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

GPs tell patients to ‘get an Uber’ as NHS ambulance delays hit record level

Some of the country’s GP are advising patients requiring urgent hospital care to “get an Uber” or use a relative’s car because of the worst ever delays in the ambulance service in England.
Patients with breathing difficulties and other potentially serious conditions are being told in some cases that they are likely to be transferred more quickly from a general practice to accident and emergency if they travel by cab or private vehicle.
NHS England data shows that October’s average ambulance response times for category 1 to 3 emergencies, which cover all urgent conditions, appear to be the highest since the categories were introduced nationally in 2017. Some patients who require emergency treatment may have to wait several hours for an ambulance to arrive.
Dr Selvaseelan Selvarajah, a GP partner in east London, said: “If somebody is not having a heart attack or a stroke, my default advice is ‘have you got someone who can drive you or do you want to get an Uber?’
“These are patients who may have breathing difficulty or are suffering severe abdominal pain, but their life is not in immediate danger.” He said such patients would have previously been transferred by ambulance.
Read full story
Source: The Guardian, 27 November 2022
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NHS’s flagship £360m system to slash waiting lists delayed

A flagship programme intended to bring down NHS waiting backlogs is to be delayed after becoming mired in bureaucracy.
The £360 million federated data platform is seen as critical to reducing waiting lists, with a record 7.1 million people now waiting for treatment. 
When the plans were announced in the spring, health chiefs said that the system would be an “essential enabler to transformational improvements” across the NHS.
Experts have warned that progress in clearing the lists has been set back by chaotic recording systems. 
While NHS data was found to be littered with errors, such as duplicate entries and dead patients, many patients in need of follow-up care are not recorded once they have had their first slot. 
Read full story (paywalled)
Source: The Telegraph, 25 November 2022
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Palliative care: 'My dad should not have been expected to die in office hours'

A woman who struggled to access night-time care for her dying father has told the BBC he "shouldn't have been expected to die in office hours".
Tracey Bennett said she was "completely lost" when her dad Michael needed help.
Early in 2021, Mrs Bennett, 54, from Doncaster, moved in with her dad, 76-year-old Michael Woodward, to care for him in the last stages of his cancer.
One night he had a fall. Mrs Bennett was able to help him back up but turned to the local NHS palliative care phone line for help, only to find it closed.
Although she did not feel her father should be in a hospital, she called 999 as she felt she had no-one else to turn to. He died in the early hours of the next morning.
"In his hour of need I feel I let my dad down," she said. "He shouldn't have been expected to die in office hours."
Almost 70% of the UK does not have a consistent 24-hour help-line for the terminally ill, research suggests.
And 27% of these areas do not have a designated phone line, the study funded by Marie Curie found.
Ruth Driscoll, from the charity, said the research painted "a bleak picture of out-of-hours care in many areas of the UK".
Read full story
Source: BBC News, 28 November 2022
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Eight days waiting in A&E: Inside the crisis in NHS mental health care

People suffering from mental illness are increasingly struggling to access help at every level of the NHS – from record numbers facing “unacceptable” delays in referrals to patients waiting up to eight days in A&E for a hospital bed.
Figures seen by The Independent show almost four times as many people are waiting more than 12 hours in emergency departments as two years ago.
In the community, more than 16,000 adults and 20,000 children who should receive NHS care are unable to access vital services each month.
Nearly 80% of those eligible for counselling on the health service are left waiting more than three months for a second appointment, which is when treatment usually begins.
Health leaders say they are “deeply concerned” by the lack of resources available to handle the rise in demand – and warned that the cost of living crisis would exacerbate the issue further.
Monica Smith went to A&E at Lewisham last month after her mental health deteriorated when her medication ran out and she was unable to get more.
The 32-year-old said: “I was told, ‘We can’t find any beds – there’s no bed in the whole country or the whole region, so we’re going to have a bed on A&E and hopefully you’ll get a bed in the morning.’”
Monica started hallucinating and was given medication to calm her down, but in the morning there was still no bed. Doctors tried to send her home, she said, but crisis services assessed her three times over the following days and each time decided she was too unwell.
Instead, Monica stayed in an annex off A&E with other mental health patients. She said: “I was on this, like, mattress, like a mental health mattress on the floor.”
Read full story
Source: The Independent, 27 November 2022
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‘This is as much about patient safety as pay’: NHS faces wave of strikes as more unions vote

The NHS faces the threat of coordinated industrial action lasting several months, with results to be announced within days of strike ballots of ambulance crews and about 300,000 health workers.
Junior doctors, paramedics, midwives, porters, cleaners, pharmacy technicians and physiotherapists are being balloted across the NHS. The government now faces the threat of waves of strikes across the public sector, from nurses and firefighters to civil servants and teachers.
A ballot of 15,000 ambulance workers in England and Wales closes on Tuesday. The result of the GMB ballot could be announced as early as this week, with the prospect of the first national ambulance strike since the dispute of 1989-90, when police and army vehicles were brought in to transport patients.
The RCN said on Saturday that the health secretary Steve Barclay had written to the union asking for officials to “come back to the table” before the planned strikes. RCN chief executive Pat Cullen said any talks needed to focus on the pay deal and that the position of her members was “negotiations or nothing”.
Rachel Harrison, GMB public services national secretary, said: “Health service workers have suffered more than a decade of real-terms pay cuts, been on the frontline of a global pandemic and are now in the midst of the worst cost of living crisis in a generation.
“This is as much about patient safety as it is about pay. A third of GMB ambulance workers think delays they’ve been involved with have led to the death of a patient.”
Read full story
Source: The Observer, 27 November 2022
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Water jabs and burning herbs offered during natural births at NHS hospitals

Mothers are being offered water injections by the NHS to relieve pain during childbirth, while in some hospitals midwives are burning herbs to encourage breech babies to turn in the womb.
Safety campaigners have dubbed the practices dangerous and say that they amount to “pseudoscience” being offered by the health service. They have called on the chief executive of NHS England, Amanda Pritchard, to ban their use in a letter published over the weekend.
At least three trusts in England offer water injections for pain relief, including Newcastle upon Tyne Hospitals Trust, United Lincolnshire Hospitals Trust and North Tees and Hartlepool Trust.
Information on the Newcastle trust’s website describes the injections as an “alternative form of pain relief” while in Lincolnshire patients are told the body’s response to the injections “prevents pain signals from reaching the brain.”
The National Institute for Health and Care Excellence (NICE), which is responsible for setting out which treatments patients should receive, has said the NHS should not use injected water for pain relief.
Read full story (paywalled)
Source: The Times, 27 November 2022
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Midnight discharge at Colchester Hospital unacceptable says family

Lack of beds in the NHS and social care sector have been highlighted by the case of an 81-year-old woman discharged home at night, her family said.
Janice Field attended Colchester Hospital in Essex with a suspected heart attack.
She was returned to her flat at midnight, despite having no home care at that time of day.
The hospital trust said it focused on keeping patients safe and was "sorry to hear about the concerns raised".
Ms Field was checked out at the hospital last week and deemed fit to go home, but her family said she should have stayed in hospital overnight, or be found a community care bed.
Her daughter-in-law, Sarah Field, a qualified nurse, said: "To discharge an 81-year-old lady and have them having to be transferred in the middle of the night is totally unacceptable.
"But the nurse we spoke to was emphatic. She was desperate. She said, 'no, we have no beds. This has got to happen. She's clinically fit. She has got to go'.
"The NHS is broken, under-resourced and not fit for purpose. This is not the fault of those that work in it, but the fault of the system."
Read full story
Source: BBC News, 26 November 2022
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Concern voiced over 'unacceptably high level' of births by caesarean section

The rising number of women who have caesarean sections instead of natural births is causing concern for the National Childbirth Trust (NCT).
The trust, which supports women through pregnancy, childbirth and early parenthood, says it does not know why the rate of caesareans is increasing.
One in four maternity services showed a caesarean rate of between 20% and 29.9%, and 2% of services had a rate of more than 30%, according to latest figures. The World Health Organization recommends that the acceptable rate is 10 to 15%.
The maternity care working party, a multi-disciplinary group set up by the NCT, said there was an urgent need to address the problem.
"A caesarean is major abdominal surgery," the working party said in a statement to a conference in London with the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists
"Most women would prefer to give birth normally, provided that a normal birth is considered safe for them and their baby. It is important that health professionals' advice does not have the effect of denying them this opportunity without good reason."
The working party is calling for data to be published on caesarean section rates and for obstetricians to justify in each case that the benefits outweigh the hazards. It also wants action to be taken to prevent any inappropriate use of caesarean sections.
Belinda Phipps, chief executive of the NCT, said: "We know that in many cases caesareans are necessary for good clinical reasons. However, in our view rates have reached unacceptable levels and we want to know why."
Read full story
Source: The Guardian, 24 November 2022
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Human rights of mental health patients violated amid crisis in care, regulator warns

The human rights of vulnerable mental health patients are being violated because of the crisis in care, a regulator has warned.
Rob Behrens, the health service ombudsman for England, said urgent action was needed over repeated “tragedies” in NHS mental health services.
His warning comes as the latest NHS figures show there were 9,839 incidents of abuse against mental health patients from April 2021 to March this year – a higher figure than in any other sector.
It follows an investigation by The Independent last month that revealed allegations of systemic abuse of children within a group of private mental health hospitals run by a provider called The Huntercombe Group.
Mr Behrens said research carried out by his office showed that vulnerable people being detained in hospitals are “losing their human rights when they were put in difficult situations where they had no control”.
Mr Behrens told The Independent: “We can’t go on with leaders in the NHS and politicians saying ‘This cannot go on’, because it happens time and time again. It’s the amount of resource and commitment that is put into dealing with issues, which ultimately is going to turn this around".
When asked if mental health is a particular area of concern, Mr Behrens said: “Yes. It’s about human rights. It’s about vulnerable people exposing themselves to the arm of the state in a way where they have very little control, and where there needs to be accountability and scrutiny. That’s exactly where an ombudsman should be looking, to make sure that people without power are not being traduced by the system.”
Read full story
Source: The Independent, 28 November 2022
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Poorer women in UK have sixth-highest cancer death rates in Europe, WHO finds

Poorer women in Britain have some of the highest death rates from cancer in Europe, an in-depth new World Health Organization study has found.
They are much more likely to die from the disease compared with better-off women in the UK and women in poverty in many other European countries.
Women in the UK from deprived backgrounds are particularly at risk of dying from cancer of the lungs, liver, bladder and oesophagus (foodpipe), according to the research by the International Agency for Research on Cancer (IARC), the WHO’s specialist cancer body.
IARC experts led by Dr Salvatore Vaccarella analysed data from 17 European countries, looking for socioeconomic inequalities in mortality rates for 17 different types of cancer between 1990 and 2015.
Out of the 17 countries studied, Britain had the sixth-worst record for the number of poor women dying of cancer. It had the worst record for oesophageal cancer, fourth worst for lung and liver cancer and seventh worst for breast and kidney cancer.
However, the UK has a better record on poor men dying of cancer compared with their counterparts in many of the other 16 countries. It ranked fifth overall, second for cancer of the larynx and pharynx, and third for lung, stomach and colon cancer.
That stark gender divide is most likely because women in the UK began smoking in large numbers some years after men did so, the researchers believe. They pointed to the fact that while cases of lung cancer have fallen among men overall in Britain, they have remained stable or increased among women, and gone up among women from deprived backgrounds.
Read full story
Source: The Guardian, 28 November 2022
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Urgent surgery ‘may be postponed’ by nurses’ strikes, say NHS bosses

Hospitals may not be able to provide key elements of healthcare such as urgent surgery, chemotherapy and kidney dialysis during the forthcoming strikes by nurses, NHS bosses have said.
Trusts may also have to stop discharging patients, postpone urgent diagnostic tests and temporarily withdraw services to people undergoing a mental health crisis.
Executives have been warned that industrial action by nurses in their pay dispute with the government could mean that a range of important, and in some cases time-critical, services to seriously ill patients may have to be scaled back or suspended altogether.
NHS England bosses have raised that possibility in a letter sent on Monday to hospitals and other care providers ahead of crunch talks with the Royal College of Nursing later this week. At that meeting they will try to agree what areas of care will be hit on Thursday 15 and Tuesday 20 December, and which will continue as normal because they are covered by “derogations” – agreed exemptions to the action.
The letter sets out a list of 12 areas of care and some non-clinical activity in hospitals, such as food supply, which could be affected if agreement is not reached with the nurses’ union.
Eight of those involve direct patient care, three involve support services in NHS trusts and the other involves “system leadership and management to oversee safe care” on strike days.
NHS England’s letter sets out 10 other types of vital care, mainly involving life or death scenarios, headed “derogations not needed”, which they hope to agree with the RCN to go ahead as normal.
These include A&E care, services in intensive care units and emergency operating theatres as well as maternity services, including the delivery of babies, psychiatric intensive care, time-critical organ transplants and palliative and end of life care.
Meanwhile, the chief executive of NHS England has insisted patients will not have procedures cancelled at the last minute due to the nurses’ strikes, but warned some care would have to be delayed.
Read full story
Source: The Guardian, 28 November 2022
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Pritchard admits NHS behind on elective catch up

NHS England’s chief executive has admitted the service is behind on its commitment to increase elective activity to 130% of pre-covid levels by 2025, saying the recovery would need to be ‘reprofiled’ to catch up after this year.
Amanda Pritchard told MPs on the Public Accounts Committee that NHS England would need to “re-profile some of the [elective recovery] trajectories”, as progress this year was being hampered by a combination of higher than expected covid rates, flu, workforce challenges and industrial action.
She later added that the 2025 target could “theoretically” be missed, but stressed “we are a very long way from that” and indicated she believed the NHS could catch up in future years.
Elective recovery plans agreed between NHSE and government last autumn said activity would recover to 110% of pre-covid levels in 2022-23. Yet published data shows many systems have so far been carrying out fewer procedures than before covid in most months.
Asked by the committee’s chair Meg Hillier if she was confident the NHS would hit the 2025 activity target, first agreed for the 2021 spending settlement, Ms Pritchard replied: “I think at the moment we are absolutely aiming [to hit the target] at the end of that period of time, but we do recognise that we are going to need to re-profile trajectories to get there.”
Read full story (paywalled)
Source: HSJ, 28 November 2022
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Big UK trial to find best drugs to fight flu

With flu cases rising, UK Covid scientists are turning their attention to finding the best life-saving drugs to fight the winter virus.
A trial will run across 150 hospitals this year and next, recruiting thousands of patients.
Flu vaccines help prevent infection but each year some people become very sick.
And antiviral tablets - given within a couple of days of symptoms developing - are designed to reduce the severity of these bad infections.
One of the pills the Imperial College London team will be testing is oseltamivir, or Tamiflu. It is recommended to treat severe flu - but whether it saves lives is unclear.
Funded by the National Institute for Health and Care Research, the Randomised, Embedded, Multi-factorial, Adaptive Platform Trial for Community-Acquired Pneumonia (Remap-Cap) will study how good the treatments are at reducing deaths and intensive care admissions.
Chief investigator Prof Anthony Gordon told BBC News: "We want to learn at pace what works, just like we did during Covid.
"We'll test multiple treatments in different combinations. Some are antivirals that stop the virus, others are steroids or other treatments that work on how the body responds to infections.
"We hope that our trial will help to find urgently needed flu treatments rapidly. Our Covid trial changed clinical practice globally and we hope we can impact flu treatment and reduce winter pressures on the NHS in the same way."
Read full story
Source: BBC News, 29 November 2022
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Michael Watt: Review finds 'significant failures' in patient treatment

A review of the clinical records of 44 patients who died under the care of former neurologist Michael Watt has found "significant failures in their treatment" and "poor communication with families".
While this review looked at a sample of cases in which people died, potentially thousands more could be affected.
The review arises from a 2018 recall of 2,500 outpatients who were in Dr Watt's care at the Belfast Health Trust.
About one in five patients had to have their diagnoses changed.
This separate review into 44 deaths was conducted by the Royal College of Physicians at the request of the regulator, the Regulation and Quality Improvement Authority (RQIA).
It highlighted concerns over clinical decision-making, prescribing and diagnostics.
It reveals a misdiagnosis rate of 45% among this group of patients, twice that for living patients.
Speaking to BBC News NI, the RQIA's chair, Christine Collins, said the outcome of the review was "shocking and gut-wrenching as so many had experienced unpleasant deaths which they ought not to have done".
Read full story
Source: BBC News, 29 November 2022
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Brain op patients at Birmingham NHS trust suffered unnecessarily

Patients who underwent brain operations at a West Midlands NHS trust suffered unnecessarily because of poor surgical outcomes, a report has found.
More than 150 deep brain stimulation surgery cases at University Hospitals Birmingham (UHB) trust are now being investigated and surgery is suspended.
There were unacceptable delays responding to patient concerns, the independent review also said.
The investigation recommended indefinitely suspending the service at the NHS trust until it is safer.
Deep brain stimulation (DBS) for movement disorders is used on patients with conditions including Parkinson's disease and dystonia, where medication is becoming less effective.
The independent review, carried out by medics from King's College Hospital, was ordered by UHB after a serious incident investigation of a patient who underwent DBS for Parkinson's disease.
One of those 21 people, Keith Bastable, 74, from Brierley Hill, had DBS in May 2019 for his Parkinson's disease and the review found his probes were placed too far away to be acceptable.
Due to the misplacement, one was never switched on and the other probe had to be switched off as he suffered slurred speech and other side effects.
They were removed and new ones recently reinserted in Oxford after he was referred to a hospital trust there.
Mr Bastable said he had felt abandoned in the time it had taken to get resolved.
Read full story
Source: BBC News, 29 November 2022
Patient Safety Learning

NHS England ad campaign hopes to change behaviours and relieve service

Plans have been drawn up to avoid the NHS being overwhelmed this winter by encouraging patients to “behave in ways they’ve not experienced before” and cut down on in-person GP visits, the Guardian can reveal.
An advertising campaign devised by M&C Saatchi, awarded a contract by NHS England worth up to £28.6m, suggested ways people could be encouraged to settle for a virtual appointment or visit a pharmacist instead.
To help reduce the mounting pressures facing medics, documents show the agency also advised patients should be told that seeking help via alternative routes instead of rushing to A&E would help the NHS “work better for everyone”.
The three-year contract is for the ad campaign “Help Us Help You”, which seeks to change people’s behaviour when accessing healthcare to reduce pressures on the NHS and maintain capacity.
Wes Streeting, Labour’s shadow health secretary, said patients were already cutting back on in-person GP appointments – “not because they don’t need them but they’re finding it impossible to get one”.   He told the Guardian: “Among those millions of patients who can’t get an appointment when they need it, there will be problems which go undiagnosed until it’s too late".   Read full story   Source: The Guardian, 30 November 2022
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