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Patient Safety Learning

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  1. News Article
    Ambulance staff are being urged to conserve oxygen supplies because of a national shortage of small cylinders used both on ambulances and in some A&E departments. South East Coast Ambulance Service Foundation Trust has told staff the shortage is caused by the high number of patients with respiratory conditions and “the suppliers are reporting that this is higher than during the first wave of the covid pandemic”. In a message to staff last week, East of England Ambulance Service Trust said: “Oxygen suppliers, including BOC, are currently unable to supply sufficient numbers [of small cylinders] to fulfil our orders. “This has been escalated nationally and NHS Procurement are working to support ambulance trusts with supplies.” But it added that over the next few days it would need to “carefully manage” supplies. The type of cylinder affected typically provides about 30 minutes of oxygen on full flow and is widely used on ambulances and also where patients are cohorted in accident and emergency departments or kept in corridors waiting to be passed to hospitals, without access to the normal piped supply. Many ambulances will carry several smaller cylinders, and sometimes they also carry one larger one. However, if a patient requiring oxygen can’t be handed over quickly at A&E, ambulance supplies may start to run low. Read full story (paywalled) Source: HSJ, 30 December 2022
  2. News Article
    The crisis engulfing the NHS will continue until Easter, health leaders have warned, as senior doctors accused ministers of letting patients die needlessly through inaction. More than a dozen trusts and ambulance services have declared critical incidents in recent days, with soaring demand, rising flu and Covid cases and an overstretched workforce piling pressure on the health service. But amid warnings that up to 500 people a week may be dying due to delays in emergency care alone, and of oxygen for seriously ill patients running out in parts of England, NHS leaders warned more chaos was expected until April. “It seems likely that the next three months will be defined by further critical incidents needing to be declared and the quality of care being compromised,” said Matthew Taylor, chief executive of the NHS Confederation, which represents the whole healthcare system in England, Wales and Northern Ireland. Ministers face growing pressure to grip the crisis. The British Medical Association (BMA) said the government’s “deafening” silence and failure to act was a “political choice” that was leading to patients “dying unnecessarily”. The Liberal Democrats urged the government to recall parliament, while Labour blamed government “mismanagement” for creating a sense of “jeopardy” around the NHS. Read full story Source: The Guardian, 2 January 2022
  3. News Article
    The number of children in England needing treatment for serious mental health problems has risen by 39% in a year, official data shows. Experts say the pandemic, social inequality, austerity and online harm are all fuelling a crisis in which NHS mental health treatment referrals for under-18s have increased to more than 1.1m in 2021-22. In 2020-21 – the first year of the pandemic – the figure was 839,570, while in 2019-20 there were 850,741 referrals, according to analysis of official figures by the PA Media. The figures include children who are suicidal, self-harming, suffering serious depression or anxiety, and those with eating disorders. Dr Elaine Lockhart, chair of the child and adolescent psychiatry faculty at the Royal College of Psychiatrists, said the rise in referrals reflected a “whole range” of illnesses. She said “specialist services are needing to respond to the most urgent and the most unwell”, including young people suffering from psychosis, suicidal thoughts and severe anxiety disorder. Lockhart said targets for seeing children urgently with eating disorders were sliding “completely” and that more staff were needed. Read full story Source: The Guardian, 3 January 2023
  4. News Article
    Two in three UK doctors are suffering “moral distress” caused by the enfeebled state of the NHS and the damage the cost of living crisis is inflicting on patients’ health, research has found. Large numbers are ending up psychologically damaged by feeling they cannot give patients the best possible care because of problems they cannot overcome, such as long waits for treatment or lack of drugs or the fact that poverty or bad housing is making them ill. A new survey found that 65% of doctors overall, including nearly four in five (78%) GPs and more than half (56%) of hospital doctors, have experienced “moral distress” as a direct result of situations they have encountered working in the NHS. Seeing patients with malnutrition or hypothermia, or stuck on trolleys in A&E corridors asking for help or forced to choose between heating their home or getting a prescription dispensed are among the events triggering their distress, medics said. “There’s barely a doctor at work in the NHS today who doesn’t see or experience this distress on a daily basis,” said Prof Philip Banfield, the leader of the British Medical Association. The NHS is “impossibly overstretched”, has thousands of vacancies for doctors and has a quarter fewer doctors a head of population than Germany, he added. “In practice that means we can almost never give the standard of care we would want, only ever the care we can manage. That takes its toll, as we see here,” Banfield said. Read full story Source: The Guardian, 28 December 2023
  5. News Article
    Record levels of overheating and a sharp rise in flooding at England’s hospitals are putting vulnerable patients at risk, figures show. Analysis of NHS data by the Liberal Democrats found that the number of health trusts reporting overheating in clinical areas had doubled compared with six years ago, and floods had increased by nearly 60% from last year. An overheating incident is logged when an occupied ward or clinical area’s daily maximum temperature exceeds 26C, the temperature at which some patients become unable to cool themselves effectively. The latest government figures show that in the summer of 2022 there were an estimated 2,985 excess deaths due to heatwaves, the highest number on record. Heatwaves also forced a fifth of UK hospitals to cancel operations. The number of serious flooding incidents, where water caused disruption such as by breaching a building or flooding a road, rose from 176 to 279. The climate crisis is expected to increase these risks to hospitals and patients. Helen Buckingham, the director of strategy at the Nuffield Trust, said: “These figures are a cause for real concern about the resilience of the NHS’s estate to the growing threat from extreme weather in the UK. As temperatures have climbed, so too have the number of overheating incidents in NHS hospitals.” Read full story Source: The Guardian, 27 November 2023
  6. Content Article
    Hospitals are crammed full of patients, the staffing crisis in adult social care continues to escalate, and alarming numbers of junior doctors report that they are planning to quit their NHS posts to work abroad. The multiple problems confronting the UK’s health and care system are interconnected and have been years in the making. While the pandemic exacerbated many of them, hugely increasing pressures on staff, political failures and, above all, a lack of investment are making it impossible for the service to stand still this winter – let alone recover. This Guardian Editorial gives its view on the current state of the NHS.
  7. News Article
    The government should declare a national NHS major incident to rescue the healthcare system from the current crisis, a senior health official says. Dr Tim Cooksley, president of the Society for Acute Medicine (SAM), says that the pressures on the NHS seen over the festive period are not new. He added that a number of recommendations had been outlined since the pandemic that offer the “best hope” of a short-term solution. Declaring a national NHS major incident would mean all four UK nations would co-ordinate their response and allocate resources to help meet the overwhelming demand for care that is enveloping many hospitals around the country. Taking that step would help combat the current situation, Dr Cooksley says, which NHS chiefs believe is having a similar effect on the service to the first wave of the Covid-19 pandemic. “The current situation in urgent and emergency care is shocking. It is in a critical state for patients and it is an extremely difficult for healthcare staff who are unable to deliver the care they want to," Dr Cooksley said. “Political leaders across the UK need to listen, meet urgently and accept the need to declare a national NHS major incident. "The outcome must be a four-nation emergency strategy which results in short-term stabilisation, medium-term improvement and long-term growth – the grave situation we are in means it will be a long journey. Sustainable workforce and capacity plans are required urgently to boost morale among staff and patients – as we have long called for – and we now need to see action.” Read full story Source: Manchester Evening News, 1 January 2022
  8. News Article
    Almost one in four people have bought medicine online or at a pharmacy to treat their illness after failing to see a GP face to face, according to a UK survey underlining the rise of do-it-yourself treatment. Nearly one in five (19%) have gone to A&E seeking urgent medical treatment for the same reason, the research commissioned by the Liberal Democrats shows. One in six (16%) people agreed when asked by the pollsters Savanta ComRes if the difficulty of getting an in-person family doctor appointment meant they had “carried out medical treatment on yourself or asked somebody else who is not a medical professional to do so”. Ed Davey, the leader of the Liberal Democrats, said delays and difficulty in accessing GP appointments constituted a national scandal, and face-to-face GP appointments had become “almost extinct” in some areas of the country. He said: “We now have the devastating situation where people are left treating themselves or even self-prescribing medication because they can’t see their local GP.” Dr Richard Van Mellaerts, the deputy chair of the British Medical Association’s GP committee in England, said: “While self-care and consulting other services such as pharmacies and NHS 111 will often be the right thing to do for many minor health conditions, it is worrying if patients feel forced into inappropriate courses of action because they are struggling to book an appointment for an issue that requires the attention of a GP or a member of practice staff.” Read full story Source: The Guardian, 2 January 2024
  9. News Article
    Up to 500 people are dying every week because of delays in emergency care, Britain’s top accident and emergency doctor has said. Dr Adrian Boyle, the president of the Royal College of Emergency Medicine (RCEM), said a bad flu season was compounding systemic problems, leading to hundreds of unnecessary deaths. NHS leaders warned last week that the health service is in the grip of a “twindemic”, with soaring flu admissions and the impact of Covid “hitting staff hard”. Dr Boyle told Times Radio: “If you look at the graphs they all are going the wrong way, and I think there needs to be a real reset. We need to be in a situation where we cannot just shrug our shoulders and say this winter was terrible, let’s do nothing until next winter. “We need to increase our capacity within our hospitals, we need to make sure that there are alternative ways so that people aren’t all just funnelled into the ambulance service and emergency department. We cannot continue like this – it is unsafe and it is undignified.” Read full story Source: The Telegraph, 1 January 2023
  10. Content Article
    Thirty seven health leaders from organisations across the UK have called on COP26 President Alok Sharma to use his leadership at COP27 to put health at the forefront of discussions. Read the letter from the link below.
  11. Community Post
    @Anne1010 I'm so sorry to hear that your last procedure was a painful experience and can understand your fears for the hysteroscopy. If you take a look at the comment posted in this thread by @Katharine Tylko on the 6 August (a few comments up) it gives the guidance from the RCOG on hysteroscopy procedures. It also highlights the facebook group - Campaign Against Painful Hysteroscopy - which might be helpful to you and offer support and advice.
  12. News Article
    A hospital is investigating how a pair of metal surgical forceps were left inside a patient after they had been stitched up after abdominal surgery. Worcestershire Acute Hospitals NHS trust has apologised unreservedly and said the incident at Redditch’s Alexandra hospital was “exceptionally rare”. The medical blunder only became apparent after a seven-hour abdominal procedure last month, according to BBC Midlands, when the forceps were reported to be missing. The worst fears of medics were confirmed when the missing 15cm arterial clamp was found by an X-ray while the patient was still under anaesthetic. The surgical instrument could not be immediately removed and the patient was moved to intensive care overnight before another operation was performed the next day to retrieve the clamp. It is understood the trust’s investigation will look at whether the required double-checking of all instruments was conducted before the patient was stitched up after surgery. It will also examine the end of operation signing-out process, which is supposed to ensure such errors do not happen. Read full story Source: The Guardian, 23 December 2022
  13. News Article
    NHS England has revealed the latest list of trusts which it has identified as needing the most support to meet electives and cancer targets. The national body identified 15 trusts which have been assessed as being at most risk of not meeting the key targets of either having no patients waiting 78 weeks or more for elective treatment by April 2023, or returning their 62-day cancer waiting list backlog to pre-pandemic levels by March 2023. The 15 challenged trusts, which make up around 12% of acute trusts in England, are receiving “tier one” support which involves oversight from national teams, on-site expertise, extra funding and recruitment, and possible calls between their CEOs and government ministers. NHS England said it has recently added four trusts to “tier one” for electives and cancer – York and Scarborough Teaching Hospitals Foundation Trust, Sheffield Teaching Hospitals FT, North West Anglia FT, and Royal Devon and Exeter FT. York and Scarborough FT, Sheffield FT, and North West Anglia FT has previously been in tier two for cancer services only, while Royal Devon and Exeter FT had previously been in tier one for electives only but is now in tier one support for cancer as well. Read full story (paywalled) Source: HSJ, 23 December 2022
  14. News Article
    Nurses will go on strike again on 18 and 19 January in England unless pay talks are opened, the Royal College of Nursing (RCN) has said. Nurses at more hospital trusts than before will be involved in the strike action in the new year, the union said. Meanwhile, the GMB union has called off a second day of ambulance strikes planned in England and Wales for 28 December. But it announced a new co-ordinated walkout on 11 January. Read full story Source: BBC News, 23 December 2022
  15. Content Article
    Crammed wards, burned-out GPs, patients waiting hours for ambulances – the health service is at breaking point. The Guardian journalists, Andrew Gregory and Denis Campbell, take a look at the current NHS situation.
  16. Content Article
    Dr Mike Farquhar talks and writes a lot about the importance of healthcare professionals being able to look after themselves, both for their own wellbeing but also to improve the care we give to our patients. He has collated a Twitter thread of resources on the theme.
  17. News Article
    England’s network of community pharmacies is “close to collapse”, with serious consequences for millions of patients, industry leaders have warned. In a letter sent to Steve Barclay, the health secretary, they cautioned that “as a sector we are now at a fork in the road”, and urged him to “make a critical choice about the role you want pharmacies to play”. The government has said it wants to make more use of community pharmacies in England to ease pressures on GP surgeries and accident and emergency departments. But the letter argues that funding cuts over the past seven years makes this goal unrealistic. It warns: “Many pharmacies are now dispensing at a loss and facing a serious cashflow crisis which we fear if not addressed, will rapidly move towards many permanent closures. We fear that once they start, closures will be hard to stop, as the sector is now so fragile other pharmacies would struggle to pick up the slack. “We are deeply concerned that this will put medicine supply at risk — with serious consequences for the millions of people who rely on dispensed prescriptions every year.” Read full story (paywalled) Source: The Times, 23 December 2022
  18. News Article
    Ambulance staff in five areas of England are to stage two further strikes in January, union leaders say. The industrial action on 11 and 23 January is likely to heap more pressure on emergency care, which is already under serious strain. Health Secretary Steve Barclay said further strike action was in no one's best interest. Unison leaders say the action is a direct result of the government's refusal to negotiate over pay. Life-threatening calls to 999, as well as the most serious emergency calls, will still be responded to, they say. Services in London, Yorkshire, the North West, North East and South West will take action over pay and staffing. The January strikes will each last for 24 hours from midnight, Unison says, and will involve all ambulance employees - not just 999 response crews. Read full story Source: BBC News, 22 December 2022
  19. News Article
    Flu and Covid are on the rise in England, with experts stressing the importance of vaccination and warning that people who feel unwell should stay at home rather than mingling with others during the festive season. The figures come as cases of scarlet fever and strep A infections continue to rise. The UK Health Security Agency (UKHSA) added that while invasive strep A infections remain rare there have now been a total of 94 deaths in England, including 21 children. Dr Colin Brown, the deputy director at UKHSA, sought to reassure parents. “I understand how this large rise in scarlet fever and ‘strep throat’ may be concerning to parents, however the condition can be easily treated with antibiotics and it is very rare that a child will go on to become more seriously ill,” he said, adding that parents should visit NHS.UK, contact 111 online or their GP surgery if their child has symptoms so they can be assessed for treatment. Dr Mary Ramsay, the director of public health programmes at UKHSA, noted a link between indoor mixing and the rise in cases and hospital admissions for flu and Covid. “Both Covid and flu can cause severe illness or even death for those most vulnerable in our communities, and so it is also important to avoid contact with other people if you are unwell in order to help stop infections spreading over the Christmas and new year period,” she said. Read full story Source: The Guardian, 23 December 2022
  20. News Article
    The antiviral, molnupiravir, does not reduce coronavirus hospital admissions or deaths in vaccinated people at high risk, new research suggests. But the treatment was associated with a shorter recovery time, by four days, and reduced viral load. People who received molnupiravir reported feeling better compared to those who received usual care, the study found. Researchers suggest that while the drug could have some benefits in terms of symptom reduction, the cost of the drug may mean it is not the best choice for the general population, given the study findings. But it may be useful in reducing the pressure on UK health systems, they added. Chris Butler, professor of primary care in the Nuffield Department of Primary Care Health Sciences and co-chief investigator of Panoramic, said: “Finding effective, safe and scalable early treatments for Covid-19 in the community is the next major frontier in our research response to the ongoing worldwide pandemic. “It is in the community where treatments could have a massive reach and impact. “But decisions about who to treat should always be based on evidence from rigorous clinical trials that involve people who would most likely be prescribed the drugs.” Read full story Source: The Independent, 23 December 2022
  21. Content Article
    The safety, effectiveness, and cost-effectiveness of molnupiravir, an oral antiviral medication for SARS-CoV-2, has not been established in vaccinated patients in the community at increased risk of morbidity and mortality from COVID-19. In this study, Butler et al. aimed to establish whether the addition of molnupiravir to usual care reduced hospital admissions and deaths associated with COVID-19 in this population. The authors conclude that molnupiravir did not reduce the frequency of COVID-19-associated hospitalisations or death among high-risk vaccinated adults in the community.
  22. Content Article Comment
    @Cath MarslandPlease try this link: The Patient Safety Incident Response Framework (PSIRF) (brownejacobson.com) or I've attached it here for you to download the-Patient-Safety-Incident-Response-Framework-08112022.pdf
  23. Content Article
    This blog focuses on a poster presented at the World Congress on Pain that recently took place in Toronto and discusses the connection between Long Covid and fibromyalgia.
  24. Content Article
    Is it possible to tackle climate change without further widening health inequalities? Jo Vigor speaks to Dr Dominique Allwood, Chief Medical Officer at UCL Partners and Director of Population Health at Imperial College Healthcare NHS Trust, about her leadership journey, why clarity of mission is so important and the challenge of creating a sustainable and equitable health and care system. 
  25. News Article
    A teaching hospital that was lauded for its culture and championed by ministers has been downgraded from ‘outstanding’ to ‘requires improvement’ by the Care Quality Commission. CQC inspectors found multiple issues at Salford Royal Hospital during an inspection in August and September. These included nurse staffing, governance, and some cultural concerns. The trust’s urgent and emergency services were rated “inadequate” for safety. The hospital in Greater Manchester had been rated “outstanding” since 2015, and was frequently hailed as a leader on the patient safety agenda, particularly by former health secretary Jeremy Hunt. Read full story (paywalled) Source: HSJ, 22 December 2022
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