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

Government should 'declare national NHS major incident' as service under same strain as first wave of Covid

The government should declare a national NHS major incident to rescue the healthcare system from the current crisis, a senior health official says.
Dr Tim Cooksley, president of the Society for Acute Medicine (SAM), says that the pressures on the NHS seen over the festive period are not new. He added that a number of recommendations had been outlined since the pandemic that offer the “best hope” of a short-term solution.
Declaring a national NHS major incident would mean all four UK nations would co-ordinate their response and allocate resources to help meet the overwhelming demand for care that is enveloping many hospitals around the country. Taking that step would help combat the current situation, Dr Cooksley says, which NHS chiefs believe is having a similar effect on the service to the first wave of the Covid-19 pandemic.
“The current situation in urgent and emergency care is shocking. It is in a critical state for patients and it is an extremely difficult for healthcare staff who are unable to deliver the care they want to," Dr Cooksley said. “Political leaders across the UK need to listen, meet urgently and accept the need to declare a national NHS major incident.
"The outcome must be a four-nation emergency strategy which results in short-term stabilisation, medium-term improvement and long-term growth – the grave situation we are in means it will be a long journey. Sustainable workforce and capacity plans are required urgently to boost morale among staff and patients – as we have long called for – and we now need to see action.”
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Source: Manchester Evening News, 1 January 2022
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Child referrals for mental health care in England up 39% in a year

The number of children in England needing treatment for serious mental health problems has risen by 39% in a year, official data shows.
Experts say the pandemic, social inequality, austerity and online harm are all fuelling a crisis in which NHS mental health treatment referrals for under-18s have increased to more than 1.1m in 2021-22.
In 2020-21 – the first year of the pandemic – the figure was 839,570, while in 2019-20 there were 850,741 referrals, according to analysis of official figures by the PA Media.
The figures include children who are suicidal, self-harming, suffering serious depression or anxiety, and those with eating disorders.
Dr Elaine Lockhart, chair of the child and adolescent psychiatry faculty at the Royal College of Psychiatrists, said the rise in referrals reflected a “whole range” of illnesses.
She said “specialist services are needing to respond to the most urgent and the most unwell”, including young people suffering from psychosis, suicidal thoughts and severe anxiety disorder.
Lockhart said targets for seeing children urgently with eating disorders were sliding “completely” and that more staff were needed.
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Source: The Guardian, 3 January 2023
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Government urged to take action over NHS pressures

The crisis engulfing the NHS will continue until Easter, health leaders have warned, as senior doctors accused ministers of letting patients die needlessly through inaction.
More than a dozen trusts and ambulance services have declared critical incidents in recent days, with soaring demand, rising flu and Covid cases and an overstretched workforce piling pressure on the health service.
But amid warnings that up to 500 people a week may be dying due to delays in emergency care alone, and of oxygen for seriously ill patients running out in parts of England, NHS leaders warned more chaos was expected until April.
“It seems likely that the next three months will be defined by further critical incidents needing to be declared and the quality of care being compromised,” said Matthew Taylor, chief executive of the NHS Confederation, which represents the whole healthcare system in England, Wales and Northern Ireland.
Ministers face growing pressure to grip the crisis. The British Medical Association (BMA) said the government’s “deafening” silence and failure to act was a “political choice” that was leading to patients “dying unnecessarily”.
The Liberal Democrats urged the government to recall parliament, while Labour blamed government “mismanagement” for creating a sense of “jeopardy” around the NHS.
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Source: The Guardian, 2 January 2022
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Ambulance crews urged to conserve oxygen

Ambulance staff are being urged to conserve oxygen supplies because of a national shortage of small cylinders used both on ambulances and in some A&E departments.
South East Coast Ambulance Service Foundation Trust has told staff the shortage is caused by the high number of patients with respiratory conditions and “the suppliers are reporting that this is higher than during the first wave of the covid pandemic”.
In a message to staff last week, East of England Ambulance Service Trust said: “Oxygen suppliers, including BOC, are currently unable to supply sufficient numbers [of small cylinders] to fulfil our orders.
“This has been escalated nationally and NHS Procurement are working to support ambulance trusts with supplies.” But it added that over the next few days it would need to “carefully manage” supplies.
The type of cylinder affected typically provides about 30 minutes of oxygen on full flow and is widely used on ambulances and also where patients are cohorted in accident and emergency departments or kept in corridors waiting to be passed to hospitals, without access to the normal piped supply. Many ambulances will carry several smaller cylinders, and sometimes they also carry one larger one. However, if a patient requiring oxygen can’t be handed over quickly at A&E, ambulance supplies may start to run low.
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Source: HSJ, 30 December 2022
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Thousands of patients go missing from NHS care

Police have carried out more than 5,500 investigations into patients who have been reported missing from NHS facilities in Scotland since 2019.
The figures were outlined in a written response from Keith Brown, the justice secretary, to Jamie Greene, the Conservative MSP.
Greene, who is the justice spokesman for the Conservatives, said the figures gave serious cause for concern. He said that the complete figure could be much higher because the data provided only included those reported to police. He urged Brown and Humza Yousaf, the health secretary, to provide adequate resources for policing and the health sector to ensure vulnerable patients were not slipping through the cracks.
Greene said: “These figures are deeply alarming. Relatives expect their loved ones to be safe while they are staying, or being treated in, an NHS facility. It gives serious cause for concern that over 200 investigations have had to be launched in just the last few years to determine the whereabouts of young people who went missing from NHS grounds.”
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Source: The Times, 3 January 2023
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Flu rise warning from NHS in England

There were more than 3,700 patients a day in hospital with flu last week - up from 520 a day the month before, the latest data from NHS England shows.
Of these, 267 people needed specialised care in critical care beds last week.
NHS England warns pressures on the health service continue to grow as viruses like flu re-circulate after a hiatus during the pandemic.
Prof Sir Stephen Powis, NHS national medical director, said: "Sadly, these latest flu numbers show our fears of a 'twindemic' have been realised, with cases up seven-fold in just a month and the continued impact of Covid hitting staff hard, with related absences up almost 50% on the end of November."
He warned this was "no time to be complacent" with the risk of serious illness being "very real" and encouraged those eligible to take up their flu and Covid jabs as soon as possible.
Admissions among children under 5 have been high this flu season, as well as among older people.
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Source: BBC News, 30 December 2022
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NHS patients resort to sleeping in cars as crisis deepens

A combination of Covid, flu, and Strep A has seen more than a dozen trusts and ambulance services declare critical incidents in recent days.
NHS patients are sleeping in their cars outside hospitals, as the chaos engulfing the health service is set to last until Easter.
Some 13% of hospital beds in England are filled with people with Covid or flu, NHS England figures show, with the treatment backlog also at a record high of 7.2 million.
But Matthew Taylor, the chief executive of the NHS Confederation, which represents health service managers, said no reprieve is expected until April.
"It seems likely that the next three months will be defined by further critical incidents needing to be declared and the quality of care being compromised," he told the Guardian.
Read full story (paywalled)
Source: The Telegraph, 3 January 2023
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Record number of 'foreign objects' left inside patients after surgical blunders

A record number of "foreign objects" have been left inside patients' bodies after surgery, new data reveals.
Incidents analysed by the PA news agency showed it happened a total of 291 times in 2021/22.
Swabs and gauzes used during surgery or a procedure are one of the most common items left inside a patient, but surgical tools such as scalpels and drill bits have been found in some rare cases.
A woman from east London described how she "lost hope" after part of a surgical blade was left inside her following an operation to remove her ovaries in 2016.
The 49-year-old, who spoke to PA on condition of anonymity, said: "When I woke up, I felt something in my belly.
"The knife they used to cut me broke, and they left a part in my belly."
She added: "I was weak, I lost so much blood, I was in pain, all I could do was cry."
The object was left inside her for five days, leading to an additional two-week hospital stay.
Commenting on the analysis, Rachel Power, chief executive of the Patients Association, said: "Never events are called that because they are serious incidents that are entirely preventable because the hospital or clinic has systems in place to prevent them happening.
"When they occur, the serious physical and psychological effects they cause can stay with a patient for the rest of their lives, and that should never happen to anyone who seeks treatment from the NHS.
"While we fully appreciate the crisis facing the NHS, never events simply should not occur if the preventative measures are implemented."
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Source: Sky News, 4 January 2022
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Staff mental health support faces axe after national funding cut

Mental health and wellbeing hubs for NHS and social care staff could be axed within months, as national funding for them is likely to be cut, HSJ has learned.
NHS England and the Department of Health and Social Care are understood to be close to ending ring-fenced national funding for the 41 hubs, which were set up in February 2021, at the peak of acute covid pressures and concern about the impact on staff.
Sources told HSJ discussions were ongoing, but that it is likely integrated care systems would need to find funding themselves if they are to continue. Amid tight local finances, it is expected many will be wound down or closed.
This is despite problems with low staff morale, high absence rates and with large numbers of experienced staff thought to be leaving the service.
Read full story (paywalled)
Source: HSJ, 4 January 2022
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The targets the NHS no longer has to meet

NHS England has shelved priorities on Long Covid and diversity and inclusion – as well as a wide range of other areas – in its latest slimmed down operational planning guidance, HSJ analysis shows.
NHSE published its planning guidance for 2023-24, which sets the national “must do” asks of trust and integrated care systems, shortly before Christmas.
HSJ has analysed objectives, targets and asks from the 2022-23 planning guidance which do not appear in the 2023-24 document.
The measures on which trusts and systems will no longer be held accountable for include improving the service’s black, Asian and minority ethnic disparity ratio by “delivering the six high-impact actions to overhaul recruitment and promotion practices”.
Another omission from the 2023-24 guidance compared to 2022-23 is a target to increase the number of patients referred to post-Covid services, who are then seen within six weeks of their referral.
Several requirements on staff have been removed, including to ”continue to support the health and wellbeing of our staff, including through effective health and wellbeing conversations” and ”continued funding of mental health hubs to enable staff access to enhanced occupational health and wellbeing and psychological support”. 
Read full story (paywalled)
Source: HSJ, 4 January 2022
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People urged to wear masks and stay at home if unwell as pressure on NHS mounts

People have been urged to wear face coverings and remain at home if feeling unwell, as an already crisis-stricken NHS faces down multiple waves of winter illnesses.
With children returning to school at a time when high levels of flu, Covid-19 and scarlet fever are all being reported, the UK Health Security Agency (UKHSA) has issued fresh guidance in a bid to minimise the diseases’ spread.
Parents have been urged to keep children at home if they are unwell and have a fever, with adults told to only go out if necessary and wear face coverings if they are ill and avoid visiting vulnerable people.
While transport secretary Mark Harper said the advice was “very sensible”, Downing Street insisted that such guidance was “pretty longstanding”, stressing that it was “not mandatory” and remained a far cry from ministers “telling people what to do” at the height of the pandemic.
The government has also reintroduced travel bans for those testing positive for Covid-19 in China from 5 January amid a mass outbreak there.
It comes as pressure on the NHS continues to grow, but Rishi Sunak said he was “confident” the NHS has the funding it needs despite accusations from senior doctors his government is in denial about the scale of the crisis in the health service.
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Source: The Independent, 3 January 2023
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NHS bosses consider deploying field hospitals in 'call to arms'

Managers in an NHS area are considering using "field hospitals" to deal with the surge in patients.
Sarah Whiteman, chief medical director of the Bedfordshire, Luton and Milton Keynes Integrated Care Board told colleagues the use of tents was a "real possibility".
In an email, she also asked colleagues to sign temporary contracts to work in emergency departments.
The board said the use of tents in hospital grounds was not imminent.
Dr Whiteman's email, obtained by The Sunday Times and seen by the BBC, began with the statement: "Call to arms".
It emphasised how busy the acute units were within her board's operational area, including Bedford, Milton Keynes and Luton and Dunstable Hospitals.
In the message, she promised staff would receive training and induction if they stepped forward to support colleagues.
Read full story
Source: BBC News, 4 January 2023
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USA: Congress commits funding for research to reduce diagnostic Error and improve patient safety in final FY2023 spending bill

The Society to Improve Diagnosis in Medicine (SIDM) has announced that Congress in the final FY 2023 Omnibus spending bill has doubled dedicated federal funding for research to reduce patient harm from diagnostic error. Statistically, each of us is likely to experience a meaningful diagnostic error in our lifetime.
The significant human and financial toll of diagnostic errors, which occur in all settings of care, was first highlighted in a landmark 2015 National Academy of Medicine (NAM) report, Improving Diagnosis in Health Care. The report found that missed, delayed, or un-communicated diagnoses result in more patient harm than all other healthcare-associated harms combined. The NAM report called diagnostic error "a blind spot" in health care quality and safety, and improving medical diagnosis a "moral, professional, and public health imperative."
Since the release of the NAM report, SIDM has been working hard to educate policymakers about these issues and advocating for more research funding. SIDM has assembled a coalition of dozens of groups representing health systems, patients, clinicians, and others to raise awareness and spark action. "This funding is an important signal that Congress is becoming aware of the magnitude of the public health burden, both human and financial, associated with diagnostic error and intends to tackle it," says Jennie Ward-Robinson, CEO of SIDM. 
Citing diagnosis as "the next frontier of patient safety," the NAM report summarised what is known about factors that affect diagnostic safety and accuracy at the clinician, system, and policy levels, and made recommendations at each of those levels. A few promising interventions are already emerging for specific and commonly misdiagnosed conditions, as well as for specific systems-level problems, such as failure to "close the loop" on abnormal test results. But these initiatives are tiny compared the scope and scale of the issue.   
Read full story
Source: CISION PR Newswire, 3 January 2023
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Ambulance crews told to leave patients on a trolley if A&E wait exceeds 45 minutes

Paramedics will only wait with patients for 45 minutes before leaving them on a trolley in A&E, one ambulance trust has said.
One in five ambulances are waiting at least an hour outside accident and emergency departments to hand over patients, the latest data show, despite NHS standards stating it should only be 15 minutes.
Now, London Ambulance Service (LAS) leaders have told hospitals their staff will only remain with patients for a maximum of 45 minutes for handover due to “the significant amount of time being lost” waiting in A&E departments.
A leaked letter, seen by ITV News, from the LAS said: "From January 3 we are asking that any patients waiting for 45 minutes for handover... are handed over immediately to ED (emergency department) staff allowing the ambulance clinicians to leave and respond to the next patient waiting in the community.
"If the patient is clinically stable the ambulance clinicians will ensure the patient is on a hospital trolley or wheelchair/chair and approach the nurse in charge of the emergency department to notify them that the patient is being left in the care of the hospital and handover the patient."
The email added that if the patient was not clinically stable, ambulance crews would stay with the patient until handover is achieved but added that the clinical responsibility for the patient lied with the hospital.
Read full story (paywalled)
Source: The Telegraph, 3 January 2023
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Shortage of cold medicines in UK is government’s fault, say pharmacists

A shortage of cough and cold medicines in the UK is a result of ministers’ “lack of planning”, according to pharmacy leaders.
Rishi Sunak’s Conservatives were accused of “being in denial” as supply chain problems worsen, with pharmacists reporting shortages of once-common cold and flu medicines.
The Association of Independent Multiple Pharmacies said throat lozenges, cough mixtures and some painkillers are among the affected medicines, after issues with the supply of antibiotics and HRT last year.
“Pharmacists are struggling to obtain the very basic, most common cold and flu medicine,” chief executive Leyla Hannbeck told the PA news agency. “This isn’t just the branded medicines, it is also simple things like throat lozenges, cough mixtures or painkillers – particularly the ones that are soluble.
“The demand has been high because this season we’ve seen higher cases of colds and flu and people are obviously trying very hard to look after themselves and making sure that they use the relevant products to manage the symptoms.
“And that has led to a shortage of these products in terms of us not being able to obtain them.”
Read full story
Source: The Guardian, 4 January 2023
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Man carries grandad into hospital amid ambulance shortage

When Steve Parsons's grandfather collapsed at his Monmouthshire home, his family immediately dialled 999.
However when they were told there were no ambulances available, they had to take measures into their own hands.
In desperation, Mr Parsons drove and then carried the 83-year-old, who had suffered a cardiac arrest, into the Grange Hospital near Cwmbran, Torfaen.
Aneurin Bevan University Health Board (ABUHB) and Welsh Ambulance Service Trust (WAST) admitted the incident did not match the service they wished to offer - but said it was indicative of the "unprecedented" pressures both organisations were under.
Mr Parsons said: "It was horrible. They're on the phone, you're there and he's grey in the face and looks horrendous. You just panic."
By the time Mr Parsons drove to the hospital, his grandfather had gone into cardiac arrest. He then carried his relative on his shoulder across the car park "yelling for help".
A passing nurse heard his calls and was able to help save the 83-year-old's life using CPR. 
His grandfather is now recovering at Nevill Hall Hospital in Abergavenny, but Mr Parsons said his family has been traumatised. 
"It makes me feel angry," said the 31-year-old. 
"If my grandfather had that ambulance, had that oxygen, I fully believe he wouldn't have gone into cardiac arrest and my family wouldn't have gone through what they've gone through these past seven days."
Read full story
Source: BBC News, 4 January 2023
 
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