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Patient Safety Learning

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  1. Patient Safety Learning
    Regulators have warned hospital leaders they may have to ‘depart from established procedures’ over winter to minimise ambulance handover delays.
    In a joint letter to nursing and medical leaders, NHS England, the Care Quality Commission and professional regulators said it was “vital that we have a whole system approach to risk across the urgent and emergency care pathway”.
    The push has come amid a huge increase in instances of crews being held outside emergency departments, resulting in extended response times for time-critical 999 calls.
    The letter added: “We… understand there will be concerns about working under pressure, and that you and your teams may need to depart from established procedures on occasion to provide the best care.
    “Please be assured that your professional code and principles of practice are there to guide and support your judgments and decision making in all circumstances. This includes taking into account local realities and the need to adapt practice at times of significantly increased pressure.
    “In the unlikely event of a complaint to your professional regulator they will, as is their usual practice, consider carefully whether they need to investigate. If an investigation is needed, they will consider all relevant factors including the context and circumstances in which you were working.
    “One area that may be an example of this is in handing patients over to emergency departments from ambulance services. There is a strong correlation between ambulance handover delays at emergency departments and ambulance category 2 response delays, meaning longer handovers increase the chances those in need will wait longer for an ambulance.”
    Read full story (paywalled)
    Source: HSJ, 11 December 2023
  2. Patient Safety Learning
    GP practices with the most outdated technology and processes do not have enough staff or funding to take part in NHS England’s performance recovery programme, integrated care boards are warning.
    In new recovery plans which they were required to publish by NHSE, multiple ICBs have said that stretched capacity means hardly any practices have signed up to the “general practice improvement programme”, which is meant to help them implement the national primary care access recovery plan.
    The ICBs pointed out that the programme is time consuming, and practices which take part are not always given funding to pay for staff time.
    HSJ has reviewed the primary care recovery plans which all ICBs were required to bring to their board meetings in October and November, to explain how they were implementing the national plan published by NHSE in the spring.
    NHSE’s plan sought to improve ease and speed of access through spreading “modern” methods and processes; as well as measures to save clinicians’ time, improving same-day access, and delivering more appointments.
    But HSJ’s  review of the ICB plans found several warning that their uptake of the improvement plan was off track, especially for “intermediate” and “intensive” support, which require substantial time for the practices, and are likely to be required by those most in need of help.
    Read full story (paywalled)
    Source: HSJ, 12 December 2023
  3. Patient Safety Learning
    After the $261 million verdict against Johns Hopkins All Children's Hospital, health system public relations departments have a new concern: unwillingly becoming the subject of a streaming service documentary.
    Released on Netflix in June, "Take Care of Maya" tells the story of Maya Kowalski, whose family brought her to the St. Petersburg, Fla., hospital's emergency department in 2016 with chronic pain. After physicians suspected child abuse, the then-10-year-old was kept there apart from her loved ones for nearly three months, during which time her mother killed herself.
    Millions of viewers watched the documentary, which detailed the family's then-unsuccessful attempt to sue the hospital. In November, a Florida jury awarded the Kowalskis the nine-figure sum for damages on counts including medical negligence and false imprisonment.
    "The level of global exposure and awareness of this case helped drive the interest, engagement and discussions in the community," Karen Freberg, PhD, professor of strategic communication at University of Louisville (Ky.), told Becker's. "This is a situation where hospitals across the board must evaluate their crisis communication plans from this experience and see how they would address this situation if it happened to them."
    She said any reputation-fixing lessons for this case, then, will come not from hospitals that have lost big lawsuits, but from companies that have been the subject of unflattering documentaries.
    Read full story
    Source: Becker's Hospital Review, 7 December 2023
  4. Patient Safety Learning
    Women in labour at a London maternity unit deemed “inadequate” were left alone with unsupervised support workers who were not given any guidance, an NHS safety watchdog has found.
    In a scathing report of North Middlesex Hospital’s maternity services, the Care Quality Commission also found examples of delays to induction of birth for women, and one case of a woman with a still-born baby who was left waiting for the unit to call her in for an induction.
    Inspectors have downgraded the maternity unit from “good” to the lowest possible rating “inadequate” following an inspection earlier this year.
    Staff reportedly told inspectors they felt they were “criticised” or “bullied” when reporting safety incidents within the unit.
    “We heard that the criticism or bullying was worse if the incident reported was relative to other staff and their perceived behaviours,” the report said.
    There was also evidence the hospital was not recording the severity of safety incidents correctly for example two “never events”, which are among the highest category incidents, were categorised as “low harm”.
    Other findings included women and babies came to harm as the hospitals did not follow standards to language interpretation despite covering a higher than average minority ethnic population.
    Read full story
    Source: The Independent, 11 December 2023
  5. Patient Safety Learning
    The risk of dying from cancer in England “varies massively” depending on where a person lives, according to a study that experts say exposes “astounding” health inequalities.
    Researchers who analysed data spanning two decades found staggering geographical differences. In the poorest areas, the risk of dying from cancer was more than 70% higher than the wealthiest areas. 
    Overall, the likelihood of dying from cancer has fallen significantly over the last 20 years thanks to greater awareness of signs and symptoms, and better access to treatment and care. The proportion dying from cancer before the age of 80 between 2002 and 2019 fell from one in six women to one in eight, and from one in five men to one in six.
    However, some regions enjoyed a much larger decline in risk than others, and the new analysis has revealed that alarming gaps in outcomes remain.
    “Although our study brings the good news that the overall risk of dying from cancer has decreased across all English districts in the last 20 years, it also highlights the astounding inequality in cancer deaths in different districts around England,” said Prof Majid Ezzati, from Imperial College London, who is a senior author of the study.
    Read full story
    Source: The Guardian, 11 December 2023
  6. Patient Safety Learning
    Campaigners have written to the chief constables of Norfolk and Suffolk to request an investigation into thousands of mental health deaths in those areas.
    They say coroners are raising safety issues but no improvements are being made.
    A report by independent auditors found as many as 8,440 patients had died unexpectedly over three years.
    Norfolk and Suffolk NHS Foundation Trust said it had started a review of patient deaths.
    Coroners worried about the risk of future deaths highlight unsafe practices in prevention of future deaths reports (PFDs). And authorities are required by law to respond with an action plan within 56 days. The Norfolk and Suffolk trust said it had responded to all PFDs and was working to ensure recommendations and actions were implemented.
    But Mark Harrison, from the Campaign to Save Mental Health Services in Norfolk and Suffolk, said: "There's a criminal case to answer. And we want the police to investigate, where the same mistakes have been repeated time and time again."
    He said coroners were repeatedly warning of risks such as delays to treatment, lack of patient follow-ups, chaotic record keeping and disorganised communication between teams.
    Mr Harrison said: "The mental health trust always responds saying they've learned lessons, they are changing policy and practices.
    "But then what we're seeing in analysing the orders from the coroner are repeat circumstances where other people have died in similar circumstances to a previous prevention-of-future-deaths notice."
    Read full story
    Source: BBC News, 12 December 2023
  7. Patient Safety Learning
    An overworked nurse who failed to give medication to a patient told a colleague “I don’t care anymore”, a hearing was told.
    Niall O’loingsigh was lead nurse in the Avon unit within the Charterhouse Care Home in Keynsham, Somerset, which looks after elderly residents and those with dementia. In 2020 a complaint was made by a colleague about him breaching safe medication management protocols and being dishonest in relation to medication administration. A misconduct hearing at the Nursing and Midwifery Council was told later, in May 2021, he was seen behaving in an “unsupportive manner” and told a colleague: “I don’t care anymore”.
    The panel also heard how on 18 May 2021, Mr O’loingsigh failed to record he had administered medication to three residents, BristolLive reported. A colleague wanted to report Mr O’loingsigh’s conduct, in which Mr O’loingsigh patted her on the back and said “well done mate, you did the right thing but I may lose my PIN though”.
    Mr O’loingsigh told his colleague of feelings of distress and anxiety about being reported and its impact on his career, but he wanted to reassure her. The colleague however felt “uncomfortable”. The panel found that he underwent “a course of conduct which put patients at risk of suffering harm at the time of the incidents” and noted “there were repeated failures over a period of time”.
    Read full story
    Source The Mirror, 10 December 2023
  8. Patient Safety Learning
    Physician Associates (PAs) and Anaesthesia Associates (AAs) will soon be regulated by the General Medical Council (GMC), improving patient safety and supporting plans to expand medical associate roles in the NHS to relieve pressure on doctors and GPs. 
    The government will lay legislation this week to allow the GMC to begin the process of regulating medical associates, who are medically trained healthcare professionals who work alongside doctors to care for patients.  
    The GMC will set standards of practice, education and training, and operate fitness to practice procedures, ensuring that PAs and AAs have the same levels of regulatory oversight and accountability as doctors and other regulated healthcare professionals. The regulations will come into force at the end of 2024. 
    Physician Associates and Anaesthesia Associates are already making a great contribution to the NHS, supporting doctors to provide faster high quality care for patients. 
    This new legislation paves the way for these professionals to be held to the same strict standards as doctors, boosting patient safety. 
    Regulation and growth of these roles will support plans to reduce pressure on frontline services and improve access for patients.
    Health and Social Care Secretary, Victoria Atkins, said: 
    "Physician Associates and Anaesthesia Associates are already making a great contribution to the NHS, supporting doctors to provide faster high quality care for patients. 
    This new legislation paves the way for these professionals to be held to the same strict standards as doctors, boosting patient safety. 
    This is part of our Long Term Workforce Plan to reform the NHS to ensure it has a workforce fit for the future."
    Read Press release
    Source: The Department of Health and Social Care and The Rt Hon Victoria Atkins MP, 11 December 2023
  9. Patient Safety Learning
    Patients needing emergency treatment are becoming sicker in A&E as hospitals struggle to free up enough beds, top doctors have warned.
    Dr Adrian Boyle, president of the Royal College of Emergency Medicine (RCEM), told The Independent that elderly patients are waiting so long for treatment in A&E that they’re developing bed sores and delirium.
    Another senior NHS doctor, Dr Vicky Price, who is president-elect of the Society for Acute Medicine, warned that corridor care is now “routine practice” with the situation only set to worsen as A&E departments come under increasing pressure.
    Their comments highlight the ongoing chaos in emergency medicine, as strikes take place during the most difficult time of the year. The chief executive of the NHS, Amanda Pritchard, said on Thursday that last winter was the worst she’d ever seen for the health service, warning that strikes by junior doctors will only make the situation harder for hospitals this year
    The warnings come as the latest NHS data shows that the prime minister, Rishi Sunak, could fail in his promise to deliver 5,000 more acute hospital beds to the NHS this month. Current data shows that the NHS is falling short of the target by just under 1,200 beds, with 97,818 against a target of 99,000.
    Read full story
    Source: The Independent, 10 November 2023
  10. Patient Safety Learning
    The Care Quality Commission (CQC) has apologised after admitting it failed to act on whistleblowing concerns “in a timely manner”.
    Allegations had been made to the CQC about staff at Cambridgeshire and Peterborough Foundation Trust tampering with a patient’s record after they had died by suicide.
    As previously reported, the accusations by whistleblower Des McVey have sparked a review of the trust’s conduct in more than 60 suicide cases.
    Mr McVey says the trust only took action following media coverage and that the CQC had ignored his concerns.
    The regulator has now upheld a complaint from him, with operations manager James DeCothi writing to Mr McVey: “I have established that [the relevant CQC inspector] did not share your concerns with the provider in a timely manner and that our contact with you from July 2022 to June 2023 was inconsistent. I apologise on behalf of CQC for this. [The CQC inspector] has reflected on this and has asked me to offer her apologies to you also.
    “I can confirm that CQC have followed up the areas of concern that you have shared, and we will continue to use the information you have shared to inform future regulatory activity. I would like to thank you again for sharing this information with us.”
    Read full story (paywalled)
    Source: HSJ, 11 December 2023
  11. Patient Safety Learning
    Doctors at a Black Country mental health trust have backed a vote of no confidence in their management team.
    Sources say that the Black Country Healthcare NHS Trust is not acting in the best interests of patients and they believe it wants to cut beds.
    They also have no confidence in the way that the trust has removed its chief medical officer, Mark Weaver.
    The NHS Trust said it was aware of concerns and had agreed to work on them going forward.
    The doctors wrote to the trust board following a meeting of the Medical Advisory Committee claiming that over the past two years the relationship with the board had become fractured.
    In the letter they claimed the voice of doctors was not being taken seriously by the board and that clinical priorities were secondary to financial performance.
    They also said they were seriously disturbed with the way in which Mr Weaver had been asked to step down and that the deputy chief medical officer Dr Sharada Abilash had not been asked to take over while due process occurred.
    Read full story
    Source: BBC News, 9 December 2023
  12. Patient Safety Learning
    The under delivery of intravenous antibiotics in some NHS hospitals due to lack of polices and compliance may be contributing to antimicrobial resistance (AMR), according to a parliamentary report.
    Findings in the report indicated that many health service organisations do not have policies in place to reduce the risk of under delivery and those that do can struggle to comply fully with them.
    The report’s authors warned that the residual volume of antibiotic remaining in the line of the IV administration set can result in under delivery of up to 30% of the prescribed dose.
    They said that, as a result, this could be leading to possible resistance within patients, owing to the accumulative effect. Nurses involved with compiling the document have called for action.
    Based on the findings, the report recommended that all NHS organisations implement line flushing policies by late 2024, with support from the Department for Health and Social Care.
    Read full story (paywalled)
    Source: Nursing Times, 9 December 2023
    Further reading on the hub:
    Short-term intermittent IV antibiotics – Understanding the issue of under delivery Understanding the importance of accurate antibiotic administration through an IV administration set (drip): A patient’s guide Top picks: 10 key resources on antimicrobial resistance
  13. Patient Safety Learning
    Surgeons at one London hospital are performing an entire week’s operations in a single day as part of a ground-breaking initiative that could help tackle the record waiting lists in the NHS.
    Guy’s and St Thomas’ NHS Foundation Trust has already slashed its own elective backlog in certain specialities by running monthly HIT (High Intensity Theatre) lists at weekends.
    Under the innovative model, two operating theatres run side by side and as soon as one procedure is finished the next patient is already under anaesthetic and ready to be wheeled in.
    Nurses are on standby to sterilise the operating theatre and instead of taking 40 minutes between cases it takes less than two, the only delay is the 30 second it takes for the anti-bacterial cleaning fluid to work.
    Kariem El-Boghdadly, the consultant anaesthetist who designed the programme with his colleague Imran Ahmad, compares it to a Formula One pit stop. “They’ve got one person doing the rear right wheel, one person doing the front left wheel. It’s the same thing. The operating theatre is effectively like that.”
    Read full story (paywalled)
    Source: The Times, 10 December 2023
  14. Patient Safety Learning
    The health inequalities between different ethnicities, neighbourhoods and social classes are already stark, with millions of women in the most deprived areas in England dying almost eight years earlier than those from wealthier areas.
    But according to the UK Health Security Agency’s (UKHSA) report, these disparities will worsen as the impact the climate crisis has on health is disproportionately negative to the most disadvantaged groups.
    These particular groups include people with disabilities, homeless people and people living in local authorities with high levels of deprivation.
    Sir Michael Marmot, the director of the Institute of Health Equity and the author of the landmark Marmot review into health inequalities in 2010, said that climate breakdown can make health inequalities worse.
    Prof Lea Berrang Ford, the head of the Centre for Climate and Health Security at the UKHSA, made it clear that the negative health effects of climate breakdown will not be distributed equally across the UK, social determinants or generations.
    The report said that children and young people will experience increasingly severe weather into their retirement, with effects persisting or increasing for their children.
    Ford said: “The distribution of the impacts of climate change do not just differ across geographic regions, but also across different socio-demographic groups.
    “Climate change is well recognised as likely to exacerbate existing health inequalities, and across a range of health impacts the most vulnerable groups are adults over 65 years old, children and those with pre-existing medical conditions.”
    Read full story
    Source: The Guardian, 11 December 2023
  15. Patient Safety Learning
    NHS England has issued a national alert to all trusts providing maternity services after faults were discovered in IT software that could pose “potential serious risks to patient safety”.
    According to the alert, the Euroking electronic patient record provided by Magentus Software could be displaying incorrect patient information to clinicians.
    The Euroking EPR is used in the maternity departments of at least 15 trusts according to information held by HSJ.
    These organisations have been asked to “consider if Euroking meets their maternity service’s needs” and to “ensure their local configuration is safe”. Trusts with different maternity EPR providers have also been asked to reassess the clinical safety of their solutions.
    The potential “serious risks” relate to a fault in the Euroking EPR which allows new patient information to overwrite previously recorded information, which could lead to “incorrect management of the pregnancy and subsequent harm”.
    Read full story (paywalled)
    Source: HSJ,  8 December 2023
  16. Patient Safety Learning
    GPs have warned that the extent of verbal abuse directed at them and their practice staff ‘is increasing’, with the majority reporting that things are worse now than during the height of the Covid pandemic.
    A UK-wide survey of more than 2,000 doctors – of which 617 were GPs – found that 85% of GPs have reported receiving verbal abuse from patients within the last 12 months.
    The research conducted by Medical and Dental Defence Union of Scotland (MDDUS) also found that 15% of GPs reporting verbal abuse said they ‘had to resort to involving the police’ to deal with abusive patient situations over the past year.
    In the survey, GPs identified key triggers such as ‘lack of access to a face-to-face consultation’ and ‘complaints about their quality of care’ as the factors that could escalate to verbal abuse.
    One GP who responded to the survey said: "During a consultation with a young adult, they got very irate and demanded I just give them what they came for.
    "I explained they had to calm down and we would only proceed then at which they called me an ugly, fat, c**t and threatened to smash my face in. That consultation stayed with me for quite a while after that."
    Another said: ‘A patient smashed the surgery front door (it needed replacing) because he didn’t get what he wanted when he wanted it.
    "This was very scary for staff and other patients and the police didn’t even come until the next day. I felt alone, defensive and wondered why we bother to try to provide a service when some patients have already decided it isn’t good enough for them."
    Read full story
    Source: Pulse, 7 December 2023
  17. Patient Safety Learning
    A hospital has introduced a new artificial intelligence system to help doctors treat stroke patients.
    The RapidAI software was recently used for the first time at Hereford County Hospital.
    It analyses patients' brain images to help decide whether they need an operation or drugs to remove a blood clot.
    Wye Valley NHS Trust, which runs the hospital, is the first in the West Midlands to roll out the software.
    Jenny Vernel, senior radiographer at the trust, said: “AI will never replace the clinical expertise that our doctors and consultants have.
    "But harnessing this latest technology is allowing us to make very quick decisions based on the experiences of thousands of other stroke patients.”
    Radiographer Thomas Blackman told BBC Hereford and Worcester that it usually takes half an hour for the information to be communicated.
    He said the new AI-powered system now means it is "pinged" to the relevant teams' phones via an app in a matter of minutes.
    "It's improved the patient pathway a lot," he added.
    Read full story
    Source: BBC News, 7 December 2023
  18. Patient Safety Learning
    NHS leaders have issued a warning over surging flu cases as the number of patients in hospital with the bug soared by more than 50% in a week.
    An average of 234 people were in hospital with flu each day last week – up 53% on the previous seven days. Figures from NHS England also showed a rise in norovirus cases in hospitals last week with an average of 406 cases per day, up from 351 the previous week and a 28% rise from last year.
    The latest data comes after public health officials sent a warning over whooping cough levels, with 719 suspected cases reported between July and November, up from 217 last year.
    This week several NHS hospitals have sent out alerts to the public warning of “extremely busy” A&Es.
    Dr Tim Cooksley, former president of the Society for Acute Medicine, warned: “Pressures are being exacerbated by increasing rates of sickness among colleagues, as well as pressures on precious resources such as isolation areas and side rooms, adding to the strain on already overstretched services...
    “Undoubtedly we will see more older patients enduring prolonged degrading periods of corridor care and many people experiencing difficult symptoms whilst they sit on elective waiting lists.
    “Most hospitals are already experiencing chaotic and dangerous scenarios.”
    He added that there was “a lack of understanding of the gravity of the situation” from new health secretary Victoria Atkins.
    Read full story
    Source: The Independent, 7 December 2023
  19. Patient Safety Learning
    Pregnant women have been urged to get vaccinated following a spike in suspected whooping cough cases in England and Wales.
    Official figures show doctors reported some 716 suspected cases between July and November - up from 217 in the previous period last year.
    Whooping cough, or pertussis, is a bacterial infection of the lungs and breathing tubes that spreads easily and infected tens of thousands of people before vaccines were introduced.
    It is easily preventable, experts say, but can sometimes cause serious problems for babies and children.
    Dr Gayatri Amirthalingam, consultant epidemiologist at the UKHSA, said the rise in suspected cases of whooping cough was “expected” due to low immunity as a result of the Covid pandemic.
    Despite vaccinations being available in the UK the infection hasn’t gone away “completely” but immunisation can provide “life-long protection”.
    “Social distancing and lockdown measures imposed across the UK during the COVID-19 pandemic had a significant impact on the spread of infections, including whooping cough,” Dr Amirthalingam added.
    “As expected, we are now seeing cases of whooping cough increase again so it’s vital pregnant women ensure they get vaccinated to protect their baby.”
    Read full story
    Source: The Independent, 7 December 2023
  20. Patient Safety Learning
    More than 40 million women a year experience lasting health issues after childbirth, a global review has found, prompting calls for greater recognition of common postnatal problems.
    The sweeping analysis of maternal health worldwide shows a very high burden of long-term conditions that last for months and even years after giving birth. One in three new mothers worldwide are affected.
    The findings emerged from a series published in the Lancet Global Health and eClinicalMedicine, backed by the UN’s Special Programme on Human Reproduction, the World Health Organization and the US Agency for International Development.
    Prof Pascale Allotey, the director of sexual and reproductive health and research at the WHO, said: “Many postpartum conditions cause considerable suffering in women’s daily life long after birth, both emotionally and physically, and yet they are largely underappreciated, underrecognised, and underreported.
    “Throughout their lives, and beyond motherhood, women need access to a range of services from healthcare providers who listen to their concerns and meet their needs – so they not only survive childbirth but can enjoy good health and quality of life.”
    Read full story
    Source: The Guardian, 6 December 2023
  21. Patient Safety Learning
    Patient Safety Learning sets out its response to the announcement by the Department of Health and Social Care that it will be reviewing the statutory duty of candour for health and social care providers in England.
    "We welcome today's announcement by the Government that they will hold a review into the statutory duty of candour for health and social care providers.
    The statutory duty of candour is intended to ensure that healthcare providers are open and transparent with the public. It sets specific requirements for organisations to follow when things go wrong with care and treatment.

    Earlier this year the Parliamentary and Health Service Ombudsman highlighted concerns around the implementation of duty of candour and called for a review to assess its effectiveness in their report Broken trust: making patient safety more than just a promise. In our response to this report, we supported this recommendation.

    As part of reviewing problems with compliance, we believe that there are also broader questions that also need to be addressed concerning how the implementation of this is monitored and what remediation and redress is available to patients and the families when these obligations are not met.

    We also believe that this review should look at how the duty of candour is being implemented in light of the introduction of the new Patient Safety Incident Response Framework (PSIRF), given that this represents a significant change to the NHS’s approach to incident investigation."
    Source: Patient Safety Learning, 6 December 2023
  22. Patient Safety Learning
    Private hospitals saw record admissions this year after hundreds of thousands of people sought care through their insurance amid rocketing NHS waiting lists, new figures show.
    Between January and June 443,000 private treatments took place – a 7% rise from 2022, the vast majority of which were claimed through medical insurance policies.
    According to the Private Hospital Information Network (PHIN), which collects data from hospitals in the sector, there was a 12% increase in the number of people paying for care via insurance with 157,000 people using this route from January to March and 148,000 from April to June this year.
    The news comes as the NHS’s waiting list continues to grow with almost 7.8 million appointments recorded. Recently published data shows that there is a total of 6.5 million individual people on the waiting list.
    Read full story
    Source: The Independent, 7 December 2023
  23. Patient Safety Learning
    A coroner has warned a trust in the West Midlands for the third time about bed shortages, after three patient deaths which he believes are linked.
    In his report on the death in July of Philip Malone, area coroner for Birmingham and Solihull James Bennett told Birmingham and Solihull Mental Health Foundation Trust that its psychiatric bed capacity “remains inadequate”.
    Mr Malone – who was diagnosed with treatment-resistant schizophrenia in the 1980s and adult autism in May this year – died by suicide while awaiting an inpatient psychiatric bed at BSMHFT after a deterioration in his symptoms of anxiety, thought disorder, and hallucinations.
    Clinicians decided on 28 June that Mr Malone should be detained under the Mental Health Act, but as no inpatient psychiatric bed was available, he remained in the supported accommodation. Mr Malone died on 3 July.
    In a public report warning of the risks which may cause future deaths, issued last week, Mr Bennett said he had issued two previous “prevention of future death” reports which focused on a “chronic lack” of mental health resources in Birmingham and Solihull.
    Mr Bennett said: “The issue of adequately funding psychiatric beds is local and national. Locally, BSMHFT requires its commissioners to provide the necessary funding.
    “Whilst some action may have been taken it is insufficient to resolve the problem. It follows there is a genuine risk of future deaths directly connected to a shortage of psychiatric bed spaces in Birmingham and Solihull unless further action is taken.”
    Read full story (paywalled)
    Source: HSJ, 5 November 2023
  24. Patient Safety Learning
    A consultant gynaecologist who admitted sterilising a woman without her permission has been suspended from practising for 12 months.
    The woman - known as Patient A - was sterilised by Dr David Sim following an emergency caesarean section.
    Dr Sim previously admitted that the sterilisation was not necessary to save the woman's life or prevent harm to her health.
    The procedure took place at Daisy Hill Hospital in Newry in September 2021.
    On 1 December, the Medical Practitioners Tribunal Service (MPTS) found his fitness to practice was impaired.
    The tribunal previously heard Dr Sim and the patient had discussed sterilisation twice over a period of years, but the patient had never consented or expressed any wish to undergo sterilisation.
    When she required the emergency caesarean section, Dr Sim delivered the baby and blocked the patient's fallopian tubes to permanently impair their normal function.
    Dr Sim previously admitted to the tribunal that this was in violation of the woman's reproductive rights.
    Read full story
    Source: BBC News, 5 December 2023
  25. Patient Safety Learning
    Living with seizures and crippling pain, Zara Corbett says she's "begging for help" as she copes with endometriosis.
    The 21-year-old told BBC News NI that if she had any other condition she would be receiving help.
    "With gynae problems, particularly endometriosis, you are left waiting for years."
    "Women should not be left suffering this pain, it's not good enough," the beautician said.
    Zara has been put into early menopause - which is one potential treatment for endometriosis.
    The County Down woman said Northern Ireland needed a dedicated centre to provide specialist support.
    "I am begging for help from medical professionals including support from a multi-agency network because we are at our wits end - life cannot go on like this," she said.
    Endometriosis UK, an organisation that helps women with the condition, said it was shocked and saddened that it does not see "good, prompt care" in Northern Ireland.
    Its chief executive, Emma Cox, who visited Belfast in May, said services in Northern Ireland were "lagging behind" the rest of the UK.
    "We hear of the very long waiting lists to access gynaecologists to get a diagnosis but also waiting lists to access surgeons, it's about the disease being taken seriously," Ms Cox said.
    Read full story
    Source: BBC News, 6 December 2023
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