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

Orthopaedic patients face seven-year wait for surgery

Orthopaedic patients in NHS Highland face a wait of up to seven years for surgery, new research has found.
A University of Aberdeen study said the worst case estimate would apply if surgical rates did not increase for those listed in July this year.
Researchers also discovered the average wait across Scotland's 14 health boards could be as long as two years and three months.
The Scottish government said it was working to maximise NHS capacity.
Luke Farrow, clinical research fellow, warned that the significance of the delays could not be underestimated.
He said: "Prolonged waits for certain orthopaedic procedures can have a major negative impact on patient health.
"This occurs both in terms of deterioration in quality of life whilst awaiting surgery, as well as potential negative connotations for post-operative recovery and longer-term health in addition to reduced independence and increased social care needs."
Read full story
Source: BBC News, 14 December 2022
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Largest nursing strike in NHS history starts

Nurses in England, Wales and Northern Ireland have started a nationwide strike in the largest action of its kind in NHS history.
Staff will continue to provide "life-preserving" and some urgent care but routine surgery and other planned treatment is likely to be disrupted.
The Royal College of Nursing said staff had been given no choice after ministers refused to reopen pay talks.
RCN general secretary Pat Cullen has called on the government to "do the decent thing" and resolve the dispute before the year ends.
Ms Cullen told BBC Breakfast the strike marked "a tragic day in nursing".
"We need to stand up for our health service, we need to find a way of addressing those over seven million people that are sitting on waiting lists, and how are we going to do that? By making sure we have got the nurses to look after our patients, not with 50,000 vacant posts, and with it increasing day by day," she said.
Health Minister Maria Caulfield, a former nurse, accepted "it is difficult" living on a nurse's wage, but said that a 19% pay rise "is an unrealistic ask".
Under trade union laws, the RCN has to ensure life-preserving care continues during the 12-hour strike.
Chemotherapy and kidney dialysis should run as normal, along with intensive and critical care, children's accident and emergency and hospital neonatal units, which look after newborn babies.
Read full story
Source: BBC News, 15 December 2022
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Antibiotic supply gone from bad to worse, say pharmacists

Pharmacists say supplies of key antibiotics to treat strep A have "gone from bad to worse" in the past week.
The Association of Independent Multiple Pharmacies (AIMP) said the situation was "unacceptable" and it was time for the government to get a plan in place.
Four antibiotics, which treat different conditions, have been added to a list of products that the UK cannot export.
The UK government says it is working urgently with manufacturers and wholesalers to speed up deliveries.
However, Leyla Hannbeck, chief executive of the AIMP, which represents 4,000 pharmacies in the UK, said the supply of antibiotics to treat bacterial infections including strep A and scarlet fever was "very poor".
She said the problem had been highlighted a week ago, but it was now getting worse, making it very difficult to get hold of any antibiotics.
"People are having to go from one pharmacy to another - it's chaos," she said.
"Supplies are not coming through to us and it feels like no-one cares."
Read full story
Source: BBC News, 14 December 2022
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‘Deadly cancer timebomb’ as thousands more than expected killed by the illness since pandemic

Nearly 8,900 more people have died of cancer than expected in Britain since the start of the pandemic, amid calls for the Government to appoint a minister to deal with the growing crisis. 
In an essay in The Lancet Oncology, campaigners and medics said the upward trend of cancer deaths is likely to continue, with 3,327 in the last six months alone. 
They urged the Government to tackle the crisis with the same focus and urgency given to the Covid vaccine rollout, and called for a cancer minister to get on top of the backlog.
NHS data from November showed that in the last 12 months, 69,000 patients in the UK have waited longer than the recommended 62-day wait from suspected cancer referral to start of treatment.
Professor Gordon Wishart, a former cancer surgeon and chief medical officer of Check4Cancer, said: “The Covid-induced cancer backlog is one of the deadliest backlogs and has served to widen the cracks in our cancer services". 
“Now we face a deadly cancer timebomb of treatment delays that get worse every month because we don’t have a sufficiently ambitious plan from policymakers. I urge the Government to work with us.”
Read full story (paywalled)
Source: The Telegraph, 15 December 2022
Sam

Vulnerable patients facing long delays for beds amid funding rows

Vulnerable patients, including some children, have faced long delays for a suitable bed as organisations argue over whose responsibility it is to fund and deliver their care, HSJ understands.
In a letter outlining winter arrangements, NHS England has warned trust leaders and commissioners against delaying emergency mental health admissions – typically needed when a patient is away from home, and understood to be more common over the Christmas period – while determining which area has which responsibility.
National mental health director Claire Murdoch wrote: “It is not acceptable to delay an emergency mental health admission while determining which area has clinical and financial responsibility for the care of an individual.”
She added such admissions should be arranged “as quickly as possible, and without delay caused by any financial sign-off process”. 
It comes as HSJ has been told patients can often end up waiting for several days in emergency departments or in “inappropriate” out of area or acute beds when disputes occur over who is responsible for their care.
Read full story (paywalled)
Source: HSJ, 15 December 2022
Sam

Nottingham placenta error hampered baby death probe - coroner

A coroner says an investigation into the death of a newborn baby at a hospital was compromised by the way the placenta was dealt with.
Quinn Lias Parker was born at Nottingham's City Hospital in July 2021 but died two days later from multiple organ failure.
It later emerged the placenta was dissected by pathology staff when it should have been preserved.
Hospital bosses said procedures had since been revised.
An inquest into Quinn's death, held in April, returned a narrative verdict. 
After Quinn's birth, Ms Studencki's placenta was sent from the hospital's maternity unit to pathology, where it was dissected - meaning it was cut up for examination. 
But Dr Elizabeth Didcock, assistant coroner for Nottinghamshire, said the dissection meant the post-mortem examination was compromised.
In a prevention of future deaths report, she detailed how Quinn was born in a "poor condition" and there was a "high probability that he would not survive" and therefore "thought needed to be given to the preservation of the placenta" to ensure it could be used in an examination.
"It is not clear to me exactly how the placenta was cut into after Quinn's death without discussion with the coroner," she said.
"What is clear is that the outcome has been highly detrimental to the independent investigation by the coroner and other agencies investigating the circumstances of this case.
"This death follows a number of similar early neonatal deaths in Nottingham, where the placenta has not been retained, and therefore key information regarding placental pathology has been lost."
Patient Safety Learning

‘Every chemist has a backroom’: the rise of secret FGM in Kenya

In Kisii town, south-west Kenya, a rundown roadside building houses a pharmacy. Like many others in the area, the pharmacy doubles as a clinic.
Lilian Kemunto (not her real name), a former surgical nurse, set it up after she retired in 2018. She mainly does health check-ups but has also offered female genital mutilation (FGM) services on request.
Kemunto has performed cuts since the 90s, after receiving training in basic surgical techniques from male colleagues in the local hospital where she worked. She would do the cuts in the hospital at night, but it was risky, she says, because management didn’t approve. “They would tell us: ‘Just do it, but if you’re caught, you’re on your own.’”
She preferred cutting girls in a private home, in the middle of the night, saying it was much easier: “By 6am, the girls are back in their own homes, like nothing happened.”
In Kisii county, medicalisation is standard. Two out of three cases of cutting are performed by health practitioners, in contrast to much of the country, where 70% of FGM cases are performed by traditional practitioners.
Kemunto says she tries to avoid mishaps, and at a minimum requires some anaesthesia, a surgical blade, sterile towels, and cleaning solution to proceed.
She also claims to use a non-invasive procedure: a small incision of the clitoris that practitioners call a “signature”. Kisii’s FGM practice is considered less severe than other areas, and anti-FGM campaigners are concerned that there’s a growing acceptance of the practice as more safe, hygienic and cosmetic.
FGM rates in Kenya have gone down significantly over the past decade. The country passed strong laws in 2011, imposed hefty fines on practitioners, and stepped up surveillance and enforcement. But medicalisation is posing a new challenge for the east African nation, which has a 15% medicalisation rate: one of the highest in Africa.
Earlier this month, Kenyan president William Ruto backed the country’s chief justice who said that FGM “should not be a conversation we are having in Kenya in the 21st century”, and reiterated his administration’s commitment to eradicating the practice.
Read full story
Source: The Guardian, 15 December 2022
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Ambulance strike threatens ‘different magnitude of risk’

The ambulance staff strike next week represents a far higher risk to patient safety and services than the nurses’ strike, but a blanket elective ban will only be used as “an absolute last resort”, a senior NHS England director said today.
However, NHSE elective recovery chief Sir Jim Mackey’s comments come despite several local leaders telling HSJ significant amounts of elective activity are likely to need to be postponed due to the ambulance staff walkout on 21 and 28 December, to free up capacity to deal with emergency care pressure.
Speaking at a King’s Fund conference this morning, Sir Jim said: “The ambulance strike is a completely different order of magnitude of risk [than the nurses’ strike]. I think that’s the main thing people are worried about because of the complexity and fragility of urgent care.”
However, he added: “If we were to give [national guidance on what elective activity to cancel] today, the only guidance we could give would be to cancel absolutely everything, and that’s really not going to help anybody…
“I think we’ll just have to take it day-by-day and keep learning from each other and sharing intelligence… and then, if at some point, there is a case for blanket order, we’ll consider that… But, we really want to do that as an absolute last resort.”
Read full story (paywalled)
Source: HSJ, 15 December 2022
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‘Constructive’ first ambulance strike agreement revealed

Elderly people who fall may only be sent an ambulance after they have spent four hours on the floor, and some category 2 calls may not be responded to under one of the first agreements with ambulance unions about next week’s strikes.
But the deal between South East Coast Ambulance Service and the GMB union will see many union staff continue to work on ambulances and in control rooms – and others may be asked to come off the picket line if operational pressures escalate.
HSJ has seen the details of the deal – thought to be one of the first agreed before next Wednesday’s strike. Some other trusts are hoping to conclude negotiations shortly, but for several — such as in the North West and London — it is thought no strike “derogations” (exceptions) have so far been agreed, and managers are concerned that unions are resistant. Trusts have been pushing for more cover on strike days – especially around category 2 calls.
Read full story (paywalled)
Source: HSJ, 15 December 2022
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No timetable for infected blood victims' compensation

There is a "moral case" for compensation to be paid to people affected by the contaminated blood scandal, the government has said.
But Paymaster General Jeremy Quin told MPs he could not commit to a timetable.
In August, the government announced that 4,000 UK victims would receive interim payments of £100,000.
Tens of thousands of people contracted HIV or hepatitis C in the 1970s and 80s after being given infected blood. 
In September, modelling by a group of academics commissioned by the public inquiry estimated that 26,800 people were infected after being given contaminated transfusions between 1970 and 1991.
The study calculated that 1,820 of those died as a result, but that the number could be as high as 3,320.
The inquiry, chaired by retired High Court judge Sir Brian Langstaff, began taking evidence in 2018.
The interim compensation announcement in August came after Sir Brian argued there was a compelling case to make payments quickly - saying victims were on borrowed time because of their failing health.
Payments have been made to those whose health is failing after developing hepatitis C and HIV, and partners of people who have died.
But families have complained that many people affected, such as bereaved parents, missed out.
Read full story
Source: BBC News, 15 December 2022
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Strep A kills three more children as UK activates alternative medicines plan

Three more children have died from strep A, it has emerged, and pharmacists in the UK have been told they can supply alternative antibiotics to those originally prescribed, in a bid to ease shortages of certain forms of penicillin.
The UK Health Security Agency (UKHSA) data shows at least 19 children have now died across the UK, while there are 7,750 cases of scarlet fever so far this season. This is more than treble the 2,538 at the same point in the year during the last comparably high season in 2017 to 2018.
The Department of Health and Social Care (DHSC) has issued serious shortage protocols (SSPs) for three penicillin medicines amid increased demand for the antibiotics.
Pharmacists and GPs in the UK have faced serious difficulties in securing supplies of penicillin and amoxycillin, antibiotics used to treat infections including strep A. As a result, parents have reported having to visit a string of pharmacies to obtain medicines prescribed for their sick children, while the price of some antibiotics has risen sharply – a situation pharmacists say has left them facing losses.
The health minister Will Quince said: “The increased demand for the antibiotics prescribed to treat strep A has meant some pharmacists have been unable to supply the medicine shown on the prescription.
“These serious shortage protocols will allow pharmacists to supply an alternative form of penicillin, which will make things easier for them, patients, and GPs.
“We are taking decisive action to address these temporary issues and improve access to these medicines by continuing to work with manufacturers and wholesalers to speed up deliveries, bring forward stock they have to help ensure it gets to where it’s needed, and boost supply to meet demand as quickly as possible.”
Read full story
Source: The Guardian, 15 December 2022
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Flu hospitalisations in England soar as NHS braces for severe outbreak

Flu hospitalisations in England have jumped by more than 40 per cent in a week as the NHS braces for one of the worst outbreaks of the virus in recent years.
Analysis of NHS data by The Telegraph shows that rates are more than eight times higher than expected at this time of year.
On the current trajectory, admissions next week could pass the peak of the 2017-18 outbreak – one of the worst of the last 20 years – which led to nearly 30,000 deaths.
Flu hospitalisations are so high that they have overtaken Covid admissions for the first time since the start of the pandemic.
The rise could not come at a worse time for the NHS. It is already suffering the biggest treatment backlog in its history, which is set to be exacerbated by strikes by nurses and ambulance paramedics.
Read full story
Source: The Telegraph, 15 December 2022
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One in eight UK adults using private medical care due to NHS delays

One in eight adults in the UK have paid for private medical care in the last year because of long delays in getting NHS treatment, renewing fears that the NHS is becoming “a two-tier system”.
“Around one in eight (13%) adults reported they had paid for private medical care, with 5% using private insurance and 7% paying for the treatment themselves,” according to a new report by the Office for National Statistics (ONS).
Patients also say that waiting for tests or treatment is badly affecting them, including making their illness worse.
The ONS survey of 2,510 adults across the UK found that one in five were waiting for an appointment, test or treatment at an NHS hospital. Of those in that situation:
Three-quarters said their delay had had either a strongly (34%) or slightly (42%) negative impact on their life 36% said waiting had made their condition worse 59% said it had damaged their wellbeing A third said long waits had affected either their mobility (33%) or ability to exercise (34%) Read full story
Source: The Guardian, 16 December 2022
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ER doctors in the US misdiagnose patients with unusual symptoms

As many as 250,000 people die every year because they are misdiagnosed in the emergency room, with doctors failing to identify serious medical conditions like stroke, sepsis and pneumonia, according to a new analysis from the US federal government.
The study by the Agency for Healthcare Research and Quality estimates roughly 7.4 million people are inaccurately diagnosed of the 130 million annual visits to hospital emergency departments in the United States. Some 370,000 patients may suffer serious harm as a result.
Researchers from Johns Hopkins University analysed data from two decades’ worth of studies to quantify the rate of diagnostic errors in the emergency room and identify serious conditions where doctors are most likely to make a mistake.
While these errors remain relatively rare, they are most likely to occur when someone presents with symptoms that are not typical.
“This is the elephant in the room no one is paying attention to,” said Dr. David E. Newman-Toker, a neurologist at Johns Hopkins University and director of its Armstrong Institute Center for Diagnostic Excellence, and one of the study’s authors.
The findings underscore the need to look harder at where errors are being made and the medical training, technology and support that could help doctors avoid them, Dr. Newman-Toker said. “It’s not about laying the blame on the feet of emergency room physicians,” he said.
Read full story
Source: New York Times, 15 December 2022
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Republic of Ireland: 'Unsafe' A&Es criticised as doctors warn of GP crisis

Patients are not safe from harm in three out of seven emergency departments, a damning new Hiqa inspection report has revealed. 
The report was released on the same day as an Oireachtas committee was warned of a growing crisis in primary care, with patients in some parts of the country unable to access basic GP services. 
Emergency Departments in Cork University Hospital (CUH) and University Hospital Limerick (UHL) were among seven EDs assessed by the health watchdog.
In three EDs, including Cork and Limerick, inspectors found failures to ensure “service providers protect service users from the risk of harm.” 
Inspectors also found patients’ “dignity, privacy and autonomy” was not respected in UHL, while CUH was only partially compliant in this area.
The report also highlighted lengthy waiting times, including one patient who spent 116 hours on a trolley at UHL.
Read full story
Source: The Irish Examiner, 15 December 2022
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Life Sciences Council Joint Statement on Medical Devices Regulatory Reform

The reform of the UK’s Medical Device regulation offers a golden opportunity to drive innovation and growth in the UK’s Life Science sector while ensuring patient safety remains at the heart of the regulatory approach. But there is an urgent need for action to ensure we do not lose this opportunity.
Senior members of the Life Sciences Council, Will Quince MP, Minister of State at the Department of Health and Social Care, Dr June Raine, CEO, Medicines and Healthcare products Regulatory Agency (MHRA) and Peter Ellingworth, CEO, Association of British HealthTech Industries (ABHI) have today announced a new agreement to accelerate the delivery of the future UK HealthTech regulatory system.
Acknowledging the Chancellor’s priorities of stability and growth supported by regulatory reforms, and the importance of the success of the system to UK patients and the Life Science sector, they have formed an advisory group on behalf of the Life Sciences Council to drive the delivery of the ambition of the Life Sciences Vision to have a best in class regulatory system.
The advisory group has agreed that aligned proposals will be published on three priority areas:
international recognition routes for innovation system capacity. Read full press release
Source; Gov.UK, 16 December 2022
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