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Patient Safety Learning

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  1. Patient Safety Learning
    A Harley Street doctor suspended for working while testing positive for Covid at the height of the pandemic has said that his patient’s cancer treatment took priority.
    Dr Andrew Gaya was found to have “blatantly disregarded” the rules by going to work at a centre for patients with brain tumours after he tested positive for the disease.
    The “highly regarded” consultant oncologist “dishonestly” misled colleagues that he was safe to work by keeping his positive test secret, a tribunal found.
    Dr Gaya, whose work is at the forefront of tumour care and has been described as “world class”, said he defied Covid-19 rules because he believed “the risk of harm to his patient” in delaying treatment was “greater than the risk he posed”.
    Now, the doctor of 27 years has been suspended for three months at a Medical Practitioners’ Tribunal.
    Read full story (paywalled)
    Source: The Times, 20 Ocotober 2022
  2. Patient Safety Learning
    Norah Bassett was hours old when she died in 2019, after multiple failings in her care. What can be learned from her heartbreaking loss?
    The maternity unit at the Royal Hampshire county hospital in Winchester was busy the evening when Charlotte Bassett gave birth. When the night shift came on duty, a midwife introduced.
    “She was very brusque,” Charlotte, 37, a data manager, remembers. “She said, ‘We’ve got too many people here. I’ve got this and this to do.’” Charlotte tried to breastfeed Norah, but she wasn’t latching. The midwife told Charlotte to cup feed her with formula. She didn’t stay to watch. Charlotte poured milk from a cup into Norah’s rosebud mouth. Blood came out. It was staining the muslin. The midwife didn’t seem concerned.
    “I was drowning my child, who was drowning in her own blood. And there was no one there to say: this isn’t normal,” Charlotte says.
    The Health Services Safety Investigations Body (now HSSIB but at the time known as HSIB), which investigates patient safety in English hospitals, produced a report into Norah’s care in 2020. One sentence leaped out to Charlotte and her husband James. “An upper airway event (such as occlusion of the baby’s airway during skin-to-skin) may have contributed to the baby’s collapse.” In other words, it was possible that Charlotte might have smothered her daughter.
    “So Charlotte spent four years in agony,” says James, “thinking it was her.”
    Dr Martyn Pitman remembers the night Norah died, because it was unusual. A crash call, for a baby born to a low-risk mother. It played on his mind, because eight days earlier, on 4 April 2019, Pitman, a consultant obstetrician and gynaecologist, had presented proposals for enhanced foetal monitoring to a meeting of the maternity unit’s doctors and senior midwives. Pitman, 57, who is an expert in foetal monitoring, felt the proposals would prevent more babies suffering brain injuries at birth. “We’re not that good at detecting the high-risk baby, in the low-risk mum,” he says.
    Another doctor would later characterise the meeting as “hideous … hands down the worst meeting I’ve ever been to. Martyn … was being set upon.” A midwife felt the animosity in the room was “personal towards Martyn”, and was “appalled” by the “unprofessionalism that I saw from my midwifery colleagues”.
    James and Charlotte join an unhappy club: a community of parents whose children died young, after receiving poor care, and were told their deaths were unavoidable, or felt blamed for them.
    “I’ve spoken to so many families,” says Donna Ockenden, who authored a 2022 report into Shrewsbury’s maternity services, “who have been blamed for the eventual poor outcome in their cases. This has included being blamed for their babies’ death.” She has also met the families of women blamed for their own deaths. “This never fails to shock me,” she says.
    Read full story
    Source: The Guardian, 26 March 2024
  3. Patient Safety Learning
    Private hospitals are caring for a record number of patients paying through their own savings or private medical insurance, according to figures from the Private Healthcare Information Network. 
    Helen, a semi-retired frontline worker in south-east England, spent nearly £50,000 of her retirement savings on major spinal surgery to get her life back after two years of debilitating pain.
    Helen, 56, began experiencing extreme lower back pain and leg pain in September 2021, triggered by a dog colliding with her leg in the park. Though it was not caused by the trigger, she was diagnosed by the NHS with spondylosis in November 2021, and then a pars defect (a condition affecting the lower spine), and offered scans and physiotherapy. She said six months of physiotherapy, beginning in early 2022, resulted in no improvement, and she was offered pain management and a steroid epidural, which she said also did not help.
    “I rarely ventured out in these two years … due to the extreme pain I was in when sitting, standing or walking. Life effectively stopped in 2021,” she said. Desperate, she booked a consultation in May 2023 with a neurosurgeon and was told she needed an operation.
    Helen asked whether it would be possible for the neurosurgeon, who also works within the NHS, to do it on the NHS rather than privately. A referral could be made, she was told – but the surgery was likely to involve a waiting time of 18 months to two years. “My husband and I discussed it, and he said: you’ve already had no life for the last two years, do you really want to wait another two?”
    She had the spinal surgery in August 2023 and is now managing her pain with over-the-counter medication, rather than the stronger painkillers she was on before. It cost her a staggering £48,345.
    The financial hit has been huge. “I was absolutely gutted to have to go private. This has knocked us both; we didn’t see us in our lives having to pay for something like this. We’ve managed our finances carefully and always saved where we can. But that lump sum [that we] can access when we retire … That lump sum has just gone now.”
    Read full story
    Source: The Guardian, 8 March 2024
     
  4. Patient Safety Learning
    NHS England has launched a new framework for quality improvement and delivery, including a national board that will pick a “small number of shared national priorities”.
    The new document says NHSE will “establish a national improvement board, to agree the small number of shared national priorities on which NHS England, with providers and systems, will focus our improvement-led delivery work”.
    The review says NHSE will, among other actions: 
    Create a “national improvement board” to “agree a small number of shared national priorities and oversee the development and quality assure the impact of the NHS improvement approach”. Set an expectation that all NHS providers, working in partnership with integrated care boards, will embed a quality improvement method aligned with the NHS improvement approach”. Incentivise a universal focus on embedding and sustaining improvement practice”, including with “regulatory incentives alongside clearer and more timely offers of support. Work with the [Care Quality Commission] to align the revised CQC well-led [inspection method] with the improvement approach. Read full story (paywalled)
    Source: HSJ, 21 April 2023
  5. Patient Safety Learning
    More than 120,000 people in England died last year while on the NHS waiting list for hospital treatment, figures obtained by Labour appear to show.
    That would be a record high number of such deaths, and is double the 60,000 patients who died in 2017/18.
    For example, the Royal Free hospital in London said it had had 3,615 such deaths, while there were 2,888 at the Morecambe Bay trust in Cumbria and 2,039 at Leeds teaching hospitals trust.
    Hospital bosses said the deaths highlighted the dangers of patients having to endure long waits for care and reflected a “decade of underinvestment” that had left the NHS with too few staff and beds.
    Healthwatch England, a patient advocacy group that scrutinises NHS performance, said the number of people dying while waiting for care was “a national tragedy”.
    Louise Ansari, the chief executive, said: “We know that delays to care have significant impacts on people’s lives, putting many in danger.”
    Read full story
    Source: The Guardian, 31 August 2023
  6. Patient Safety Learning
    More than a third of delayed discharges for long-stay patients are being caused by factors generally associated with the NHS, according to new data obtained by HSJ.
    Delayed discharges from hospital are often blamed on issues around social care, but figures for the nine months to January, for patients who have been in hospital for at least 21 days, suggest a significant proportion are due to NHS-related delays.
    The most common reason is waiting for rehabilitation beds in a community hospital or similar facility, which accounts for 23% of total delayed discharges, based on daily averages.
    Other reasons generally associated with NHS-related issues included delays around medical decisions (4%), therapist decisions (4 per cent), transfers to another acute site (2%), and diagnostic tests (1%).
    On top of this, a further 12% of the causes were at least partly associated with the NHS, such as delays relating to transfer of care hubs, which are generally jointly run with councils.
    Read full story (paywalled)
    Source: HSJ, 9 February 2023
  7. Patient Safety Learning
    Community and mental health service providers have warned the ongoing fuel crisis and other traffic disruption is starting to impact the care of vulnerable patients.
    Warnings about a HGV drivers shortage have prompted the panic-buying of fuel, with many petrol stations running out or heavily congested.
    Julia Winkless, a senior social worker and approved mental health professional in Suffolk, told HSJ clinical visits had to be cancelled as people were unable to get to work. 
    Ms Winkless said: “We work over a very rural area, none of these petrol stations where [staff] live have got any fuel and we don’t know when there is going to be deliveries. Today, there were four mental capacity assessments cancelled.”
    There is also disruption to patient transport. A senior source at a West Midlands patient transport provider which often conveys people to mental health services told HSJ: “It’s been a bit of a nightmare in all honesty. We turned down a request this morning for a patient going to London because of the fuel and because of the [climate protesters disrupting motorways]… ultimately those patients are either at home and distressed carrying a big risk in the community or [accident and emergency] departments which [are not] the right settings.”
    Read full story (paywalled)
    Source: HSJ, 28 September 2021
  8. Patient Safety Learning
    There is ‘no capacity anywhere’ to deal with an unprecedented surge in admissions of children with mental health problems, a senior clinician has told HSJ.
    Last week, multiple children with eating disorders were understood to have been left on children’s wards in general acute hospitals, due to specialist mental health units across England being full.
    This appears to be a deterioration from the situation last month, when several areas of the country were reporting an extreme shortage of specialist beds.
    Rory Conn, a member of the Royal College of Psychiatrists’ children and adolescent mental health division, told HSJ that specialist inpatient beds were full nationally.
    He added: “We are seeing a greater number of children restricting [their food and drink] intake for a variety of reasons, often to extreme degrees.
    “Some are stopping eating and drinking entirely, in a clinical pattern that we haven’t traditionally seen. For example, they might not have an identified eating disorder like anorexia, but their restriction seems to be a response to their uncertain social environment during the pandemic.
    Read full story (paywalled)
    Source: HSJ, 23 March 2021
  9. Patient Safety Learning
    At least 137,000 women in the UK live with the painful and traumatic consequences of cutting, but there is no provision for reconstructive surgery.
    In May 2023, Shamsa Araweelo was in the A&E department of a London hospital in excruciating pain. It wasn’t the first time she had sought urgent treatment for the gynaecological damage caused by the female genital mutilation (FGM), or cutting, forced on her as a six-year-old. In fact, this was one of many such visits to emergency departments that Araweelo had made in her desperate attempt to find a surgeon who could help undo the damage done to her as a child and which has caused her so much pain and trauma as an adult.
    Araweelo says that in A&E she was told that she had severe nerve damage and that it could be reversed through reconstructive surgery. But not in the UK.
    “No doctor in the country will touch you, because you are an FGM survivor,” Araweelo says she was told. “I felt no compassion, no respect. Only in London did they tell me they wished they had the appropriate training to help me, and it breaks my heart. We are not valued in the UK.”
    Current NHS rules state that if a health practitioner suspects a patient has been cut, they must report the case to the police and complete a safeguarding risk assessment to determine whether a social care referral is required. Guidance for GPs also recommends referrals for mental health issues related to FGM or referrals to uro-gynaecological specialist clinics.
    Araweelo says that in all the years she has sought help she has never been offered any kind of support from medical professionals.
    Read full story
    Source: The Guardian, 21 December 2023
  10. Patient Safety Learning
    Professor Sir Ian Diamond, head of the Office for National Statistics (ONS), has said there will “no doubt” be another wave of coronavirus infections in the autumn.
    Speaking on Sunday, Sir Ian acknowledged the impact of the “wonderful” vaccine rollout though cautioned “we need to recognise that this is a virus that isn’t going to go away.”
    "And I have no doubt that in the autumn there will be a further wave of infections," he told The Andrew Marr Show on BBC One.
    The UK’s national statistician pointed toward regional variations in terms of how many people have antibodies. “There is a lot of regional variation, so we find 30 per cent of London have antibodies whereas only 16 per cent in the South West, so we need to recognise that as well,” he told the programme.
    This comes after Professor Chris Whitty, England’s chief medical officer, said he would “strongly advise” against any rapid easing of coronavirus restrictions.
    Read full story
    Source: The Independent, 14 March 2021
  11. Patient Safety Learning
    Across the country there have been reports of “do not resuscitate” (DNR) orders being imposed on patients with no consultation, as is their legal right, or after a few minutes on the phone as part of a blanket process.
    Laurence Carr, a former detective chief superintendent for Merseyside Police, is still angry over the actions of doctors at Warrington Hospital who imposed an unlawful “do not resuscitate” order on his sister, Maria, aged 64.
    She has mental health problems and lacks the capacity to be consulted or make decisions and has been living in a care home for 20 years. As her main relative, Mr Carr found out about the notice on her records only when she was discharged to a different hospital a week later.
    Maria had been admitted for a urinary tract infection at the end of March. Although she has diabetes and an infection on her leg her condition was not life threatening.
    Mr Carr said: “My sister has no capacity to effectively be consulted due to her mental illness and would not understand if they did try to explain, so I was furious that I had not been consulted."
    He later learnt that the reason given by the hospital for imposing the DNR was "multiple comorbitidies".
    In a statement, Warrington and Halton Teaching Hospitals Foundation Trust said it was fully aware of the law, which was reflected in its policies and regular training.
    It said: “We did not follow our own policy in this case and have the requisite discussions with the family. The template form which was completed in this case indicates that discussion with the family was ‘awaiting’. Regretfully due to human error this did not occur."
    Mr Carr and his sister are not alone. National charity Turning Point said it had learnt of 19 inappropriate DNARs from families, while Learning Disability England said almost one-fifth of its members had reported DNARs placed in people’s medical records without consultation during March and April.
    Read full story
    Source: The Independent, 14 July 2020
  12. Patient Safety Learning
    There were ’obfuscations, difficulties and failures’ in a scandal-hit trust’s handling of a baby’s death, a damning review has found, although it cleared the organisation’s former chair of ’serious mismanagement’.
    A fit and proper person review into the conduct of former Shrewsbury and Telford Hospital Trust chair Ben Reid, who left in August 2020, has been published by the board.
    The report follows complaints about Mr Reid’s conduct from the family of baby Kate Stanton-Davies, who died in the trust’s care and whose case – alongside that of Pippa Griffiths – sparked the original Ockenden inquiry.
    In March 2022, the final Ockenden report into maternity services at Shrewsbury found poor maternity care had resulted in almost 300 avoidable baby deaths or brain damage cases in the most damning review of maternity services in the NHS’s history.
    Report author Fiona Scolding KC said she does not believe Mr Reid “lied” or acted unethically in his handling of complaints from the family and therefore this does not disqualify him from holding office within the terms of such a review.
    However, the report is highly critical of the trust, with Ms Scolding concluding it is “undoubtedly true” the provider had not dealt with Kate’s father Richard Stanton and her mother Rhiannon Davies in an “open and honest” way in respect of their daughter’s death.
    Read full story (paywalled)
    Source: HSJ, 13 October 2022
  13. Patient Safety Learning
    A new report has condemned ‘serious issues’ with NHS referral processes, amid findings that one in five patient referrals made by GPs went into a ‘black hole’.
    Healthwatch England said that 21% of people they spoke to with a GP referral to another NHS service were rejected, not followed up on or sent back to general practice.
    The watchdog said that more support should be given to help GP and hospital teams to reduce the numbers of people returning to general practice due to ‘communication failures’ following a referral.
    According to the findings, the failures were due to GP teams not sending referrals, referrals going missing between services, or being either booked or rejected by hospitals without any communication.
    Louise Ansari, Healthwatch England’s national director, said that thousands of people told the watchdog that the process is ‘far from straightforward.’
    She said: "Falling into this “referrals black hole” is not just frustrating for patients but ultimately means people end up going back to their GP or visiting crowded A&E departments to get the help they need.
    "This adds more burden to already stretched services, making things even harder for the doctors and nurses trying to provide care."
    Read full story
    Source: Pulse, 20 February 2023
  14. Patient Safety Learning
    A major acute trust has warned ahead of next week’s nursing strike that it will face ‘very severe staffing shortages’ in children’s A&E, with ‘as few as one nurse per ward’, much less critical care capacity, and fewer operating theatres open than on Christmas Day.
    Cambridge University Hospitals Foundation Trust’s medical director said in a note, seen by HSJ,  that the hospital would only have 60 to 70% of its critical care beds open and that “it is not possible to guarantee patient safety on our wards over the forthcoming weekend” with severe staffing shortages in “almost all areas”. 
    The Royal College of Nursing is planning no derogations (exceptions) to its planned 48-hour walkout, from 8pm on Sunday until 8pm on Tuesday, whereas its previous action has exempted emergency care. 
    There have been national warnings about the significant safety threat posed, but the CUH message, sent to all staff by medical director Ashley Shaw, sets out a more stark picture of critical services scaled back.
    It says: ”Our current information indicates there will be a severe shortage of nurses in almost all ward areas, with as few as 1 nurse per ward per shift."
    Read full story (paywalled)
    Source: HSJ, 26 April 2023
  15. Patient Safety Learning
    Harold Chugg spent much of early 2023 in a hospital bed because of worsening heart failure. During his most recent admission in June, the 75-year-old received several blood transfusions, which led to fluid accumulating in his lungs and tissues.
    Ordinarily, he would have remained in hospital for further days or weeks while the medical team got his fluid retention under control. But Harold was offered an alternative: admission to a virtual ward where he would be closely monitored in the comfort of his own home.
    Armed with a computer tablet, a Bluetooth-enabled blood pressure cuff and weighing scales, Harold returned to his farm near Chulmleigh in north Devon and logged his own symptoms and measurements daily, which were reviewed by a specialist nurse in another part of the county.
    Virtual wards provide hospital-level care in people’s homes through the use of apps, wearables and daily “virtual ward rounds” by medical staff, who review patient data and follow up with telephone calls or home visits where necessary.
    More than 10,000 such beds are already available across England and at least a further 15,000 are planned. Scotland, Wales and Northern Ireland are also funding their expansion.
    But while proponents claim patients in virtual wards recover at the same rate or faster than those treated in hospital, and that the wards’ provision can help cut waiting lists and costs, some worry that their rapid expansion could place additional strain on patients and caregivers while distracting from the need to invest in emergency care.
    “Virtual wards, if they deliver hospital-level processes of care, are just one part of the solution, not a panacea,” said Dr Tim Cooksley, a recent ex-president of the Society for Acute Medicine.
    Read full story
    Source: The Guardian, 7 February 2024
  16. Patient Safety Learning
    In England, only a third of adults – and half of children – now have access to an NHS dentist. As those in pain turn to charity-run clinics for help, can anything stop the rot?
    It is over an hour before the emergency dental clinic is due to open, but Jodie Manning is taking no chances. She hasn’t been able to eat for four days – “I can’t physically bite down any more” – and is determined to get an appointment. 
    Aged 19, she has been to hospital with severe toothache “three-and-a-half times” in the previous year. The half is when they sent her home without treatment; on the other occasions, she was kept in overnight after collapsing from pain and dehydration, when even drinking liquids hurt her swollen mouth. Morphine has become her crutch: she fell asleep in college recently after taking the powerful painkiller. Like many of those waiting grimly in line, she has been struck off by her NHS dentist after not attending for two years, even though surgeries were shut to all but emergency cases during Covid.
    The same desperation can be seen across England, particularly in the north and east. Only a third of adults – and less than half of English children – now have access to an NHS dentist, according to the Association of Dental Groups (ADG). At the same time, three million people suffer from oral pain and two million have undertaken a round trip of 40 miles for treatment, the ADG calculated recently, calling dentistry “the forgotten healthcare service”. Tooth extraction is now the most common reason for a child to be admitted to hospital, costing the NHS £50m a year.
    The decline of NHS dentistry has deep roots. Years of underfunding and the current government contract, blamed for problems with burnout, recruitment and retention. Dentists are paid a flat fee for services regardless of how long a treatment takes (they get the same amount if they extract one tooth or five, for example). Covid exacerbated existing challenges, with the airborne disease posing a health risk for dentists peering into strangers’ mouths all day.
    As the British Dental Association put it in its most recent briefing: “NHS dentistry is facing an existential threat and patients face a growing crisis in access, with the service hanging by a thread.”
    Read full story
    Source: The Guardian, 24 May 2022
  17. Patient Safety Learning
    Sharply rising cases of some sexually transmitted diseases (STDs), including a 26% rise in new syphilis infections reported last year, are prompting US health officials to call for new prevention and treatment efforts.
    “It is imperative that we ... work to rebuild, innovate, and expand (STD) prevention in the US,” said Leandro Mena of the US Centers for Disease Control and Prevention in a speech on Monday at a medical conference on sexually transmitted diseases.
    Infections rates for some STDs, including gonorrhoea and syphilis, have been rising for years in the US. Last year the rate of syphilis cases reached its highest since 1991 and the total number of cases hit its highest since 1948. HIV cases are also on the rise, up 16% last year.
    An international outbreak of monkeypox has further highlighted the nation’s worsening problem with diseases spread mostly through sex.
    David Harvey, executive director of the National Coalition of STD Directors, called the situation “out of control”.
    Officials are working on new approaches to the problem, such as home-test kits for some STDs that will make it easier for people to learn they are infected and to take steps to prevent spreading it to others, Mena said.
    Read full story
    Source: The Guardian, 20 September 2022
  18. Patient Safety Learning
    Mental health patients who arrive at emergency departments (ED) in crisis are increasingly facing ‘outrageous’ long waits for an inpatient bed, with some being forced to wait several days.
    HSJ research suggests ED waits of more than 12 hours have ballooned in 2022, and are now around two-and-a-half times as high as pre-Covid levels.
    Early intervention for patients in mental health crisis is deemed to be crucial in their care and recovery.
    The Royal College of Emergency Medicine said the findings are a “massive concern”, while the Royal College of Psychiatrists described them as “unacceptable”.
    RCEM president Katherine Henderson said the experience of mental health patients in accident and emergency departments “is not what it should be from a caring healthcare system”.
    She said: “We have massive concern for this patient group. We feel they are getting a really poor deal at the moment.
    “The bottom line is there are not enough mental health beds. There are not enough community mental health services to support patients and perhaps therefore prevent a crisis and the need for beds in the first place.
    “Mental health crisis first responder teams work – a mental health practitioner working with the ambulance service can prevent the need for an ED visit.”
    Read full story (paywalled)
    Source: HSJ, 19 July 2022
  19. Patient Safety Learning
    An acute trust currently rated ‘outstanding’ has been served with a warning notice by the Care Quality Commission, after senior doctors’ safety concerns prompted an inspection.
    Inspectors visited University Hospitals Sussex Foundation Trust days after HSJ reported on a letter from consultants highlighting “an extremely unsafe situation” and calling for elective work to be moved away from one of the trust’s main hospitals.
    The inspection looked at surgical areas at the Royal Sussex County Hospital, in Brighton, and maternity services at four sites – the RSCH, St Richard’s in Chichester, Worthing Hospital and the Princess Royal Hospital in Haywards Heath.
    In a letter to all staff, seen by HSJ, chief executive Dame Marianne Griffiths said the trust was “striving to improve” but that “the last four months are like nothing I have ever seen before. Like others we are facing unprecedented daily challenges”.
    She said: “High patient numbers combined with continuing to work through the pandemic with the stringent infection prevention and control processes that entails make for a challenging work environment.”
    Chief nurse Maggie Davies said: “The safety of our patients is always our number one priority. Our services remain under unprecedented pressure and our staff are working hard to provide the highest standards of care to all our patients.
    Read full story (paywalled)
    Source: HSJ, 5 November 2021
  20. Patient Safety Learning
    When Jenny* had a mastectomy after being diagnosed with breast cancer, she believed the major surgery to remove her breast, although traumatic, had saved her life.
    She described feeling “rage” when at a follow-up appointment three years later, she said to her surgeon, “I would probably be dead by now” if she had not received the surgery, to which he replied: “Probably not.”
    It was only then, after she had already undergone invasive and life-changing treatment, that Jenny learned about “overdiagnosis”.
    While breast cancer screening programs are essential and save lives, sometimes they also detect lumps that may never go on to cause harm in a woman’s lifetime, leading to overtreatment, and psychological and financial suffering.
    Jenny is 1 of 12 women from the UK, US, Canada and Australia whose stories were published in the medical journal BMJ Open. It is the first study to interview breast cancer patients who believe they may have received unnecessary and harmful treatment, highlighting the effect this has had on their lives.
    “The usual story of breast cancer screening is ‘screening saves lives’,” an author of the study and a professor of public health at the University of Sydney in Australia, Alexandra Barratt, said.
    “This study reports the other side of the story – how breast cancer screening can cause harm through overdiagnosis and overtreatment.”
    Read full story
    Source: The Guardian, 8 June 2022
  21. Patient Safety Learning
    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.
    Read full story (paywalled)
    Source: HSJ, 16 February 2023
  22. Patient Safety Learning
    NHS England’s chief strategy officer has called for a “reset” of the current “overwhelmingly negative narrative” about the health service.
    Chris Hopson said there was a collective responsibility to present a more balanced picture, while still being honest about problems.
    The service should do more to emphasise successes, improvements and where there is good performance, he said.
    He acknowledged there were too many instances where good quality care could not be delivered due to current pressures on the service. But they were being addressed and improvements being made.
    “We need to make sure that our staff, our patients but also the taxpayers hear that more balanced narrative,” he said at the Ambulance Leadership Forum event on Wednesday. Ambulance services – whose response times have sky-rocketed, well beyond their targets, over the past 18 months – have been at the centre of much recent negative coverage.
    Mr Hopson argued that the constantly negative narrative was having an impact on staff – whose work was not being recognised – and creating a sense that the NHS was broken.
    “That narrative is partly being driven by opponents of the NHS and also [those] who want to attack the government,” Mr Hopson said, although he acknowledged that it also reflected genuine instances of staff and patient experience.
    Read full story (paywalled)
    Source: HSJ, 8 September 2022
  23. Patient Safety Learning
    NHS England’s approach to recovering cancer services has been described as ‘pathetic and dishonest’ by the deputy chief executive of a major trust.
    Andy Welch, deputy chief executive and medical director of Newcastle Hospitals Foundation Trust, has publicly criticised comments made in November by NHSE’s national cancer director Dame Cally Palmer, who said “we have our foot on the gas” towards reaching cancer waiting time targets.
    Mr Welch is an outspoken figure who has also slammed NHSE for “destroying” the morale of midwives through its “failed ‘continuity of care’ concept”, and described the potential “toppling” of the government as “brilliant” within the last three weeks alone.
    The Newcastle medic is the chair of the Northern Cancer Alliance. His criticism of Dame Cally comes as performance against the flagship cancer target remains largely unchanged since last year.  
    Read full story (paywalled)
    Source: HSJ, 18 May 2023
  24. Patient Safety Learning
    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
  25. Patient Safety Learning
    A “perilous” shortage of homecare workers is the biggest reason thousands of people are languishing longer in hospital than needed, driving up waiting lists and making people sicker, figures reveal.
    Almost one in four people unable to be discharged – sometimes for weeks – were trapped in hospital because they were waiting for home care, as agencies hand back contracts because staff are quitting owing to low pay, leaving 15% of jobs vacant.
    A fifth of people unable to be discharged were also waiting for short-term rehabilitation and 15% were waiting for a bed in a care home, according to analysis of data obtained using freedom of information requests and public records by Nuffield Trust and the Health Foundation.
    It estimated that in April this year, one in six patients were in hospital because of delayed discharge, and the discharge of patients with a hospital stay of more than three weeks was delayed by 14 days on average.
    “People are ending up in hospital for malnutrition and dehydration, problems which, even if you supported people a little bit at home, would stop,” said Jane Townson, the director of the Homecare Association.
    “More providers are having to turn down work than usual and some are having to hand back people because they can’t do it.”
    Read full story
    Source: The Guardian, 3 October 2022
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