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Patient Safety Learning

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  1. Content Article
    Letter from Mike Prentice, NHS England’s national director for emergency, planning and incident response, to hospitals and other care providers ahead of talks with the Royal College of Nursing later this week on the industrial action from nurses. At that meeting they will try to agree what areas of care will be hit on Thursday 15 and Tuesday 20 December, and which will continue as normal because they are covered by “derogations” – agreed exemptions to the action.
  2. News Article
    NHS England’s chief executive has admitted the service is behind on its commitment to increase elective activity to 130% of pre-covid levels by 2025, saying the recovery would need to be ‘reprofiled’ to catch up after this year. Amanda Pritchard told MPs on the Public Accounts Committee that NHS England would need to “re-profile some of the [elective recovery] trajectories”, as progress this year was being hampered by a combination of higher than expected covid rates, flu, workforce challenges and industrial action. She later added that the 2025 target could “theoretically” be missed, but stressed “we are a very long way from that” and indicated she believed the NHS could catch up in future years. Elective recovery plans agreed between NHSE and government last autumn said activity would recover to 110% of pre-covid levels in 2022-23. Yet published data shows many systems have so far been carrying out fewer procedures than before covid in most months. Asked by the committee’s chair Meg Hillier if she was confident the NHS would hit the 2025 activity target, first agreed for the 2021 spending settlement, Ms Pritchard replied: “I think at the moment we are absolutely aiming [to hit the target] at the end of that period of time, but we do recognise that we are going to need to re-profile trajectories to get there.” Read full story (paywalled) Source: HSJ, 28 November 2022
  3. News Article
    Hospitals may not be able to provide key elements of healthcare such as urgent surgery, chemotherapy and kidney dialysis during the forthcoming strikes by nurses, NHS bosses have said. Trusts may also have to stop discharging patients, postpone urgent diagnostic tests and temporarily withdraw services to people undergoing a mental health crisis. Executives have been warned that industrial action by nurses in their pay dispute with the government could mean that a range of important, and in some cases time-critical, services to seriously ill patients may have to be scaled back or suspended altogether. NHS England bosses have raised that possibility in a letter sent on Monday to hospitals and other care providers ahead of crunch talks with the Royal College of Nursing later this week. At that meeting they will try to agree what areas of care will be hit on Thursday 15 and Tuesday 20 December, and which will continue as normal because they are covered by “derogations” – agreed exemptions to the action. The letter sets out a list of 12 areas of care and some non-clinical activity in hospitals, such as food supply, which could be affected if agreement is not reached with the nurses’ union. Eight of those involve direct patient care, three involve support services in NHS trusts and the other involves “system leadership and management to oversee safe care” on strike days. NHS England’s letter sets out 10 other types of vital care, mainly involving life or death scenarios, headed “derogations not needed”, which they hope to agree with the RCN to go ahead as normal. These include A&E care, services in intensive care units and emergency operating theatres as well as maternity services, including the delivery of babies, psychiatric intensive care, time-critical organ transplants and palliative and end of life care. Meanwhile, the chief executive of NHS England has insisted patients will not have procedures cancelled at the last minute due to the nurses’ strikes, but warned some care would have to be delayed. Read full story Source: The Guardian, 28 November 2022
  4. News Article
    Poorer women in Britain have some of the highest death rates from cancer in Europe, an in-depth new World Health Organization study has found. They are much more likely to die from the disease compared with better-off women in the UK and women in poverty in many other European countries. Women in the UK from deprived backgrounds are particularly at risk of dying from cancer of the lungs, liver, bladder and oesophagus (foodpipe), according to the research by the International Agency for Research on Cancer (IARC), the WHO’s specialist cancer body. IARC experts led by Dr Salvatore Vaccarella analysed data from 17 European countries, looking for socioeconomic inequalities in mortality rates for 17 different types of cancer between 1990 and 2015. Out of the 17 countries studied, Britain had the sixth-worst record for the number of poor women dying of cancer. It had the worst record for oesophageal cancer, fourth worst for lung and liver cancer and seventh worst for breast and kidney cancer. However, the UK has a better record on poor men dying of cancer compared with their counterparts in many of the other 16 countries. It ranked fifth overall, second for cancer of the larynx and pharynx, and third for lung, stomach and colon cancer. That stark gender divide is most likely because women in the UK began smoking in large numbers some years after men did so, the researchers believe. They pointed to the fact that while cases of lung cancer have fallen among men overall in Britain, they have remained stable or increased among women, and gone up among women from deprived backgrounds. Read full story Source: The Guardian, 28 November 2022
  5. News Article
    The human rights of vulnerable mental health patients are being violated because of the crisis in care, a regulator has warned. Rob Behrens, the health service ombudsman for England, said urgent action was needed over repeated “tragedies” in NHS mental health services. His warning comes as the latest NHS figures show there were 9,839 incidents of abuse against mental health patients from April 2021 to March this year – a higher figure than in any other sector. It follows an investigation by The Independent last month that revealed allegations of systemic abuse of children within a group of private mental health hospitals run by a provider called The Huntercombe Group. Mr Behrens said research carried out by his office showed that vulnerable people being detained in hospitals are “losing their human rights when they were put in difficult situations where they had no control”. Mr Behrens told The Independent: “We can’t go on with leaders in the NHS and politicians saying ‘This cannot go on’, because it happens time and time again. It’s the amount of resource and commitment that is put into dealing with issues, which ultimately is going to turn this around". When asked if mental health is a particular area of concern, Mr Behrens said: “Yes. It’s about human rights. It’s about vulnerable people exposing themselves to the arm of the state in a way where they have very little control, and where there needs to be accountability and scrutiny. That’s exactly where an ombudsman should be looking, to make sure that people without power are not being traduced by the system.” Read full story Source: The Independent, 28 November 2022
  6. Event
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    The new and re-developed SMASH Dashboard is now ready for rollout across Greater Manchester. The Safety Medication Dashboard (SMASH) has been developed and tested by GM PSTRC researchers. It builds on the same prescribing indicators as PINCER and is a pharmacist-led intervention using audit and feedback. In this 1-hour webinar, we will showcase the new dashboard which utilises the GMCR BI Analytics Platform and provide an overview on how it works, and how it differs from the current platform. We will share the journey the SMASH has been on to this point, and the benefits it will now bring to the GM system. Details will also be provided on how to access and set up accounts, and the local processes to follow. We will have guest speakers on the day from across all of the SMASH journey and an opportunity, if time, to answer some questions. Agenda Outline: Introduction The SMASH Journey The New Dashboard and Tutorial Benefits of the New Platform Access and Processes for Your Locality Q & A Register
  7. News Article
    The rising number of women who have caesarean sections instead of natural births is causing concern for the National Childbirth Trust (NCT). The trust, which supports women through pregnancy, childbirth and early parenthood, says it does not know why the rate of caesareans is increasing. One in four maternity services showed a caesarean rate of between 20% and 29.9%, and 2% of services had a rate of more than 30%, according to latest figures. The World Health Organization recommends that the acceptable rate is 10 to 15%. The maternity care working party, a multi-disciplinary group set up by the NCT, said there was an urgent need to address the problem. "A caesarean is major abdominal surgery," the working party said in a statement to a conference in London with the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists "Most women would prefer to give birth normally, provided that a normal birth is considered safe for them and their baby. It is important that health professionals' advice does not have the effect of denying them this opportunity without good reason." The working party is calling for data to be published on caesarean section rates and for obstetricians to justify in each case that the benefits outweigh the hazards. It also wants action to be taken to prevent any inappropriate use of caesarean sections. Belinda Phipps, chief executive of the NCT, said: "We know that in many cases caesareans are necessary for good clinical reasons. However, in our view rates have reached unacceptable levels and we want to know why." Read full story Source: The Guardian, 24 November 2022
  8. Content Article
    Developed in 2020, this Picker survey aims to understand the experiences of cancer and tumour care among children and their parents/carers. The results will help improve children’s cancer services across England. The survey, conducted by the charity Picker on behalf of NHS England, included children, young people, and their parents – with separate questions designed to be appropriate to different age groups. Children and young people were included in the survey if they had a confirmed cancer or tumour diagnosis, received inpatient or day case care from an NHS Principal Treatment Centre (PTC) in 2021, and were under 16 years of age at the time of their discharge.
  9. Content Article
    Reducing socioeconomic inequalities in cancer is a priority for the public health agenda. In this study, cancer-specific mortality data by socioeconomic status, as measured by educational level, were collected and harmonised across 18 countries in Europe and for multiple points in time over the period 1990–2015. The study found that everywhere in Europe, lower-educated individuals have higher mortality rates for nearly all cancer-types relative to their more highly educated counterparts, particularly for tobacco/infection-related cancers. However, the magnitude of inequalities varies greatly by country and over time, predominantly due to differences in cancer mortality among lower-educated groups, as for many cancer-types higher-educated have more similar (and lower) rates, irrespective of the country. Inequalities were generally greater in Baltic/Central/East-Europe and smaller in South-Europe, although among women large and rising inequalities were found in North-Europe. These results call for a systematic measurement, monitoring and action upon the remarkable socioeconomic inequalities in cancer existing in Europe.
  10. Event
    Difficult conversations - Thursday 2nd February 2023 Difficult people - Tuesday 7th February 2023 Conflict management - Wednesday 15th February 2023 This 3 day intensive training course will provide an effective guide to improving your communication skills. With each day focusing on difficult conversations, managing difficult people, and conflict and conflict resolution the course will empower you with the skills to deal with difficult issues and difficult situations within your everyday practice. Day 1 - how to deal with and manage difficult conversations. With a focus on telephone and virtual consultations with patients this masterclass focuses on dealing with difficult conversations, The event will focus on speaking to patients in distress, understanding where patient safety issues arise, and managing unhappy patients and complaints. It will discuss strategies and tools to improve communication and interactions. Day 2 - how to with difficult people. Do you have someone at work who consistently triggers you? Doesn’t listen? Takes credit for work you’ve done? Wastes your time with trivial issues? Acts like a know-it-all? Can only talk about themselves? Constantly criticises? It will discuss strategies and tools to improve communication and interactions with others. Day 3 - conflict from how to manage different types of conflict through to conflict resolution This course is aimed at all healthcare staff from frontline staff through to senior managers in dealing with conflict with colleagues, staff, clients and patients. Further information and registration
  11. Event
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    NHS England (NHSE) and Picker are pleased to announce a National Insight Webinar designed to unpick the results of the 2021 Under 16 Cancer Patient Experience Survey (U16 CPES). The webinar is dedicated to helping NHS teams, providers, charities, commissioners, and the wider public to better understand their results, identify areas for action, and place person centred care at the heart of operations. Register
  12. News Article
    Lack of beds in the NHS and social care sector have been highlighted by the case of an 81-year-old woman discharged home at night, her family said. Janice Field attended Colchester Hospital in Essex with a suspected heart attack. She was returned to her flat at midnight, despite having no home care at that time of day. The hospital trust said it focused on keeping patients safe and was "sorry to hear about the concerns raised". Ms Field was checked out at the hospital last week and deemed fit to go home, but her family said she should have stayed in hospital overnight, or be found a community care bed. Her daughter-in-law, Sarah Field, a qualified nurse, said: "To discharge an 81-year-old lady and have them having to be transferred in the middle of the night is totally unacceptable. "But the nurse we spoke to was emphatic. She was desperate. She said, 'no, we have no beds. This has got to happen. She's clinically fit. She has got to go'. "The NHS is broken, under-resourced and not fit for purpose. This is not the fault of those that work in it, but the fault of the system." Read full story Source: BBC News, 26 November 2022
  13. News Article
    Mothers are being offered water injections by the NHS to relieve pain during childbirth, while in some hospitals midwives are burning herbs to encourage breech babies to turn in the womb. Safety campaigners have dubbed the practices dangerous and say that they amount to “pseudoscience” being offered by the health service. They have called on the chief executive of NHS England, Amanda Pritchard, to ban their use in a letter published over the weekend. At least three trusts in England offer water injections for pain relief, including Newcastle upon Tyne Hospitals Trust, United Lincolnshire Hospitals Trust and North Tees and Hartlepool Trust. Information on the Newcastle trust’s website describes the injections as an “alternative form of pain relief” while in Lincolnshire patients are told the body’s response to the injections “prevents pain signals from reaching the brain.” The National Institute for Health and Care Excellence (NICE), which is responsible for setting out which treatments patients should receive, has said the NHS should not use injected water for pain relief. Read full story (paywalled) Source: The Times, 27 November 2022
  14. News Article
    The NHS faces the threat of coordinated industrial action lasting several months, with results to be announced within days of strike ballots of ambulance crews and about 300,000 health workers. Junior doctors, paramedics, midwives, porters, cleaners, pharmacy technicians and physiotherapists are being balloted across the NHS. The government now faces the threat of waves of strikes across the public sector, from nurses and firefighters to civil servants and teachers. A ballot of 15,000 ambulance workers in England and Wales closes on Tuesday. The result of the GMB ballot could be announced as early as this week, with the prospect of the first national ambulance strike since the dispute of 1989-90, when police and army vehicles were brought in to transport patients. The RCN said on Saturday that the health secretary Steve Barclay had written to the union asking for officials to “come back to the table” before the planned strikes. RCN chief executive Pat Cullen said any talks needed to focus on the pay deal and that the position of her members was “negotiations or nothing”. Rachel Harrison, GMB public services national secretary, said: “Health service workers have suffered more than a decade of real-terms pay cuts, been on the frontline of a global pandemic and are now in the midst of the worst cost of living crisis in a generation. “This is as much about patient safety as it is about pay. A third of GMB ambulance workers think delays they’ve been involved with have led to the death of a patient.” Read full story Source: The Observer, 27 November 2022
  15. News Article
    People suffering from mental illness are increasingly struggling to access help at every level of the NHS – from record numbers facing “unacceptable” delays in referrals to patients waiting up to eight days in A&E for a hospital bed. Figures seen by The Independent show almost four times as many people are waiting more than 12 hours in emergency departments as two years ago. In the community, more than 16,000 adults and 20,000 children who should receive NHS care are unable to access vital services each month. Nearly 80% of those eligible for counselling on the health service are left waiting more than three months for a second appointment, which is when treatment usually begins. Health leaders say they are “deeply concerned” by the lack of resources available to handle the rise in demand – and warned that the cost of living crisis would exacerbate the issue further. Monica Smith went to A&E at Lewisham last month after her mental health deteriorated when her medication ran out and she was unable to get more. The 32-year-old said: “I was told, ‘We can’t find any beds – there’s no bed in the whole country or the whole region, so we’re going to have a bed on A&E and hopefully you’ll get a bed in the morning.’” Monica started hallucinating and was given medication to calm her down, but in the morning there was still no bed. Doctors tried to send her home, she said, but crisis services assessed her three times over the following days and each time decided she was too unwell. Instead, Monica stayed in an annex off A&E with other mental health patients. She said: “I was on this, like, mattress, like a mental health mattress on the floor.” Read full story Source: The Independent, 27 November 2022
  16. News Article
    A woman who struggled to access night-time care for her dying father has told the BBC he "shouldn't have been expected to die in office hours". Tracey Bennett said she was "completely lost" when her dad Michael needed help. Early in 2021, Mrs Bennett, 54, from Doncaster, moved in with her dad, 76-year-old Michael Woodward, to care for him in the last stages of his cancer. One night he had a fall. Mrs Bennett was able to help him back up but turned to the local NHS palliative care phone line for help, only to find it closed. Although she did not feel her father should be in a hospital, she called 999 as she felt she had no-one else to turn to. He died in the early hours of the next morning. "In his hour of need I feel I let my dad down," she said. "He shouldn't have been expected to die in office hours." Almost 70% of the UK does not have a consistent 24-hour help-line for the terminally ill, research suggests. And 27% of these areas do not have a designated phone line, the study funded by Marie Curie found. Ruth Driscoll, from the charity, said the research painted "a bleak picture of out-of-hours care in many areas of the UK". Read full story Source: BBC News, 28 November 2022
  17. News Article
    Some of the country’s GP are advising patients requiring urgent hospital care to “get an Uber” or use a relative’s car because of the worst ever delays in the ambulance service in England. Patients with breathing difficulties and other potentially serious conditions are being told in some cases that they are likely to be transferred more quickly from a general practice to accident and emergency if they travel by cab or private vehicle. NHS England data shows that October’s average ambulance response times for category 1 to 3 emergencies, which cover all urgent conditions, appear to be the highest since the categories were introduced nationally in 2017. Some patients who require emergency treatment may have to wait several hours for an ambulance to arrive. Dr Selvaseelan Selvarajah, a GP partner in east London, said: “If somebody is not having a heart attack or a stroke, my default advice is ‘have you got someone who can drive you or do you want to get an Uber?’ “These are patients who may have breathing difficulty or are suffering severe abdominal pain, but their life is not in immediate danger.” He said such patients would have previously been transferred by ambulance. Read full story Source: The Guardian, 27 November 2022
  18. News Article
    A flagship programme intended to bring down NHS waiting backlogs is to be delayed after becoming mired in bureaucracy. The £360 million federated data platform is seen as critical to reducing waiting lists, with a record 7.1 million people now waiting for treatment. When the plans were announced in the spring, health chiefs said that the system would be an “essential enabler to transformational improvements” across the NHS. Experts have warned that progress in clearing the lists has been set back by chaotic recording systems. While NHS data was found to be littered with errors, such as duplicate entries and dead patients, many patients in need of follow-up care are not recorded once they have had their first slot. Read full story (paywalled) Source: The Telegraph, 25 November 2022
  19. News Article
    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
  20. News Article
    A carer who murdered the elderly woman he was employed to look after had a history of violent crime including actual bodily harm, a report found. A safeguarding adults review over the death of a 77-year-old Devon woman in 2021 criticised working practices among organisations involved in her care. Devon and Cornwall Police did not disclose information about domestic abuse callouts involving the killer in a DBS check by the care provider. He was jailed for life in July 2022. The woman had seen her killer as "a grandson" figure, it said. The 35-year-old killer attacked his victim after she discovered he had stolen several thousand pounds from her. The had no previous employment experience of care before being taken on as her sole carer by Complete Quality Care Ltd, an independent care provider. Read full story Source: BBC News, 24 November 2022
  21. News Article
    There is now an "imminent threat" of measles spreading in every region of the world, the World Health Organisation and the US public health agency has said. In a joint report, the health organisations said there had been a fall in vaccines against measles and less surveillance of the disease during the COVID pandemic. Measles is one of the most contagious human viruses but is almost entirely preventable through vaccination, though it requires 95% vaccine coverage to prevent outbreaks. A record high of nearly 40 million children missed a dose last year because of hurdles created by the pandemic, according to the report by the WHO and the US Centers for Disease Control and Prevention. This has left millions of children susceptible to the disease. "We are at a crossroads," Patrick O'Connor, the WHO's measles lead, said. "It is going to be a very challenging 12-24 months trying to mitigate this." Read full story Source: Sky News, 24 November 2022
  22. News Article
    NHS England’s national cancer director has said that she is “cautiously optimistic” about reaching cancer waiting time targets by March 2023, but she refused to be drawn on what had happened to the government’s proposed 10 year cancer plan. Cally Palmer was speaking to MPs on the Health and Social Care Committee at a special one-off session on the urgent challenges facing cancer services, including workforce shortages, winter pressures, and poor performance. Latest figures from September, published on 10 November, show that 60.5% of patients began their first treatment within 62 days of being urgently referred for suspected cancer, against a target of 85%. That target was pushed back to March 2023 from March this year. Palmer told the committee on 23 November that the 85% target aimed to reduce the 62-day backlog to pre-pandemic levels. Read full story (paywalled) Source: BMJ, 24 November 2022
  23. News Article
    Nicola Sturgeon has been accused of running a two-tier NHS after it emerged that tens of thousands of patients are going private for crucial operations and healthcare. Anas Sarwar, the Scottish Labour leader, cited figures that showed more than 39,000 patients underwent private procedures in the past year. These included thousands of hip and knee surgeries, costing an average of £12,500 per patient. “Often these are people who are forced to borrow money, turn to family and friends, or even remortgage their home to get healthcare that should be free at the point of need,” Sarwar told MSPs at first minister’s questions. He said that almost 2,000 people had gone for private treatment for endoscopies and colonoscopies, more than 7,800 for cataract surgery and 3,500 have had a hip or knee replacement in a private hospital. “These figures make clear that under the SNP, healthcare in Scotland is already a two-tier system,” he added. Read full story (paywalled) Source: The Times, 24 November 2022
  24. News Article
    Bosses at Nottingham's crisis-hit maternity units are set to miss a deadline for clearing a backlog of incomplete "serious incident" investigations. Nottingham University Hospitals Trust (NUH) has 53 outstanding maternity incidents yet to be investigated. The trust had said it aimed to complete investigations by December 23. But director of midwifery Sharon Wallis says they have not progressed as quickly as she had hoped. The Local Democracy Reporting Service said the trust has managed to clear a number of those incidents - but it declared another nine in September and October. An independent review team, led by senior midwife Donna Ockenden, is examining dozens of baby deaths at the trust. Read full story Source: BBC News, 25 November 2022
  25. Content Article
    The Patients Association has been working with NHS England to look at how to improve GP referrals of patients to hospital. The goal was to look at ways specialists could support GPs so they could reduce the number of outpatient appointments patients have to attend, without compromising care. This report includes an overview of the patient panel workshops, key themes and findings from the workshops, and a set of recommendations.
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