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

Dr Heather Steen to be removed from medical register

A senior doctor is to be removed from the medical register after she was found to have attempted to cover-up the circumstances of a young girl's death.
Paediatrics consultant Dr Heather Steen was found to be unfit to practise after an investigation into the death of nine-year-old Claire Roberts in 1996.
A medical tribunal examining the doctor's case ruled that the majority of allegations against her were true.
Claire's mother said it was "just the start of getting full justice".
"I am angry at Dr Steen for putting us through 26 years of mental torment," said Jennifer Roberts.
At the time of Claire's death, her parents were told she had a viral infection that had spread from her stomach to her brain.
But in 2018 a public inquiry determined that she had died from an overdose of fluids and medication caused by negligent care at the Royal Belfast Hospital for Sick Children.
The inquiry also concluded there had been "cover up" and the girl's death had not been referred to the coroner immediately to "avoid scrutiny".
The case was then put to the Medical Practitioners Tribunal Service (MPTS), which rules on doctors' fitness to practise.
When the case reached the tribunal stage Dr Steen twice applied to be voluntarily removed from the medical register and was twice refused. Had that been successful the tribunal would have been halted as she would no longer have been a doctor.
However the tribunal continued and examined allegations that between October 1996 and May 2006 Dr Steen "knowingly and dishonestly carried out several actions to conceal the true circumstances" of Claire.
Read full story
Source: BBC News, 11 November 2022
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‘A doctor told me I could be here for months’: patients stuck in England’s hospitals

A Guardian analysis has found that as many as one in three hospital beds in parts of England are occupied by patients who are well enough to be discharged, with a chronic lack of social care meaning many do not have suitable places to go. 
Barry Long's 91-year-old mother has Alzheimer’s and was admitted to Worthing hospital on 30 May after a minor fall. She was a bit confused but otherwise unhurt, just a bit shaken. Whilst in hospital, she caught Covid and had to be isolated, which she found distressing, and became increasingly disoriented.
She was declared medically fit to be discharged but no residential bed could be found for her. Then, in August, she was left unsupervised and fell over trying to get to the toilet and she fractured her hip, which required surgery. 
Her hip was just about healed when she caught her shin between the side bars and the frame of the bed, cutting her shin so badly that she is being reviewed by a plastic surgeon to see if it needs a skin graft.
"Since the operation, my mum is pretty much bedbound and lives in a state of confusion and anxiety", says Barry. "Her physical health and mental wellbeing have deteriorated considerably in the almost five months she has spent in the care of the NHS. She spends all day practically trapped in bed, staring into space or with her eyes shut, just rocking to and fro. She has little mental stimulation."
Read full story
Source: The Guardian, 13 November 2022
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Children to be screened for diabetes risk in UK early detection trial

Scientists are launching a trial screening programme for type 1 diabetes in the UK to detect the disease earlier and reduce the risk of life-changing complications.
About 20,000 children aged between 3 and 13 are being invited to take part in the Early Surveillance for Autoimmune Diabetes (Elsa) study, with recruitment opening on Monday.
The aim is to assess children’s risk of developing type 1 diabetes at the earliest stage possible to ensure a quick and safe diagnosis, and reduce the number being diagnosed when they are already seriously ill.
Parth Narendran, a professor of diabetes medicine at the University of Birmingham, said: “As general population screening programmes for type 1 diabetes emerge around the world, we need to explore how best to screen children here in the UK.”
Dr Elizabeth Robertson, the director of research at Diabetes UK, which is co-funding the study with the not-for-profit organisation JDRF, said: “Identifying children at high risk of type 1 diabetes could put them and their families on the front foot, helping ensure a safe and soft landing into an eventual diagnosis, avoiding DKA and reducing the risk of life-altering complications.”
Read full story
Source: The Guardian, 14 November 2022
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Patients fear roof collapse at propped-up hospital

Patients have been asking to go to other hospitals rather than one where the ageing roof is being held up by more than 2,400 wooden and steel posts.
The Queen Elizabeth Hospital in King's Lynn has already had to close four of its seven operating theatres because of concerns the ceiling could collapse.
Alex Stewart, head of Healthwatch Norfolk, said some pregnant women have asked to go to other hospitals.
The Queen Elizabeth Hospital (QEH) opened in 1980, one of seven hospitals built using a material called reinforced autoclaved aerated concrete (RAAC).
The material has serious weaknesses and is deteriorating, with uncertainty over its structural integrity leading to more than £100m being spent this financial year on safety measures across the affected sites.
Mr Stewart told BBC Radio 4's Today programme: "I think people are very frustrated, they're well aware that the hospital staff inspect the hospital on a daily basis, several times a day.
"That said, we are aware of patients, for example, who are giving birth, who have asked to go to other hospitals because they're scared in case the roof might fall in on them."
The hospital's interim chief executive, Alice Webster, said while four theatres have had to be closed, "potentially" there could be problems with the ceilings in the others.
"We continue to monitor it on a daily basis," she said.
"We're making sure our theatres are functioning longer, we're functioning at weekends and trying to manage the waiting lists that way."
She added: "If we don't get a new hospital we will have to review all the services that we currently provide, but we won't be able to provide all the services that we currently do."
Read full story
Source: BBC News, 13 November 2022
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Top doctor ‘desperate’ to keep parents out of ‘lobster trap’ hospitals

One of the country’s most senior doctors has said he is “desperate” to keep his elderly parents out of hospital, which he said are like “lobster traps”.
Dr Adrian Boyle, president of the Royal College of Emergency Medicine, said hospitals are easy to get into but hard to get out of.
His comments come after figures showed the number of patients in hospital beds in England who no longer need to be there has reached a new monthly high.
An average of 13,613 beds per day were occupied by people ready to be discharged from hospital in October. That was up from 13,305 in September and the highest monthly figure since comparable data began in December 2021, according to analysis by the PA news agency.
In an interview with the Daily Mail, Dr Boyle said: “Hospitals are like lobster traps – they’re easy to get into and hard to get out of.
“If social care was able to do its job in the way we want it to, these poor people wouldn’t be stranded in hospital.
“I have elderly parents and I’m desperate to keep them out of hospital.
“For someone who is frail, hospital is often a bad place for them. They’re being harmed by being in hospital.”
Read full story
Source: The Independent, 14 November 2022
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Care homes and hospitals told to stop shutting out visitors

Care homes and hospitals will be forced to allow visitors under plans being drawn up by the government.
Helen Whately, the care minister, said shutting out relatives showed a lack of humanity. Covid-19 rules mean some of the country’s most vulnerable people still cannot have loved ones at their bedside.
Whately, who has told of her personal grief and frustration at being barred from visiting her critically ill mother, is now developing laws to give residents and patients a right to receive visitors.
Although official visiting restrictions were dropped in the spring in England, there are still widespread reports of care homes and hospitals refusing to let in relatives or imposing stringent conditions that ministers do not believe are justified by public health guidance.
Hundreds of care homes still refuse to accept visitors entirely, according to government figures, while others restrict residents to one relative at a time. 
Campaigners report residents losing weight because their relatives cannot go in to help them at mealtimes amid staff shortages. They also fear residents are being left in bed for long periods because staff know there will be no visitors to check on them. Whately said that she was “determined to fix” the issue, adding: “No one can be in any doubt now how much visits matter”. 
Read full story (paywalled)
Source: The Times, 11 November 2022
Related reading on the hub:
Visiting restrictions and the impact on patients and their families: a relative's perspective It’s time to rename the ‘visitor’: reflections from a relative
Patient Safety Learning

Trust bosses fear fallout of co-ordinated strikes

Trust leaders have raised concerns about other major unions striking on the same dates as the Royal College of Nursing in co-ordinated action, which would make avoiding disruption and harm ‘more hairy’.
The concerns were raised after the Royal College of Nursing confirmed members at various trusts had voted in favour of unprecedented action last week, with Unison and a raft of other unions also balloting members on strike action this month and in December.
Unison told HSJ co-ordinated action between itself, the RCN and the other health unions was “the best way to ensure industrial action is effective”.
One senior trust leader said that while the RCN strike days would prove a major challenge, they predicted their trust would be able to cope with the fallout. But they said the challenge would get even “more hairy” if Unison members also walked out on the same dates – a prospect they feared likely.
HSJ also understands that trust bosses have concerns about what will and won’t be classified as urgent and also about the emergency work to be carried out throughout a strike.
One senior provider figure used the example of insulin injections, which are at present to be part of the urgent and emergency care activities to continue throughout a strike, and wound treatment services, which, at this stage, are not.
They said: “If people don’t get those [insulin] injections twice a day, that person, by the end of 24 hours, will be in hospital [but] we are negotiating on [other areas] for example wound care. If you don’t dress people’s wounds at the right time, the worst situation is that a [deteriorating] wound means your leg has to be chopped off. At the moment, doing wound care is not being considered urgent care.”
Read full story (paywalled)
Source: HSJ, 15 November 2022
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NHS staff ‘petrified’ of how bad winter will be at hospitals in England

Doctors and nurses are “absolutely frightened and petrified” about how bad this winter will be for the NHS in England, hospital bosses have revealed.
Staff fear services will not be able to cope with a combination of flu, resurgent Covid, winter and the cost of living crisis damaging people’s health, and also the wave of looming strikes over pay.
“People are genuinely scared,” said the chief executive of one acute NHS trust in England.
“I’m talking to senior clinicians and consultants and nurses who are absolutely frightened and petrified about what’s potentially to come,” added the hospital boss, speaking on condition of anonymity. Staff are anxious because of “the potential for the impact of Covid and flu, the impact of industrial action, the impact of cost of living, the impact on people’s health from that, [and] the massive increases in mental health need, and the breakdown in primary care and social care.”
Chiefs of other NHS trusts in England said they shared that gloomy prognosis. They are bracing themselves for having to curtail and cancel services on days when staff stop work over pay, including outpatient clinics and non-urgent surgery. The NHS will face an “onslaught” this winter, one said.
Read full story
Source: The Guardian, 15 November 2022
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Discharge reform could save NHS £7bn, claims DHSC

A policy change to speed up hospital discharge could save the NHS more than £7bn over a decade, according to a government evaluation – but ministers have not funded it.
A Department of Health and Social Care impact assessment of the Health and Care Act, passed earlier this year, says that wider use of discharge to assess could free up as many as 6,000 hospital beds and save the NHS £7bn by 2031, the equivalent of £800m a year. It adds: “The overall societal benefits of this would likely be higher as beds could be allocated to patients with more urgent health care needs.”
The “discharge to assess” approach, which has been used on a temporary basis for several years and more widely during the pandemic – with government funding to back it – sees patients discharged more quickly, and provided with support at home while their long-term care needs are assessed. It was credited with significant reductions in the amount of time patients spent in hospital.
Changes in the Health and Care Act were intended to remove legal obstacles to the approach, by revoking a requirement for an assessments be carried out before discharge, which often leads to delays in the patient leaving hospital.
Read full story (paywalled)
Source: 15 November 2022
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Claims of sleeping staff and bullying on ward

Whistle-blowers have described neglect, patient-on-patient assault and staff who bully colleagues and sleep on the job at a troubled mental health ward.
Sources told a BBC investigation that a patient of 25-bed, mixed-gender Hill Crest Ward in Redditch, Worcestershire, suffered a broken jaw during one clash.
They also claimed three nurses were "forced out" amid bullying behaviour.
The NHS trust that runs Hill Crest said it believed changes there were having a positive impact.
Accounts have been corroborated via five independent sources to whom the BBC spoke. They follow reports earlier this year of a fire and an incident in which staff locked themselves in an office when a patient ran around armed with boiling water and sugar.
Additionally, one patient has provided the BBC with images alleged to show the effects of her battering herself out of desperation - without staff intervening.
Sources also described staff being bullied, with one saying a nurse who particularly suffered had her resignation letter read out and mocked by tormentors.
Sources independently complained of the workplace culture, with the BBC aware of explicit images bearing lewd comments about colleagues.
Read full story
Source: BBC News, 15 November 2022
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Antrim Area Hospital declared major incident because of ‘unsafe’ conditions, health chief says

A Northern Ireland hospital closed its doors to new admissions on Saturday night because conditions had become unsafe, a health chief has said.
Jennifer Welsh, chief executive at the Northern Health Trust, said the situation in the emergency department (ED) at Antrim Area Hospital on Monday remained “extremely pressured”.
A major incident was declared at the weekend when a high number of critically ill patients arrived in quick succession at the Co Antrim hospital, prompting the decision to temporarily close the doors to new admissions.
Ms Welsh said there were 45 patients in the ED on Monday for whom a decision to admit had been made, but for whom no bed is available.
She told the BBC Good Morning Ulster programme: “That would have been unthinkable about four or five years ago, we would have never seen numbers like that."
She said: “We had a high number of people arriving. A very high number of patients in the department.
“At the time we called the incident there were 131 patients and about 66 of them had a decision to admit and no bed available.
“At that stage our resuscitation unit was already full, it was over full.
“Then we got the news we had three more standby ambulances coming in. That is critically ill patients who had to be brought into our resuscitation department as quickly as possible and we simply could not cope.
“The safest thing to do in those circumstances is to call the major incident, to effectively close the door and what that means is that people are conveyed to the next nearest emergency department to ensure they begin the urgent treatment that they need because we were not able to do that.
“It was the right call to say that it was unsafe. It was unsafe at that time.”
Read full story
Source: The Independent, 14 November 2022
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Artificial intelligence could soon diagnose illness based on the sound of your voice

Voices offer lots of information. Turns out, they can even help diagnose an illness — and researchers in the USA are working on an app for that.
The National Institutes of Health is funding a massive research project to collect voice data and develop an AI that could diagnose people based on their speech.
Everything from your vocal cord vibrations to breathing patterns when you speak offers potential information about your health, says laryngologist Dr. Yael Bensoussan, the director of the University of South Florida's Health Voice Center and a leader on the study.
"We asked experts: Well, if you close your eyes when a patient comes in, just by listening to their voice, can you have an idea of the diagnosis they have?" Bensoussan says. "And that's where we got all our information."
Someone who speaks low and slowly might have Parkinson's disease. Slurring is a sign of a stroke. Scientists could even diagnose depression or cancer. The team will start by collecting the voices of people with conditions in five areas: neurological disorders, voice disorders, mood disorders, respiratory disorders and pediatric disorders like autism and speech delays.
This isn't the first time researchers have used AI to study human voices, but it's the first time data will be collected on this level — the project is a collaboration between USF, Cornell and 10 other institutions.
The ultimate goal is an app that could help bridge access to rural or underserved communities, by helping general practitioners refer patients to specialists. Long term, iPhones or Alexa could detect changes in your voice, such as a cough, and advise you to seek medical attention.
Read full story
Source: NPR, 10 October 2022
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BMA chief warns Scotland's GPs are at 'tipping point'

GP surgeries across Scotland are at risk of collapsing because of staff shortages and increased demand, a senior doctor has warned.
Dr Andrew Buist, chairman of the British Medical Association's (BMA) Scottish GP committee, told the BBC many practices were at "tipping point".
More than a third of surveyed surgeries reported at least one GP vacancy – up from just over a quarter last year.
About half of the GP surgeries in Scotland took part in the BMA survey.
It showed 81% of practices said demand was exceeding capacity - with 42% saying demand substantially exceeded capacity.
Dr Buist told BBC Scotland: "I worry that we're reaching a tipping point for some practices.
"They lose one or maybe two doctors out of three, and the remaining doctors cannot continue so they return the contract and the practice may cease to exist.
"That is a real concern in some parts of Scotland that that is happening and it's going to happen increasingly as the situation develops over this winter."
Read full story
Source: BBC News, 15 November 2022
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Children at similar risk for Long Covid as adults, study suggests

A large study today from Germany shows that children and adolescents are at the same relative risk of experiencing COVID-19 symptoms 90 days or more after acute infection as adults are, according to findings in PLOS Medicine.
Though kids and adolescents have far fewer deaths or severe outcomes from COVID-19 infections compared to adults, little is known about Long or post-Covid symptoms in this age-group, or symptoms that persist for more than 12 weeks after acute infection.
Researchers from the Technical University of Dresden, Germany, used data from half of the German population to determine that kids and adults have the same relative risk of experiencing post-Covid symptoms at 90 days following infection.
Martin Roessler, the lead author of the study, said there were significant symptom overlap among kids and adults who experienced symptoms 90 days or more after acute infection.
"We found 5 identical outcomes among the 10 outcomes with the highest relative risk among children/adolescents and adults. These symptoms are cough, fever, headache, malaise/fatigue/exhaustion, throat or chest pain," he told CIDRAP News.
Other symptoms were more commonly seen in adults, but not kids. Those included a loss of taste or smell, fever, and shortness of breath.
Daniel Blatt, MD, a pediatric infectious disease physician at the post-COVID clinic at Norton Children's Hospital in Louisville, Kentucky, said he was not surprised by the study's findings.
"It's unclear if Long Covid is the same in children and adults, in terms of pathophysiology, but it's just as real," he said. Blatt, who was not involved in the study, said his clinic also collects data on children and Long Covid. He said the most common symptoms reported in his patients are fatigue, anxiety, and "brain fog," followed by some shortness of breath or muscle pain.
"The good news is kids tend to get better, regardless of what intervention is needed," Blatt said. As in adult Long Covid, there's no one-size-fits-all approach for pediatric Long Covid patients. "Some need reassurance; some need a graduated exercise program."
Read full story
Source: CIDRAP, 10 November 2022
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Europe faces ‘cancer epidemic’ after estimated 1m cases missed during Covid

Experts have warned that Europe faces a “cancer epidemic” unless urgent action is taken to boost treatment and research, after an estimated 1m diagnoses were missed during the pandemic.
The impact of Covid-19 and the focus on it has exposed “weaknesses” in cancer health systems and in the cancer research landscape across the continent, which, if not addressed as a matter of urgency, will set back cancer outcomes by almost a decade, leading healthcare and scientific experts say.
A report, European Groundshot – Addressing Europe’s Cancer Research Challenges: a Lancet Oncology Commission, brought together a wide range of patient, scientific, and healthcare experts with detailed knowledge of cancer across Europe.
One unintended consequence of the pandemic was the adverse effects that the rapid repurposing of health services and national lockdowns, and their continuing legacy, have had on cancer services, on cancer research, and on patients with cancer, the experts said.
“To emphasise the scale of this problem, we estimate that about 1m cancer diagnoses might have been missed across Europe during the Covid-19 pandemic,” they wrote in The Lancet Oncology. “There is emerging evidence that a higher proportion of patients are diagnosed with later cancer stages compared with pre-pandemic rates as a result of substantial delays in cancer diagnosis and treatment. This cancer stage shift will continue to stress European cancer systems for years to come.
“These issues will ultimately compromise survival and contribute to inferior quality of life for many European patients with cancer.”
Read full story
Source: The Guardian, 15 November 2022
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A&E staff ordered to receive ambulances ‘in all instances’

Directors of a major hospital have ordered their accident and emergency staff to continue receiving ambulance patients into their department “in all instances”, following angry exchanges with paramedics.
Hospital staff and ambulance crews have clashed at the new Royal Liverpool Hospital since its opening last month, after ambulance crews were prevented from bringing patients inside accident and emergency department when it was deemed to be full to capacity.
The problems were escalated to hospital directors and North West Ambulance Service Trust earlier this month, resulting in new instructions being issued to the emergency department.
In a letter to managers in A&E and the other divisions, seen by HSJ, the three most senior directors at the Royal Liverpool, wrote: “As you are aware we are currently experiencing long delays in accepting handover of patients from ambulance crews.
“This phenomenon is not unique to us at the Royal Liverpool, nor is it particularly new, but our recent challenges have undoubtedly been exacerbated due to teams still familiarising themselves with working in a new environment and the patient flow challenges we have been experiencing on site.
“However, what has changed has been the extent to which we have managed these pressures by continuing to hold patients in the back of ambulances, which we collectively agree is an unacceptable situation. Whilst providing corridor care is not what any of us would aspire to, we have to recognise and respond to the risk of patients awaiting response in the community.
“We have therefore today met with NWAS colleagues and agreed that, with immediate effect, we will, in all instances, continue to receive crews from NWAS into the hospital building.”
Read full story (paywalled)
Source: HSJ, 16 November 2022
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