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

NHS strikes force thousands to wait 18 months for surgery as flagship target to be missed

Thousands of patients are being forced to wait more than 18 months for treatments such as knee and brain surgery as the health service is set to miss its flagship target because of NHS strikes.
NHS England last week claimed it was “on track” to hit the mandated target, but senior sources have warned that the impact of prolonged walkouts combined with unprecedented demand for emergency care means that this is now unlikely.
The sources say it is probable that up to 10,000 patients will still be waiting for 18 months or more by the end of March, as a knock-on effect of the cancellation of 140,000 appointments because of strike action. More walkouts are planned over the coming weeks.
Patricia Marquis, RCN director for England, said the backlog was “yet even more evidence of what happens when you fail to invest in the workforce. If ministers are serious about preventing a further exodus and cutting the backlog, they need to hear the calls of NHS leaders and come to the table and talk about pay. Only then will patients receive the care they need and waiting lists start to come down.”
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Source: The Independent, 15 February 2023
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NHS signs nationwide £20m deal for ‘electronic infection control’ systems

The NHS has signed a £20m deal to enable health-service organisations to deploy technology to help better manage the spread of infections.
The contract – awarded to US-based healthcare giant Baxter – is intended to offer NHS trusts a means through which they can buy a comprehensive infection-control platform. According to newly published commercial information such a system would, in many cases, replace various specialist software programmes used by NHS trusts to collect and process data, alongside spreadsheets and paper documents.
“The system will support infection prevention and control activities to identify critical issues, proactively respond to improve the quality of care and streamline processes to reduce time spent on administrative and reporting tasks,” the contract notice said. 
“Most NHS Trusts tend to manage infection control surveillance through the use of various systems, collating laboratory, patient and surgery data and manually searching through the data to identify patients of interest or complex scenarios. Paper and excel spreadsheets are also used to record and manage surveillance. This process is time consuming and risk of error.  NHS trusts are finding that they do not have a robust infection control system to monitor and manage their patients.”
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Source: Public Technology, 15 February 2023
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Some ambulance callers to be told go elsewhere

A new way of screening ambulance calls is to be introduced across England in an effort to improve response times.
NHS England is asking ambulance crews to review which emergency calls other than those classed as immediately life threatening can be treated elsewhere.
The calls - known as category two - include emergencies such as heart attacks and strokes. But the category also covers some that may not need such a fast response, such as burns and severe headaches.
About 40% of these lower priority calls classed as category two by call handlers will now receive callbacks from a doctor, nurse or paramedic to see whether there is an alternative to sending an ambulance.
In trials in London and across the West Midlands, nearly half of those receiving a callback were advised to go instead to an urgent treatment clinic, their GP or a pharmacist. NHS England is now asking the other eight ambulance services in England to adopt the approach. 
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Source: BBC News, 16 February 2023
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Patients in England not collecting NHS prescriptions because of cost

Rising numbers of patients in England are failing to collect their medicines or asking pharmacists which ones they can “do without” because they cannot afford prescription charges, a survey shows.
NHS prescriptions are free in Scotland, Wales and Northern Ireland. In England there are exemptions for certain items, medical conditions and specific parts of the population, but most adults have to pay. The current prescription charge is £9.35 an item.
“We are deeply concerned that people are having to make choices about their health based on their ability to pay,” said Thorrun Govind, a pharmacist and chair of English pharmacy board of the Royal Pharmaceutical Society (RPS), which conducted the survey. “No one should have to make choices about rationing their medicines and no one should be faced with a financial barrier to getting the medicines they need.”
The findings, from a survey of 269 pharmacies, prompted the RPS to renew its call for patients with long-term conditions in England to get free prescriptions. Charges create a financial barrier to accessing medicines needed to stay well, it said.
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Source: The Guardian, 13 February 2023
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‘Overheating’ incidents nearly double across NHS estates

The number of overheating incidents in clinical areas reported by NHS trusts has almost doubled over the last five years, with directors saying ageing estates make them vulnerable to extreme weather events.
Providers reported that temperatures went above 26°C – the threshold for a risk assessment – more than 5,500 times in 2021-22, according to official data.
Overheating looks set to become an increasingly significant issue for NHS estates, HSJ was told, as climate change makes extreme weather events more frequent and more intense.
Janet Smith, head of sustainability at Royal Wolverhampton and Walsall Healthcare Trusts, said: “We’re feeling it now. And it’s not going to change unless we do something about it. We need a climate resilient estate to actually deliver sustainable care.”
An overheating incident is when the temperature surpasses 26°C in an occupied ward or clinical space in a day, with each area counting as a separate incident. When this happens, trusts should carry out a risk assessment and take action to ensure the safety of vulnerable patients.
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Source: HSJ, 16 February 2023
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'I'm well enough to leave hospital - but I can't'

"It would be much better if I was out there than in here," said Roger.
The 69-year-old looked wistfully across Newport from the window next to his bed at the Royal Gwent Hospital in Wales.
He has been here for three weeks after being admitted with an infection and although he is now well enough to leave, and desperate to do so, he can't.
Roger has cerebral palsy and the impact of his recent illness means he needs extra care to be arranged before he can safely go home.
Roger is not alone.
"At least a quarter of patients in our care of the elderly beds are in a similar position," explained Helen Price, a senior nurse at the hospital.
"It is very much a waiting game for that care to be available," she said.
Hospitals in Wales are fuller than ever, according to the latest statistics. In the final week of January more than 95% of all acute beds in the Welsh NHS were occupied, which is the highest figure ever recorded.
Paul Underwood, who manages urgent care in Aneurin Bevan University Health Board, said there are well over 350 patients medically fit enough to leave hospital.
"Roughly a third of patients do not need to be accommodated on those sites and that's extremely difficult," he said.
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Source: BBC News, 16 February 2023
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Government’s mental health review will not prevent ‘appalling’ abuse of patients, campaigners warn

A government review into mental health hospitals will fail to prevent the “appalling” treatment of patients, campaigners have warned.
The urgent inquiry into inpatient mental health services will focus solely on data, the government said on Tuesday.
The “rapid review”, launched following investigations by The Independent into “systemic abuse” across a group of children’s mental health hospitals, will last 12 weeks and is being led by a former national NHS mental health director Dr Geraldine Strathdee.
In an outline of what it will cover, the Department for Health and Social Care said it would look at what data is collected by the NHS on inpatient mental health services and whether it is used effectively to identify patient safety problems.
It will also look at the quality of data and identify good examples of care but it won’t look at individual cases of abuse or community services.
Major mental health charity Mind has warned the review “is not enough” and will not provide any learnings on how to prevent poor care. The charity is instead calling for a national statutory public inquiry into inpatient mental health services.
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Source: The Independent, 15 February 2023
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Sewage leak figures prompt warning over state of England’s hospitals

Hospitals in England have recorded more than 450 sewage leaks in the last 12 months, data shows, putting patients and staff in danger and prompting warnings that the NHS estate is “falling apart” after a decade of underinvestment.
Freedom of information requests to NHS trusts by the Liberal Democrats found alarming examples of sewage leaking on to cancer wards, maternity units and A&E departments. The investigation also uncovered multiple cases of urine and faeces flowing into hospital rooms and on to general wards.
Health officials called the revelations shocking. In some instances, sewage leaks made entire hospital departments unsafe for patients and led to staff struggling to work because they felt nauseous and had headaches.
Ed Davey, the Liberal Democrat leader, said: “This is a national scandal. Our country’s hospitals are falling apart after years of underinvestment and neglect. Patients should not be treated in these conditions and heroic nurses should not have the indignity of mopping up foul sewage.”
“At every turn, our treasured NHS is crumbling, from hospital buildings to dangerous ambulance wait times. The government needs to find urgent funds to fix hospitals overflowing with sewage. Patient and staff safety is a risk if ministers fail to act,” he said.
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Source: The Guardian, 17 February 2023
Patient Safety Learning

Somerset care training to help support loved ones at home for longer

A training programme is providing people with the skills to care for loved ones suffering from serious conditions at home in their final days.
Sarah Bow's partner Gary White, from Somerset, was 55 when he was diagnosed with motor neurone disease in 2021.
A team from NHS Somerset provided personalised training to Ms Bow which allowed the couple to spend the final 13 months of his life together at home.
The Somerset NHS Foundation Trust social care training team made visits to the couple's home as Mr White's condition progressed, to provide advice and guidance to Ms Bow.
The service was set up in November 2021 to provide free NHS standardised training and competency assessments in clinical skills to people involved in social care.
Ms Bow said the scheme had helped them spend more time together doing the things Mr White enjoyed.
"Being able to care for him meant we could have so many precious moments before he died," she said.
The training in a variety of skills including like catheters and injections, aims to reduce hospital admissions and improve patient discharge times.
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Source: BBC News, 17 February 2023
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Nurses to walk out of emergency departments for 48 hours

Nurses will walk out of emergency departments, intensive care units and cancer care services for the first time in the next wave of strike action.
The Royal College of Nursing (RCN) has announced its members will strike for 48 hours, from 6am on 1 March until 6am on 3 March and that a range of derogations will be removed, including emergency care cover. 
More than 120 NHS organisations — covering all types of providers, integrated care systems and national organisations (see map below) — will be affected by the RCN’s walkout next month as it represents the most significant escalation of strike action yet by nurses.
Previously, quite extensive exemptions (known as “derogations”) have been agreed, but the RCN has this time indicated they will be much more limited. 
HSJ asked the RCN what services will remain subject to national derogations, but a spokesman said discussions are continuing at a national level as part of a commitment to “life and limb care”.
He added services will be reduced to an “absolute minimum” and hospitals will be asked to rely on members of other unions and clinical professions instead.
Read full story (paywalled)
Source: HSJ, 16 February 2023
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Watchdogs issue safety warnings after junior doctors left unsupervised on maternity wards

Two health watchdogs have issued safety warnings after junior staff were left to work unsupervised on maternity wards previously criticised after a baby’s death.
Training regulator, Health Education England (HEE), criticised the “unacceptable” behaviour of consultants who left junior doctors to work without any superiors at South Devon and Torbay Hospital Foundation Trust’s wards.
The maternity safety watchdog Healthcare Safety Investigation Branch (HSIB) also raised “urgent concerns” over student midwives and “unregistered midwives” providing care without supervision.
The latest criticism comes after the trust was condemned over the death of Arabella Sparkes, who lived just 17 days in May 2020 after she was starved of oxygen.
According to a report from December 2022, seen by The Independent, the HEE was forced to review how trainees were working at the trust’s maternity department after concerns were raised to the regulator. It was the second visit carried out following concerns about the department, and reviewers found there had been “slow progress” against concerns raised a year earlier.
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Source: The Independent, 16 February 2023
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England’s worsening care shortages leave older people struggling

Hundreds of thousands of older people in England are having to endure chronic pain, anxiety and unmet support needs owing to the worsening shortage of social care staff and care home beds.
Age UK has said older people with chronic conditions such as diabetes, high blood pressure and heart failure are increasingly struggling with living in their own homes because of a lack of help with everyday tasks such as getting out of bed, dressing and eating.
The decline in the amount of support and care provided to older people is piling pressure on families and carers and leaving the NHS in constant crisis mode, contributing heavily to ambulance queues outside A&E departments, the charity said in a new report
It warned that there would be a repeat of the NHS crisis this winter – in which rising numbers of elderly people have been unnecessarily stuck in hospital because of an acute lack of social care – without a shift to preventing unnecessary admissions.
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Source: The Guardian, 17 February 2023
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High court judge ‘deeply frustrated’ by NHS delays in suicidal girl’s care

A high court judge has expressed her “deep frustration” at NHS delays and bureaucracy that mean a suicidal 12-year-old girl has been held on her own, in a locked, windowless room with no access to the outdoors for three weeks.
In a hearing on Thursday, Mrs Justice Lieven told North Staffordshire combined healthcare NHS trust “you are testing my patience”, after she heard that a proposal to move Becky (not her real name), could not progress until a planning meeting that would not be held until next week, and that a move was not anticipated until 2 March.
Three sets of doctors at the hospital trust have disagreed as to Becky’s diagnosis; at her most recent assessment doctors said she was not eligible to be sectioned, which would trigger the protections provided by the Mental Health Act, because her mental disorder was not of the “nature and degree” as to warrant her detention.
In a robust exchange, the judge demanded: “Where’s the urgency in this … I cannot believe that the life and health of a 12-year-old girl is hanging on an issue of NHS procurement, when you cannot tell me what it is you’re trying to procure.
“If the delay is procurement, I’m not having it,” Lieven continued. “I will use the inherent jurisdiction to make an order. We have a 12-year-old child in a completely inappropriate NHS unit for about three weeks, and it’s suddenly dawned on your client that ‘actually we’ll put her in a Tier 4 unit and we might have to do some [building] work.’”
Sometimes, the judge said, “public bodies have to move faster”.
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Source: The Guardian, 17 February 2023
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British Medical Association calls government reckless over pay talks

The British Medical Association has accused the government of "reckless" behaviour ahead of the results of a strike ballot by junior doctors.
The BMA's Professor Philip Banfield said the prime minister and health secretary were refusing to enter meaningful negotiations with unions.
The Department of Health and Social Care said it had met with the BMA and other unions to discuss pay.
Professor Banfield, the BMA's chair of council, said that Rishi Sunak and Health Secretary Steve Barclay were "standing on the precipice of an historic mistake".
He accused the government of "guaranteeing escalation", adding that officials were "reckless" for thinking they could stay silent and wait it out.
Professor Banfield also accused the government of "letting patients down", adding: "All NHS staff are standing up for our patients in a system that seems to have forgotten that valuing staff and their well-being is directly linked to patient safety and better outcomes of care."
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Source: BBC News, 19 February 2023
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Urgent action ordered at maternity scandal trust

The trust at the centre of a maternity scandal has been ordered to report on urgent improvements in services for women and babies, amid ‘significant concerns’ about the risk of harm.
The Care Quality Commission (CQC) used its enforcement powers to issue the conditions on East Kent Hospitals University Foundation Trust, after it carried out an unannounced inspection last month.
However, the “section 31” warning letter has just been made public, and the first deadline for the trust to report back to the CQC is Monday (20 February).
The CQC said some of the problems it found were due to the labour ward environment – but others involved monitoring of women and babies whose conditions deteriorate and the risk of cross-infection due to poor cleanliness standards.
“We have significant concerns about the ongoing wider risk of harm to patients and a need for greater recognition by the trust of the steps that can be taken in the interim to ensure safety and an improved quality of care,” Carolyn Jenkinson, CQC’s deputy director of secondary and specialist healthcare, said in a statement today.
Read full story (paywalled)
Source: HSJ, 17 February 2023
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Health workers ‘shattered’, says Jeremy Farrar as more NHS strikes loom

Healthcare workers are “absolutely shattered” and unless something is done to address the crisis in morale, staffing and training then “they won’t be there when you need them”, one of the world’s leading scientists has warned.
Speaking to the Guardian, Prof Jeremy Farrar, the director of Wellcome and soon to be chief scientist of the World Health Organization, warned that healthcare workers would not be ready should another crisis hit.
“This is a global issue, which I think is hugely concerning. It’s certainly true in this country,” he said. “The resilience of healthcare workers, broadly defined from ambulance drivers to nurses to doctors, to care workers in social care, etc. They’re shattered. They are absolutely shattered."
Farrar said: “I think we have to address the morale, staffing, the training, everything from public health physicians to care workers, to doctors and nurses and physios and everybody in between because there’s very little spare capacity in any system globally. It’s particularly true in the UK. As you can see from the strikes, morale and resilience is very thin.”
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Source: The Guardian, 20 February 2023
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