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

NHS staff struggling with menopause choosing to leave

The NHS faces an “exodus” of female doctors who are struggling to work due to a lack of menopause support, a report has warned.
The Medical Protection Society, which helps doctors in legal and ethical disputes, said that many quit or reduce their hours over fears that their menopause symptoms, such as brain fog, insomnia and hot flushes, will cause them to accidentally harm patients. A survey found that 36 per cent of female doctors have considered reducing their hours because of menopause symptoms, while one in five have considered early retirement.
“With females making up most of the healthcare workforce, it is crucial that they can access the support they need to avoid an exodus from the profession,” the report said.
Read full story (paywalled)
Source: The Times, 26 October 2022
Patient-Safety-Learning

Board to get anti-racism training as CQC orders cultural improvements

Regulators have told the agency that supplies blood to the NHS to develop a more inclusive culture, after hearing multiple reports of ethnic minority staff being ‘disrespected’ and discriminated against.
“Many staff” at NHS Blood and Transplant also expressed fear of reprisal for raising issues and concerns, the Care Quality Commission (CQC) said.
The CQC carried out a “well-led” inspection of the agency over the summer, after receiving concerns about its culture and the behaviour of some senior leaders.
Chief executive Betsy Bassis resigned after the inspection, although the CQC report does not refer to any specific allegations made against her.
NHSBT has acknowledged it needs to improve its culture, particularly around diversity and inclusion issues. An internal memo sent to staff last week, seen by HSJ, said executives and board members would receive one-to-one training in “inclusive leadership and understanding racism”.
Read full story (paywalled)
Source: HSJ, 27 October 2022
Patient Safety Learning

Long Covid: ‘fraction’ of patients getting NHS help in England

Just a “fraction” of people with Long Covid is getting the help they need, with a third of them waiting more than three and a half months to be assessed after a GP referral, rising to almost half in some areas.
More than 60,000 people in England had a first assessment for post-Covid syndrome in an NHS specialist service between July 2021 and August 2022.
But the latest estimates released by the Office for National Statistics (ONS) show that about 277,000 people with Long Covid in England report that the disease has limited their day-to-day activities “a lot”. These are the people that experts would expect to be referred for an assessment; however, the numbers who have been seen are far lower.
Dr Helen Salisbury, a GP and columnist for the BMJ, said: “A fraction of the people who have got this problem are actually being seen” within the existing services.
She said reasons could include patients not realising that the help is available to them; GPs not recognising Long Covid in those who do not self-label as having the condition; and a lack of knowledge of, and local access to, specialised clinics.
While Salisbury conceded that there was no current cure for long Covid, she added that patients require treatment that involves symptom management, psychology and knowing they are not alone in their diagnosis.
Ondine Sherwood, a co-founder of the advocacy charity Long Covid SOS, said many people with long Covid “are struggling to get any healthcare. Many are not getting any treatment at all.”
She said public misconceptions around long Covid made it harder for sufferers to ask for and get help. “There was a lack of preparedness for the potential long-term morbidity which was not conveyed to healthcare professionals and this has contributed to the lack of care for long Covid.”
Read full story
Source: The Guardian, 27 October 2022
Patient Safety Learning

Struggling trusts’ CEOs must ‘self certify’ to NHS England

Bosses at struggling trusts must sign new commitments to national leaders about how they are approaching the task of clearing their elective and cancer backlogs, under a new protocol drawn up by NHS England.
National leaders have written to CEOs and chairs of trusts in NHSE’s bottom two “tiers” for elective and cancer performance, telling them they must fill out a new “board self certification” by 11 November.
It requires them to sign that they have carried out a list of 12 separate actions to try to improve.
In addition to some fundamental administrative requests, these include increased scrutiny around issues such as theatre productivity, list validation, especially for non-admitted lists, and cancer pathway redesign.
Read full story (paywalled)
Source: HSJ, 28 October 2022
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Rotherham NHS Foundation Trust fined for exposing babies to 'serious harm'

A hospital trust has been fined £200,000 for putting four babies at "serious risk"of harm.
Staff at Rotherham Hospital failed to spot non-accidental injuries during admissions, Sheffield Magistrates' Court heard.
District Judge Naomi Redhouse criticised failures in the hospital's systems and processes.
Health watchdog, the Care Quality Commission (CQC), had earlier highlighted problems with safeguarding training at the trust prior to the babies' admissions between January 2019 and February 2020.
The court was told how one eight-day-old baby was brought into the hospital on 23 December 2019 suffering from breathing difficulties and bleeding from the nose and mouth.
It was only on the child's fifth visit to hospital - after a GP raised concerns - that a child safety examination took place, revealing rib and leg fractures that were deemed non-accidental.
Ms Redhouse also heard how a month-old baby brought in with a mouth injury on 20 January 2019 was on a child protection plan but this was not spotted by the paediatric nurse who examined the baby.
This child was twice released from hospital, with no safeguarding concerns, before a scan and other examinations revealed multiple fractures, the court heard.
Prosecutor Ryan Donohue said failings had been identified in areas including policy implementation, training, reporting, auditing and governance.
Eleanor Sanderson, mitigating for the trust, said: "The trust wishes to express to the court its deep regret for the circumstances which gave rise to these offences and the risk posed to those who required safeguarding."
Read full story
Source: BBC News, 26 October 2022
Patient Safety Learning

Home blood test kits ‘piling work on NHS’

Private companies are offering “misleading” home blood-testing kits that fuel health anxieties and pile pressure on the NHS, a report has suggested.
There has been a boom in sales of the kits, which promise to reveal everything from cancer risk to how long patients can expect to live.
But an investigation by the BMJ found these “unnecessary and potentially invasive tests” can be misleading and generate false alarms. The NHS is then left to “clear up the mess” as worried patients see GPs for reassurance or extra tests, piling more pressure on the overstretched service.
One GP described patients coming in “clutching the results of private screening tests”, with doctors asked to review the results.
The companies have been criticised for not providing sufficient follow-ups after the “poor quality and overhyped” tests, and for misleading results such as wrongly telling people their test levels are outside the “normal” range.
Bernie Croal, president of the Association for Clinical Biochemistry and Laboratory Medicine, said: “Most of the online [tests] will send the results to the patient with at best a sort of asterisk next to the ones that are abnormal, with advice to either pay some more money to get some sort of health professional to speak about it or go and see your own GP.”
Doctors are calling for the tests to be more tightly regulated by the health watchdog, the Care Quality Commission.
Read full story (paywalled)
Source: The Times, 27 October 2022
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WHO publishes first ever list of fungal infections that pose ‘major threat’

The World Health Organization has published its first ever list of lethal fungal infections that represent a threat to public health.
Experts have noticed an increase in deadly fungal disease, with drug-resistant bacterial infections now responsible for roughly 1.27 million deaths every year.
“Fungal pathogens are a major threat to public health as they are becoming increasingly common and resistant to treatment,” WHO said.
The types of fungal infections listed often affect severely ill patients and those with significant underlying problems with their immune system, including people with cancer, HIV or AIDs, organ transplants, chronic respiratory disease or tuberculosis.
“Emerging from the shadows of the bacterial antimicrobial resistance pandemic, fungal infections are growing, and are ever more resistant to treatments, becoming a public health concern worldwide,” said Dr Hanan Balkhy, WHO assistant director-general, antimicrobial resistance, said.
In its new report, the WHO warns that there is only limited access to quality diagnostics and treatment for these developing fungal diseases. Medicines are often unavailable in low and middle income countries, leading to increased deaths among these populations.
One deadly fungal pathogen, Candida auris, which is resistant to multiple drugs, is particularly difficult to eradicate from hospitals - even with intensive infection prevention measures, the WHO said.
This means hospital wards often have to be shut down for prolonged periods of time when Candida auris is detected.
Read full story
Source: The Independent, 26 October 2022
Patient Safety Learning

USA: Patients from minority groups face longer wait times for vital lung cancer treatment

Patients from minority groups are facing longer wait times for potentially life-saving lung cancer treatment compared to their white counterparts, according to a study.
Experts warn that disparities can have real consequences – the earlier treatment is initiated, the better the health outcomes for patients.
Researchers at the University of Virginia (UVA) Cancer Centre reviewed data from more than 222,700 patients with non-small cell lung cancer across the US.
The findings, published in the scientific journal Health Equity, showed that the mean time for radiation initiation was 61.7 days. Broken down by ethnicity, white patients had to wait only 60.9 days, while Black patients had a wait time of 65.9 days, meanwhile for Asian patients, it was 71.9 days.
A single-week delay in treatment could lead to a 3.2% and 1.6% increase in the risk of death for patients with stage I and stage II non-small cell lung cancer, respectively.
“Our results suggest that non-white lung cancer patients have delayed time to cancer treatment compared with white patients, and this is not limited to a particular type of treatment facility,” said senior researcher Rajesh Balkrishnan, PhD, of UVA Cancer Center and the University of Virginia School of Medicine’s Department of Public Health Sciences.
“Collaboration among providers and community stakeholders and organisations is much needed to increase accessibility and patient knowledge of cancer and to overcome existing disparities in timely care for lung cancer patients.”
Scientists cite multiple reasons for the racial disparities, including health insurance – non-white patients are more likely to be uninsured, face greater socioeconomic barriers to care and may be perceived by doctors as being at risk for not following through with treatment plans.
Read full story
Source: The Independent, 26 October 2022
Patient Safety Learning

Halt patient access to medical records if there are safety concerns, BMA tells GPs

General practices should delay rolling out the accelerated citizens’ access programme, due to go live on 1 November, if they have concerns over safety, the BMA has said.
In guidance published on 25 October the BMA’s General Practitioners Committee said that while many practices would be able to implement the scheme before the deadline some would need more time to prepare, to ensure that they can roll it out in line with the Data Protection Act and safeguarding measures.
The access scheme, led by NHS England, will automatically give patients the ability to see any new entries to their GP medical record through the NHS App.
As part of safeguarding practices it will require GPs to review each record to identify any safety concerns related to providing patient access, such as in cases of domestic violence or coercive relationships. Where there are safeguarding concerns, practices can prevent patients from having automatic access by adding a specific SNOMED code to the patient’s record before 1 November 2022.
David Wrigley, deputy chair of the BMA’s GP Committee for England, said, “We have a duty of care to speak up when patient safety is at risk, which is why we encourage practices even slightly unsure about whether they can deliver this programme before the start of November, to refer to our guidance. Our patients are at the heart of what we do, and we will always act in their best interests.”
Read full story
Source: BMJ, 26 October 2022
Patient Safety Learning

NHS AI Lab and Health Education England call for healthcare staff to be trained in AI

A new report published by the NHS AI Lab and Health Education England (HEE) has advocated for training and education for providers in how they deliver and develop AI guidance for staff.
The report, entitled ‘Developing healthcare workers’ confidence in AI (Part 2)’, is the second of two reports in relation to this research and follows the 2019 Topol Review recommendation to develop a healthcare workforce “able and willing” to use AI and robotics. It is also part of HEE’s Digital, AI and Robotics Technologies in Education (DART-ED) programme, which aims to understand the impact of advances of these technologies on the workforce’s education and training requirements.
In the previous report, the AI Lab and HEE found that many clinicians and staff were unaccustomed to the use of AI technologies, and without the suitable training patients would not be able to experience and share the advantages.
The new report has set out recommendations for education and training providers in England to support them in planning, resourcing, developing and delivering new training packages in this area. It notes that specialist training will also be required depending on roles and responsibilities such as involvement in implementation, procurement or using AI in clinical practice.
Brhmie Balaram, Head of AI Research and Ethics at the NHS AI Lab, added: “This important new research will support those organisations that train our health and care workers to develop their curriculums to ensure staff of the future receive the training in AI they will need. This project is only one in a series at the NHS AI Lab to help ensure the workforce and local NHS organisations are ready for the further spread of AI technologies that have been found to be safe, ethical and effective.”
Read full story
Source: Health Tech Newspaper, 25 October 2022
Patient Safety Learning

Nurses are working the equivalent of one day a week for nothing, research says

Nurses are working the equivalent of one day a week for nothing, according to a study.
Researchers from London Economics were commissioned by the Royal College of Nursing (RCN) to look at pay in England, Wales, Scotland and Northern Ireland since 2010.
They found that the salary of an experienced nurse had fallen by 20% in real terms, based on a five-day week.
Experienced nurses in England, Wales, and Northern Ireland would need a nominal pay rise of 45% by 2024-25 just to return their salaries to levels seen in 2010-11 in real terms, the research said.
And such a pay rise would actually help the NHS save money in the long term, as it would be cheaper than hiring staff from overseas, according to the study.
Dr Gavan Conlon, who oversaw the research, said that bringing staff in from overseas costs approximately £16,900 more annually than retaining a nurse, while using agency workers costs around £21,300 more per year.
He said that about 32,000 nurses leave the NHS every year, many due to the failure of their pay to keep up with the rising cost of living.
The RCN is balloting its 300,000 members for strike action, calling for higher pay and an effort by government to fill the hundreds of thousands of nursing vacancies across the country.
Read full story
Source: Sky News, 28 October 2022
Patient Safety Learning

CQC inspection approach helping fuel emergency care crisis, says trust chief

A trust chief executive says the Care Quality Commission’s (CQC) inspection regime is still overly focussed on individual organisations, rather than systems, and this is driving the “risk aversion” which is partly responsible for the emergency care crisis.
Mid Yorkshire Hospitals Trust CEO Len Richards acknowledged the CQC has started to scrutinise system-wide issues but suggested the “heat” of its regulation is still on individual providers.
Mr Richards told the House of Lords’ public services committee on Wednesday that care homes and nursing homes in his area have declined to take patients ready to be discharged from hospital, due to concerns it would put their CQC accreditation at risk.
He said: “[Last winter] we asked nursing homes and care homes to take patients and they couldn’t take them beyond a certain limit because it would put their accreditation at risk.
“We went to the CQC to try and create some flexibility. Their perspective was very much of an independent regulatory body that would look at the organisation and not look at the system. I think we’ve got an awful long way to go there.
“I think regulation does drive risk aversion… [and] the heat of regulation right at the moment is on individual organisations.
“Therefore, when the CQC come and look at my organisation, they will talk about congestion in the A&E department. They won’t talk about the assessment that we made around there being a greater risk in the community if we didn’t offload ambulances.”
Read full story (paywalled)
Source: HSJ, 28 October 2022
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Pinned down, force-fed and drugged into ‘zombie-like’ state: ‘Systemic abuse’ at children’s hospitals revealed

Children say they were "treated like animals" and left traumatised as part of a decade of “systemic abuse” by a group of mental health hospitals, an investigation by The Independent and Sky News has found.
The Department of Health and Social Care has now launched a probe into the allegations of 22 young women who were patients in units run by The Huntercombe Group, which has run at least six children’s mental health hospitals, between 2012 and this year.
They say they suffered treatment including the use of “painful” restraints and being held down for hours by male nurses, being stopped from going outside for months and living in wards with blood-stained walls. They also allege they were given so much medication they had become “zombies” and were force-fed.
But despite reports to police and regulators dating back seven years, and findings by the Care Quality Commission (CQC) that the units were inadequate, the NHS has still handed Huntercombe nearly £190m since 2015-16 to admit children to its mental health beds.
Through witness testimony, documents obtained by Freedom of Information request and leaked reports, the investigation has uncovered:
The CQC has received more than 700 whistleblowing and safeguarding reports, including “incidents of concern” and several “sexual safety” concerns. NHS England was notified of 195 safeguarding reports between 2020 and 2021. A 2018 internal report at Meadow Lodge hospital in Newton Abbot (now closed) found staff members using sexually inappropriate language in front of patients. 160 reports investigated by Staffordshire police about Huntercombe Staffordshire between 2015 and 2022. Between March 2021 and 2022, the CQC gave permission for 29 patients to be admitted to Maidenhead hospital after it was placed in special measures. Read full story
Source: The Independent, 27 October 2022
Patient Safety Learning

NICE recommends NHS collects real-world evidence on devices that monitor people with Parkinson’s disease

Five promising technologies that could help improve symptoms and quality of life for people with Parkinson’s disease have been conditionally recommended by NICE.
The wearable devices have sensors that monitor the symptoms of people with Parkinson’s disease while they go about their day-to-day life. This information may more accurately record a person’s symptoms than a clinical assessment during in-person appointments and help inform medication decisions and follow up treatment such as physiotherapy.
Parkinson's disease is an incurable condition that affects the brain, resulting in progressive loss of coordination and movement problems. It is caused by loss of the cells in the brain that are responsible for producing dopamine, which helps to control and coordinate body movements.
Mark Chapman, interim director of Medical Technology at NICE, said: “Providing wearable technology to people with Parkinson’s disease could have a transformative effect on their care and lead to changes in their treatment taking place more quickly.
“However there is uncertainty in the evidence at present on these five promising technologies which is why the committee has conditionally recommended their use by the NHS while data is collected to eliminate these evidence gaps.
“We are committed to balancing the best care with value for money, delivering both for individuals and society as a whole, while at the same time driving innovation into the hands of health and care professionals to enable best practice.”
Read full story
Source: NICE, 27 October 2022
Patient Safety Learning

'I wouldn't bring a member of my family to this hospital,' says medic

Steve Barclay is back as England's health secretary, just as the NHS prepares for what its chief executive Amanda Pritchard says could be a "very, very challenging winter".
The government has said "intensive work" is under way in the 15 most under-pressure hospital trusts in England, to speed up ambulance delays, free up beds and reduce waiting times in A&E.
Emergency departments across the UK are struggling to quickly treat patients.
Only 57% of people who turned up at major A&E departments in England last month were seen, admitted or discharged within four hours, well below the 95% national target.
The latest figures from Gloucestershire Royal show it performs slightly worse than average, with 55% dealt with in four hours.
One medic, speaking anonymously to the BBC, said: "I wouldn't bring a member of my family to this hospital. And winter is going to be worse unless something changes fast."
Read full story
Source: BBC News, 28 October 2022
Patient Safety Learning

New rules will discourage trusts from consuming more than their ‘fair share of NHS resources’

NHS England has launched the first substantive consultation on changes to the NHS provider licence since 2013. 
Licences set out the requirements providers must meet and are the legal mechanism NHS England can use to take enforcement action. Having a licence has long been mandatory for foundation trusts and independent providers, and will become so for trusts. The intention is for the proposals to take effect from next year.  
Most of the changes to the licence regime have been made to bring it into line with this year’s Health and Care Act and accompanying policy changes. For example, trusts will be required to collaborate with other providers and work effectively as part of their integrated care system. 
This extends to trusts delivering agreed financial plans decided at a system level. The aim is to provide “mutual accountability” and ensure each provider does not use “more than their fair share of NHS resources”.'
Read full story (paywalled)
Source: HSJ, 28 October 2022
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