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Patient Safety Learning

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Everything posted by Patient Safety Learning

  1. News Article
    Other countries are looking on appalled as the UK’s failure to reform social care has left its health service struggling to survive. There are blockages on the way in to the hospital, blockages inside them, and perhaps most frustrating for healthcare staff and patients, blockages getting those who have been treated and have recovered out of the front door and home, or into the community. It is this last problem that is proving hardest to crack. Despite promises from successive UK prime ministers to mend the broken social care system, it remains completely dysfunctional. This country is by no means unique in its health and social care struggles. Even in nations often held up as having model healthcare systems – such as France and Germany – the combined pressures caused by ageing populations, financial constraints, recruitment problems, Covid-19 and flu have taken their toll. On the issue of social care, French doctors and experts admit to shortcomings, though not on the scale of those in the UK. “It’s not that we don’t have problems, but things are organised differently,” said Blanche Le Bihan, a professor at the French School of Public Health and researcher at the Arènes scientific research centre in Rennes specialising in social care. “The system is far too fragmented, that’s the main issue with social care in France – communication, coordination are always complicated,” Le Bihan says. “But while it’s far from perfect, it’s not a major factor in hospitals’ current problems.” Read full story Source: The Guardian, 8 January 2023
  2. News Article
    Pupils should learn what health problems they must not bother the NHS with, doctors and pharmacists have said. In a new strategy paper they call for a “wholesale cultural shift” towards more self-care, insisting this could both empower patients and reduce demand. Conditions like lower back pain, the common cold and acute sinusitis can generally be treated without the need for GPs or hospital visits, experts said. They called for the national curriculum to include requirements for both primary and secondary pupils to be taught to treat and manage common health problems at home. Medical students or pharmacists could go into school to offer lessons on “self-care techniques and signposting to appropriate use of NHS services”, they said. The paper is from the Self-Care Strategy Group, a coalition of pharmacy bodies and GP and patient groups. Read full story (paywalled) Source: The Times, 9 January 2023
  3. News Article
    The US Food and Drug Administration (FDA) has granted accelerated approval for the Alzheimer’s disease drug lecanemab, one of the first experimental dementia drugs to appear to slow the progression of cognitive decline. Lecanemab will be marketed as Leqembi, the FDA statement said. It has shown “potential” as an Alzheimer’s disease treatment by appearing to slow progression, according to Phase 3 trial results, but it has raised safety concerns due to its association with certain serious adverse events, including brain swelling and bleeding. In July, the FDA accepted Eisai’s Biologics License Application for lecanemab under the accelerated approval pathway and granted the drug priority review, according to the company. The accelerated approval programme allows for earlier approval of medications that treat serious conditions and “fill an unmet medical need” while the drugs continue to be studied in larger and longer trials. If those trials confirm that the drug provides a clinical benefit, the FDA could grant traditional approval. But if the confirmatory trial does not show benefit, the FDA has the regulatory procedures that could lead to taking the drug off the market. Read full story Source: CNN Health, 7 January 2023
  4. Content Article
    This document summarises the current landscape of virtual wards from the perspective of healthcare for older people, and provides advice to those looking to set up such services for older people living with frailty.
  5. News Article
    Patient safety is at risk “every single day”, with patients in desperate need of intensive care waiting hours in Accident and Emergency departments across Scotland, the deputy chair of British Medical Association Scotland has said. The harrowing description of the scenes in hospitals came as health secretary Humza Yousaf admitted patients were receiving care he would not want to receive himself as the NHS continues to battle intense winter pressures. Dr Lailah Peel, deputy chair of the Scottish arm of the British Medical Association (BMA), told the BBC’s Sunday Show the crisis was “years in the making”. She blamed a creaking social care system and increased delayed discharges. The comments come after details of a January 2021 briefing from the Royal College of Emergency Medicine (RCEM) and the College of Paramedics to the health secretary warned of an unacceptable situation in Scotland’s hospitals. Reported in the Sunday Times, the briefing also specified the actions needed to avoid a similar situation during the current winter crisis, warning an increase of at least 1,000 new beds was needed as well as more doctors and nurses. Dr Peel said it was the case patients were “absolutely” dying in hospitals in Scotland due to the ongoing crisis in the health service. "There’s no shadow of a doubt that that is happening,” she told the BBC. Read full story Source: The Scotsman, 8 January 2023
  6. News Article
    A man plans to sue a nursing home because, he says, during the pandemic his mother was put on end-of-life care without her family being told. Antonia Stowell, 87, did not have the mental capacity to consent because she had dementia, say the family's lawyers. Her son, Tony Stowell, said if end-of-life care had been discussed, he would not have agreed to it. Rose Villa nursing home in Hull says all proper process in Mrs Stowell's care was followed with precision. As a prelude to legal action, Mr Stowell's lawyers have obtained his mother's hospital records which, they say, show she was diagnosed with suspected pneumonia while living in the home. End-of-life drugs were then prescribed and ordered by medical professionals. In a statement, Rose Villa said: "We believe that our dedicated and professional team provided Antonia with the very best care under the direction of her GP and medical team, and all proper process in the delivery of this care was followed with precision." Mr Stowell's lawyers, Gulbenkian Andonian solicitors, said his mother's hospital records reveal the decision to put her on end-of-life care was made two days before the family was told. In their letter to the home announcing the planned legal action, they said Mrs Stowell could have had "48 additional hours on a ventilator with treatment… with the necessary implication that Antonia Stowell could still be with us today or at least survived". The lawyer dealing with the case, Fadi Farhat, told the BBC: "As a matter of law, there is a presumption in favour of treatment which would preserve life and prolong life, irrespective of one's age or condition. "Therefore to deviate from that presumption means a patient, or family members, should be consulted as soon as that decision is made or contemplated." He adds: "What is particularly concerning for me is this case occurred at the height of the pandemic. That should worry everybody because it demonstrates that rights can be suspended in times of crisis, when the very purpose of legal rights is to protect us during times of crisis." Read full story Source: BBC News, 9 January 2023
  7. News Article
    Care providers are demanding double the usual fees to look after thousands of people who need to be discharged from hospitals to ease the crisis in the NHS. Care England, which represents the largest private care home providers, said on Sunday it wanted the government to pay them £1,500 a week per person, citing the need to pay care workers more and hire rehabilitation specialists so people languishing in hospital can eventually be sent home. The rate is about double what most local authorities currently pay for care home beds, an amount Martin Green, the chief executive of Care England, described as “inadequate”. The demand comes as the health secretary, Steve Barclay promised “urgent action” with up to £250m in new funding for the NHS to buy care beds to clear wards of medically fit patients. The money will be used to buy beds in care homes, hospices and hotels where people are looked after by homecare providers, as well as pay for hospital upgrades. Stays will be no longer than four weeks until the end of March. The use of hotels as care homes began during the pandemic and has been controversial, with reports of problems with hygiene and supplies of specialist equipment. The charity Age UK last week criticised their renewed use as “not an appropriate place to provide high-quality care for older people in need of support to recuperate after a spell in hospital”. Read full story Source: The Guardian, 9 January 2023
  8. News Article
    Rishi Sunak has held emergency talks over the weekend with NHS and care leaders in an attempt to tackle the winter healthcare crisis in England. The NHS Recovery Forum at No 10 on Saturday focused on four key issues: social care and delayed discharge, urgent and emergency care, elective care and primary care. A Downing Street spokesperson said the aim was “to help share knowledge and practical solutions so that we can tackle the most crucial challenges such as delayed discharge and emergency care”. But Sunak has been warned that the meeting is unlikely to reverse the NHS’s fortunes. Labour said patients deserved more than a “talking shop” and the Liberal Democrats said it was “too little, too late”. Senior doctors say the NHS is on a knife-edge, with many A&E units struggling to keep up with demand and trusts and ambulance services declaring critical incidents. Matthew Taylor, the chief executive of the NHS Confederation, said there were “no silver bullets” to solving the crisis at hospitals and other care centres. “This crisis has been a decade or more in the making and we are now paying the high price for years of inaction and managed decline,” he said. “Patients are experiencing delays that we haven’t seen for years". Read full story Source: The Guardian, 7 January 2023
  9. News Article
    NHS trusts in England have increased recruitment from low-income “red list” countries to make up for the post-Brexit loss of EU staff, despite a code of practice to safeguard health services in those developing countries. A report by the Nuffield Trust thinktank also identified shortages in vital specialist areas since Brexit, including dentistry, cardiothoracic surgery and anaesthesiology. It found that Brexit is still causing issues with the supply of medicines in Northern Ireland despite a change in the arrangements put in place by the EU last April. The report says that since 2021, the Northern Ireland protocol obliging EU trade rules to be followed in the region has led to a different set of medicines being available compared with the rest of the UK. Of the 597 products specifically approved by the Medicines and Healthcare products Regulatory Agency since Brexit, “only eight were also approved for Northern Ireland under the same name and company”. It also found that since 2021, 52 products had been granted marketing authorisation for Northern Ireland but not in Great Britain under the EU approvals system, including a painkiller from the Slovenian company Sandoz Farmacevtska Druzba designed to stop people dying from opiate overdoses. The Democratic Unionist Party (DUP) described the report as “deeply alarming”. Read full story Source: The Guardian, 7 January 2023
  10. Content Article
    On the 5 February 2020 an inquest was opened into the death of Hayley Smith. The jury concluded on 9 March 2022 with a narrative conclusion “The deceased died from complications of anorexia nervosa.” Hayley had developed severe and enduring anorexia nervosa at around the age of nine or ten and was resistant to treatment including several hospital admissions both voluntary, and at times compulsory treatment under the Mental Health Act. She was repeatedly admitted to hospital. On the 23 December 2019 Hayley had not eaten, became confused and unwell, and an ambulance was called. The correct emergency treatment was provided but Hayley responded quickly and regained consciousness and refused further treatment or admission to hospital. On 24 December she became unwell again and this time was taken to Queen Elizabeth the Queen Mother hospital where she again refused treatment and discharged herself against medical advice. The responsible medical officer from the Kent Eating disorder team gave evidence that had the team known of either of these episodes they would have taken steps to admit her and treat her.] On Christmas Day 2019 she collapsed for a final time and this time, had an out of hospital cardiac arrest, and was admitted to Queen Elizabeth the Queen Mother hospital and transferred to Intensive care where she was diagnosed as suffering from hypoxic brain damage as a result of her cardiac arrest due to severe hypoglycaemia as a consequence of her Anorexia Nervosa. She died on 29 December 2019 at the age of 27.
  11. Content Article
    This paper from Natalie Offord and colleagues describes a service redesign in which has gained learning and experience in two areas. First, a description of measured improvement by the innovation of redesigning the traditional hospital-based assessment of frail older patients’ home support needs (assess to discharge) into their own home and meeting those needs in real time (discharge to assess). In combination with the formation of a collaborative health and social care community team to deliver this new process, there has been a reduction in the length of stay from completion of acute hospital care to getting home (from 5.5 days to 1.2 days for those patients that require support at home). Second, the methodology through which this has been achieved. The authors describe their translation of a Toyota methodology used for the design of complex cars to use for engaging staff and patients in the design of a healthcare process.
  12. Event
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    Join a moderated panel discussion with IQVIA leaders following the release of the IQVIA Institute’s annual global trend report on The Global Use of Medicines 2023. The webinar will look closely at: Global outlook drivers The impact of the COVID-19 pandemic on medicine use, market growth, and vaccines and therapeutics. Total global market size and growth in spending and defined daily doses. Innovation from the R&D pipeline, including the number of and type of expected drug launches. Therapy area market size and growth. Highlights from key regions globally Market size and elements of growth 2023-27. Therapy area highlights. Health system drivers of medicine demand and spending. Major uncertainties and the wild cards to watch. Register
  13. Event
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    Royal Society of Medicine webinar with Chris Hopson, Chief Strategy Officer at NHS England and former Chief Executive at NHS Providers for ten years. Interviewed by the Dean of Education at the Royal Society of Medicine, Professor Gillian Leng, he will talk about his career and the current state of the NHS. Chris Hopson took up the post of Chief Strategy Officer at NHS England on 13 June 2022 after working as Chief Executive at NHS Providers for ten years and a career spanning the public, private and voluntary sectors. Register
  14. News Article
    With NHS staff being forced to witness our patients dying in corridors, in cupboards, on floors and in stranded ambulances, we can only thank our lucky stars that the country’s second most powerful politician is the man who last year published Zero: Eliminating Unnecessary Deaths in a Post-Pandemic NHS. Because the chancellor, Jeremy Hunt, cannot possibly stand back and permit these crisis conditions to continue, can he? He knows better than anyone – having written 320 pages on precisely this fact – that avoidable deaths are the very worst kinds of death, the ones that sicken families and clinicians to their core. Let’s remind ourselves of how strongly Hunt feels about this subject. The blurb of his book, published only last May, rings out with moral righteousness. “How many avoidable deaths are there in the NHS every week?” he asks. “150. What figure should we aim for? Zero. Mistakes happen. But nobody deserves to become a statistic in an NHS hospital. That’s why we need to aim for zero.” He even offers a road map towards achieving that end that, unusually for a politician, centres on radical candour. Don’t lie. Don’t deflect. Don’t spin. Don’t cover up. Be honest and open about mistakes and failures because this is the first, essential step to fixing them. To the collective despair of frontline staff, the government’s actual, as opposed to rhetorical, response to the humanitarian crisis gripping the NHS is a perverse inversion of everything the chancellor purports to hold dear. Read full story Source: The Guardian, 6 January 2023
  15. News Article
    The NHS is on the verge of collapse due to demand for healthcare rising significantly faster than funding levels, a consultant has warned. Peter Neville, a consultant for NHS Wales, took to social media to explain why, in his view, the system is failing. The consultant physician, who has been working in the NHS in Yorkshire and Wales for 32 years, set out the challenges facing the health service in a Twitter thread. He said he had experienced the NHS at its best, in 2008, and its worst, in 2022. He wrote: "Over at least the past 15 years, we have seen a relentless increase in demand, both in primary care and in hospital care. This has been absolutely predictable by social statisticians for decades and is based on the fact that our elderly are surviving much longer. "Our elderly use a very large percentage of NHS of resources, unsurprisingly because they are more prone to disease, frailty, and dementia. They need more social care and hospital care as they get older. And they are living longer. (Immigrants, by the way, use much less care). "Over this period NHS funding has, broadly speaking, risen about 1-2% over inflation. If NHS funding increases with inflation yet demand increases, then clearly spend per person will drop. Demand has increased considerably above 2%, which is why the NHS is failing to manage it." Read full story Source: Wales Online, 3 January 2023
  16. Event
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    The landscape of the health and care system is ever-changing and complex. At this free online event, the expert panel will provide insight and context into the wider health and care landscape and the big issues they want to see progress in 2023. The panel will explore how recent trends and future developments could affect people working in the sector, as well as people, patients and communities. Register
  17. News Article
    Hours lost to ambulance handover delays, and the numbers of ambulances waiting more than an hour outside hospitals hit new highs in the week after Christmas. Data published this morning by NHS England revealed nearly 55,000 hours were lost to delays between 26 December and 1 January and 18,720 ambulances had to wait more than an hour to handover patients as emergency departments struggled, with many trusts declaring critical incidents. The number of hour-plus delays followed previous years’ trend of a slight dip in the week leading up to Christmas followed by an acceleration afterwards. However, levels this year were more than twice those seen in 2021 and three times those of the previous two years. Read full story (paywalled) Source: HSJ, 6 January 2023
  18. News Article
    The extent of the gridlock in hospitals over Christmas has been revealed, with data in England showing record numbers of ambulances delayed dropping off patients at A&E. More than 40% of crews were forced to wait at least half an hour to hand over patients in the week up to 1 January. That is the highest level since records began a decade ago. But there is hope pressures could soon start easing, with flu and Covid admissions dropping last week. But the UK Health Security Agency is warning it is too early to say whether the flu season - the worst in a decade - has peaked, because reporting lags over the festive period may have affected the data. And Matthew Taylor, of the NHS Confederation, which represents hospitals, said wards were still incredibly full, which was creating delays in A&E and for ambulances. He said hospitals were facing "crisis conditions" that were presenting a risk to patients. Read full story Source: BBC News, 5 January 2023
  19. News Article
    Patients discharged from hospital without social care packages could die at home, doctors have warned. They said Welsh government advice to do this showed a system at breaking point. The British Medical Association (BMA) said it rejects the guidance to "change the risk threshold" for releasing people from hospital. The Welsh government said discharging patients could help them get better "by reducing the risk of infection and muscle wastage". Royal College of General Practitioners Wales chairwoman, Rowena Christmas, said the NHS was "unbelievably stretched". "A frail, elderly person coming home, who can't really safely get from their bed or their chair to the bathroom without risk of falling over, they're not going to be able to survive at home," Dr Christmas said. "I completely understand we need more beds, but that feels like a bad move." Read full story Source: BBC News, 6 January 2023
  20. News Article
    An ICS chief has said the NHS workforce crisis is not the result of a ‘funding issue’ but caused by an inefficient use of resources. Patricia Miller, chief executive of Dorset Integrated Care Board, told a board meeting on Thursday that “constantly talking about the NHS needing more money” was undermining leaders’ case to government. She said: “We have got a workforce issue in the NHS, there is no doubt about that. I don’t actually believe we have got a funding issue. We just don’t use our resources very efficiently and I don’t think we do our case any positive favour with government when we’re constantly talking about the NHS needing more money when we can’t demonstrate that what we do is efficient. “So I don’t actually accept we’ve got a funding issue unless we start to work at the optimum and then we can absolutely demonstrate that. “I think what this comes down to is that our systems are too complicated and that starts at the centre, where every initiative we have is not about redesigning service models end-to-end but about layering on different solutions to different ends of the pathway and it just makes it more complicated. “I’ve no doubt that we’ve probably got 50-plus entrance and exit points to our urgent emergency care service, it’s ridiculous. I can’t navigate my way around 50 or 60, so there’s no way a patient can do it.” Read full story (paywalled) Source: HSJ, 6 January 2023
  21. Content Article
    We know that NHS organisations may sometimes need to reorganise their services to consider how they can best deliver care to patients. This can mean there is a need to repurpose existing environments, for example hospital wards or clinical areas. Staff may also be redeployed to deal with surges in demand when the pressure on the system is at its greatest. We commonly see this during winter, with ‘winter pressures’ wards, but we have also seen this become more common during other times of the year as the NHS deals with the lasting impact of coronavirus (COVID-19) and staff shortages in some key areas. It’s important that the NHS has this ability to adapt to try and make sure it can deliver the best and safest care to as many patients as possible. The ability to flex in this way helps to keep the NHS operating when it is at its busiest and makes sure that patients can still access appropriate care. Scott Hislop, the Healthcare Safety Investigation Branch (HSIB) Principal National Investigator, looks at the challenges faced by the NHS when flexing to meet demands and how to mitigate potential risks to patient safety.
  22. News Article
    Junior doctors have threatened to stage a “full walkout” for three consecutive days in March in which they would not treat A&E patients. The British Medical Association told the government this morning that junior doctors would strike for 72 hours if it is supported in a ballot that opens next week. The association said that “doctors will not provide emergency care during the strike”, which is likely to worsen deadly accident and emergency delays. Hospital bosses said they were “deeply worried” by the BMA’s announcement, urging the government to start negotiating rather than “sitting back and letting more strikes happen”. NHS bosses fear that the BMA will co-ordinate strike action with the nursing and ambulance unions if the dispute is allowed to rumble on. Nurses will strike on January 18 and 19, and ambulance workers are due to walk out on January 11 and 23. Read full story (paywalled) Source: The Times, 6 January 2023
  23. News Article
    Excess deaths in the week before Christmas were the highest in two years amid a crisis in NHS care, new figures show. Approximately 2,500 more people died than usual in the week ending 23 December in England and Wales, numbers from the Office for National Statistics reveal. The total death toll of 14,530 is 21% higher than would be expected for this period, compared with averages from the last five years. The new figures represent the highest excess and overall deaths recorded since February 2021. At that time, the UK recorded 15,943 deaths from Covid as transmission rates remained high. But only 429 of the most recent deaths have been linked to the virus. Read full story Source: The Independent, 5 January 2023
  24. News Article
    More and more older people are being “warehoused” in inappropriate care beds, condemned unnecessarily to long-term care, and “lost” to health and care services, due to the rush to discharge from full hospitals and a lack of community rehab services, leaders have warned. Several senior figures in community and social care have raised the issue with HSJ, warning it has been a growing concern over the past 18 months of severe system pressure following on from acute covid peaks. The Health and Safety Investigation Branch has also raised the issue, telling HSJ inappropriate care placements are leading to harm and readmissions, while a major accountability gap remained over the safety of discharges. The average length of hospital stay has increased compared to pre-Covid, with a big jump in those staying more than three weeks. Many in the NHS put this down to a lack of social care capacity meaning more medically fit people are stuck in hospital. Senior staff in community health and social care services told HSJ hospitals were increasingly demanding rapid discharges, often as part of “surge” measures when they are very full and under pressure to reduce ambulance queues. Homecare cannot be organised, and with suitable step-down and care beds also full, trusts are instead “spot purchasing” space in unsuitable homes which may be a long journey from the person’s home area, and in a different council area. Read full story (paywalled) Source: HSJ, 5 January 2023 Further reading HSIB interim bulletin - Harm caused by delays in transferring patients to the right place of care
  25. News Article
    NHS hospitals are discharging patients into a hotel in a bid to ease demand for beds. Bristol, North Somerset and South Gloucestershire trusts are using the hotel for patients who no longer need urgent treatment but need social care. The Integrated Care Board (ICB) for the three trusts has booked the "hotel care facility" for up to 30 patients. A spokesperson for the ICB said care services were "under significant pressure". "This temporary care facility delivered at a local hotel will help us to improve the flow of patients through our hospitals by ensuring more people can be discharged as soon as they are medically fit to leave hospital," they said. The hotel care facility was introduced in late November 2022 and will run until the end of March. It is being provided by CQC-registered homecare company Abicare. The service is being delivered by live-in care workers on a 24/7 basis with visiting clinical teams providing rehabilitation and primary care support, the ICB said. Nadra Ahmed OBE, chair of the National Care Association (NCA), told BBC Radio 4 Today she is concerned about the quality of care in a hotel setting. "This is a short-term solution- what we really need is a robust, sustainable and well-invested social care sector," she said. Read full story Source: BBC News, 5 January 2022
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