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

Ministers consider staff body cameras to tackle NHS mental health abuse scandals

Ministers are considering the use of body cameras within mental health units as part of the government’s response to NHS abuse scandals, The Independent has learned.
Senior sources with knowledge of the conversation between the Department for Health and Social Care and the NHS have raised concerns about the plans. There are fears that using the technology in mental health units could have implications for human rights and patient confidentiality.
One senior figure criticised the proposals and said: “The DHSC are all talking about body-worn cameras, closed circuit TV, etc... The whole thing is fraught with huge difficulties regarding human rights, about confidentiality. They are thinking about it [cameras] and it is ridiculous.”
The DHSC’s mental health minister Maria Caulfield said in parliament earlier this month that she and health secretary Steve Barclay were due to meet with NHS officials to discuss what response was needed to recent exposes of abuse within mental health services.
It comes after a string of reports from The Independent, BBC Panorama and Dispatches revealing abuse of inpatients. The Panorama and Dispatches reports included video evidence of abuse captured by hidden cameras.
Following a scathing independent review into the deaths of three young women, Tees, Esk and Wear Valleys NHS Trust said it is piloting the use of body-worn cameras across 10 inpatient wards “to support post incident reviews for staff and patients.”
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Source: The Independent, 23 November 2022
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Plea to blur line between doctors and nurses amid NHS staff crisis

The NHS staffing crisis will be solved only if doctors and nurses get more flexible about their job descriptions and break down barriers between roles, according to Rishi Sunak’s health adviser.
Bill Morgan argues that training times for doctors and nurses may have to be reduced, and suggests developing “sub-consultants” and entirely new medical professions, He wants ministers to create an Office for Budget Responsibility-style body to predict future workforce needs.
The Treasury has held down the numbers of doctors and nurses Britain trains to prevent “supply-induced demand”, which encourages people to seek appointments that are not needed, Morgan argues.
Chronic shortages of qualified staff are the biggest problem facing the health service, which has more than 130,000 vacancies. Morgan acknowledges that this means “some of the government’s key manifesto commitments will not be met”, citing the promise of 6,000 extra GPs.
Sunak said this week that the government was “thinking creatively about what new roles and capabilities we need in the healthcare workforce of the future”. He urged the NHS to shed “conventional wisdom”.
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Source: The Times, 24 November 2022
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The puzzle of UK’s half a million missing workers

For the first time, more than 2.5 million people in the UK are out of work because of a long-term health problem. The number has jumped by half a million since the start of the pandemic - but, BBC News analysis reveals, the impact is spread unevenly across the country, with some regions and types of job far more affected.
For Mary Starling, there are good days and bad days.
The 61-year-old is on strong painkillers, for arthritis. She needs a knee replacement - but that could mean another 18 months on an NHS waiting list.
Mary is keen to return to that work - but needs her operation first.
"I feel despair - but I'm resigned to it," she says. "I understand it isn't possible to magic up something, though it's wearing not being able to plan my life."
The UK is in its fourth year of sharply rising chronic illness. The highest rates are among 50- to 64-year-olds, but there have also been significant increases in some younger groups.
Although the link is not conclusive, the Bank of England has said record NHS waiting lists are likely to be playing a "significant role".
Some of the largest increases are in people reporting mobility difficulties, such as leg and back problems, or heart and blood-pressure problems. More younger people, in particular, say they are not in work because of different forms of mental illness.
But the largest increase in long-term sickness is in the catch-all "other health problems" category, likely to include some of those with "long Covid" symptoms.
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Source: BBC News, 23 November 2022
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NHS Highland slammed over three year wait for bowel op

A report by the Scottish Public Services Ombudsman (SPSO) said the health board's own investigation into the patient's complaint was of "poor quality" and "failed to acknowledge the significant and unreasonable delays" suffered.
The delays led 'Patient C' to develop a severe hernia which left them unable to work, reliant on welfare benefits, and requiring riskier and more complex surgery than originally planned.
The watchdog criticised NHS bosses for blaming Covid for the delays when the patient had been ready for surgery since December 2018, and said there had been "no sense of urgency" despite "the gravity of C's situation".
The report said: "It is of significant concern that the Board has failed to fully acknowledge the consequences of the delays and the adverse effects upon C's physical and mental health as a result.
"The consequences for C of these delays cannot and should not be underestimated."
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Source: The Herald, 24 November 2022
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Ministers ditch NHS England’s A&E target review

Ministers have effectively ditched NHS England’s planned new bundle of A&E targets and want trusts to be firmly regulated on the existing four-hour standard and 12-hour breaches, HSJ understands.
Multiple senior figures familiar with the process, from inside the NHS and government, said the performance focus for the next two years will be on the two existing accident and emergency waiting time measures, as well as ambulance handover delays.
For the last three years, NHS England has been lobbying government to scrap the headline four-hour target, and replace it with a bundle of measures which have been trialled at around a dozen providers. This work has been led by medical director Steve Powis.
HSJ understands the decision to continue using the existing four-hour target was driven by concerns among ministers and senior NHS figures that the bundle of measures was too confusing, both for patients and as a means for government to hold the service to account.
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Source: HSJ, 23 November 2022
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Nine trusts account for third of ambulance ‘hours lost’

Nine acute trusts accounted for a third of all ‘hours lost’ to ambulance handover delays last week, according to new data.
The first NHS England winter sitrep data showed wide variation between providers on ambulance handover performance, with a small number of providers accounting for a huge proportion of delays.
There were nine trusts where, for each ambulance arrival in the week to 20 November, an average (mean) of more than an hour was lost to handover delays. The providers accounted for around 7,000 hours lost, 33% the national total, despite only accounting for 7% of ambulance arrivals. 
At University Hospitals Plymouth an average of 2.3 hours were lost.
The other trusts were; Norfolk and Norwich University Hospitals; East and North Hertfordshire; The Queen Elizabeth Hospital King’s Lynn; Great Western Hospitals; University Hospitals of Leicester; Torbay and South Devon; University Hospitals of North Midlands; and Worcestershire Acute Hospitals.
Many of the worst performing hospitals were in the South West and East of England regions, which have previously been identified as areas which struggle on handover delays.
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Source: HSJ, 24 November 2022
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Nurses across UK to strike for first time on 15 and 20 December

Nurses across the UK will go on strike for the first time over two days in the fortnight before Christmas after ministers rejected their pleas for formal talks over NHS pay.
The Royal College of Nursing (RCN) said its members would stage national strikes – the first in its 106-year history – on 15 and 20 December. Senior sources said the industrial action was expected to last for 12 hours on both days – most likely between 8am and 8pm.
The unprecedented national industrial action will seriously disrupt care and is likely to be the first in a series of strikes over the winter and into the spring by other NHS staff, including junior doctors and ambulance workers.
On Friday, RCN general secretary, Pat Cullen, said the UK government had chosen strikes over listening to nursing staff, adding: “If you turn your back on nurses, you turn your back on patients.”
The RCN said that despite a pay rise of about £1,400 awarded in the summer, experienced nurses were worse off by 20% in real terms due to successive below-inflation awards since 2010. It said the economic argument for paying nursing staff fairly was clear when billions of pounds were being spent on agency staff to plug workforce gaps.
It added that in the last year, 25,000 nursing staff around the UK had left the Nursing and Midwifery Council register, with poor pay contributing to staff shortages across the country, which it warned were affecting patient safety. There are 47,000 unfilled NHS registered nurse posts in England alone.
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Source: The Guardian, 25 November 2022
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‘Staggering’ rise in restraint of black people in mental healthcare

The rate of people from black backgrounds being restrained in mental healthcare has more than doubled in the past six years, widening the gap with other racial groups, according to official NHS data.
Standardised rates of black and black British people subject to restrictive interventions – including physical, chemical and mechanical restraints – have leapt from 52.1 per 100,000 people in 2016-17 to 106.2 in 2021-22.
That is compared to a much smaller increase of 30% in the same period for people from white backgrounds, from 15.8 per 100,000 to 20.5.
NHS race and health observatory director Habib Naqvi told HSJ he was “very concerned” at the rise.
He said a “range of complex causes are likely to be presented to account for this pattern”, including disparities in care pathways, late presentation and lack of timely diagnosis, and general overuse of restrictive practice on people from minority ethnic backgrounds.
He added: “It is critical we also focus on ‘causes of the causes’ of these disparities, including the impact of discrimination and bias on access, experience and therefore outcomes of mental health services.”
Read full story (paywalled)
Source: HSJ, 24 November 2022
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Logan Mwangi murder: Injuries seen as accident by doctor

Hospital doctors failed to share with child protection services a list of "significant" injuries a five-year-old boy suffered 11 months before he was murdered, a case review has found.
Logan Mwangi had a broken arm and multiple bruises across his body when he was taken to A&E in August 2020. But a paediatric consultant said these injuries were accidental and did not make a child protection referral.
Logan, from Bridgend, was murdered by his mother, stepfather and a teenager.
A Child Practice Review (CPR) has looked at how different agencies were involved with Logan's family in the 17 months before his death.
Cwm Taf Morgannwg health board said it welcomed the commissioning of an independent review into how it identifies and investigates non-accidental injuries.
The report said that if the injuries had been shared with social services, appropriate action could have been taken to safeguard Logan.
Jan Pickles, the independent chair of the review panel, said it was a "a significant missed opportunity".
She added: "Had further information from health been shared it most likely, though we cannot say for sure because of hindsight bias, would have triggered a child protection assessment in line with the joint agreed guidelines, as the nature of those injuries clearly met the threshold."
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Source: BBC News, 24 November 2022
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NHS faces ‘perfect winter storm’ with tenfold rise in hospital flu cases

The NHS in England is facing a “perfect winter storm” with 10 times more people in hospital with flu than this time last year, and ambulances experiencing deadly delays when arriving at A&E with sick patients.
There were an average of 344 patients a day in hospitals in England with flu last week, more than 10 times the number at the beginning of last December.
And as many as 3 in 10 patients arriving at hospitals by ambulance are waiting at least 30 minutes to be handed over to A&E teams. Health chiefs say the crisis is leading to deaths.
The figures on flu and ambulance delays were published by NHS England on Thursday and offered the first weekly snapshot of how hospitals are performing this season.
Matthew Taylor, the chief executive of the NHS Confederation, which represents the healthcare system in England, said: “These figures really hammer home just how stretched services already are as we head into a perfect winter storm. Significantly higher numbers of people are in hospital because of flu compared to this time last year, coupled with the fact that Covid-19 has not gone away.”
He added: “The life-saving safety net that NHS ambulance services provide is being severely compromised by these unnecessary delays, and patients are dying and coming to harm as a result on a daily basis.”
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Source: The Guardian, 24 November 2022
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Nottingham maternity units set to miss investigations deadline

Bosses at Nottingham's crisis-hit maternity units are set to miss a deadline for clearing a backlog of incomplete "serious incident" investigations.
Nottingham University Hospitals Trust (NUH) has 53 outstanding maternity incidents yet to be investigated.
The trust had said it aimed to complete investigations by December 23.
But director of midwifery Sharon Wallis says they have not progressed as quickly as she had hoped.
The Local Democracy Reporting Service said the trust has managed to clear a number of those incidents - but it declared another nine in September and October.
An independent review team, led by senior midwife Donna Ockenden, is examining dozens of baby deaths at the trust.
Read full story
Source: BBC News, 25 November 2022
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Scotland’s NHS ‘already two-tier’ as more pay to go private

Nicola Sturgeon has been accused of running a two-tier NHS after it emerged that tens of thousands of patients are going private for crucial operations and healthcare.
Anas Sarwar, the Scottish Labour leader, cited figures that showed more than 39,000 patients underwent private procedures in the past year. These included thousands of hip and knee surgeries, costing an average of £12,500 per patient.
“Often these are people who are forced to borrow money, turn to family and friends, or even remortgage their home to get healthcare that should be free at the point of need,” Sarwar told MSPs at first minister’s questions.
He said that almost 2,000 people had gone for private treatment for endoscopies and colonoscopies, more than 7,800 for cataract surgery and 3,500 have had a hip or knee replacement in a private hospital.
“These figures make clear that under the SNP, healthcare in Scotland is already a two-tier system,” he added.
Read full story (paywalled)
Source: The Times, 24 November 2022
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Cancer waiting times: “We have our foot on the gas,” says NHS England’s cancer lead

NHS England’s national cancer director has said that she is “cautiously optimistic” about reaching cancer waiting time targets by March 2023, but she refused to be drawn on what had happened to the government’s proposed 10 year cancer plan.
Cally Palmer was speaking to MPs on the Health and Social Care Committee at a special one-off session on the urgent challenges facing cancer services, including workforce shortages, winter pressures, and poor performance.
Latest figures from September, published on 10 November, show that 60.5% of patients began their first treatment within 62 days of being urgently referred for suspected cancer, against a target of 85%. That target was pushed back to March 2023 from March this year.
Palmer told the committee on 23 November that the 85% target aimed to reduce the 62-day backlog to pre-pandemic levels.
Read full story (paywalled)
Source: BMJ, 24 November 2022
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Devon carer who murdered woman had violent crime history

A carer who murdered the elderly woman he was employed to look after had a history of violent crime including actual bodily harm, a report found.
A safeguarding adults review over the death of a 77-year-old Devon woman in 2021 criticised working practices among organisations involved in her care.
Devon and Cornwall Police did not disclose information about domestic abuse callouts involving the killer in a DBS check by the care provider.
He was jailed for life in July 2022.
The woman had seen her killer as "a grandson" figure, it said.
The 35-year-old killer attacked his victim after she discovered he had stolen several thousand pounds from her.
The had no previous employment experience of care before being taken on as her sole carer by Complete Quality Care Ltd, an independent care provider.
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Source: BBC News, 24 November 2022
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‘Patient safety progress stopped in its tracks by covid’ says Hunt report

A report commissioned by Jeremy Hunt before he became Chancellor has highlighted how the pandemic ’stopped progress on patient safety in its tracks’ and called for more accurate data to be published on a range of measures.
The National State of Patient Safety was funded by Mr Hunt’s Patient Safety Watch charity and produced by Imperial College London’s Institute of Global Health Innovation. 
It highlights a rise in rates of MRSA and C. difficile since the onset of the pandemic in 2020, as well as an increase in deaths due to venous thromboembolism and hip fractures. The report said the pandemic had also exacerbated issues associated with staff wellbeing, claiming there had been “notable rises” in staff burnout and ill-health.
The researchers described problems with the breadth and accuracy of available patient safety data and highlighted that only 44% of trusts currently fulfilled the obligation to report their own estimated number of avoidable deaths.
Although the report added that “data on rates of avoidable deaths are not a panacea”, it described them as a “snapshot of safety and harm and are most usefully used to initiate further work to understand the causes of unwarranted variation”.
Read full story (paywalled)
Source: HSJ, 27 November 2022
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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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