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

Long Covid: What's changed, and what we know now

More than two million people in the UK say they have symptoms of Long Covid, according to the latest Office for National Statistics (ONS) survey.
Many long Covid patients now report Omicron was their first infection.
But almost three years into the pandemic there is still a struggle to be seen by specialist clinics, which are hampered by a lack of resources and research.
So has the condition changed at all, and have treatments started to progress?
NICE defines Llong Covid, or post-Covid syndrome, as symptoms during or after infection that continue for more than 12 weeks and are not explained by an alternative diagnosis.
An estimated 1.2m of those who answered the ONS survey reported at least one such symptom continuing for more than 12 weeks - health issues that they didn't think could be explained by anything else.
It's easy to assume that new cases of long Covid have significantly decreased, given recent research suggesting the risk of developing long Covid from the Omicron variant is lower. However, the sheer scale of cases over the past year has resulted in more than a third of people with long Covid acquiring it during the Omicron wave, according to the ONS.
Patients are usually referred to post-Covid assessment clinics after experiencing symptoms for 12 weeks - however, waiting times have not improved much within the past year.
The latest NHS England figures show 33% of Londoners given an initial assessment had to wait 15 weeks or more from the time of their referral, compared to 39% from a similar period in 2021.
The British Medical Association (BMA) has called on the government to increase funding for Long Covid clinics to deal with ever-increasing patient numbers. The BMA says that NHS England's 2022 strategy set out in July failed to announce any new funding.
Read full story
Source: BBC News, 18 November 2022
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Government wants new NHS cyber security chief

The Government is looking to hire a new cyber security chief for the NHS and Department of Health and Social Care (DHSC), at a time of heightened risk of cyber attacks against the health service. 
The DHSC last month issued a job advert for a “national chief information security officer”, who will sit within the digital policy unit of NHS England’s transformation directorate.
It comes at a time when the risk of cyber attacks against the NHS is increasing. Earlier this summer, an attack on an NHS electronic patient record supplier impacted several providers, including a dozen mental health trusts, with some trusts still not having recovered their service fully.
Meanwhile, in February, NHSE wrote to trusts to tell them to strengthen their cyber defences in the wake of Russia’s invasion of Ukraine. 
Read full story (paywalled)
Source: HSJ, 18 November 2022
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USA: Address ‘plane-crash level’ patient harm, HHS tells hospitals

Health and Human Services (HHS) Secretary Xavier Becerra startled a recent meeting of senior health system leaders by declaring in opening remarks that a plane crash had just killed all 200 passengers. He immediately added that this hadn’t really happened; he’d said it only to illustrate the toll taken by medical error.
The 14 November meeting at which Becerra spoke signalled a renewed commitment by HHS to preventing patient harm as it launched an “Action Alliance to Advance Patient Safety.” The Alliance aims to recruit the nation’s largest health systems as participants.
“We’re losing pretty much an airline full of Americans every day to medical error, but we don’t think about it,” said Becerra. (The department’s fiscal 2022-2026 strategic plan actually estimated the death toll at roughly 550 daily, which would be a very large airliner.) “But the worst part about it is that it’s avoidable.”
Though the meeting rhetoric was rousing and the invitee list impressive, specifics remained scarce. The Alliance is described only in general terms as a partnership among health systems, federal agencies, patients and others to implement Safer Together: A National Action Plan to Advance Patient Safety. 
Read full story
Source: Forbes, 17 November 2022
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Canada's healthcare system has a data problem putting patients at risk, experts say

Greg Price died of complications after testicular cancer surgery, but a review of his case found missed faxes, follow-ups and botched data-sharing ultimately cost the vibrant 31-year-old Alberta man his life.
All the missteps in his case meant it took 407 days from his first complaint for Price — an engineer, pilot, and athlete — to be diagnosed with cancer. He died three months after his doctor said he should see a specialist, and while he was being passed between multiple doctors, his health data often was not.
Now, his sister, Teri Price, says too little has changed in medical information-sharing in the decade since her brother's death. This, despite a review of his case — the 2013 Alberta Continuity of Patient Care Study — that recommended life-saving changes to the healthcare system to avoid more experiences like his.
So, she's fighting to improve the system that she says not only failed her brother, but keeps failing to change.
Price says that Canadians assume that their health information is shared between doctors to keep them safe and studied to improve the system, but often, it's not. And medical front-line staff in Canada say problems persist when it comes to sharing everything from patient information to aggregate medical and staffing data. 
"Information tends to be broken up between the services that patients attend," said Ewan Affleck, a doctor in the Northwest Territories who has spent his career fighting for better data access, and a member of the expert advisory arm of the Pan-Canadian Health Data Strategy Group.
"The cohesion and use of health data in Canada is legislated to fail." 
Read full story
Source: CBC News, 17 November 2022
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Toxic workplaces pushing GPs out of UK practice

GPs are leaving UK practice over workplace incidents rather than due to falling ‘out of love’ with the profession, the General Medical Council (GMC) has warned.
Speaking to the NHS Providers conference (16 November), chief executive Charlie Massey said that many specialty and associate specialist (SAS) and locally employed (LE) doctors feel their careers are being ‘curtailed’ and that they ‘can’t tolerate the environments’ in which they work.
He cited new GMC research into doctors’ migration which identified poor workplace conditions and ‘negative experiences with colleagues’ as a ‘far more impactful’ as a trigger compared to poor experiences with patients.
According to the research, bullying at work, lack of respect from line managers and experiences of favouritism ‘provided the nudge for them to consider making a change and migrating abroad’.
Mr Massey said: "This is a senseless waste of talent, not least because these issues are preventable. With a focus on compassionate, supportive cultures, they can be put right. This will not only improve doctors’ wellbeing, but also their productivity. Happier workers are better workers, and they deliver better results."
Read full story
Source: Healthcare Leader, 16 November 2022
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40 new hospitals - a reality or a pipe dream?

The Government has insisted that plans to build 48 ‘new’ hospitals by 2030 will still go ahead, despite widespread concerns over timelines and increasing construction costs.
In its 2019 manifesto, the Conservative Party announced the New Hospitals Programme, a pledge to build 48 new hospitals across the country, including eight schemes that had been announced by previous governments.
However, since then, the number has been seemingly interchangeable, with the Government, in a response to questions from BBH, referring to just 40 developments in total, even though the GM Government website clearly mentions 48.
And, to date, just two of those projects have been completed, while only five others are under construction.
The remaining schemes are still in the planning or approval stages, and this, combined with rising inflation and construction costs and a shortage of building materials, has led to concerns that they will not go ahead.
Read full story
Source: Building Better Healthcare, 28 November 2022
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Big rise in trusts ‘red rated’ for infant mortality

Nearly a fifth of trusts providing maternity care have been red rated for their infant mortality rates in a national audit.
Twenty-three trusts were flagged for their perinatal mortality in the latest Mothers and Babies: Reducing Risk through Audit and Confidential Enquiries audit for maternity services. Trusts with mortality rates more than 5% higher than an average of peer group providers are given a red rating.
The report was published last month and looked at data for 2020. Average perinatal mortality rates have been falling across England since 2013, although there is significant variation across England.
Six trusts in the latest audit were red rated for both stillbirths and neonatal mortality; Buckinghamshire Healthcare; Gloucestershire Hospitals; University Hospitals Dorset; Sandwell and West Birmingham Hospitals; University Hospitals Coventry and Warwickshire; and University Hospitals of Leicester.
Twenty-three trusts rated red on a combined perinatal mortality indicator (including the six listed above). For 17 of them, their mortality rates were not high enough on one of the stillbirth or neonatal measures to be red rated, but sufficiently high enough on both indicators to tip their overall extended overall perinatal rating into the red.
Andrew Furlong, medical director of University Hospitals Leicester, said: “Where learnings have been identified from reviews of care, we have developed robust action plans and strengthened care practice to shape and improve future services.”
These include aiming to improve access to interpreters, provide clearer medical review guidelines, and update ultrasound scanning processes, he added.
Read full story (paywalled)
Source: HSJ, 21 November 2022
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Scars and ulcers among risks from boom in beauticians treating varicose veins

The adverts promise beautiful legs, zero risk, and treatment in as little as 15 minutes. But unregulated injections to “eliminate” varicose veins are putting clients at risk of serious health complications, surgeons have warned.
Vein removal treatments costing as little as £90 a session are being offered by beauticians without medical supervision across the UK, Observer analysis has found.
Promoted with dramatic before and after photos and billed as a quick fix, microsclerotherapy involves the injection of a chemical irritant to disrupt the vein lining. This causes the vein walls to stick together, making it no longer visible on the skin. When performed correctly on finer veins, known as “thread” or “spider” veins, the procedure is generally considered safe, provided no underlying issues are present.
But beauticians and other non-healthcare professionals are also offering vein treatments for people with varicose veins, which can signify underlying venous disease, analysis of promotional materials shows. In such cases, treatments should be performed by practitioners in a regulated clinic, where specialists first use ultrasound scans to assess the area.
Conducting vein removal incorrectly or when there are underlying problems can lead to complications including leg ulcers, nerve damage, blood clots, stroke, allergic reactions and scarring, the Joint Council for Cosmetic Practitioners (JCCP) said. Even in cases where only thread veins are visible, other problems may be present.
Prof Mark Whiteley, a consultant venous surgeon and chair of the Whiteley chain of clinics, said he had seen cases of women with leg ulcers and permanent scarring after treatment for varicose veins from non-medics. In other cases, people had paid for treatment but saw no effect because the underlying cause was not tackled. “It’s totally disgraceful,” he said.
Read full story
Source: The Guardian, 20 November 2022
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GPs in England treat up to three times more patients than safety limit demands

GPs are struggling to cope with as many as 90 appointments and consultations a day – more than three times a recommended safety limit.
General practices in England are carrying out more appointments than before the pandemic but face severe workforce shortages. More than 1.45 million patients waited at least 28 days to see a GP in September, according to the most recent NHS figures.
GPs who spoke to the Observer last week say that almost every day they breach the BM) guideline of “not more than 25 contacts per day” to deliver safe care. One doctor said he had more than 90 consultations on one day.
A conference of local medical committee representatives in England this week will highlight the growing pressures faced in general practice. Surgeries are being urged to impose stricter caps on the number of patient appointments for each GP.
One of the proposed motions submitted to the conference by Kensington and Chelsea local medical committee says “focusing on patient safety” is more appropriate than meeting high patient demand. It says the NHS should focus on “safe capacity”.
Such a move would mean longer waits for GP appointments, but doctors say it would help safeguard patient care and the welfare of staff in general practice.
Read full story
Source: The Guardian, 20 November 2022
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NHS chiefs in Scotland discuss having a 2-tier health system

NHS leaders in Scotland have discussed abandoning the founding principles of the service by having the wealthy pay for treatment.
The discussion of a "two-tier" health service is mentioned in draft minutes of a meeting of NHS Scotland health board chief executives in September.
They also raise the possibility of curtailing some free prescriptions.
Scotland's Health Secretary Humza Yousaf insisted the NHS would stay publicly owned and publicly operated.
He added that health services "must always" be based on individual patient need and "any suggestion" that it should be about the ability to pay was "abhorrent".
The minutes of the meeting seen by BBC News highlight the degree of official concern about the sustainability of Scotland's NHS in its present form.
They include suggestions that hospitals should change their appetite for risk by aiming to send patients home more quickly, and pause the funding of some new drugs.
The group were advised that they had been given the "green light to present what boards feel reform may look like" and that "areas which were previously not viable options are now possibilities".
Describing a "billion pound hole" in the budget, the minutes warn that it "is not possible to continue to run the range of programmes" the NHS currently offers while remaining safe "and doing no harm." And they warn that: "Unscheduled care is going to fall over in the near term before planned care falls over."
Read full story
Source: BBC News, 21 November 2022
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"If we are queuing, we can't get to patients"

Paramedics describe a health service in crisis with a lack of investment and increasing demand, of lengthy waits to transfer patients to hospitals and of a social care system facing collapse. So what does a typical ambulance shift look like?
The area covered by the East of England Ambulance Service's nearly 400 front-line ambulances is vast.
In 2020-21, the service received nearly 1.2 million 999 calls.
Ed Wisken has been a paramedic for 13 years.
An advanced paramedic specialising in urgent care, Mr Wisken says: "It is really sad to see patients who have had to wait such a long time for an ambulance - but this is just the culmination of years of underfunding and of reduced resources peaking now where demand outstrips supply."
"It is upsetting to see it," he says. "It is not nice to see people who have been waiting hours and hours for an ambulance - but we have really hit crisis point now."
He says the morale of fellow paramedics and other healthcare workers is currently very low.
"The key is you just have to do just one job at a time and just take the patients that you see and do the best for them," he says.
"If you worry about the bigger picture too much you will get frustrated and angry - but that's not going to be beneficial for yourself or your patients."
Read full story
Source: BBC News, 21 November 2022
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‘We’re in a trauma together’: Americans need therapy – but psychologists are booked

At a time when it feels like the world’s perpetually on fire, we all need a therapist – but trying to find one in the USA is difficult.
A study from the American Psychological Association (APA) found that 6 in 10 psychologists “no longer have openings for new patients” in America. The shortage comes as demand for therapy soars: since the beginning of the pandemic, about three-quarters of practitioners have seen their waiting lists expand. In the same period, almost 80% of practitioners report an increase in patients with anxiety disorders and 66% have seen an increase in those needing treatment for depression.
“I started my private practice just before Covid hit, and it was certainly filling up then,” says Dr Jennifer Reid, a psychiatrist, writer and podcast host in Philadelphia. “But the numbers have exponentially risen since that time.”
Reid focuses on anxiety and insomnia, which have been “major players” in the pandemic. Early on, people with anxiety, phobias or obsessive-compulsive disorder related to germs had particular trouble, she says. Then there was the isolation and the doomscrolling. And now, she says, people are struggling to re-enter the world. “People are finding they’re having anxiety trying to re-engage in social settings in situations that were previously not as safe” at Covid’s peak, she says. 
Often, she says, people may need to return to their primary care doctor for a period of time, “or they just end up going without and waiting on waitlists, unfortunately”. The APA study found that the average psychologist reported being contacted by 15 potential patients every month; Reid, who combines therapy and medical approaches, says she generally has space for about one new patient every few weeks.
Read full story
Source: The Guardian, 21 November 2022
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UK health spending ‘to grow less than in austerity era’, analysis reveals

Health spending over the next two years will grow less than during the austerity era of the last decade, according to a new analysis of the autumn statement.
The chancellor, Jeremy Hunt, a former health secretary who previously campaigned for greater resources from the backbenches, announced last week that the NHS would receive an extra £3.3bn in each of the next two years. With severe pressures growing on the service, he said it would be one of his “key priorities”.
However, research by the Health Foundation charity has found that when the whole health budget is included – covering the NHS, training, public health services and capital investment – it will only increase by 1.2% in real terms over the next two years. That is below the 2% average seen in the decade preceding the pandemic, as well as the historical average of about 3.8%.
The research comes as NHS trusts face almost impossible decisions over staff wages, waiting lists and keeping buildings and equipment up to date. The Health Foundation analysis highlighted the continued “significant uncertainty” facing the delivery of health services over the remainder of this parliament. It said there were now “difficult trade-offs” on issues such as pay and the backlog.
Anita Charlesworth, director of the Real (Research and economic analysis for the long term) Centre at the Health Foundation, said that there had been “short-term relief” for the health service, especially when compared with the cuts made to non-protected departments.
However, she said it would be “treading water at best as inflation bites and it faces rising pressures from an ageing population, pay, addressing the backlog and continuing Covid costs”.
“If other parts of the system – especially social care and community care – are also struggling with cost pressures, this makes it harder to deliver healthcare and the 2% will buy less,” she said. “Efficiency can only take the NHS so far. Since 2010, if we had kept up with German health spending we’d have spent £73bn more each year, and £40bn more if we’d kept up with France.”
Read full story
Source: The Guardian, 19 November 2022
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Oklahoma proposes landmark rule to keep mailed medications safe

Patients in Oklahoma, USA, who get their prescription medications by mail may soon have better protections for the safety of those drugs than any other state. On Wednesday, Oklahoma regulators proposed the nation’s first detailed rule to control temperatures during shipping, according to pharmacy experts. 
“This is a huge step,” said Marty Hendrick, executive director of the Oklahoma State Board of Pharmacy, after the board voted to approve the rule Wednesday. “We’ve got a tremendous amount of prescriptions that get mailed to patients. … What we did today was make sure our patients in Oklahoma are receiving safe products.”
Exposure to extreme temperatures can degrade or weaken drugs, potentially changing their dosage or chemical makeup and rendering them ineffective or unsafe for patients. But while government oversight of how pharmacies store medications to keep them in defined safe temperature ranges is very detailed, an NBC News investigation in 2020 found oversight of shipping to patients — during which drugs might be exposed to heat waves and below-freezing temperatures — is largely a system of blind trust. Mail-order pharmacy is a booming business, with soaring profits for some of the nation’s largest companies last year and more than 26 million people receiving their medication by mail in 2017 — more than double the number two decades earlier, according to federal data.
NBC News found that most state pharmacy boards, the regulators responsible for pharmacy safety, did not have specific rules for how pharmacies should ship customers’ medication, few asked about this process in their inspections, and many said it was simply up to the pharmacy to ensure safe shipping. 
Read full story
Source: NBC News, 17 November 2022
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GPs can block abusive patients from automatic records access if they fear harm to staff

GP practices can block abusive patients from gaining automatic access to their records online if they pose a ‘risk of harm’ to staff, the Royal College of General Practice has said.
Automatic access to patients’ prospective patient records is due to be switched on by the end of this month, following delays related to concerns about patient safety.
But the RCGP’s toolkit on access to records said practices can refuse access to online records for patients that pose a risk of harm to others too.
The guidance said access should "be refused where there is a clear risk of serious harm to the safety of the patient or members of the practice team, or to the privacy of a third party".
It added: "If potentially harmful information cannot be successfully redacted and the practice remains concerned about the safety of record access for an individual patient – or in extreme cases, remains concerned that the patient may react violently to information in the record – then the practice may refuse to give the patient record access or restrict the level of access.
"It may be possible to give them access to a reduced part of the record such as the Summary Care Record or restrict access to appointments and repeat prescriptions."
The guidance said that records access should only be refused or restricted "after discussion with the practice leads for GP Online Services and Safeguarding or after seeking further professional advice from a local relevant agency or national medical indemnity organisation".
Read full story
Source: Pulse, 18 November 2022
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One dogged coroner, four needless deaths and a stark conclusion: the NHS is broken

When David Morganti’s case notes landed on Andrew Cox’s desk this autumn they told a devastating story — but one which was depressingly familiar to the senior coroner for Cornwall.
The 87-year-old RAF veteran had fallen and hit his head in the bathroom of the house he shared with his wife, Valerie, in April. It took nine hours for paramedics to reach their home near St Austell, Cornwall. As they waited, the bleeding on his brain became gradually worse until he lost consciousness. By the time he reached hospital it was too late. An expert neurosurgeon told Cox that had he reached hospital faster, Morganti might have survived.
The coroner said the effects of the injuries he suffered were likely to have been exacerbated “by a delay in the arrival of an ambulance and his subsequent admission into hospital.”
It was the latest in a series of similar deaths the coroner had encountered. 
After Morganti’s inquest, Cox resolved to carry out a wider investigation into what appeared to be a broken system. He has now sent his findings to Steve Barclay, the health secretary, and demanded he act to prevent more deaths.
Read full story (paywalled)
Source: The Times, 19 November 2022
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