costs “by decreasing demand and acuity”, and ”increasing people’s functional outcomes” by giving more people better rehab care on discharge. This appears to be a recognition that at present many people discharged receive inadequate rehab, which can exacerbate their condition, requiring more care.
Read full story (paywalled)
Source: HSJ, 12 October 2022
Patient Safety Learning

Australian doctors struggling to meet demand of patients seeking help for Long Covid, inquiry told

Long Covid clinics across Australia are being inundated with requests for assessments from patients struggling with ongoing symptoms, an inquiry has heard.
Doctors told the federal parliamentary inquiry into long and repeated coronavirus infections that they were struggling to keep up with demand as waitlists increased.
At least 10 million Australians have been infected with Covid and it is estimated 3-5% will develop Long Covid at some point.
“Our waitlist is increasing because what we’ve observed is that it can take some time for the recognition of post-Covid conditions, particularly with the fatigue-predominant types, to reach us,” Royal Children’s hospital Associate Prof Shidan Tosif told the inquiry on Wednesday.
Patients are usually referred to specialist clinics through a GP and while there is no official cure, symptoms can sometimes be treated on a case-by-case basis.
The inquiry by the House of Representatives health committee is investigating the economic, social, educational and health impacts of long Covid and repeat infections.
Read full story
Source: The Guardian, 12 October 2022
Patient Safety Learning

Outstanding air ambulance team 'go the extra mile'

An air ambulance service has been praised by inspectors for providing an "outstanding level of care".
The Care Quality Commission (CQC) carried out checks on the Essex & Herts Air Ambulance Trust (EHAAT) in August and September.
The report said patients felt "truly respected and valued as individuals" and described teamwork as "exemplary".
Ben Myer, EHAAT head of clinical delivery, said "everyone worked so hard to make the desired result a reality".
The service provides emergency care and transport in Essex and Hertfordshire, and surrounding areas when needed.
As well as being rated outstanding overall, the charity was also rated outstanding for being safe, effective, caring, responsive to people's needs - and being well-led.
Jane Gurney, EHAAT chief executive, thanked the local community for supporting the service, and issued a personal thank you to "each team member across the charity, whatever their role, all of whom work so hard every day to uphold these high standards".
Read full story
Source: BBC News, 12 October 2022
Patient Safety Learning

Deaths inquiry will exclude dozens of concerning cases, says whistleblower

An inquiry into alleged efforts to cover up care failings at an ambulance trust has been criticised by a key whistleblower for being too limited in scope.
NHS England recently commissioned the inquiry into North East Ambulance Service, which has been accused of withholding key details from coroners in a number of deaths. Whistleblowers have raised concerns about disclosure in more than 90 cases.
Draft terms of reference for the review, seen by HSJ, say it will examine cases which occurred over a 12-month period up until December 2019.
Paul Calvert, a coroners’ officer at NEAS who raised concerns about the issues, said this effectively means only five cases will be scrutinised.
He added: “The terms of reference are clearly designed to not include the ongoing malpractice, only focusing on a limited time period and limited cases."
“The fact that the [inquiry] has chosen such a narrow time window and a handful of cases, is designed to perpetuate that after 2018 and 2019, the mistakes of the past were remedied. This is simply incorrect, misleading and dishonest to suggest.”
He said concerns about information being withheld continued “well into 2021” and the terms of reference risked “continuing the cover up of univestigated deaths”.
Read full story (paywalled) 
Source: HSJ, 13 October 2022
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Bullied 12-year-old struggled to get mental health support before suicide, inquest hears

The mother of a bullied 12-year-old girl has said her daughter struggled to get mental health support on the NHS in the months before she killed herself, and accused her school of failing to deal with inappropriate messages circulating among pupils.
The mother of Charley-Ann Patterson, Jamie, told a hearing that despite being seen by three medical professionals, Charley-Ann had been unable to get mental health support in the months before her death.
In a statement read at an inquest at Northumberland coroner’s court on 12 October, Jamie said her daughter had changed halfway through her first year of secondary school, when she was sent “inappropriate” and “shocking” messages by other pupils.
The inquest heard that Jamie first took her daughter to a GP over self-harm concerns in June 2019, but she said she “did not believe that the GP took Charley-Ann’s self-harm seriously, potentially due to her age”.
She took Charley-Ann to A&E in May 2020 after a second episode of self-harm, where she was referred to a psychiatric team and given a telephone appointment in which she was told Charley-Ann would be referred to child and adolescent mental health services (CAMHS), but that “it was likely that she would not be seen for three years”.
In an appointment with a nurse she was told that she would be referred to the Northumberland mental health hub for low mood and anxiety, but later learned “that this referral was never made”.
Read full story
Source: The Guardian, 12 October 2022
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NHS doing fewer operations as theatres go unused

The push to tackle the hospital backlog is being undermined by the struggle to get services back to full strength.
A BBC analysis shows the expected surge in new patients has not yet happened.
Instead, the waiting list in England is growing because the NHS is carrying out fewer operations and treatments than it was before Covid, despite a government push to boost capacity.
Surgeons said it was really frustrating as operating theatres were not being used due to a lack of beds and staff.
They say it is not unusual to find surgery cancelled at the last minute as staff are unavailable or intensive care and ward beds are full with other patients.
"It's tough on patients and tough on staff who want to get on and treat patients," said Tim Mitchell, vice-president of the Royal College of Surgeons of England.
"Without treatment, the health of patients can deteriorate. Not only do we need to get back to where we were before the pandemic, we need to do more if we are going to tackle the backlog."
Read full story
Source: BBC News, 13 October 2022
Patient Safety Learning

Heart attack responses a ‘shambles’ as patients face eight-hour ambulance waits

Senior doctors have sent a warning over the “shambles” of heart attack care after pressures on the NHS have left patients waiting eight hours for an ambulance.
The caution comes as several hospitals in the past week have declared critical incidents over the level of pressure on their emergency care services.
Portsmouth Hospital said on Monday: “Demand for an emergency response is far outstripping the capacity available in Portsmouth and South East Hampshire at this time.”
Professor Mama Mamas, a consultant cardiologist in Stoke and Professor of Cardiology at Keele University, told The Independent: “I was on call this weekend and I was seeing delays of eight hours. It was several people, three or four this weekend with heart attacks that waited between four and eight hours … it’s a national disgrace that we’re in this situation.
“I think that patient care is being compromised. We know that time is muscle and an eight-hour delay getting an ambulance to a patient with a heart attack is impacting on the survival levels.”
Read full story
Source: The Independent, 13 October 2022
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Signs of dementia may be detectable nine years before diagnosis

Scientists have discovered that it may be possible to spot signs of dementia as early as nine years before patients receive an official diagnosis.
The findings raise the possibility that, in the future, at-risk people could be screened to help select those who could benefit from interventions, or help identify patients suitable for clinical trials for new treatments.
Researchers at Cambridge University published the study – funded by the Medical Research Council with support from the NIHR Cambridge Biomedical Research Centre – in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.
Dr Richard Oakley, associate director of research at the Alzheimer’s Society, said the “important” findings suggested that “for some people who go on to develop Alzheimer’s disease, memory and thinking problems can begin up to nine years before they receive a diagnosis”.
He added: “This opens up the possibility of screening programmes in the future to help identify people at risk and who may benefit from interventions, and identify more people suitable for clinical trials for new dementia treatments, which are both so desperately needed.”
The study’s first author, Nol Swaddiwudhipong, said: “This is a step towards us being able to screen people who are at greatest risk – for example, people over 50 or those who have high blood pressure or do not do enough exercise – and intervene at an earlier stage to help them reduce their risk.”
Read full story
Source: The Guardian, 13 October 2022
Patient Safety Learning

Doctors furious at NHS bosses’ TikTok video showing off gleaming offices

A video of an NHS trust’s flamboyant head office complete with a £1,000 coffee machine, sleeping pods and a “great view” has triggered fury from doctors and nurses.
Barts Health, which covers hospitals in east London as well as St Bartholomew’s in the City, shared a TikTok video of its corporate office in Canary Wharf. The video, which has since been deleted, showed a luxury coffee machine, “wellbeing rooms” on each floor, free snacks and curved computer screens.
However, doctors working at Barts reacted angrily and compared the video with their own facilities.
One junior doctor shared a photo of a cramped locker room in the same trust. They wrote on Twitter: “Bags on the floor as ‘no lockers available for juniors’. This tiny room is the entirety of the space available to get changed into mandatory uniform/scrubs – nightmare at shift changeover.” 
Another shared a picture of their “handmade rest facility” – a row of chairs with paper towels for a pillow.
The British Medical Association’s Junior Doctors Committee said it was “sobering” to see the “no expenses spared” approach in the trust’s corporate office.
Read full story (paywalled)
Source: The Telegraph, 11 October 2022
Patient Safety Learning

Insulin access still “severely limited” in low-income countries, report finds

Efforts by pharmaceutical companies to tackle global insulin inequity are “fragmented” and “falling short,” with many people with diabetes around the world still not having access to the drug.
A report by the Access to Medicine Foundation examined access schemes run by the three main insulin manufacturers—Eli Lilly, Novo Nordisk, and Sanofi. It found that despite the programmes they run, access to the treatment is still severely limited or lacking in many low and middle income countries (LMICs).
By 2030, the number of people with diabetes worldwide is expected to reach 643 million, with the numbers rising most rapidly in LMICs.
The analysis reported that over the past decade pharmaceutical companies have carried out a “patchwork of approaches” that were often focused on a small number of countries or based around particular types of products or specific patient populations.
It noted that most of the strategies had not guaranteed “sustained access for insulin dependent patients requiring ongoing, lifelong treatment” and most of the affordability schemes have been primarily focused on human insulins, with only a few for analogue products.
Read full story (paywalled)
Source: BMJ, 11 October 2022
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