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Patient Safety Learning

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  1. Content Article
    Emergency access to healthcare is in crisis. Unmet need in primary and community care and low capacity in hospitals and social care has left the emergency health services gridlocked and overwhelmed, unable to provide safe care. This Cross party House of Lords Public Services Committee report recommends that a COBR Committee be assigned the responsibility to address the crisis in emergency healthcare. In the long-term, it recommends a a substantial overhaul is needed, one which sets out a bold new operating model for the system as a whole, and which is backed by equally bold leadership.
  2. Content Article
    In this blog Patient Safety Learning considers the impact on patient safety of the shortage of hospital beds facing the NHS this winter. It focuses on two specific issues stemming from this, the increasing numbers of patients being cared for in corridors and other non-clinical areas, and current proposals to reduce the number of patients waiting to be discharged.
  3. News Article
    Ambulance workers are to join nurses in taking strike action on 6 February in England and Wales in what will be the biggest NHS walkout in this dispute. The GMB announced four new stoppages for ambulance staff - one of which coincides with a nurses' strike date. It is the first time both ambulance staff and the Royal College of Nursing (RCN) have acted on the same day. GMB national secretary Rachel Harrison said: "Ambulance workers are angry. Our message to the government is clear - talk pay now." The walkouts by staff including paramedics, call handlers and support workers in seven of the 10 English ambulance services along with the national Welsh service will take place on 6 and 20 February, and 6 and 20 March. Under trade union laws, both unions will have to provide emergency cover. But it raises the prospect of urgent 999 calls for falls not being responded to, and a huge chunk of pre-planned hospital care such as hernia repair, hip replacements or outpatient clinics not being done. Read full story Source: BBC News, 18 January 2023
  4. News Article
    Hospital inspectors have raised safety concerns over maternity care at an NHS trust where dozens of babies died unnecessarily. The Care Quality Commission (CQC) is threatening the East Kent Hospitals trust with enforcement action to ensure patients are protected. An independent review in October found that at least 45 babies might have survived with better care at the trust. The East Kent Hospitals trust has been approached for comment. Inspectors carried out an unannounced inspection of the trust's maternity services over two days last week. Following the visit, the CQC has now written to the trust "to request evidence of the steps it is taking to ensure people are safe and protected from risk." In a statement to the BBC, Deanna Westwood, a director of operations with the CQC, said they would "review the trust's response to determine whether the use of our enforcement powers is required." The warning comes just four months after the trust was severely criticised for its maternity care between 2009 and 2020. Read full story Source: BBC News, 18 January 2023 Further reading: Patient Safety Learning - Mind the implementation gap: The persistence of avoidable harm in the NHS
  5. News Article
    The fact that the NHS is under enormous pressure is undisputed. Almost everything else is debated, including the question of how many patients are dying as a result of the chaos in hospitals. The proportion of patients who wait more than 12 hours in A&E departments to be admitted to a ward has risen from 2% to 7% over the past year. The Royal College of Emergency Medicine has estimated that delays in A&E are leading to 300-500 additional deaths per week. However, officials at NHS England do not accept this figure. The data suggest that something is very awry. Read full story (paywalled) Source: The Economist, 11 January 2023
  6. News Article
    Young people in the midst of a mental health crisis need to have attempted suicide several times before they get a bed in an inpatient unit in England, a report has revealed. Admission criteria for beds in child and adolescent mental health units are now so tight that even very vulnerable under-18s who pose a clear risk to themselves cannot get one. The practice – caused by the NHS’s lack of mental health beds – leaves young people at risk of further harm, their parents confused, exhausted and worried, and the police and ambulance services potentially having to step in. The high thresholds for admission to a child and adolescent mental health services (Camhs) unit are detailed in a report on NHS mental health care for under-18s in England based on interviews with patients, their parents and specialist staff who look after them. The report says a young person has to “have attempted suicide multiple times to be offered inpatient support”. Olly Parker, the head of external affairs at the charity Young Minds, said: “It is shameful that children and young people are reaching crisis point before they get any support for their mental health. We know from our own research that thousands have waited so long for mental health support or treatment that they have attempted to take their own life. “Those who end up in A&E are often there because they don’t know where else to turn. But A&E can be a crowded and stressful environment, and is usually not the best place to get appropriate help.” Read full story Source: The Guardian, 18 January 2023
  7. Content Article
    Young people and expert mental healthcare staff say patients are unlikely to receive in-patient mental health care unless they “have attempted suicide multiple times”, according to a new report published by Look Ahead Care and Support. Launched in the House of Lords, the report – funded by Wates Family Enterprise Trust and produced by experts Care Research – argues Accident and Emergency departments have become an ‘accidental hub’ for children and young people experiencing crisis but are ill-equipped to offer the treatment required.   Based on in-depth interviews with service users, parents and carers, and NHS and social care staff from across England, the findings from the Look Ahead Care and Support report draws on experience of treating depression, anxiety, self-harm, suicidal thoughts and suicide attempts, eating disorders, addiction and psychosis.  
  8. Content Article
    The health service needs to develop innovative ways of treating an increasingly elderly and frail population, while harnessing new technology to help mitigate the staffing crisis. As part of the Times Health Commission, this article outlines some potential solutions — encompassing new ways of working and regulation to promote healthier lifestyles — to some aspects of the health and social care crisis in the UK.
  9. News Article
    Patients will suffer if ministers bow to nurses’ demands for pay rises, the health secretary has warned as tens of thousands of NHS staff walk out on today. Steve Barclay told the Independent said any boost to wages would “take billions of pounds away from where we need it most”. He wrote: “Unaffordable pay hikes will mean cutting patient care and stoking the inflation that would make us all poorer.” Today tens of thousands of nurses will strike across 55 trusts. NHS data shows 4,567 operations and 25,009 outpatient appointments were cancelled during the nurse’s strikes on 15 and 20 December. The NHS also faces further ambulance strikes next Monday, which sources indicate will go ahead, and new strikes are to be announced for February by union GMB. The Royal College of Nursing (RCN) criticised Mr Barclay for “pitting nurses against patients”, branding the comments “a new low for the health secretary”. Read full story Source: The Guardian, 18 January 2023
  10. News Article
    An acute trust chief executive has criticised the lack of communication during last month’s nursing strike, warning that he and other accountable officers could face manslaughter charges if patients are put in danger by decisions made by senior colleagues elsewhere in the system. Matthew Hopkins told a board meeting that Worcestershire Royal Hospital’s emergency department was “pushed to the extreme” on 20 December, with 176 people squeezed into a facility originally built for 50. He said that without warning from regional colleagues, an additional 18 people were brought in to the hospital by the ambulance service and ended up in corridors, at which point the trust declared a critical incident. The chief executive officer said he wanted to put on record an apology to staff for the incident, adding that he was “not aware” of the situation until it unfolded. Read full story (paywalled) Source: HSJ, 17 January 2023
  11. News Article
    A series of concerns about serious incidents at a mental health trust are being investigated by the Care Quality Commission, with a referral also made to the police, HSJ has learned. HSJ understands that various incidents at Black Country Healthcare Foundation Trust have been raised with the Care Quality Commission by whistleblowers. According to a well-placed source, one of the alleged incidents involved alleged inappropriate sexual behaviour, and this has been referred to West Midlands police. Other complaints are understood to include staff using mental health inpatients’ rooms to sleep in, and an information governance breach in which patient information was shared with members of staff who did not need to receive them. It is understood this was in an email raising patient safety concerns. Read full story (paywalled) Source: HSJ, 17 January 2023
  12. News Article
    Visiting times have been extended at Dorset's hospitals during strike action so relatives and friends of patients can help. Times at general inpatient wards have been altered to be between 10:00 and 20:00 GMT on Wednesday and Thursday. Hospital bosses said help at mealtimes, for example, would allow nursing staff to focus on clinical care. All wards "will be safely staffed during the industrial action", the hospitals said. The UHD trust said: "If you wish to help your loved one at mealtimes or with any personal care, please do so - just let a member of the ward team know." Read full story Source: BBC News, 18 January 2023
  13. News Article
    The issue of children dying unexpectedly and without any known cause has been debated in Parliament for the first time. Sudden unexplained death in childhood (SUDC) is a rare category of death in which the cause remains unknown even after thorough investigation. Former Chancellor Kwasi Kwarteng, who led the debate, said SUDC had not had the attention it deserved. In his first speech as a backbencher for six years, he said it was important to not shy away from discussing "something that is incredibly difficult to deal with, emotionally very taxing, and one of the most serious medical phenomena". He said: "Imagine a death of a child, who has all his or her life in front of them, suddenly ended. If you can imagine that and if you can imagine that for one of your own children you can get a sense of how tragic and how difficult that occurrence is." He added: "It's such an uncomfortable issue but it is important to grasp uncomfortable issues to honour those who had died and prevent future deaths." He added: "It's such an uncomfortable issue but it is important to grasp uncomfortable issues to honour those who had died and prevent future deaths." The MPs were united in their call for more research to be carried out. They also called for the NHS website to be updated to include information about SUDC and for there to be more training for medical practitioners. Read full story Source: BBC News, 17 January 2023
  14. News Article
    A man has waited eight years to get adequate mental health care, as waiting lists for therapy grow. Myles Cook, 47, from Essex, lives with severe depression and has been fighting to get one-to-one counselling for eight years but he has been told there are not enough therapists locally to respond to the demand. Instead, he has been referred to group sessions, which he said were “detrimental” to his condition and manages his condition with medication but said he did not find that helpful either. He said: “If you’re not getting help, and all you keep getting are pills and pills that don’t seem to be doing much. It might take the edge off but it doesn’t really do anything for my depression and because of the way the benefits system works, I’m not getting any therapy If I’m not on tablets, they’ll probably kick me off on my benefits because I’m not being treated.” “I take the tablets, the psychiatric medications, I keep taking them although they’re not helpful because I need to have something to prove that I’m being treated to keep my benefits.” At least 95% of patients needing NHS talking therapy services, called IAPT, should receive treatment within 18 weeks. But figures previously uncovered by The Independent showed that just one in five patients have their second IAPT appointment within three months. And the NHS has failed to meet its target of having 1.6 million patients seen by IAPT services last year. Data published last year shows this was missed by 400,0000 at the end of 2021-22. Read full story Source: The Independent, 16 January 2023
  15. News Article
    A construction firm has been ordered to pay £5m after fire and electrical safety defects were found at one of the NHS’s largest cancer centres. Lendlease was responsible for the design and build of the Bexley Wing at St James’s University Hospital in Leeds, under a private finance initiative deal nearly 20 years ago. The building houses Leeds Cancer Centre, one of the largest in the country, and some other services. It is run by Leeds Teaching Hospitals Trust. Concerns were later raised over fire and electrical safety in the plant room, where the building’s power supply is situated, according to a ruling published by the technology and construction court. This included a lack of fire separation between the primary and secondary source of power, which risked a single incident disabling them both. Read full story (paywalled) Source: HSJ, 16 January 2023
  16. News Article
    A doctor in Cambridge is spearheading a project to help to reform "blunt" medical language that patients and their families can find upsetting. Ethicist Zoe Fritz said language that "casts doubt, belittles or blames patients" was long overdue for change. Sixteen-year-old Josselin Tilley from Wiltshire has charge syndrome that reduces her life expectancy. Her mother Karen said Josselin's death was often referred to in correspondence "like she's not a person. "It's not person-centred at all, it's like she's just nothing." The example she gave was an extract from a typical letter in November that she was copied in to by a community paediatrician addressed to colleagues. "Death below 35: On discussion with Josselin's mum early death has been discussed with her, and there is plan, discussed with Josselin's mother about a wishes document being done." Mrs Tilley, from Westbury, said she objected to the use of language that "very bluntly discusses Josselin's death like she's something going off in the fridge". Doctor Fritz said the reason she and doctor Caitriona Cox were running the campaign at Cambridge University was because they recognised language regularly used by clinicians was often problematic for anyone outside of medical practice. "Even just (the term) presenting [a] complaint. Patients coming into hospital with whatever's bothering them we [doctors] talk about as a complaint and I think that infantilises the patient. They're not complaining when telling us what's going on." Read full story Source: BBC News, 17 January 2023 Further reading on the hub: Presenting complaint: use of language that disempowers patients
  17. News Article
    The BBC has come under fire from scientists for interviewing a cardiologist who claimed certain Covid vaccines could be behind excess deaths from coronary artery disease. Experts have criticised Dr Aseem Malhotra’s appearance on the BBC's news channel last Friday, accusing him of pushing “extreme fringe” views, which are “misguided”, “dangerous” and could mislead the public. Scientists have described the doctor as “hijacking” an interview on statins to air his views, causing BBC staff to be “alarmed and embarrassed” by their booking. Malhotra recently retweeted a video by the MP Andrew Bridgen, who had the Tory whip removed on Wednesday after comparing the use of Covid vaccines to the Holocaust. After criticising new guidance on statins, he cited British Heart Foundation (BHF) figures that suggested there had been more than 30,000 excess deaths linked to heart disease since Covid first arrived. Malhotra, a cardiologist at ROC Private Clinic, claimed mRNA Covid vaccines play a role, saying his “own research” showed “Covid mRNA vaccines do carry a cardiovascular risk”. He added that he has called for the vaccine rollout to be suspended pending an inquiry because of the “uncertainty” behind excess deaths. Read full story Source: The Guardian, 13 January 2023
  18. News Article
    Two new nurses' strikes will be held on 6 and 7 February in England and Wales - unless there is movement on pay, the Royal College of Nursing says. The walkouts will be the biggest so far, with more than a third of NHS trusts in England and all but one Welsh health board affected. It comes as nurses prepare to walk out on Wednesday and Thursday, following the two strike days before Christmas. As required under trade union laws, emergency care will be covered. Most of the 73 NHS trusts involved in the new set of strike dates are hospitals. It means the biggest disruption is likely to be in pre-booked treatment such as hernia repair, hip replacements or outpatient clinics. Services such as chemotherapy, kidney dialysis and intensive care will be staffed, however, as part of the emergency cover. Read full story Source: BBC News, 16 January 2023
  19. News Article
    A group of transgender people have lost their legal case against NHS England over waiting times to get seen by a gender specialist. The two trans adults and two trans children had tried to get the wait times - more than four years in one of their cases - deemed illegal. But a High Court judge ruled on Monday the waiting times are lawful. The Good Law Project - which helped to bring the legal action - said it would seek permission to appeal. The four people brought the legal action against NHS England (NHSE) over the waiting time to get a first appointment with a gender dysphoria specialist. The claimants argued that NHS England was failing to meet a duty to ensure 92% of patients referred for non-urgent care start treatment within 18 weeks. They said the waiting times were discriminatory, arguing the delays faced by trans people were longer than for other types of NHS treatment. But the judge dismissed the claim on several grounds. Read full story Source: BBC News, 16 January 2023
  20. News Article
    GPs whose patients want to stop taking antidepressants should reduce the dose of their medication in stages to lower the risk and severity of withdrawal symptoms, the medicines watchdog has said. About one in six (16%) adult Britons experience moderate to severe depression, according to the Office for National Statistics. In England alone, 21.4m antidepressant drugs were prescribed between July and September 2022, according to the NHS Business Services Authority. A new draft quality standard for the care of adults with depression from the National Institute for Health and Care Excellence (NICE) – the first update in 11 years – includes specific guidance to help adults come off antidepressant medication permanently. NICE’s independent advisory committee, which includes experts in treating adults with depression, recommends the staged withdrawal of antidepressants in patients who want to stop taking the drugs. A staggered reduction of medicine, known as tapering, helps to reduce withdrawal effects and long-term dependence on the medication, according to Nice. The committee said primary care and mental health professionals should follow the NICE guideline recommendations on stopping antidepressant medication, including agreeing with their patient whether it is right for them to stop taking the medication and, if so, the speed and duration of withdrawal from it. Read full story Source: The Guardian, 17 January 2023
  21. News Article
    An NHS trust declined to provide care for a vulnerable Black man days before he died in police custody while having a psychotic episode, The Independent has learnt. Godrick Osei, 35, died after being restrained by up to seven Devon and Cornwall Police officers in the early hours of 3 July 2022, after fleeing his flat and hiding in the cupboard of a care home in Truro. His family said he had been expressing “paranoid thoughts” and had called the police himself for help. He was arrested and died within an hour. Mr Osei had been diagnosed with anxiety and depression, had suspected post-traumatic stress disorder (PTSD) and was prescribed various medications to treat these conditions. He also intermittently used illicit drugs and had suffered alleged sexual assault in prison around 2013, according to a medical report from North East London NHS Foundation Trust (NELFT). In the days before his death, Mr Osei was in the care of NELFT’s community mental health team, whose caseworkers were concerned that he was exhibiting signs of a further severe illness – emotionally unstable personality disorder (EUPD) – and was a high risk to himself. However, Mr Osei was based outside the team’s catchment area, and NELFT asked the neighbouring Cornwall Partnership NHS Foundation Trust (CPT) to assess him instead. CPT refused without explaining why, according to a medical report seen by The Independent. Following Mr Osei’s death, an investigating officer from NELFT made multiple attempts to contact CPT to explore the possibility of a joint investigation into the matter, but didn’t receive a response. Read full story Source: The Independent, 16 January 2023
  22. News Article
    Child mortality from trauma and sudden unexpected death increased last year, according to figures highlighting the stark impact of poverty on child health. The analysis, which tracked all child deaths in England between 2019 and 2022, found overall mortality dipped during the pandemic due to a decrease in infectious illnesses, but that numbers of deaths have since returned to pre-pandemic levels. This included a 32% increase in trauma deaths and a 13% rise in sudden unexpected death in infancy or childhood (Sudic) last year compared with pre-pandemic rates. Prof Karen Luyt, the programme lead for the National Child Mortality Database, based at the University of Bristol, said the figures could be “the first mortality signal” from families struggling with the cost of living crisis. “This is worrying and I think we’re likely to see things getting worse,” she said. “Certainly for childhood illness and mortality, we know there’s a strong social gradient and we know that more families are now living in poverty.” Sudic deaths are defined as being unexplained and unexpected at the point death is registered, but may be subsequently found to be due to cardiac arrest after infection or an asthma attack, for instance. It is a broader category than sudden infant death syndrome (Sids), where the cause of death often remains a mystery even after postmortem examination. Read full story Source: The Guardian, 16 January 2023
  23. News Article
    Complications after a procedure to treat IBS left Jennifer Hill in pain – and fighting for compensation. Earlier this year, an NHS inquiry found surgeon Anthony Dixon had caused women to “suffer harm” as a result of the mesh operations he carried out between 2007 and 2017. Dixon, who is now banned from practising in the UK, carried out hundreds of laparoscopic ventral mesh rectopexy (LVMR) operations for both the North Bristol NHS Trust and privately at Bristol’s Spire Hospital. Mesh is used to repair the pelvic floor, but the inquiry concluded that women should have been offered alternative treatments first. Jennifer Hill, from Herefordshire, is one of those women. She wishes she could go back in time and not have her mesh operation, which took place in May 2012. “I was totally unaware of the controversy surrounding mesh,” she says. “I still kick myself that I didn’t get a second opinion or ask more questions.” Read full story (paywalled) Source: The Telegraph, 11 January 2023
  24. Content Article
    This study examined the risks and patterns of childhood deaths before and during the COVID-19 pandemic.  In this cohort study, there were 3409 childhood deaths from April 2019 to March 2020, 3035 deaths from April 2020 to March 2021, and 3428 deaths from April 2021 to March 2022. Overall risk of death was significantly lower from 2020 to 2021, but not from 2021 to 2022 when compared with the reference year of 2019 to 2020. These findings suggest that there was a significant reduction in all-cause child mortality during the first year of the COVID-19 pandemic (2020-2021), which returned to near prepandemic levels the following year (2021-2022).
  25. Content Article
    With the NHS under relentless pressure this winter and as records keep getting broken for all the wrong reasons, Helen Buckingham takes a closer look at why hospitals are so full, and emphasises the importance of supporting and helping the health service’s staff.
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