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

‘It feels very unsafe’: the NHS staff bracing for winter as cuts loom

Further funding cuts to the NHS will unavoidably endanger patient safety, an NHS leader warned last week after the chancellor’s promise of spending cuts of “eye-watering difficulty”.
Matthew Taylor, the chief executive of the NHS Confederation, said his members were issuing the “starkest warning” about “the huge and growing gulf between what the NHS is being asked to deliver and the funding and capacity it has available”.
The warning came as figures showed that paramedics in England had been unavailable to attend almost one in six incidents in September due to being stuck outside hospitals with patients. Service leaders say wait times for A&E and other care are being exacerbated by an acute lack of nurses, with a record 46,828 nursing roles – more than one in 10 – unfilled across the NHS.
"Patients are presenting more unwell," says a GP from South Wales,
"Wait times in A&E have become unmanageable, so we’re seeing patients who have waited so long to be seen they’re bouncing back to us. Things we can’t deal with, like injuries and chest pain. We tell them they have to go back to A&E.
"Abuse of surgery reception and admin staff began last year and it’s just scaled up from there. We’ve had staff members who have been verbally and physically threatened and we’re struggling to recruit and retain staff – people are hired and quit in a couple days. A lot of people are going off sick with stress."
Five healthcare workers describe the pressures they are facing, including ambulance stacking, rising A&E wait times and difficulties discharging patients.
Read full story
Source: The Guardian, 1 November 2022
Patient Safety Learning

NHSE ‘forgot the people’ when it ‘rushed’ controversial appointment rules, Mackey admits

NHS England “forgot the people” when it published controversial guidelines last month which said patients faced being removed from the waiting list if they declined two appointment dates, a senior director has admitted.
NHSE elective recovery chief Sir Jim Mackey said the guidance was drafted to address legitimate concerns from trusts, but that the process had been “rushed”.
Following Sir Jim’s comments, NHSE told HSJ the guidance, which had sparked widespead criticism including from patient groups, would not be changing. But Sir Jim said NHSE would “spend time” better understanding patients after “reflecting” on the process which had created the controversial guidelines.
Speaking at the King’s Fund annual conference, Sir Jim said: “[The guidance] was largely a response to trusts saying to us: ‘We keep offering these patients options and they won’t take them, so what do we do?’
“We rushed through a policy to try and deal with that, and in the process, I think forgot the people…We’ve reflected on that.”
Read full story (paywalled)
Source: HSJ, 1 November 2022
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Can interim care help ease Scotland's hospital bed shortage?

Many people who are medically ready to leave hospital are not able to go home because of pressures in social care.
Health and social care teams across Scotland are working to create more room in hospitals as we go into winter when it traditionally gets busier.
In Lothian, they are using care homes as an interim measure to help rehabilitate people before they can go back home.
Nineteen rooms at the Elsie Inglis Nursing Home in Edinburgh are being used in an effort to help people get out of hospital.
Archie McQuater, who spent seven months in The Royal Infirmary of Edinburgh after one of his big toes was removed because of an infection, has finally got out of hospital and is now staying at the Elsie Inglis.
The 94-year-old has been in the care home for two months and is trying to improve his mobility so that he can return home.
Archie is among 200 people in Edinburgh who have been moved from a hospital to a care home between November 2021 and September 2022.
NHS Lothian estimates it has saved about 13,000 bed days in hospitals during that time.
Read full story
Source: BBC News, 2 November 2022
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Oliver McGowan: NHS autism training mandatory after teen's death

Mandatory training for treating people with autism and learning disabilities is being rolled out for NHS health and care staff after a patient died.
It comes after Oliver McGowan, 18, from Bristol, died following an epileptic seizure.
At the time, in November 2016, he had mild autism and was given a drug he was allergic to despite repeated warnings from his parents.
His mother Paula lobbied for mandatory training to potentially "save lives".
A spokesman for the NHS said the training had been developed with expertise from people with a learning disability and autistic people as well as their families and carers.
The first part of the Oliver McGowan Mandatory Training is being rolled out following a two-year trial involving more than 8,300 health and care staff across England.
Mark Radford, chief nurse at Health Education England said: "Following the tragedy of Oliver's death, Paula McGowan has tirelessly campaigned to ensure that Oliver's legacy is that all health and care staff receive this critical training.
"Paula and many others have helped with the development of the training from the beginning.
"Making Oliver's training mandatory will ensure that the skills and expertise needed to provide the best care for people with a learning disability and autistic people is available right across health and care."
Read full story
Source: BBC News, 2 November 2022
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Oncologist who attended surgery on two patients while he had covid is suspended for three months

A consultant oncologist who ignored a hospital instruction and attended patients’ cancer surgery on two days when he knew he was still testing positive for Covid-19 has been suspended from the UK medical register for three months.
Andrew Gaya admitted knowingly breaking the rules but told the medical practitioners tribunal he had feared that the patients’ treatments would be postponed if he could not attend the private London Gamma Knife Centre, part of HCA Healthcare UK. The two incidents occurred in the early weeks of the pandemic, at a time of high covid death rates.
“I did not take the decision to attend the centre on 3 April 2020 lightly and was aware it was not in accordance with the instructions I had been given,” Gaya told the tribunal. “At the time I thought that I wasn’t going to do any harm and that I was acting in the best interests of the patient as the case was urgent.
“I know I should have telephoned [the relevant manager] and asked if she would allow me to undertake the treatment, but I was afraid her answer would be ‘no’ and that the patient’s treatment would be cancelled,” he told the tribunal in a witness statement.
Both patients have since died, but after the tribunal concluded Gaya told the Daily Telegraph, “One lived for 6 months with good quality of life.”
Gaya, who was present as part of a multidisciplinary team, wore protective gear and observed social distancing. There is no evidence that he had infected anyone.
Read full story
Source: BMJ, 1 November 2022
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‘Contentious’ US tech firm to harvest patient data in NHSE waiting list push

NHS England has ordered the collection of identifiable patient data from hospitals by US data firm Palantir, for a pilot scheme aimed at accelerating recovery of elective waiting lists.
The regulator has instructed NHS Digital, with which it will merge in January, to use Palantir’s Foundry platform to collect data about patients’ admission, inpatient, discharge and outpatient activity at acute hospitals.
Identifiable data such as patients’ NHS numbers, date of birth, and postcode will be collected through Palantir’s software. Patients cannot opt out of having their data collected.
But NHS Digital’s Caldicott Guardian – who is meant to safeguard use of data – has identified “risks” in the pilot and said it needs additional work before it can meet confidentiality requirements.
The data collected will be “anonymised in accordance with the ICO’s (Information Commissioner’s) Anonymisation Code of Practice”. However, privacy campaigners Medconfidential claimed this code is not fit for purpose and warned that NHS chiefs were making the same mistakes as previous failed efforts to use patient data appropriately.
Read full story (paywalled)
Source: HSJ, 1 November 2022
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Gender identity specialists accuse psychology body of ‘contributing to fear’

Some of the most senior gender identity specialists in the UK have accused their professional body of “contributing to an atmosphere of fear” around young people receiving gender-related healthcare.
More than 40 clinical psychologists have signed an open letter to the Association of Clinical Psychologists UK in protest at the organisation’s recent position statement on the provision of services for gender-questioning children and young people. They say they believe there was a failure to properly consult experts in the field or service users, resulting in a “misleading” statement that “perpetuates damaging discourses about the work and gender-diverse identities more broadly”.
About half of those signatories are current or former holders of senior roles – including the current director – at what was the only NHS gender identity service for children in England and Wales, the Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS foundation trust in London.
NHS England announced in July it would be closing the GIDS and replacing it with regional hubs, after being warned by the interim report of the Cass Review into gender services for young people that having only one provider was “not a safe or viable long-term option”.
In 2021, inspectors rated the service “inadequate” overall and highlighted overwhelming caseloads, deficient record-keeping and poor leadership, suggesting that record waiting lists meant thousands of vulnerable young people were at risk of self-harm as they waited years for their first appointment.
In a position statement published last month, the ACP-UK wrote that “the new, regional services will have to offer a radical alternative [after the closure of GIDS] to meet the needs of all young people with gender dysphoria.”
The letter suggests: “An alternative interpretation is that it is possible to provide support for distress related to gender identity where mental health needs and neurodiversity are also present, and remain cognisant of all factors within formulation-based practice”.
Read full story
Source: The Guardian, 2 November 2022
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NHS disruption driving rise in heart deaths, charity says

Extreme disruption to NHS services has been driving a sharp spike in heart disease deaths since the start of the pandemic, a charity has warned.
The British Heart Foundation (BHF) said ambulance delays, inaccessible care and waits for surgery are linked to 30,000 excess cardiac deaths in England.
It has called for a new strategy to reduce "unacceptable" waiting times.
Doctors and groups representing patients have become increasingly concerned about the high number of deaths of any cause recorded this year.
New analysis of the mortality data by the BHF suggests heart disease is among the most common causes, responsible for 230 deaths a week above expected rates since February 2020.
The charity said "significant and widespread" disruption to heart care services was driving the increase.
Its analysis of NHS data showed that 346,129 people were waiting for time-sensitive cardiac care at the end of August 2022, up 49% since February 2020.
It said 7,467 patients had been waiting more than a year for a heart procedure - 267 times higher than before the pandemic.
At the same time, the average ambulance response time for a suspected heart attack has risen to 48 minutes in England against a target of 18 minutes, according to the latest NHS figures.
The BHF said difficulty accessing face-to-face GP and hospital care may have also contributed to the rise.
Read full story
Source: BBC News, 3 November 2022
Patient Safety Learning

C-section delay left baby severely disabled

A baby was left "severely disabled" after a delay during his delivery by Caesarean section, a High Court judge has been told.
Betsi Cadwaladr health board will pay £4m in compensation after a negligence claim was brought by one of the boy's relatives.
He has required 24-hour care since his birth in 2018 at Glan Clwyd Hospital in Denbighshire.
The hospital apologised, saying doctors are "working hard" to learn lessons.
"We are extremely sorry," barrister Alexander Hutton KC, representing the health board, told Mr Justice Soole.
"[Betsi Cadwaladr] is working hard to learn lessons from this case," he added.
Read full story
Source: BBC News, 2 November 2022
Patient Safety Learning

Three girls died after major failings in NHS mental health care, inquiry finds

Three teenage girls died after major failings in the care they received from NHS mental health services in the north-east of England, an independent investigation has found.
“Multifaceted and systemic” failures by the Tees, Esk and Wear Valleys (TEWV) NHS trust contributed to the young women’s self-inflicted deaths within eight months of each other, it concluded.
Christie Harnett died aged 17 on 27 June 2019 at the trust’s West Lane hospital in Middlesbrough. Nadia Sharif, also 17, died there six weeks later, on 5 August. Emily Moore, who had been treated there, died on 15 February 2020 at a different hospital in Durham. All three had complex mental health problems and had been receiving NHS care for several years.
The investigation into their deaths, commissioned by the NHS, found that 119 “care and service delivery problems” by NHS services, especially TEWV, had occurred.
Charlotte and Michael Harnett, Christie’s parents, said their daughter had “lost her life whilst in a hospital run by TEWV trust where there was little or no care or compassion”. Emily’s parents, David and Susan Moore, said she received “horrific care” while at West Lane. Services at the hospital were understaffed, “unstable and overstretched”, the investigation’s final report found.
Both families, and also Nadia’s parents, Hakeel and Arshad Sharif, said the dangerous inadequacy of the care provided by TEWV, and the likelihood that other patients with fragile mental health had died as a result, showed that ministers should order a full public inquiry. “This mental health trust is a danger to the public,” the Moores said.
The report said TEWV failed to properly monitor the girls, given their known risk of self-harm; to take seriously concerns about their care and suicide risk raised by their families; and to remove all potential ligature points.
Read full story
Source: The Guardian, 2 November 2022
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1.5m fewer people on waiting list than thought

NHS England has revealed it estimates there are 5.5 million people on elective referral to treatment waiting lists, rather than the 7 million which is often reported.
No figures have previously been given for the number of separate individuals, but many in politics, policy and the media have often indicated it is the same as the total number of entries on the RTT list – which hit 7 million in August.
NHSE elective recovery chief Sir Jim Mackey, speaking at the King’s Fund annual conference in London yesterday, revealed an estimate for the first time of the number of individuals.
Sir Jim said: “It’s actually 5.5 million people, but seven million entries on the waiting list. There are around a million and a half people, we think, who are on multiple times. So, it’s a lot more complicated than we all think.”
He said it was not clear how many were patients waiting for genuinely separate issues or procedures, and how many were duplicates for the same pathway – essentially errors. Sir Jim said he hoped a new NHSE project would clarify the picture.
He said: “Sometimes there are people on twice, where they need one thing then another thing. Other times it’s a bit more complicated… We’re just about to start a process with a handful of organisations to try and work out what that means.”
Read full story (paywalled)
Source: HSJ, 2 November 2022
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Damning report on surgeon's botched operations

A damning report has highlighted failures in how NHS Tayside oversaw a surgeon who harmed patients for years. 
Prof Eljamel, the former head of neurosurgery at NHS Tayside in Dundee, harmed dozens of patients before he was suspended in 2013. 
The internal Scottish government report into Prof Sam Eljamel, which has been leaked to the BBC, said the health board repeatedly let patients down. It outlined failures in the way Prof Eljamel was supervised and the board's communication with patients.
The report was commissioned last year over unanswered questions and concerns from patients Jules Rose and Pat Kelly.
Mr Kelly has been left housebound and Ms Rose has PTSD after the neurosurgeon removed the wrong part of her body.
After her operation in 2013, Ms Rose discovered that Prof Eljamel had taken out the wrong part of her body. He removed her tear gland instead of a tumour on her brain.
She still has not been told exactly when health bosses knew he was a risk to patients.
The latest Scottish government report said she should receive an apology.
The written apology she received from the board last month said it was sorry she "feels" there has been a breakdown in trust.
"I actually rejected the apology," she said.
Ms Rose said she wanted the chairwoman of the health board to explain why it will not offer a "whole-hearted apology" for its failures.
Scottish Conservative MSP Liz Smith called for a public inquiry, saying there had been a lack of accountability and the investigation had still not got to the truth.
Read full story
Source: BBC News, 3 November 2022
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Just 10 trusts responsible for half of ‘unacceptable’ placements

Just 10 trusts account for more than half of patients ‘inappropriately’ sent out of their area for a mental health bed – with dozens having to travel up to 300km, according to HSJ analysis.
Official NHS data for adults shows these 10 mental health providers accounted for 9,485 “inappropriate” out of area placement bed days during July, out of 18,705 across the 44 trusts reported nationally. 
At one trust, Sussex Partnership FT, 40 placements were recorded as being between 200km and 300km away in that single month. The trust has revealed in board papers that four were sent to Glasgow. It has cited a shortage of capacity in the Kent and Sussex adult eating disorder service having led to 25 OAPs, and also said “quality concerns” had caused a temporary lack of acute beds in the county.
Nationally, levels of “inappropriate” out of area placement – where people with acute mental health needs are sent up to hundreds of miles for a bed – are rising again, driven by quality failures, bed closures and staffing shortages.
Read full story (paywalled)
Source: HSJ, 3 November 2022
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NHS boss Amanda Pritchard says patients not always getting care they deserve

Patients are not always getting the care they deserve, says the head of NHS England.
Amanda Pritchard told a conference the pressures on hospitals, maternity care and services caring for vulnerable people with learning disabilities were of concern.
She even suggested the challenge facing the health service now was greater than it was at the height of the pandemic.
Despite making savings, the NHS still needs extra money to cope, she said.
Next year the budget will rise to more than £157bn, but NHS England believes it will still be short of £7bn.
Ms Pritchard told the King's Fund annual conference in London that demand was rising more quickly than the NHS could cope with.
"I thought that the pandemic would be the hardest thing any of us ever had to do," she said.
"Over the last year, I've become really clear.... it's the months and years ahead that will bring the most complex challenges."
Read full story
Source: BBC News, 2 November 2022
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More than two-fifths of people in Britain have chronic pain by mid-40s

More than two-fifths of people in Britain suffer from some form of chronic pain by the time they are in their mid-40s, research suggests.
Scientists have found that persistent bodily pain at this age is also associated with poor health outcomes in later life – such as being more vulnerable to Covid-19 infection and experiencing depression.
The findings, published in the journal Plos One, suggest chronic pain at age 44 is linked to very severe pain at age 51 and joblessness in later life.
Study co-author Professor Alex Bryson, of University College London’s Social Research Institute, said: “Chronic pain is a very serious problem affecting a large number of people.
“Tracking a birth cohort across their life course, we find chronic pain is highly persistent and is associated with poor mental health outcomes later in life including depression, as well as leading to poorer general health and joblessness.
“We hope that our research sheds light on this issue and its wide-ranging impacts, and that it is taken more seriously by policymakers.”
Read full story
Source: The Independent, 2 November 2022
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State of social care in England ‘never been so bad’, social services boss warns

The state of social care in England has “never been so bad”, the country’s leading social services chief has said, with half a million people now waiting for help.
Sarah McClinton, president of the Association of Directors of Adult Social Services (ADASS), told a conference of council care bosses in Manchester: “The shocking situation is that we have more people requesting help from councils, more older and disabled with complex needs, yet social care capacity has reduced and we have 50,000 fewer paid carers.”
Over 400,000 people rely on care homes in England and more than 800,000 receive care at home. But care services are struggling with 160,000 staff vacancies, rising demand and already tight funding for social care that is being squeezed by soaring food and energy inflation.
About a third of care providers report that inability to recruit staff has negatively affected their service and many have stopped admitting new residents as a result. Last month the Care Quality Commission warned of a “tsunami of unmet care” and said England’s health and social care system was “gridlocked”. Problems in social care make it harder to free up beds in hospitals, slowing down the delivery of elective care.
“The scale of how many people are either not getting the care and support they need, or are getting the wrong kind of help, at the wrong time and in the wrong place is staggering,” said McClinton, who is also director for health and adult services in Greenwich. “It is also adding to the endless pressures we see with ambulances and hospitals, and adding to the pressures we see in our communities, more people requesting help with mental health and domestic abuse.”
Read full story
Source: The Guardian, 2 November 2022
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