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Patient Safety Learning

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  1. Patient Safety Learning
    The Care Quality Commission has ordered immediate improvements to a trust after it reported six never events inside eight months.
    The watchdog has issued a warning notice to Royal Cornwall Hospitals Trust after it carried out an announced inspection which focused on the trust’s surgical care group – where six never events had occurred between February and October last year.
    In November, HSJ reported that a total of eight never events had been recorded in 2020, with trust chief executive Kate Shields saying it had raised fears the trust had not fully embedded safety improvements initiated as part of the special measures regime.
    The inspectors visited three of the trust’s sites where the never events had happened. These were: Royal Cornwall Hospital in Truro, St Michael’s Hospital in Hayle and West Cornwall Hospital in Penzance.
    The inspectors reported that governance processes were “not effective enough” to ensure that changes were made across the trust, and that lessons from incidents and near misses were “not shared with the whole team and wider service to ensure patient safety”.
    Their report also stated the trust’s safety checklist for surgical procedures had improved but was not fully compliant with the World Health Organisation’s standards.
    However, the CQC found staff apologised and provided patients with information when things had gone wrong, and that there was an open culture in which staff felt able to raise concerns.
    Read full story (paywalled)
    Source: HSJ, 17 February 2021
  2. Patient Safety Learning
    One in five female doctors are concerned about whether their personal protective equipment (PPE) is the correct size as fears grow over more infectious strains of coronavirus.
    Exclusive data from the British Medical Association, which polled over 7,000 UK healthcare workers, found a fifth of female doctors were not at all confident their PPE is “fully fit-tested” or adjusted to tally with their requirements. Just 13% of men said the same.
    The professional organisation for doctors argues PPE is generally designed to fit the “size and shape of male bodies” even though women make up 75% of NHS workers.
    Helena McKeown, chair of the BMA representative body, told The Independent the situation is not improving due to a lack of action from the government as she warned there is a dearth of different sized PPE for a range of body shapes available.
    Dr McKeown, who is a GP, said: “Without properly sitting face protection, these doctors are putting themselves at risk. Poorly fitting PPE makes performing simple tasks more difficult and at worst exposes health professionals to dangerous infection."
    “We’ve had the pandemic a year and we know a one size fits all approach does not work. Whether that is for the size of the gown, clothes or fit of the face mask. We have had a year to get this right.”
    Read full story
    Source: The Independent, 16 February 2021
     
  3. Patient Safety Learning
    Waiting lists for NHS surgery in England could hit 10 million by April, a think tank has claimed while calling for NHS hospitals to use more private sector capacity to reduce delays for patients.
    In a new report the right-wing think tank Reform said the worst case scenario for patient waits could see one in six people in England waiting for treatment by April. It said the impact of coronavirus had turned the NHS into a “national Covid service” with six million fewer referrals for treatment in 2020.
    It warned the delays in treatments could have dire consequences for patients with an estimated 1,660 additional lung cancer deaths.
    But NHS bosses have hit back at the report saying it is inaccurate to say the NHS focused only on Covid, and that despite widespread cancellations it has continued to treat other patients.
    Predictions that the NHS waiting list would hit 10 million were made last year and proved wrong after hospitals ramped up routine services during the summer – although the second wave of the virus has again led to widespread cancellations including for surgery patients.
    The new Reform report claims capacity in private sector hospitals, where NHS England has secured new contracts to take on additional work during the Covid surge, have not been effectively used.
    The think tank wants NHS England to mandate the publication of ‘waiting list recovery plans’ by NHS trusts setting out how each hospital will use the private sector.
    Read full story
    Source: The Independent, 17 February 2021
  4. Patient Safety Learning
    There is to be a large expansion of the number of people being asked to shield in England.
    An extra 1.7 million people are expected to be added to the 2.3 million already on the list. Half of the group have not yet been vaccinated so will now be prioritised urgently by their local GPs.
    It comes after a new model was developed that takes into account extra factors rather than just health.
    This calculation includes things such as ethnicity, deprivation (by postcode) and weight to work out a person's risk of becoming seriously ill if they were to catch Covid. It also looks at age, underlying health issues and prescribed medications. 
    Prof Andrew Hayward, a member of the New and Emerging Respiratory Virus Threats Advisory Group (Nervtag), which has been involved in the modelling, said it considered a "combination of factors" such as age, ethnicity and chronic illness and put them together to reach a score.
    He told BBC Radio 4's PM programme that this score could "more or less order people in the population according to their level of risk" and "identify those at the top of that range to say, 'you should be prioritised for vaccine and you have a level of risk that is similar to those on the shielding list'".
    Read full story
    Source: BBC News, 16 February 2021
  5. Patient Safety Learning
    Thousands of lives could be saved if people at risk of developing Britain’s deadliest cancer were screened to diagnose it before it becomes incurable, a major NHS study has found.
    Giving smokers and ex-smokers a CT scan uncovers cancerous lung tumours when they are at an early enough stage so they can still be removed, rather than continuing to grow unnoticed, it shows.
    Experts are demanding the government moves to bring in routine CT scanning of smokers and ex-smokers in order to cut the huge death toll from lung cancer. About 48,000 people a year are diagnosed with the disease in the UK and 35,100 die from it – 96 a day.
    Lung cancer is a particularly brutal form of cancer because it is hard to detect and three out of four cases are diagnosed at stage three or four, when it is already too late to give the person potentially life-saving treatment. However, the Summit study, being run by specialists in the disease at University College London Hospital NHS trust, offers real hope that lung cancer can become a condition that is detected early.
    CT scanning meant that 70% of the growths detected in people’s lungs were identified when the disease was at stage one or two – a huge increase in the usual rate of early diagnosis.
    “It’s really a major breakthrough for lung cancer,” Dr Sam Janes of UCLH, the senior investigator of the trial, told the Guardian. "Lung cancer has never had anything that enabled us to detect this devastating cancer earlier and offer curative treatment to this number of lung cancer patients.”
    Read full story
    Source: The Guardian, 14 February 2021
  6. Patient Safety Learning
    People with learning disabilities have been given do not resuscitate orders during the second wave of the pandemic, in spite of widespread condemnation of the practice last year and an urgent investigation by the care watchdog.
    Mencap said it had received reports in January from people with learning disabilities that they had been told they would not be resuscitated if they were taken ill with COVID-19.
    The Care Quality Commission (CQC) said in December that inappropriate Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) notices had caused potentially avoidable deaths last year.
    DNACPRs are usually made for people who are too frail to benefit from CPR, but Mencap said some seem to have been issued for people simply because they had a learning disability. The CQC is due to publish a report on the practice within weeks.
    The disclosure comes as campaigners put growing pressure on ministers to reconsider a decision not to give people with learning disabilities priority for vaccinations. There is growing evidence that even those with a mild disability are more likely to die if they contract the coronavirus.
    Read full story
    Source: The Guardian, 13 February 2021
  7. Patient Safety Learning
    NHS guidance which often forces pregnant women who test positive with coronavirus to give birth alone is legally wrong, lawyers warned.
    Official guidance drawn up by NHS England states that if a woman tests positive for Covid, their husband or partner must self-isolate at home and is not allowed to support them during childbirth.
    But campaigners and lawyers told The Independent their guidance for visitor restrictions in maternity services during the pandemic is legally inaccurate as people have the “right to private and family life” under Article Eight of the Human Rights Act.
    Maria Booker, of Birthrights, a leading maternity care charity, said: “The NHS oversimplifies the government’s self-isolating Covid regulations and tells partners they have to stay at home. But this hasn’t taken into account the legal nuance that government rules state people can leave home if they have a reasonable excuse."
    “A woman being anxious about giving birth alone, which most people will be, is likely to legally constitute as a reasonable excuse."
    “It is completely inhumane for a woman to give birth without a partner or supporter. It is even scarier giving birth alone you are Covid positive. It is terrifying. Nobody should give birth alone and that includes Covid positive women.”
    Read full story
    Source: The Independent, 13 February 2021
  8. Patient Safety Learning
    The backlog of patients who have been waiting for cancer treatment for more than 104 days has more than doubled since last year, according to internal NHS England papers seen by HSJ.
    At the start of February, the backlog of cases already at more than 15 weeks had hit 6,109, compared to 3,000 at the same point in 2020.
    National targets state cancer patients should be treated with 62 days of being referred.
    In the North West region, the backlog has nearly tripled over the same time period, from 289 to 831 (see regional breakdown below). Senior sources told HSJ the increase had been largely driven by acute providers in Greater Manchester and Merseyside.
    Cases in which patients have to wait more than 104 days for treatment are generally considered serious breaches, and typically trigger a process to identify if the delay has caused harm to the patient. Some local systems have declared a “zero tolerance” for such instances. The data in the papers is provisional.
    Michelle Mitchell, Cancer Research UK’s chief executive, said the impact of covid-19 on cancer patients has been “devastating”. She added: “The government must urgently make sure the NHS gets the funding it needs to increase cancer service capacity, and give every person with cancer the timely diagnosis and treatment they deserve.”
    Read full story (paywalled)
    Source: HSJ, 13 February 2021
  9. Patient Safety Learning
    A new trial is to test how well the Oxford-AstraZeneca coronavirus vaccine works in children.
    Some 300 volunteers will take part, with the first vaccinations in the trial taking place later in February.
    Researchers will assess whether the jab produces a strong immune response in children aged between six and 17.
    The vaccine is one of two being used to protect against serious illness and death from Covid in the UK, along with the Pfizer-BioNTech jab.
    As many as 240 children will receive the vaccine - and the others a control meningitis jab - when the trial gets under way.
    Andrew Pollard, professor of paediatric infection and immunity, and chief investigator on the Oxford vaccine trial, noted that most children were relatively unaffected by Covid and were unlikely to become unwell with the virus.
    But he said it was important to establish the safety and immune response to the vaccine in children and young people as some children might benefit from vaccination.
    Read full story
    Source: BBC News, 14 February 2021
  10. Patient Safety Learning
    Tens of thousands of coronavirus survivors needing long-term care are heaping pressure on Britain’s stretched community services, threatening a crisis that experts warn could dwarf that seen in hospitals over the past 12 months.
    As many as 100,000 intensive care patients, including up to 15,000 Covid-19 survivors, will need long-term community nursing care after being discharged from hospitals during the past 12 months, The Independent has been told.
    This will be on top of an as yet unknown number of Covid patients from the 350,000 treated on general wards since the pandemic began, as well as tens of thousands of people who were sick without going to hospital but have been left with debilitating symptoms of long Covid.
    Labour’s shadow health minister Liz Kendall warned: “There will be huge pressures on community services as people who need long-term support are discharged back into their own homes.
    “Ministers have got to put in place a proper workforce strategy for the NHS and community care otherwise we will see people struggling to recover and the burden of care could also fall on their families."
    “This is one of the long-term consequences of Covid that we haven’t begun to even think through yet.”
    Read full story
    Source: The Independent, 14 February 2021
  11. Patient Safety Learning
    The NHS must have a realistic and steady approach to resuming services disrupted by the pandemic that explicitly recognises the need for staff to recover, NHS leaders have said.
    In a letter to the prime minister leaders from the NHS Confederation, which represents healthcare providers, warned, “The NHS cannot recover its services at the same rate of increase when staff are so exhausted.”
    The letter noted that there were over 5000 more patients with COVID-19 in UK hospitals right now that at the peak of the first wave and that this was taking its toll on staff. The leaders called for sustained local mental health support for the NHS workforce beyond the end of March and for a long term, fully funded plan to increase staffing numbers.
    The government must also set out clear expectations for the public on when routine procedures and other treatments would be fully back on line, they added.
    “With a workforce on its knees and many of the pre-pandemic challenges still very much at play they need your government both to acknowledge the consequences of the immense pressure their workers have been under so far, and to be realistic and honest with the public about what the NHS can safely deliver moving forward,” the letter said.
    Layla McCay, director of policy at the NHS Confederation, said that while health leaders would continue to prioritise urgent care and patients with the greatest clinical need, the prime minister must “be upfront with the public about what the NHS can safely deliver in this next phase.”
    Read full story
    Source: The BMJ, 11 February 2021
  12. Patient Safety Learning
    The number of patients in critical care grew at one in four English hospital trusts in the past week, despite overall covid-19 occupancy falling, HSJ can reveal.
    It comes with adult critical care occupancy still very high in many areas — 10 trusts still have at least double the number of patients that they normally have space for. It highlights the ongoing pressure still on hospitals, with the prime minister due to decide in coming days on a timetable for loosening lockdown.
    HSJ analysis of NHS sitrep data shows that 31 trusts (of a total 125 general acute trusts) saw the number of critically ill adults climb between 2 and 9 February.
    Twenty-five of these trusts were either at or above their total capacity available last winter. The critical care units still seeing increasing pressure when compared to last year are spread nationally, but are predominantly in Yorkshire, Midlands and the North West, where the covid third wave peaked later.
    Read full story (paywalled)
    Source: HSJ, 11 February 2021
  13. Patient Safety Learning
    Nearly 6 out of every 10 people who died with coronavirus in England last year were disabled, figures suggest.
    Some 30,296 of the 50,888 deaths between January and November were people with a disability, Office for National Statistics (ONS) data shows. It also suggests the risk of death is three times greater for more severely disabled people.
    Charities have called for urgent government action, describing the data as "horrifying and tragic".
    The ONS figures suggest disabled people were disproportionately affected by the pandemic - accounting for 17.2% of the study population but nearly 60% of coronavirus deaths.
    Among women, the risk of death involving coronavirus was 3.5 times greater for more-disabled women - defined as having their day-to-day activities "limited a lot" by their health - compared with non-disabled women.
    For less-disabled women, defined as having their day-to-day activities "limited a little", the risk was two times greater.
    Compared to non-disabled men, the data showed that the risk was 3.1 times greater for more-disabled men, and 1.9 times greater for less-disabled men.
    Looking at people with a medically diagnosed learning disability, the risk of death involving Covid was 3.7 times greater for both men and women compared with people who did not have a learning disability.
    Read full story
    Source: BBC News, 11 February 2021
  14. Patient Safety Learning
    A drug used to treat rheumatoid arthritis could cut the number of Covid deaths and speed up recovery, a new scientific trial has found.
    The drug, tocilizumab, could save the lives of one in 25 coronavirus patients in hospital and reduce the need for ventilators in intensive care.
    Researchers say around half of the people admitted to hospital with coronavirus could benefit from the treatment.
    Scientists from the nationwide Recovery trial said when tocilizumab was given alongside the steroid dexamethasone, it reduced the absolute risk of mortality by four percentage points. The medicine was already being used by the NHS to treat some coronavirus patients after early results last month showed it reduced the risk of death as well as time spent in hospital by up to 10 days.
    As a result of the latest findings, the health secretary said the drug would be made more widely available on the NHS to help treat Covid patients.
    Read full story
    Source: The Independent, 11 February 2021
  15. Patient Safety Learning
    Hospitals across the UK opened more than 2,250 extra intensive care beds to cope with the demand from coronavirus patients during the last 12 months – the equivalent of 140 new intensive care units.
    In a new report, the Intensive Care Society (ICS) warned pressure on hospitals could last for many more months with makeshift beds for critical care patients having to stay open, hampering efforts to restart more routine services.
    The ICS said that 20,675 patients had been admitted to intensive care in England, Wales and Northern Ireland by 5 February. It said patients had a median length of stay in the first wave of 12 days, a lot longer than normal with 2,251 extra beds occupied in January 2021 compared to last year.
    The ICS warned thousands of extra staff drafted in to look after critical care patients would be needed for months to come and this was despite staffing levels been stretched to dangerous levels.
    Read full story
    Source: The Independent, 10 February 2021
  16. Patient Safety Learning
    Patients and families who suffer avoidable harm as a result of mistakes in the NHS should be given targeted help and support to recover.
    Campaign group the Harmed Patients Alliance and patient safety charity Action against Medical Accidents (AvMA) believe the NHS needs to develop a specific harmed patient pathway to care for families affected by errors in their care.
    They are hoping to define what the pathway will look like in partnership with families, patients and NHS trusts with the idea of piloting an approach in the NHS and getting it adopted nationally.
    There are more than two million safety incidents reported in the NHS every year, with more than 10,000 incidents resulting in severe harm and death.
    Read full story
    Source: The Independent, 11 February 2021
  17. Patient Safety Learning
    People previously admitted to hospital or needing "continuous or repeated" steroid use because of asthma are to be prioritised for the Covid vaccine.
    The most severe cases will fall into priority-group four, the "clinically extremely vulnerable", who should have received a letter advising they shield.
    And the government has now confirmed the rest who meet the above category will be included in group six, the clinically "at risk", including some but not all those usually eligible for a free flu jab.
    It follows patients' calls for clarity.
    The government said it was following independent experts' advice.
    Read full story
    Source: BBC News, 11 February 2021
  18. Patient Safety Learning
    More than 100,000 people were waiting for ‘urgent’ priority two operations in late January, as planned care rates plummeted amid the covid third wave, according to NHS data seen by HSJ.
    However, the rate of elective procedures carried out last month appears to have been a lot higher than in the spring wave of coronavirus, despite there being more covid patients in hospital this time.
    In the three weeks to 20 December, the NHS was reporting around 110,000 day cases and 18,000 planned overnight admissions each week. But during January these totals dropped to around 85,000 day cases and 10,000 planned overnight admissions per week. This equates to a reduction of 23% and 44%, respectively.
    Regions that were more severely impacted by the third wave of coronavirus saw steeper reductions as covid pressures forced staff working in routine care services to be redeployed.
    In London and the South East, day case activity reduced by around 40% between the same periods, while elective overnight admissions fell by around 57%.
    Read full story (paywalled)
    Source: HSJ, 10 February 2021
  19. Patient Safety Learning
    The MP leading an investigation into coronavirus fears long Covid could cost the UK around £2.5 billion a year. 
    Layla Moran believes the emerging crisis is comparable to the impact rheumatoid arthritis has on the health service, with hundreds of thousands of people expected to be dealing with the condition for months. 
    The ONS says around one in ten people who test positive will go on to develop long Covid, a catch all term to describe a host of ongoing symptoms in coronavirus patients. More than 1.7 million COVID-19 infections have been reported since Christmas Day in the UK. 
    Speaking exclusively to Metro.co.uk, Ms Moran – who chairs the All Party Parliamentary Group (APPG) on coronavirus, said: "The amount of money that we are expecting to spend long term on long Covid could be similar to rheumatoid arthritis. How many people know someone with rheumatoid arthritis? It is going to be higher for long Covid."
    Read full story
    Source: The Metro, 10 February 2021
  20. Patient Safety Learning
    Tens of thousands of nurses across the UK have not had their first coronavirus vaccine, sparking fears that they could contract COVID-19 or infect patients.
    A Royal College of Nursing (RCN) survey of 24,370 nurses found that 85% had had at least one dose, with the remaining 15% unvaccinated.
    The findings show that the government is in danger of failing to deliver one of the main elements of its pledge that all 15 million Britons in the top four priority groups for immunisation – which includes all health and social care staff – should have been offered a first shot by next Monday, 15 February.
    “It is extremely worrying that, as our survey suggests, many thousands of nursing staff have yet to be given their COVID-19 vaccine less than a week before the government’s deadline,” said Dame Donna Kinnair, the RCN’s chief executive and general secretary.
    “With only days to go, every effort must be made to reach all nursing staff to ensure their protection and that of the patients and vulnerable people they care for.”
    Read full story
    Source: The Guardian, 9 February 2021
  21. Patient Safety Learning
    One in three Covid patients put on a ventilator experience extensive symptoms of post-traumatic stress disorder (PTSD), according to research, which adds to mounting evidence of the virus’s impact on mental health.
    The study of 13,049 patients with confirmed or suspected coronavirus, by Imperial College London and the University of Southampton, found that one in five who were admitted to hospital but did not require a ventilator also experienced extensive symptoms of PTSD.
    The most common PTSD symptom experienced by COVID-19 patients was intrusive images, sometimes known as flashbacks. Examples of these could be images of the intensive care unit (ICU) environment, ICU doctors wearing full personal protective equipment or other patients in the ICU.
    The study, published in the Royal College of Psychiatrists’ BJPsych Open, on Tuesday, found lower levels of extensive symptoms of PTSD for patients given medical help at home (approximately one in six) and patients who required no help at home but experienced breathing problems (one in ten).
    Dr Adam Hampshire, from Imperial College London, said: “We can see that the pandemic is likely to be having an acute and lasting impact, including for a significant proportion of patients who remained at home with respiratory problems and received no medical help. This evidence could be important for informing future therapy and reducing the long-term health burden of this disease.”
    Read full story
    Source: The Guardian, 9 February 2021
  22. Patient Safety Learning
    People aged 70 or older in England who have not yet had their coronavirus vaccine but would like to are being asked to contact the NHS.
    A national booking system can be accessed online or people can call 119 free of change between 7am and 11pm.
    At a Downing Street news briefing, deputy chief medical officer Prof Jonathan Van-Tam urged people to get the vaccine "without delay".
    "Protect yourself against the clear and present danger," he said.
    He said the vaccines worked very well against the "immediate threat" of the Kent variant of coronavirus circulating in the UK.
    Read full story
    Source: BBC News, 8 February 2021
  23. Patient Safety Learning
    The use of ten million surgical gowns, bought by the UK government, has been suspended for frontline NHS staff because of how the items were packaged.
    Sterile gowns were bought for £70m from a US firm last year, but safety concerns were raised when they arrived in one layer of protective packaging.
    The contract had not requested double packaging, as used in sterile settings.
    The government says all personal protective equipment (PPE) is quality assured, but Labour has called for an inquiry into the awarding of contracts.
    The BBC has been investigating the purchase of PPE - or personal protective equipment - for NHS staff since the beginning of the pandemic. It has already been revealed how millions of face masks bought by the UK government cannot be used in the NHS as intended.
    Read full story
    Source: BBC News, 8 February 2021
  24. Patient Safety Learning
    The NHS bill due to land in Parliament before the summer break will be the first for nearly 10 years, so will address various overdue changes and is certain to be significant.
    The bill’s thrust has become clear from the draft of the government’s white paper leaked on Friday, though some important details might change before a final version is published in the next few weeks. Many of the white paper proposals are what NHS England has been asking for in formal proposals over the last 18 months, and reflect the direction the NHS has been moving slowly but inexorably towards for several years.
    NHSE’s central aim of clearing up the NHS landscape by turning integrated care systems into statutory agencies, but without overdoing the central specification of how they will work, is largely intact. Clinical commissioning groups are reconstituted as ICSs, a move unpopular with some but accepted by most. There is a formal role for local authorities planned in the shape of “partnership councils”. This creates a little extra bureaucracy but does not give them real power in the NHS. NHSE and ICSs are given a bit more sway over foundation trusts, but probably not enough to set off a huge row with NHS Providers.
    The leaked version of the white paper also includes proposals which NHSE will not be happy about, including giving the health secretary a sweeping “general power to direct NHS England on its functions”, another to transfer functions between all arm’s length bodies and even abolish them, and ability to intervene at any stage in NHS service reconfigurations.
    If pursued, these risk bringing even more toxic politics back into the NHS, both in the process of putting through the legislation itself, and beyond that, in the day to day running of the service.
    Read full story (paywalled)
    Source: HSJ, 6 February 2021
  25. Patient Safety Learning
    NHS hospitals are defying official rules to give nurses and doctors masks with greater protection amid fears over the spread of coronavirus within hospital wards.
    An analysis of the latest NHS data by The Independent shows more than 35,000 patients were likely to have been infected with coronavirus while already in hospital between 1 August and 31 January.
    NHS England has estimated as many as 20% of infections could be due to spread within hospitals. Outbreaks at some hospitals have seen whole teams of doctors or nurses affected, in some cases leading to wards having to be closed.
    The Independent has learnt several hospitals are now supplying higher grade masks to staff working in general wards, despite Public Health England saying only surgical masks are needed. Research this week suggested staff exposed to coughing were at greatest risk of infection from the virus.
    Read full story
    Source: The Independent, 7 February 2021
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