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Patient Safety Learning

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Everything posted by Patient Safety Learning

  1. News Article
    NHS waiting lists will take more than three years to be reduced to pre-pandemic levels, according to a new analysis. Despite recent reductions in the waiting list in England, the Institute for Fiscal Studies (IFS) think tank said that it is “unlikely that waiting lists will reach pre-pandemic levels” by December 2027 – even under a “best-case scenario”. The latest figures show that the waiting list for routine hospital treatment in England has fallen for the third month in a row. An estimated 7.6 million treatments were waiting to be carried out at the end of December, relating to 6.37 million patients, down slightly from 7.61 million treatments and 6.39 million patients at the end of November, according to NHS England figures. Cutting NHS waiting lists is one of Prime Minister Rishi Sunak’s top priorities. However, the PM admitted earlier this month he would not meet his promise to reduce waiting lists. However, the new IFS analysis highlights how the NHS waiting list was already growing before the pandemic, but it rose “rapidly” during the crisis. The IFS report suggests a range of scenarios about how the waiting list could look in December 2024. Under a “more pessimistic scenario”, waiting lists will remain at the same elevated level while an “optimistic scenario” would see them fall to 5.2 million by December 2027.
  2. Content Article
    This Institute for Fiscal Studies briefing, outlines what has happened to NHS waiting lists (in England, given that health is a devolved responsibility) over the last 17 years – the period for which consistent data are available – and present new scenarios of what could happen to waiting lists over the years to come. It focuses on the elective waiting list – the list of people waiting for pre-planned hospital treatment and outpatient appointments. This is what most people mean when they talk about NHS waiting lists, but it also considers a range of other NHS waiting lists and waiting times. Alongside this report, IFD has updated their interactive online tool that allows you to produce waiting list scenarios under your own assumptions.
  3. News Article
    The medical regulator failed to sound the alarm over Covid vaccine side effects and should be investigated, MPs have said. The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for approving drugs and devices and monitors side effects caused by treatments. But the all-party parliamentary group (APPG) on pandemic response and recovery, an influential group of MPs, has raised “serious patient safety concerns”. It has claimed that “far from protecting patients” the regulator operates in a way that “puts them at serious risk”. Some 25 MPs across four parties have written to the health select committee asking for an urgent investigation. In reply, Steve Brine, the health committee chairman, has said an inquiry into patient safety is “very likely”. In a letter to Mr Brine, the APPG said that there was reason to believe that the MHRA had been aware of post-vaccination heart and clotting issues as early as February 2021, but did not highlight the problems for several months. Read full story (paywalled) Source: The Telegraph, 27 February 2024 Related reading on the hub: Interview with Charlet Crichton, founder of UKCVFamily
  4. Content Article
    Spina bifida develops early in the embryonic stage of pregnancy but is not usually detected until the midterm (20 week) ultrasound scan.  Shine conducted a survey to assess the antenatal care experiences of parents to children with spina bifida. Volunteers were recruited via social media and 71 eligible (UK-based) responses were received, revealing numerous elements of antenatal care in need of significant improvement. Shine have published the findings and recommendations for improving antenatal diagnosis and care for spina bifida. 
  5. Content Article
    Spina bifida is a developmental condition affecting the brain and spine, often leading to physical and cognitive impairments, and bladder and bowel issues. Widely regarded as one of the most severe conditions compatible with life, open spina bifida can result in significant morbidity, with numerous body systems and tissues affected.
  6. News Article
    Long A&E waits have got worse at more than one in five acute trusts, despite an improving trend nationally. Around 30 acute trusts have reported an increase in long accident and emergency waits, bucking the national trend. According to data covering the nine months to December, the proportion of waits more than 12 hours from time of arrival has improved to 6.3%, down from 8% during the same period in 2022. However, 28 out of 119 acute trusts reported a rise of up to 3 percentage points. HSJ’s analysis, which used published and unpublished data, showed 11 of these trusts had worsened despite improving their headline performance against the four-hour target. Adrian Boyle, of the Royal College of Emergency Medicine, said the emphasis on the four-hour target “incentivises focus on the people who are being sent home, and takes effort and attention away from the people who are being admitted to hospital”. He added: “The harms of long waits are greatest for people being admitted to hospital. We are disappointed by the current lack of focus in the planning guidance to help our most vulnerable patients.” Read full story (paywalled) Source: HSJ, 27 February 2024
  7. News Article
    Death threats, physical abuse and racist slurs aimed at NHS workers has prompted one hospital to make it easier for staff to “red card” violent and abusive patients. Aggressive patients or visitors could be banned from Barking, Havering and Redbridge University Hospitals NHS Trust for up to 12 months. The trust has also started using a series of body cameras in a bid to curb violence and aggression towards health workers after cases at the East London/Essex trust have doubled in the last three years. Trust workers have been punched, subject to racist slurs – including being told to “go back to the jungle” – and had their teeth broken by violent patients. As a result, hospital bosses have launched a new campaign – ‘No Abuse, No Excuse’ – to reduce violence and aggression towards staff, which includes: The introduction of 60 body cameras for staff in areas such as A&E and frailty units. Easier policies to ban patients or visitors, with bans which can last for up to a year. An increased visibility of security staff. A “de-escalation” training course for trust employees. Read full story Source: Medscape, 26 February 2024
  8. Content Article
    Avoidant/restrictive Food Intake Disorder (ARFID) is a severe feeding and eating disorder marked by food avoidance and/or restricted food intake. Individuals with ARFID can restrict the amount of food eaten, and therefore do not get enough calories, or they can restrict the range of foods eaten and therefore do not get all the nutrients needed for maintaining health. ARFID differs from the generalised term “picky eating”. Many people may experience picky eating at some point in their lives. Individuals with ARFID experience severe health and psychological consequences resulting from their disordered eating, which is not the case for picky eating. Also, some individuals with ARFID are not picky about the types of foods they eat, but they limit the amount of food they eat due to low appetite or lack of interest in food. Referrals for ARFID are increasing, but health services lack an evidence base to support individuals with ARFID effectively
  9. Content Article
    A framework for boards and an example of what has worked in practice.
  10. Content Article
    The audit committee handbook reflects developing best practice in governance.
  11. Content Article
    A new BMA report, “It’s broken” Doctors’ experiences on the frontline of a failing mental healthcare system", based on first-hand accounts of doctors working across the NHS, reveals a ‘broken’ system of mental health services in England. The current economic cost of mental ill health has been estimated to be over £100 billion in England alone*, but this report demonstrates that across the NHS, doctors are in an ongoing struggle to give patients the care they need because the funding is just not enough, there are not enough staff, and the infrastructure and systems are not fit for purpose. The report makes plain that without a concerted effort from central government to resource mental healthcare based on demand (which continues to grow beyond what the NHS can respond to) as well as changes in society to promote good mental health, the future looks bleak. The BMA carried out in-depth interviews with doctors across the mental health system, including those working in psychiatry, general practice, emergency medicine, and public health.
  12. News Article
    Deaths of newborn babies should be more thoroughly investigated by health boards in Scotland, experts have said after reviewing an increase in infant mortality. The team found inquiries into baby deaths conducted by health boards were “poor quality, inconsistent and incomplete”. The experts added that information about staffing levels on maternity wards at the time of the deaths was so poor that they could not draw any conclusions. They were also unable to determine if health boards enlisted independent, external advisers when considering if deaths could have been prevented. Helen Mactier, a retired neonatologist and chairwoman of the Neonatal Mortality Review, said: “This review has helped to get a clearer understanding of the increase in neonatal deaths that occurred in 2021-22. “We understand that there are still unanswered questions, and our recommendations are focused on ensuring that future opportunities to learn are not missed and acted on in a timely and comprehensive manner.” Read full story (paywalled) Source: The Times, 27 February 2024
  13. News Article
    Drugs used to treat ADHD are being openly traded in "potentially lethal" doses to UK buyers on encrypted apps, a BBC North West investigation has found. Criminals are cashing in on a national shortage to offer the prescription tablets in a secret mail-order service. The BBC found an unregulated online market stacked with medication which high street chemists were struggling to stock. It is feared patients are turning to the black market in desperation, but one psychiatrist has warned some of the drugs could contain other potentially harmful chemicals. Thousands of people with ADHD have been unable to get prescribed medication amid a major supply shortage. The BBC has heard how the situation has left children and adults in limbo and with the shortage set to last until December many are believed to be turning to illegitimate traders to help treat the condition. The BBC took these findings to Dr Morgan Toerien, associate specialist in mental health at Beyond Clinics in Warrington, who said: "A lot of these drugs are potentially lethal, not just dangerous - particularly if you weren't used to taking them and if you took a higher dose. "During my work in illicit drug treatment, we've tested people alleged to have taken a lot of the drugs seen on this channel and they don't actually contain what they say they do." He said people could be taking a tablet purporting to be to treat ADHD, but could be "far more dangerous". Read full story Source: BBC News, 28 February 2024
  14. News Article
    Health systems will be asked to deliver the same amount of elective activity next year as they were tasked with completing in 2023-24, HSJ understands. Local leaders have been issued with varying interim targets for 2024-25 that produce an average national threshold of 7% more activity than pre-covid levels, on a value-weighted basis. It means the target for the current year has effectively been rolled over into next, suggesting the elective recovery is a year behind schedule. Even if systems hit their thresholds next year, they will still fall well short of the central target set out in the elective recovery plan in 2022. Recent weeks have seen other elective ambitions ditched or watered down, including the prime minister’s headline pledge to bring the overall waiting list down. It is likely a result of the government accepting it cannot push more elective activity due to ongoing strikes and overspending. Read full story (paywalled) Source: HSJ, 27 February 2024
  15. Content Article
    On 8 February 2024, Ombudsman, Rob Behrens and Patient Safety Commissioner, Henrietta Hughes, wrote a joint letter to government. Both have regulatory roles to play in improving patient safety and both are struggling to gain headway with the recalcitrant NHS. Supposedly independent of government, this correspondence shows they are in fact totally dependent on government, due to their limited powers writes Della Reynolds in this blog.
  16. News Article
    Cancer patients in the UK wait up to seven weeks longer to begin radiotherapy or chemotherapy than people in comparable countries, research has revealed. The stark findings are yet more damning evidence of the extent to which the UK lags behind other nations, as experts warn that people’s chances of survival are being affected by long waits for treatment. In the first research of its kind, experts at University College London analysed data from more than 780,000 cancer patients diagnosed between 2012 and 2017 in four comparable countries: Australia, Canada, Norway and the UK. Eight cancer types were included: oesophageal, stomach, colon, rectal, liver, pancreatic, lung and ovarian cancer. The two studies, published in the Lancet Oncology, were the first to examine treatment differences for eight cancer types in countries across three continents. UK patients experienced the longest waits for treatment, the research found. The average time to start chemotherapy was 48 days in England, 57 in Northern Ireland, 58 in Wales and 65 in Scotland. The shortest time was 39 days in Norway. In radiotherapy, the UK fared even worse. It took 53 days on average for treatment to begin in Northern Ireland, 63 in England, 79 in Scotland and 81 in Wales. Cancer Research UK, which part-funded the two studies, said delays to begin treatment were partly a result of the UK government’s lack of long-term planning on cancer in recent years. Countries with robust cancer strategies backed by funding had seen better improvements in survival rates, it said. Read full story Source: The Guardian, 27 February 2024
  17. News Article
    NHS England is looking to ditch a key elective target that aimed to deliver large reductions in follow-up appointments, HSJ has learned. Senior sources privately admit progress has not been made against the target to cut the volume of the most common type of outpatient follow-up by 25 per cent target. This is supported by publicly available data. While this only gives a partial picture, the data suggests the volumes have actually increased compared to pre-covid levels. The volume-based target is widely viewed as unrealistic and senior figures told HSJ it had also “masked” some genuine progress trusts have made in reforming outpatient services and reducing less productive appointments. Sources familiar with discussions said having a volume-based target to reduce a subset of patients while trying to increase overall activity volumes had been logistically complex. NHSE is instead pushing for a new “ratio-based” target which sources said would be a better measure to reduce the least productive types of outpatient follow-ups and be a fairer measure of progress. Read full story (paywalled) Source: HSJ, 26 February 2024
  18. News Article
    An inquiry into birth trauma has received more than 1,300 submissions from families. It is estimated that 30,000 women a year in the UK have suffered negative experiences during the delivery of their babies, while 1 in 20 develop post-traumatic stress disorder. The investigation is a cross-party initiative, led by MPs Theo Clarke and Rosie Duffield, in collaboration with the Birth Trauma Association. Ms Clarke the Conservative MP for Stafford, triggered the first ever parliamentary debate on the issue in October. In an emotional exchange in the House of Commons, she described her own experience following her daughter's birth at the Royal Stoke University Hospital in 2022. She bled heavily after suffering a tear and had to undergo two-hour surgery without general anaesthetic, due to an earlier epidural. The Birth Trauma Association, which is administering the inquiry, invited the public to submit written accounts of their own experiences. Dr Kim Thomas, from the association, said she had received an "overwhelming" number of personal accounts. Some cases date back as far as the 1960s. Read full story Source: BBC News, 25 February 2024
  19. News Article
    Accountability is top of the wishlist from the Covid inquiry as it comes to Wales, say bereaved families and those charged with protecting vulnerable people. Over the next three weeks the focus will largely be on the decisions made by the Welsh government during the pandemic. From the timings of lockdowns to the rationale of doing things differently to the UK government, the hearings will scrutinise actions taken in Wales. For many, it will be a chance to hear the justifications for policies that they say left them feeling unsupported and alone. Ann Richards did not get to say a final goodbye to her husband Eirwyn before he died from hospital-acquired Covid in January 2021. Ann still wonders if non-urgent healthcare had been fully up and running, could Eirwyn have been discharged sooner, or perhaps even avoided a hospital admission altogether? Additional rules put in place to reduce the spread of the virus meant there were delays in getting a purpose-built wheelchair – delaying his discharge from hospital. "I understand there had to be rules in place," said Ann. "But it's the wellbeing of the patients I think they lost a lot of." Read full story Source: BBC News, 26 February 2024
  20. Content Article
    While some patients fully embrace access to test results as soon as they become available, those who may be less informed or receiving results for the first time may find reading results without the guidance of a doctor or oncologist to be fear-inducing and anxiety provoking. The intention of this poster from Tambre Leighn, presented at AACR2023, is to raise awareness and generate conversations about gaps in the process that create barriers and concerns along with potential strategies to improve the overall experience for patients, caregivers and their doctors without interfering with those patients who want to know without delay.
  21. Event
    until
    Restorative practice - learning culture, how do you create a culture where people feel able to speak up and be listened to. Freedom to speak up, enabling a culture where people feel able to speak up, governance, board assurance, Culture and Good Governance - OFLOG dept launched in July which will look at governance in local authorities. There’s been an incident in your organization. People are impacted. You need to do something. How do you avoid blame, and how do you start learning and improving? This session will explore the principles and theory behind a just and learning culture and give you some insights into how this can be implemented. Alongside an international thought leader on this subject we will hear from an NHS organisation’s experience of developing and sustaining their approach to this. This session will help you understand how your teams/services/organisations can create cultures that foster learning when things don't go as expected. People will leave with an understanding of a just and learning culture alongside insights around implementation in their own organisations. Register
  22. Event
    This introductory course is aimed at those who are new to Human Factors or those who are interested in refreshing existing knowledge. You will gain the fundamental knowledge and skills for Human Factors in health and care. Taking place online over two half days, this course will blend guided independent study with facilitated discussion and activities. You will be encouraged to apply your learning to your own role and environment, to reduce error, improve processes that underpin patient safety, and support organisational safety culture. Learning objectives: Understand the basic concept of Human Factors. Understand the importance of Human Factors for safety and quality improvement. Have awareness of what influences human and system performance. Understand the basic concepts of systems thinking. Who is this for? This programme is ideal for any staff who wish to develop a basic knowledge/awareness of human factors. Register
  23. Event
    This introductory course is aimed at those who are new to Human Factors or those who are interested in refreshing existing knowledge. You will gain the fundamental knowledge and skills for Human Factors in health and care. Taking place online over two half days, this course will blend guided independent study with facilitated discussion and activities. You will be encouraged to apply your learning to your own role and environment, to reduce error, improve processes that underpin patient safety, and support organisational safety culture. Learning objectives: Understand the basic concept of Human Factors. Understand the importance of Human Factors for safety and quality improvement. Have awareness of what influences human and system performance. Understand the basic concepts of systems thinking. Who is this for? This programme is ideal for any staff who wish to develop a basic knowledge/awareness of human factors. Register
  24. Event
    On this programme you will learn the benefits of taking an approach to measurement, focused specifically on improvement. You’ll discover a range of techniques to understand variation and measure change. This programme comprises of two modules, with an opportunity at the end to discuss your own measurement project. Our fast measurement start-up. You’ll learn about the different types of variation. You’ll be able to produce a Statistical Process Control (SPC) chart and understand what it’s telling you. In this session you will explore measurement in more depth, such as advanced SPC charts and confidence intervals, to help you dig into your data and turn it into intelligence you can act upon. Who is this for? Individuals who want to discover a range of techniques to understand variation and measure change. Register
  25. Content Article
    Nicholas Gerasimidis had a history of mental illness manifesting as obsessive compulsive disorder (OCD) and anxiety. In 2022, his condition deteriorated. His GP referred him twice to the Community Mental Health Team but the referrals were rejected with medication being prescribed instead, together with advice to contact Talking Therapies.   He was taken on to CMHT workload after being assessed by the Psychiatric Liaison Team in Royal Cornwall Hospital in November 2022. The preferred course of treatment was psychological treatment in the form of Cognitive Behavioural Therapy with Exposure Response Prevention. There was a waiting list of a year. In May 2023, Mr Gerasimidis became worse. It was felt an informal admission to hospital was required but a bed was not available. He was found hanged at his home address on 3 June 2023.
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